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Tong J, Shen Y, Xu A, He X, Luo C, Edmondson M, Zhang D, Lu Y, Yan C, Li R, Siegel L, Sun L, Shenkman EA, Morton SC, Malin BA, Bian J, Asch DA, Chen Y. Evaluating site-of-care-related racial disparities in kidney graft failure using a novel federated learning framework. J Am Med Inform Assoc 2024; 31:1303-1312. [PMID: 38713006 PMCID: PMC11105132 DOI: 10.1093/jamia/ocae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/09/2024] [Accepted: 03/26/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES Racial disparities in kidney transplant access and posttransplant outcomes exist between non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients in the United States, with the site of care being a key contributor. Using multi-site data to examine the effect of site of care on racial disparities, the key challenge is the dilemma in sharing patient-level data due to regulations for protecting patients' privacy. MATERIALS AND METHODS We developed a federated learning framework, named dGEM-disparity (decentralized algorithm for Generalized linear mixed Effect Model for disparity quantification). Consisting of 2 modules, dGEM-disparity first provides accurately estimated common effects and calibrated hospital-specific effects by requiring only aggregated data from each center and then adopts a counterfactual modeling approach to assess whether the graft failure rates differ if NHB patients had been admitted at transplant centers in the same distribution as NHW patients were admitted. RESULTS Utilizing United States Renal Data System data from 39 043 adult patients across 73 transplant centers over 10 years, we found that if NHB patients had followed the distribution of NHW patients in admissions, there would be 38 fewer deaths or graft failures per 10 000 NHB patients (95% CI, 35-40) within 1 year of receiving a kidney transplant on average. DISCUSSION The proposed framework facilitates efficient collaborations in clinical research networks. Additionally, the framework, by using counterfactual modeling to calculate the event rate, allows us to investigate contributions to racial disparities that may occur at the level of site of care. CONCLUSIONS Our framework is broadly applicable to other decentralized datasets and disparities research related to differential access to care. Ultimately, our proposed framework will advance equity in human health by identifying and addressing hospital-level racial disparities.
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Affiliation(s)
- Jiayi Tong
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Yishan Shen
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Applied Mathematics and Computational Science, The University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Alice Xu
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Xing He
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, United States
| | - Chongliang Luo
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
| | | | - Dazheng Zhang
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Yiwen Lu
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Chao Yan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Ruowang Li
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Lianne Siegel
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN 55414, United States
| | - Lichao Sun
- Department of Computer Science and Engineering, Lehigh University, Bethlehem, PA 18015, United States
| | - Elizabeth A Shenkman
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, United States
| | - Sally C Morton
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ 85287, United States
| | - Bradley A Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Computer Science, Vanderbilt University, Nashville, TN 37212, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, United States
| | - David A Asch
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, United States
| | - Yong Chen
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Applied Mathematics and Computational Science, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, United States
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Derkach A, Kantor ED, Sampson JN, Pfeiffer RM. Mediation analysis using incomplete information from publicly available data sources. Stat Med 2024. [PMID: 38606437 DOI: 10.1002/sim.10076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Our work was motivated by the question whether, and to what extent, well-established risk factors mediate the racial disparity observed for colorectal cancer (CRC) incidence in the United States. Mediation analysis examines the relationships between an exposure, a mediator and an outcome. All available methods require access to a single complete data set with these three variables. However, because population-based studies usually include few non-White participants, these approaches have limited utility in answering our motivating question. Recently, we developed novel methods to integrate several data sets with incomplete information for mediation analysis. These methods have two limitations: (i) they only consider a single mediator and (ii) they require a data set containing individual-level data on the mediator and exposure (and possibly confounders) obtained by independent and identically distributed sampling from the target population. Here, we propose a new method for mediation analysis with several different data sets that accommodates complex survey and registry data, and allows for multiple mediators. The proposed approach yields unbiased causal effects estimates and confidence intervals with nominal coverage in simulations. We apply our method to data from U.S. cancer registries, a U.S.-population-representative survey and summary level odds-ratio estimates, to rigorously evaluate what proportion of the difference in CRC risk between non-Hispanic Whites and Blacks is mediated by three potentially modifiable risk factors (CRC screening history, body mass index, and regular aspirin use).
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Affiliation(s)
- Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Elizabeth D Kantor
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Koide Y, Kodaira T, Kitayama M, Kawakita D, Kirita T, Yoshimoto S, Nakamizo M, Nibu KI. Definitive radiotherapy for nasopharyngeal carcinoma in Japan: analysis of cases in the National Head and Neck Cancer Registry from 2011 to 2014. Jpn J Clin Oncol 2024; 54:54-61. [PMID: 37781753 DOI: 10.1093/jjco/hyad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the nationwide prognosis of patients with nasopharyngeal carcinoma who underwent definitive radiotherapy in Japan, utilizing the National Head and Neck Cancer Registry data. METHODS A total of 741 patients diagnosed with primary nasopharyngeal carcinoma were screened from 2011 to 2014. The inclusion criteria were histologically proven nasopharyngeal squamous cell carcinoma, receiving definitive radiotherapy, and no distant metastases. Patients with unclear prognoses or unknown staging were excluded. The primary endpoint was 5-year overall survival, and secondary endpoints were 5-year progression-free survival and survival by stage. RESULTS A total of 457 patients met the inclusion criteria. The median age was 60 years, and 80% were male. The proportions of patients with performance status 0, 1, 2 and 3 were 69, 10, 1 and 1%, respectively. Chemoradiotherapy was administered to 84.7%. Radiotherapy modalities were recorded only for 29 patients (three received intensity-modulated radiotherapy and 26 received two/three-dimensional radiotherapy). Of those included, 7.4, 24.7, 35.7, 24.5 and 7.7% had Stage I, II, III, IVA and IVB disease, respectively. The 5-year overall survival was 72.5% for all patients: 82.6, 86.6, 76.0, 51.4 and 66.5% for Stage I, II, III, IVA and IVB disease, respectively. The 5-year progression-free survival was 58.6%: 75.6, 66.8, 61.5, 43.7 and 46.5% for Stage I, II, III, IVA and IVB disease, respectively. CONCLUSIONS This nationwide survey demonstrated favorable prognoses and provided valuable foundational data for similar future surveys to monitor the penetration of appropriate treatment and changes in clinical structures based on new evidence.
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Affiliation(s)
- Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
| | - Megumi Kitayama
- Clinical Study Support Center, Data Center Department, Wakayama Medical University Hospital, Wakayama, Japan
| | - Daisuke Kawakita
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadaaki Kirita
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Seiichi Yoshimoto
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Munenaga Nakamizo
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Otorhinolaryngology-Head and Neck Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken-Ichi Nibu
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Otolaryngology, Kobe University School of Medicine, Kobe, Hyogo, Japan
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Fauser D, Zimmer JM, Banaschak H, Golla A, Sternberg A, Mau W, Bethge M. Use of a job exposure matrix to predict the risk of work disability in individuals with back pain: An inception cohort study. Work 2024:WOR230410. [PMID: 38306084 DOI: 10.3233/wor-230410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Low back pain has a high economic burden in Germany due to back pain-related sick leave, disability pensions, and health care utilization. Work-related factors can predict disabling back pain. Job exposure matrices can be used to consider job demands and occupational characteristics in routine data analysis. OBJECTIVE This longitudinal analysis tested whether rehabilitation utilization due to musculoskeletal disorders is associated with occupation-linked job exposures in employees with back pain. METHODS Data from a German cohort study were used, including employees aged 45 to 59 years with self-reported back pain in the last three months. Individuals' job titles were assessed in the baseline survey in 2017 and matched with parameters of aggregated job exposure indices. Administrative data from the German Pension Insurance were used to extract information on rehabilitation utilization. Proportional hazard models tested the associations. RESULTS We considered data of 6,569 participants (mean age: 52.3 years; 57.7% women). During follow-up, with a maximum of 21 months, 296 individuals (4.5%) utilized medical rehabilitation due to musculoskeletal disorders. Adjusted analyses showed that high physical (HR = 2.87; 95% CI 1.74; 4.75) and overall (HR = 2.34; 95% CI 1.44; 3.80) job exposures were associated with a higher risk of rehabilitation utilization. CONCLUSION Individuals with back pain working in occupations with high physical job exposures have a higher risk for rehabilitation utilization. To prevent work disability in individuals with back pain, occupational groups with high physical job exposures should be actively informed about tailored intervention options.
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Affiliation(s)
- David Fauser
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Julia-Marie Zimmer
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Hannes Banaschak
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - André Golla
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Annika Sternberg
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Bethge
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
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Mamouris P, Nassiri V, Verbeke G, Janssens A, Vaes B, Molenberghs G. A longitudinal transition imputation model for categorical data applied to a large registry dataset. Stat Med 2023; 42:5405-5418. [PMID: 37752860 DOI: 10.1002/sim.9919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/26/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
Imputation of longitudinal categorical covariates with several waves and many predictors is cumbersome in terms of implausible transitions, colinearity, and overfitting. We designed a simulation study with data obtained from a general practitioners' morbidity registry in Belgium for three waves, with smoking as the longitudinal covariate of interest. We set varying proportions of data on smoking to missing completely at random and missing not at random with proportions of missingness equal to 10%, 30%, 50%, and 70%. This study proposed a 3-stage approach that allows flexibility when imputing time-dependent categorical covariates. First, multiple imputation using fully conditional specification or multiple imputation for the predictor variables was deployed using the wide format such that previous and future information of the same patient was utilized. Second, a joint Markov transition model for initial, forward, backward, and intermittent probabilities was developed for each imputed dataset. Finally, this transition model was used for imputation. We compared the performance of this methodology with an analyses of the complete data and with listwise deletion in terms of bias and root mean square error. Next, we applied this methodology in a clinical case for years 2017 to 2021, where we estimated the effect of several covariates on the pneumococcal vaccination. This methodological framework ensures that the plausibility of transitions is preserved, overfitting and colinearity issues are resolved, and confounders can be utilized. Finally, a companion R package was developed to enable the replication and easy application of this methodology.
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Affiliation(s)
- Pavlos Mamouris
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | - Geert Verbeke
- I-BioStat, KU Leuven University of Leuven, Leuven, Belgium
- I-BioStat, Hasselt University, Diepenbeek, Belgium
| | - Arne Janssens
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Geert Molenberghs
- I-BioStat, KU Leuven University of Leuven, Leuven, Belgium
- I-BioStat, Hasselt University, Diepenbeek, Belgium
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Hübner J, Baltus H, Eisemann N, Rohr M, Schumann L, Augustin J, Hagenström K, Wolf S, Garbe C, Augustin M, Katalinic A. Evaluation der Hautkrebsfrüherkennung in Deutschland mit Krebsregisterdaten - Herausforderungen, Lösungen und aktuelle Trends. J Dtsch Dermatol Ges 2023; 21 Suppl 5:13-21. [PMID: 38063278 DOI: 10.1111/ddg.15171_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 06/06/2023] [Indexed: 12/18/2023]
Abstract
ZusammenfassungHintergrund und ZieleDie Evidenz für einen Nutzen des 2008 in Deutschland eingeführten Hautkrebsscreenings ist schwach. Wir untersuchen, inwieweit Daten der deutschen epidemiologischen Krebsregister geeignet sind zur Evaluation des Hautkrebsscreenings beizutragen, und berichten diese Evaluationsergebnisse.Material und MethodikDie Hautkrebsdaten der Krebsregister aus den Jahren 1999–2019 wurden hinsichtlich Vollzähligkeit und Vollständigkeit beschrieben. Regionale Datenpools unterschiedlicher Validität wurden definiert, fehlende Daten sofern sinnvoll mehrfach imputiert und zeitliche Trends analysiert. Ergänzend wurden Daten der Todesursachenstatistik herangezogen.ErgebnisseBelastbare Vollzähligkeitsschätzungen liegen nur für das maligne Melanom (ICD‐10: C43) vor. Auf Basis eines regionalen Datenpools, der circa 21% der deutschen Bevölkerung abdeckt, kann das melanombezogene Krankheitsgeschehen seit 2005 valide beschrieben werden. Für T‐Stadium und Lokalisation liegen ausreichend Informationen für eine multiple Imputation vor. Die Trendanalysen zeigen im zeitlichen Zusammenhang mit der Einführung der Früherkennung kurzfristig erwartbare Inzidenzänderungen, die in eine langanhaltende hohe Inzidenz übergehen. Die Rate fortgeschrittener Stadien geht nicht wesentlich zurück. Ab 2014 sinkt die bis dahin steigende Melanommortalität.SchlussfolgerungenAdäquat ausgewählte und aufbereitete Krebsregisterdaten eignen sich zur bevölkerungsbezogenen Bewertung des Hautkrebsscreenings. Eine Erklärung des anhaltend hohen Inzidenzniveaus gelingt auf Basis der Krebsregisterdaten nicht. In Betracht kommen insbesondere Überdiagnosen oder ein Anstieg der Hintergrundinzidenz. Der Nutzen des Hautkrebsscreenings bleibt offen.
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Affiliation(s)
- Joachim Hübner
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Germany
- Klinische Landesauswertungsstelle Niedersachsen, Oldenburg, Germany
| | - Hannah Baltus
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Germany
| | - Nora Eisemann
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Germany
| | - Maren Rohr
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Germany
| | - Laura Schumann
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Germany
| | - Jobst Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kristina Hagenström
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sandra Wolf
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claudia Garbe
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Germany
- Institut für Krebsepidemiologie, Universität zu Lübeck, Lübeck, Germany
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Hübner J, Baltus H, Eisemann N, Rohr M, Schumann L, Augustin J, Hagenström K, Wolf S, Garbe C, Augustin M, Katalinic A. Evaluation of early skin cancer detection in Germany with cancer registry data - challenges, solutions and current trends. J Dtsch Dermatol Ges 2023; 21 Suppl 5:13-20. [PMID: 38063276 DOI: 10.1111/ddg.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 06/06/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND AND AIMS The evidence for the benefit of the skin cancer screening introduced in Germany in 2008 is weak. We investigate to what extent data from the German epidemiological cancer registries are suitable to contribute to the evaluation of skin cancer screening and report these evaluation results. MATERIAL AND METHODS Skin cancer-related cancer registry data from 1999-2019 were described in terms of completeness and comprehensiveness. Regional pools with data of different validity were defined, missing data were multiply imputed where appropriate, and temporal trends were analyzed. In addition, data from the cause of death statistics were used. RESULTS Reliable estimates of completeness are only available for malignant melanoma (ICD-10: C43). Based on a regional data pool covering approximately 21% of the German population, melanoma-related incidence can be validly described since 2005. Sufficient information for multiple imputation is available for T-stage and localization. The trend analyses show incidence changes that can be expected in the short term in the temporal context of the introduction of early detection, which changes into a long-lasting high incidence. The rate of advanced stages does not decrease significantly. From 2014 onwards, the melanoma mortality rate, which had been rising until then, decreases. CONCLUSIONS Adequately selected and processed cancer registry data are suitable for population-based evaluation of skin cancer screening. An explanation of the persistently high incidence level is not possible based on the cancer registry data. Overdiagnosis or an increase in the background incidence can be considered. The benefit of skin cancer screening remains open.
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Affiliation(s)
- Joachim Hübner
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Agency for Clinical Cancer Data of Lower Saxony, Oldenburg, Germany
| | - Hannah Baltus
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Nora Eisemann
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Maren Rohr
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Laura Schumann
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Jobst Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kristina Hagenström
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sandra Wolf
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claudia Garbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Katalinic
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Institute of Cancer Epidemiology, University of Lübeck, Lübeck, Germany
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Black RJ, Lester S, Tieu J, Sinnathurai P, Barrett C, Buchbinder R, Lassere M, March L, Proudman SM, Hill CL. Mortality estimates and excess mortality in rheumatoid arthritis. Rheumatology (Oxford) 2023; 62:3576-3583. [PMID: 36919770 PMCID: PMC10629787 DOI: 10.1093/rheumatology/kead106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/30/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES To determine long-term (20 year) survival in RA patients enrolled in the Australian Rheumatology Association Database (ARAD). METHODS ARAD patients with RA and data linkage consent who were diagnosed from 1995 onwards were included. Death data were obtained through linkage to the Australian National Death Index. Results were compared with age-, gender- and calendar year-matched Australian population mortality rates. Analysis included both the standardized mortality ratio (SMR) and relative survival models. Restricted mean survival time (RMST) at 20 years was calculated as a measure of life lost. Cause-specific SMRs (CS-SMRs) were estimated for International Classification of Diseases, Tenth Revision cause of death classifications. RESULTS A total of 1895 RA patients were included; 74% were female, baseline median age 50 years (interquartile range 41-58), with 204 deaths. There was no increase in mortality over the first 10 years of follow up, but at 20 years the SMR was 1.49 (95% CI 1.30, 1.71) and the relative survival was 94% (95% CI 91, 97). The difference between observed (18.41 years) and expected (18.68 years) RMST was 4 months. Respiratory conditions were an important underlying cause of death in RA, primarily attributable to pneumonia [CS-SMR 5.2 (95% CI 2.3, 10.3)] and interstitial lung disease [CS-SMR 7.6 (95% CI 3.0, 14.7)], however, coronary heart disease [CS-SMR 0.82 (95% CI 0.42, 1.4)] and neoplasms [CS-SMR 1.2 (95% CI 0.89, 1.5)] were not. CONCLUSION Mortality risk in this RA cohort accrues over time and is moderately increased at 20 years of follow-up. Respiratory diseases may have supplanted cardiovascular diseases as a major contributor to this mortality gap.
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Affiliation(s)
- Rachel J Black
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Susan Lester
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Joanna Tieu
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, Australia
- Rheumatology Unit, Northern Adelaide Local Health Network, Modbury, SA, Australia
| | - Premarani Sinnathurai
- Northern Clinical School, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia
- Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Claire Barrett
- Rheumatology Department, Redcliffe Hospital, Redcliffe, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourse, VIC, Australia
| | - Marissa Lassere
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
- Department of Rheumatology, St George Hospital, Kogarah, NSW, Australia
| | - Lyn March
- Northern Clinical School, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia
- Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Susanna M Proudman
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Catherine L Hill
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, Australia
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9
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Barry T, Kasemiire A, Quinn M, Deasy C, Bury G, Masterson S, Segurado R, Murphy A. Outcomes of out-of-hospital cardiac arrest in Ireland 2012-2020: Protocol for an observational study. HRB Open Res 2023; 6:17. [PMID: 37662479 PMCID: PMC10474347 DOI: 10.12688/hrbopenres.13699.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 09/05/2023] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a leading cause of preventable mortality that now affects almost 3,000 people each year in Ireland. Survival is low at 6-7%, compared to a European average of 8%. The Irish Out-of-Hospital Cardiac Registry (OHCAR) prospectively gathers data on all OHCA in Ireland where emergency medical services attempted resuscitation.The Irish health system has undergone several developments that are relevant to OHCA care in the period 2012-2020. OHCAR data provides a means of exploring temporal trends in OHCA incidence, care, and outcomes over time. It also provides a means of exploring whether system developments were associated with a change in key outcomes.This research aims to summarise key trends in available OHCAR data from the period 2012 - 2020, to explore and model predictors of bystander CPR, bystander defibrillation, and survival, and to explore the hypothesis that significant system level temporal developments were associated with improvements in these outcomes. Methods The following protocol sets out the relevant background and research approach for an observational study that will address the above aims. Key trends in available OHCAR data (2012 - 2020) will be described and evaluated using descriptive summaries and graphical displays. Multivariable logistic regression will be used to model predictors of 'bystander CPR', 'bystander defibrillation' and 'survival to hospital discharge' and to explore the effects (if any) of system level developments in 2015/2016 and the COVID-19 pandemic (2020) on these outcomes. Discussion The findings of this research will be used to understand temporal trends in the care processes and outcomes for OHCA in Ireland over the period 2012-2020. The results can further be used to optimise future health system developments for OHCA in both Ireland and internationally.
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Affiliation(s)
- Tomás Barry
- UCD School of Medicine, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
| | - Alice Kasemiire
- UCD Centre for Support and Training in Analysis and Research, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
| | - Martin Quinn
- Out-of-Hospital Cardiac Arrest Register, National Ambulance Service, Donegal, D24 XNP2, Ireland
| | - Conor Deasy
- School of Medicine, University College Cork, Cork, County Cork, T12 CY82, Ireland
| | - Gerard Bury
- UCD School of Medicine, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Services Executive, Dublin, D24 XNP2, Ireland
| | - Ricardo Segurado
- UCD Centre for Support and Training in Analysis and Research, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
| | - Andrew Murphy
- Discipline of General Practice, University of Galway, Galway, County Galway, H91 TK33, Ireland
| | - Out-of-Hospital Cardiac Arrest Registry Steering Group
- UCD School of Medicine, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
- UCD Centre for Support and Training in Analysis and Research, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
- Out-of-Hospital Cardiac Arrest Register, National Ambulance Service, Donegal, D24 XNP2, Ireland
- School of Medicine, University College Cork, Cork, County Cork, T12 CY82, Ireland
- National Ambulance Service, Health Services Executive, Dublin, D24 XNP2, Ireland
- Discipline of General Practice, University of Galway, Galway, County Galway, H91 TK33, Ireland
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10
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Sarkeala T, Lamminmäki M, Nygård M, Njor SH, Virtanen A, Leivonen A, Hirvonen E, Toikkanen S, Campbell S, Stefansdóttir H, Ursin G, Heinävaara S. Cervical, liver and stomach cancer incidence and mortality in non-Western immigrant women: a retrospective cohort study from four Nordic countries. Acta Oncol 2023; 62:977-987. [PMID: 37594889 DOI: 10.1080/0284186x.2023.2245557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/20/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Cervical, liver and stomach cancers are the most common infection-associated malignancies and the leading cause of morbidity in non-Western regions. We compared the incidence and mortality of these cancers between non-Western immigrant and non-immigrant Nordic female populations. We also analysed the effect of age at immigration, duration of residence and education on cancer burden. MATERIAL AND METHODS Study population consisted of women residents in Denmark, Finland, Iceland and Norway in 1973-2020. Non-Western women contributed 3.1% of the total 260 million person-years at risk. All women were followed from their 20th birthday, or from the date of immigration if after, until the date of their first primary cancer diagnosis, death, emigration, or the end of the country-specific study period. All data were adjusted for 10-year age groups and calendar periods, and immigrant data was further broken down by region of birth, age at immigration and education level. Country-specific estimates were produced by multivariable Poisson regression and pooled in Finland with a random effects model. RESULTS Altogether, there were 60 982 cases of cervical, liver and stomach cancer in the study population, causing 36 582 deaths. The immigrant women had significantly higher liver (rate ratio [RR] 1.78, 95% confidence interval (CI) 1.03-3.06) and stomach cancer incidence (RR 1.68, CI 1.29-2.18), and stomach cancer mortality (RR 1.49, CI 1.17-1.92) than non-immigrant women. In the immigrant population, high education was related to lower incidence and mortality of studied cancers. The rate ratio of cervical cancer decreased with duration of residence and increased with rising age at immigration. CONCLUSION Due to the increased incidence and mortality of infection-related cancers and changes in cancer patterns by age at immigration and duration of residence, attention should be paid to targeted health care services for immigrants. Special efforts should be given to women who have spent their youth in high-risk areas.
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Affiliation(s)
| | | | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Sisse Helle Njor
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anni Virtanen
- Finnish Cancer Registry, Helsinki, Finland
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Aku Leivonen
- Finnish Cancer Registry, Helsinki, Finland
- Data and Analytics Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | | | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Sirpa Heinävaara
- Finnish Cancer Registry, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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11
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Rostad HM, Burrell LV, Skinner MS, Hellesø R, Sogstad MKR. Quality of Municipal Long-Term Care in Different Models of Care: A Cross-Sectional Study From Norway. Health Serv Insights 2023; 16:11786329231185537. [PMID: 37475731 PMCID: PMC10354822 DOI: 10.1177/11786329231185537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
The quality of care remains a critical concern for health systems around the globe, especially in an era of unprecedented financial challenges and rising demands. Previous research indicates large variation in several indicators of quality in the long-term care setting, highlighting the need for further investigation into the factors contributing to such disparities. As different ways of delivering long-term care services likely affect quality of care, the objectives of our study is to investigate (1) variation in structure, process and outcome quality between municipalities, and (2) to what extent variation in quality is associated with municipal models of care and structural characteristics. The study had a cross-sectional approach and we utilized data on the municipal level from 3 sources: (1) a survey for models of care (2) Statistics Norway for municipal structural characteristics and (3) the National Health Care Quality Indicator System. Descriptive statistics showed that the Norwegian long-term care sector performs better (measured as percentage or probability) on structure (85.53) and outcome (84.86) quality than process (37.85) quality. Hierarchical linear regressions indicated that municipal structural characteristics and model of care had very limited effect on the quality of long-term care. A deeper understanding of variation in service quality may be found at the micro level in healthcare workers' day-to-day practice.
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Affiliation(s)
- Hanne Marie Rostad
- Center for Care Research East, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Lisa Victoria Burrell
- Center for Care Research East, Norwegian University of Science and Technology, Gjøvik, Norway
| | | | - Ragnhild Hellesø
- Center for Care Research East, Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Public Health Science, University of Oslo, Oslo, Norway
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12
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Otero JE, Heckmann ND, Jaffri H, Mullen KJ, Odum SM, Lieberman JR, Springer BD. Dual Mobility Articulation in Revision Total Hip Arthroplasty: An American Joint Replacement Registry Analysis of Patients Aged 65 Years and Older. J Arthroplasty 2023; 38:S376-S380. [PMID: 37230227 DOI: 10.1016/j.arth.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Increasingly, dual mobility (DM) articulations have been used in revision total hip arthroplasty (THA), which may prevent postoperative hip instability. The purpose of this study was to report on outcomes of DM implants used in revision THA from the American Joint Replacement Registry (AJRR). METHODS Revision THA cases performed between 2012 and 2018 Medicare were eligible and categorized by 3 articulations: DM, ≤32 mm, and ≥36 mm femoral heads. The AJRR-sourced revision THA cases were linked to Centers for Medicare and Medicaid Services (CMS) claims data to supplement (re)revision cases not captured in the AJRR. Patient and hospital characteristics were described and modeled as covariates. Using multivariable Cox proportional hazard models, considering competing risk of mortalities, hazard ratios were estimated for all-cause re-revision and re-revision for instability. Of 20,728 revision THAs, 3,043 (14.7%) received a DM, 6,565 (31.7%) a ≤32 mm head, and 11,120 (53.6%) a ≥36 mm head. RESULTS At 8-year follow-up, the cumulative all-cause re-revision rate for ≤32 mm heads was 21.9% (95%-confidence interval (CI) 20.2%-23.7%) and significantly (P < .0001) higher than DM (16.5%, 95%-CI 15.0%-18.2%) and ≥36 mm heads (15.2%, 95%-CI 14.2%-16.3%). At 8-year follow-up, ≥36 heads had significantly (P < .0001) lower hazard of re-revision for instability (3.3%, 95%-CI 2.9%-3.7%) while the DM (5.4%, 95%-CI 4.5%-6.5%) and ≤32 mm groups (8.6%, 95%-CI 7.7%-9.6%) had higher rates. CONCLUSION The DM bearings are associated with lower rates of revision for instability compared to patients who had ≤32 mm heads and higher revision rates for ≥36 mm heads. These results may be biased due to unidentified covariates associated with implant selection.
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Affiliation(s)
- Jesse E Otero
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina; Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Heena Jaffri
- American Academy of Orthopaedic Surgeons, Combined Analytics Team, Rosemont, Illinois
| | - Kyle J Mullen
- American Academy of Orthopaedic Surgeons, Combined Analytics Team, Rosemont, Illinois
| | - Susan M Odum
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Bryan D Springer
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina; Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
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13
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Youlden DR, Steliarova-Foucher E, Gini A, Silva NDP, Aitken JF. The growing prevalence of childhood cancer survivors in Australia. Pediatr Blood Cancer 2023; 70:e30383. [PMID: 37092826 DOI: 10.1002/pbc.30383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 04/25/2023]
Abstract
Survivors of childhood cancer have an increased risk of long-term health issues arising mostly from the side effects of treatment. Using population-based data from the Australian Childhood Cancer Registry (ACCR) for children aged 0-14 at diagnosis between 1983 and 2018, there were a total of 17,468 prevalent cases of childhood cancer survivors on 31 December 2018. We also found an 80% increase in the number of 5-year prevalent cases, from 1979 in 1988 to 3566 in 2018. Both short- and long-term prevalence estimates are important for monitoring childhood cancer survivorship and planning for the specific needs of this expanding cohort.
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Affiliation(s)
- Danny R Youlden
- Cancer Council Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | | | - Andrea Gini
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Neimar De Paula Silva
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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14
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Henry BM, Lippi G, Nasser A, Ostrowski P. Characteristics of Phase IV Clinical Trials in Oncology: An Analysis Using the ClinicalTrials.gov Registry Data. Curr Oncol 2023; 30:5932-5945. [PMID: 37366926 DOI: 10.3390/curroncol30060443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
The present study analyzed the characteristics of phase IV clinical trials in oncology using data from the ClinicalTrials.gov registry. The included trials were conducted between January 2013 and December 2022 and were examined for key characteristics, including outcome measures, interventions, sample sizes, and study design, different cancer types, and geographic regions. The analysis included 368 phase IV oncology studies. An amount of 50% of these studies examined both safety and efficacy, while 43.5% only reported efficacy outcome measures, and 6.5% only described safety outcome measures. Only 16.9% of studies were powered to detect adverse events with a frequency of 1 in 100. Targeted therapies accounted for the majority of included studies (53.5%), with breast (32.91%) and hematological cancers (25.82%) being the most frequently investigated malignancies. Most phase IV oncology studies lacked sufficient power to detect rare adverse events due to their small sample sizes and instead focused on effectiveness. To ensure that there is no gap in drug safety data collection and detection of rare adverse events due to limited phase IV clinical trials, there is a significant need for additional education and participation by both health care providers and patients in spontaneous reporting processes.
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Affiliation(s)
- Brandon Michael Henry
- Cmed Research Inc., Morrisville, NC 27560, USA
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
- Youthoria, Youth Research Organization, 30-363 Kraków, Poland
| | - Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University Hospital of Verona, 37129 Verona, Italy
| | - Ameen Nasser
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Patryk Ostrowski
- Youthoria, Youth Research Organization, 30-363 Kraków, Poland
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland
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15
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Charvat H, Fukui K, Matsuda T, Katanoda K, Ito Y. Impact of cancer and other causes of death on mortality of cancer patients: A study based on Japanese population-based registry data. Int J Cancer 2023. [PMID: 37278616 DOI: 10.1002/ijc.34610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023]
Abstract
Cancer registry data provide a very important source of information for improving our understanding of the epidemiology of various cancers. In this work, we estimated the 5-year crude probabilities of death from cancer and from other causes for five common cancers, namely stomach, lung, colon-rectum, prostate and breast, in Japan, using population-based registry data. Based on data on 344 676 patients diagnosed with one of these cancers between 2006 and 2008 in 21 prefectures participating in the Monitoring of Cancer Incidence in Japan (MCIJ) and followed-up for at least 5 years, we used a flexible excess hazard model to compute the crude probabilities of death for different combinations of sex, age and stage at diagnosis. For tumours diagnosed at the distant stage, as well as for regional lung tumours, the vast majority of deaths at 5 years in cancer patients were attributable to the disease itself (although this proportion was only around 60% in older prostate cancer patients). For localised and most regional tumours, the impact of other causes of death on the total mortality increased with age at diagnosis, especially for localised breast, colorectal and gastric cancer. By allowing the partition of the mortality experience of cancer patients into a cancer- and an other-cause-specific component, crude probability of death estimates provide insight into how the impact of cancer on mortality might differ among populations with different background mortality risks. This might be useful for informing discussions between clinicians and patients about treatment options.
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Affiliation(s)
- Hadrien Charvat
- Faculty of International Liberal Arts, Juntendo University, Tokyo, Japan
- Division of International Health Policy Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Keisuke Fukui
- Graduate School of Societal Safety Sciences, Faculty of Societal Safety Sciences, Kansai University, Osaka, Japan
| | - Tomohiro Matsuda
- Division of International Health Policy Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Kota Katanoda
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Yuri Ito
- Department of Medical Statistics Research and Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
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16
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Palipana AK, Gecili E, Song S, Johnson SR, Szczesniak RD, Gupta N. Predicting Individualized Lung Disease Progression in Treatment-Naive Patients With Lymphangioleiomyomatosis. Chest 2023; 163:1458-1470. [PMID: 36610667 PMCID: PMC10258438 DOI: 10.1016/j.chest.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Lung function decline varies significantly in patients with lymphangioleiomyomatosis (LAM), impeding individualized clinical decision-making. RESEARCH QUESTION Can we aid individualized decision-making in LAM by developing a dynamic prediction model that can estimate the probability of clinically relevant FEV1 decline in patients with LAM before treatment initiation? STUDY DESIGN AND METHODS Patients observed in the US National Heart, Lung, and Blood Institute (NHLBI) Lymphangioleiomyomatosis Registry were included. Using routinely available variables such as age at diagnosis, menopausal status, and baseline lung function (FEV1 and diffusing capacity of the lungs for carbon monoxide [Dlco]), we used novel stochastic modeling and evaluated predictive probabilities for clinically relevant drops in FEV1. We formed predictive probabilities of transplant-free survival by jointly modeling longitudinal FEV1 and lung transplantation or death events. External validation used the UK Lymphangioleiomyomatosis Natural History cohort. RESULTS Analysis of the NHLBI Lymphangioleiomyomatosis Registry and UK Lymphangioleiomyomatosis Natural History cohorts consisted of 216 and 185 individuals, respectively. We derived a joint model that accurately estimated the risk of future lung function decline and 5-year probabilities of transplant-free survival in patients with LAM not taking sirolimus (area under the receiver operating characteristic curve [AUC], approximately 0.80). The prediction model provided estimates of forecasted FEV1, rate of FEV1 decline, and probabilities for risk of prolonged drops in FEV1 for untreated patients with LAM with a high degree of accuracy (AUC > 0.80) for the derivation cohort as well as the validation cohort. Our tool is freely accessible at: https://anushkapalipana.shinyapps.io/testapp_v2/. INTERPRETATION Longitudinal modeling of routine clinical data can allow individualized LAM prognostication and assist in decision-making regarding the timing of treatment initiation.
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Affiliation(s)
- Anushka K Palipana
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Statistics and Data Science, University of Cincinnati, Cincinnati, OH
| | - Emrah Gecili
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Seongho Song
- Division of Statistics and Data Science, University of Cincinnati, Cincinnati, OH
| | - Simon R Johnson
- Translational Medical Sciences, NIHR Biomedical Research Centre and Biodiscovery Institute, University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham, England; National Centre for Lymphangioleiomyomatosis, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Rhonda D Szczesniak
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Nishant Gupta
- Division of Pulmonary Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH; Medical Service, Veterans Affairs Medical Center, Cincinnati, OH.
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17
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Friedman J. Commentary on Lim et al.: Mortality database linkages-A critical methodology to understand the structural drivers of the overdose crisis. Addiction 2023; 118:468-469. [PMID: 36625315 DOI: 10.1111/add.16117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, CA, USA
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18
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Lutski M, Shahar R, Vered S, Novick D, Zucker I, Weinstein G. Hospitalizations in older-adults newly diagnosed with dementia: A population-based longitudinal study in Israel. Int J Geriatr Psychiatry 2023; 38:e5871. [PMID: 36683135 PMCID: PMC10108175 DOI: 10.1002/gps.5871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To compare inpatient burden (i.e. likelihood of hospitalization, number of admissions and length of stay) in persons with newly diagnosed dementia to the general population without dementia. Additionally, to evaluate whether inpatient burden is increased during the years prior to and post dementia diagnosis, and to identify factors associated with increased inpatient burden. METHOD The Israeli National Dementia Dataset (2016) was cross-linked with the National Hospital Discharge Database of the Israeli Ministry of Health (2014-2018). Dementia definition was based on documented dementia diagnoses and/or the purchase of medications during 2016. Mixed-effects models were applied to identify demographic and health characteristics associated with inpatient burden in the one and 2 years prior to and after dementia diagnosis. RESULTS The dataset included 11,625 individuals aged ≥65 years, identified as incident dementia cases. Compared to the general population of older-adults without dementia, those with newly diagnosed dementia had a higher age-standardized proportion of hospitalizations (26.4% vs. 40%). The odds for hospitalization were highest during the year preceding dementia diagnosis (OR = 3.19, 95% CI 2.51-4.06) compared to 2 years prior to diagnosis, and remained high (although slightly decreased) after dementia diagnosis. Older age was associated with inpatient burden after, but not prior to dementia diagnosis. CONCLUSIONS Older persons with dementia are a vulnerable population group with increased utilization of inpatient burden compared to those without dementia, particularly in the years surrounding dementia diagnosis. Sociodemographic risk factors may differ with respect to the time surrounding dementia diagnosis.
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Affiliation(s)
- Miri Lutski
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Rotem Shahar
- School of Public Health, University of Haifa, Haifa, Israel
| | - Shiraz Vered
- School of Public Health, University of Haifa, Haifa, Israel
| | - Deborah Novick
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Inbar Zucker
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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19
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Robsahm TE, Tsuruda KM, Hektoen HH, Storås AH, Cook MB, Hurwitz LM, Langseth H. Applying recommended definition of aggressive prostate cancer: a validation study using high-quality data from the Cancer Registry of Norway. Acta Oncol 2023; 62:8-14. [PMID: 36762472 PMCID: PMC10301241 DOI: 10.1080/0284186x.2023.2175331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The Prostate Cancer Cohort Consortium (PC3) Working Group proposed a definition for aggressive prostate cancer (PC) for aetiologic epidemiologic research. We aimed to validate this definition as well as a second approach utilising only information on stage at diagnosis. METHODS First primary PCs diagnosed 2004 - 2009 in the population-based Janus Serum Bank (JSB) cohort were identified by linkage to the population-based Cancer Registry of Norway (CRN) (n = 3568). The CRN and Norwegian Prostate Cancer Registry provided clinicopathological data for these cases. Approach 1 classified PC as aggressive if it was clinically T4, or N1, or M1, or had a Gleason score ≥8 at diagnosis (as proposed). Approach 2 classified PC as aggressive if CRN stage at diagnosis was 'regional spread' or 'distant metastases'. Both approaches were validated by calculating the sensitivity and positive predictive value (PPV) against PC-death within 10 years of diagnosis. RESULTS Overall, 555 died from PC within 10 years. Approach 1 classified 24.7% of cases as aggressive and 13.6% were unclassified due to missing information. Approach 2 classified 19.6% as aggressive and 29% were unclassified. Sensitivity was highest for Approach 1 (0.76, 95% CI: 0.72 - 0.80 vs 0.69, 95% CI: 0.64 - 0.73), while PPVs were similar for both approaches (0.43, 95% CI: 0.40 - 0.46 and 0.40, 95% CI: 0.36 - 0.44). We observed similarly high sensitivity and higher PPVs than those reported by the PC3 Working Group. CONCLUSIONS The proposed definition of aggressive PC was applicable and valid in the JSB cohort. Stage at diagnosis can be useful if data on cTNM or Gleason score is unavailable.
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Affiliation(s)
- TE Robsahm
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - KM Tsuruda
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - HH Hektoen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - AH Storås
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - MB Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - LM Hurwitz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - H Langseth
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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20
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de Vries S, Verheij R. Residential green space associated with the use of attention deficit hyperactivity disorder medication among Dutch children. Front Psychol 2022; 13:948942. [PMID: 36118499 PMCID: PMC9479333 DOI: 10.3389/fpsyg.2022.948942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
Several studies have observed an inverse relationship between attention deficit hyperactivity disorder (ADHD)-related behavior of children, as reported by parents or teachers, and the amount of green space in their residential environment. Research using other, more objective measures to determine ADHD prevalence is scarce and could strengthen the evidence base considerably. In this study, it is investigated whether a similar beneficial association will be observed if the use of ADHD-related medication is selected as an outcome measure. More specifically, registry data from a health insurance company on the reimbursement of ADHD-related medication in 2011 were available for 248,270 children between 5 and 12 years of age. Amounts of green space within 250 and 500 m of the home address were calculated. Multilevel logistic regression analyses for the prevalence of use were conducted, including the following covariates: sex, age, urbanity of the neighborhood, neighborhood socioeconomic status (SES), and percentage of people with a non-Western migration background in the neighborhood population. Results showed that the amount of green space was inversely related to the prevalence of use of ADHD medication. Moreover, the relationship was strongest among children living in the least wealthy neighborhoods and absent among those living in the wealthiest neighborhoods. Results also show that in less wealthy neighborhoods, there is, on average, less green space available nearby: children who are likely to benefit most from nearby green space tend to have the least of it.
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Affiliation(s)
- Sjerp de Vries
- Wageningen Environmental Research, Wageningen University and Research, Wageningen, Netherlands
- Cultural Geography Chairgroup, Wageningen University and Research, Wageningen, Netherlands
| | - Robert Verheij
- Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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21
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Abstract
BACKGROUND Oral contraceptive use has been previously associated with an increased risk of suicidal behavior in some, but not all, samples. The use of large, representative, longitudinally-assessed samples may clarify the nature of this potential association. METHODS We used Swedish national registries to identify women born between 1991 and 1995 (N = 216 702) and determine whether they retrieved prescriptions for oral contraceptives. We used Cox proportional hazards models to test the association between contraceptive use and first observed suicidal event (suicide attempt or death) from age 15 until the end of follow-up in 2014 (maximum age 22.4). We adjusted for covariates, including mental illness and parental history of suicide. RESULTS In a crude model, use of combination or progestin-only oral contraceptives was positively associated with suicidal behavior, with hazard ratios (HRs) of 1.73-2.78 after 1 month of use, and 1.25-1.82 after 1 year of use. Accounting for sociodemographic, parental, and psychiatric variables attenuated these associations, and risks declined with increasing duration of use: adjusted HRs ranged from 1.56 to 2.13 1 month beyond the initiation of use, and from 1.19 to 1.48 1 year after initiation of use. HRs were higher among women who ceased use during the observation period. CONCLUSIONS Young women using oral contraceptives may be at increased risk of suicidal behavior, but risk declines with increased duration of use. Analysis of former users suggests that women susceptible to depression/anxiety are more likely to cease hormonal contraceptive use. Additional studies are necessary to determine whether the observed association is attributable to a causal mechanism.
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Affiliation(s)
- Alexis C. Edwards
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Sara Larsson Lönn
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Isungset MA, Conley D, Zachrisson HD, Ystrom E, Havdahl A, Njølstad PR, Lyngstad TH. Social and genetic associations with educational performance in a Scandinavian welfare state. Proc Natl Acad Sci U S A 2022; 119:e2201869119. [PMID: 35709318 DOI: 10.1073/pnas.2201869119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Recent research has suggested that across Western developed societies, the influence of genetics on educational outcomes is relatively constant. However, the degree to which family environment matters varies, such that countries with high levels of intergenerational mobility have weaker associations of family background. Research in this vein has relied on twin-based estimates, which involve variance decomposition, so direct assessment of the association of genes and environments is not possible. In the present study, we approach the question by directly measuring the impact of child genotype, parental genetic nurture, and parental realized education on educational achievement in primary and secondary school. We deploy data from a social democratic context (Norway) and contrast our findings with those derived from more liberal welfare state contexts. Results point to genetics only confounding the relationship between parent status and offspring achievement to a small degree. Genetic nurture associations are similar to those in other societies. We find no, or very small, gene-environment interactions and parent-child genotype interactions with respect to test scores. In sum, in a Scandinavian welfare state context, both genetic and environmental associations are of similar magnitude as in societies with less-robust efforts to mitigate the influence of family background.
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23
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A Überall M, Bösl I, Hollanders E, Sabatschus I, Eerdekens M. Postsurgical neuropathic pain: lidocaine 700 mg medicated plaster or oral treatments in clinical practice. Pain Manag 2022; 12:725-735. [PMID: 35713406 DOI: 10.2217/pmt-2022-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: To compare the effectiveness and tolerability of the lidocaine 700 mg medicated plaster (LMP) and oral first-line medications (OM) for the treatment of postsurgical neuropathic pain (PSNP) in routine clinical practice. Patients & methods: Data from a noninterventional, retrospective 24-week cohort study in patients with localized peripheral NP refractory to at least one recommended OM using anonymized German Pain eRegistry data were retrieved. A subgroup analysis was conducted on 531 datasets of PSNP patients. Results: Pain relief, improvements in pain-related impairments of daily living and quality of life, and tolerability were significantly greater under LMP than under OM (p < 0.001 for all parameters). Conclusion: These real-world data show the effectiveness and good tolerability of LMP for PSNP treatment in routine clinical practice.
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24
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Willers A, Swol J, van Kuijk SMJ, Buscher H, McQuilten Z, Ten Cate H, Rycus PT, McKellar S, Lorusso R, Tonna JE. HEROES V-A-HEmoRrhagic cOmplications in veno-arterial Extracorporeal life Support-Development and internal validation of a multivariable prediction model in adult patients. Artif Organs 2022; 46:2266-2283. [PMID: 35712783 DOI: 10.1111/aor.14340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 05/10/2022] [Accepted: 06/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Risk factors for bleeding complications during extracorporeal life support (ECLS) indicated for cardiac support remain poorly investigated. The aim is to develop and internally validate a prediction model to calculate the risk for bleeding complications in adult patients receiving veno-arterial (V-A) ECLS. METHODS Data of the Extracorporeal Life Support Organization registry of adult patients undergoing V-A ECLS between 2010 and 2020 were analyzed. The primary outcome was bleeding complications recorded during V-A ECLS. Multivariable logistic regression with backward stepwise elimination was used to develop the prediction model. Performance of the model was tested by discriminative ability and calibration with receiver operator characteristic, area under the curve, and visual inspection of the calibration plot. Internal validation was performed to detect overfitting of the model. RESULTS In total 28 767 adult patients were included, of which 29.0% developed bleeding complications. Sex, body mass index, surgical cannulation, pre-ECLS respiratory and hemodynamic variables, pre-ECLS support and interventions, and different type of diagnosis were included in the prediction model. This prediction model showed a predictive capability with an AUC of 0.66. CONCLUSION The model is based on the largest cohort of V-A ECLS patients and is the best available predictive model for bleeding events given the predictors that are available in V-A ECLS compared to current literature. The model can help in identifying patients at high risk for bleeding complications and will help in developing further research and decision-making in terms of anticoagulation management. External validation is warranted to extrapolate this model in the clinical setting.
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Affiliation(s)
- Anne Willers
- ECLS Center, Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Hergen Buscher
- Department of Intensive Care Medicine, Center of Applied Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Zoe McQuilten
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne Australia Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Hugo Ten Cate
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Center for Thrombosis and Hemostasis (CTH), Gutenberg University Medical Center, Mainz, Germany.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Peter T Rycus
- Extracorporeal Life Support Organization, Ann Arbor, Michigan, USA
| | - Stephen McKellar
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Roberto Lorusso
- ECLS Center, Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah, USA.,Division of Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA
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Serong S, Fickert S, Niemeyer P, Banke IJ, Goronzy J, Sobau C, Zinser W, Landgraeber S. Outcome-Affecting Parameters of Hip Arthroscopy for Femoroacetabular Impingement with Concomitant Cartilage Damage-Data Analysis from the German Cartilage Registry. J Clin Med 2022; 11:1532. [PMID: 35329858 DOI: 10.3390/jcm11061532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023] Open
Abstract
This study aims to report on a prospectively collected, multicenter database of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAI) and concomitant cartilage damage (according to the International Cartilage Repair Society) and to assess the outcome-affecting parameters. In the study, 353 hips with up to 24 months’ follow-up were assessed by iHOT-33 scoring and achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) levels. Multiple and binary regression analyses were performed to identify factors related to (un-) favorable outcomes and to assess their clinical relevance with regard to achieving the MCID and PASS. Multiple regression yielded the parameters of male sex (p = 0.022) and lower body mass index (BMI) (p = 0.019) at 6 months, lower BMI (p = 0.022) and younger age (p = 0.022) at 12 months, and younger age at 24 months (p = 0.039) to be significantly associated with higher iHOT scoring. Male sex (p = 0.019) and lower BMI (p = 0.018) were significantly correlated with achievement of the PASS in binary regression at 6 months, whereas at 12 (p = 0.010) and at 24 (p = 0.003) only younger age was shown to be significantly correlated. None of the parameters was statistically associated with achievement of the MCID. As the parameters of younger age, male sex, and lower BMI were identified as temporarily correlated with a preferable outcome in general and with achievement of the PASS in particular, these findings help to preoperatively identify factors associated with (un-) favorable therapy results.
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26
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Facile R, Muhlbradt EE, Gong M, Li Q, Popat V, Pétavy F, Cornet R, Ruan Y, Koide D, Saito TI, Hume S, Rockhold F, Bao W, Dubman S, Jauregui Wurst B. Use of Clinical Data Interchange Standards Consortium (CDISC) Standards for Real-world Data: Expert Perspectives From a Qualitative Delphi Survey. JMIR Med Inform 2022; 10:e30363. [PMID: 35084343 PMCID: PMC8832264 DOI: 10.2196/30363] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/17/2021] [Accepted: 10/09/2021] [Indexed: 01/16/2023] Open
Abstract
Background Real-world data (RWD) and real-world evidence (RWE) are playing increasingly important roles in clinical research and health care decision-making. To leverage RWD and generate reliable RWE, data should be well defined and structured in a way that is semantically interoperable and consistent across stakeholders. The adoption of data standards is one of the cornerstones supporting high-quality evidence for the development of clinical medicine and therapeutics. Clinical Data Interchange Standards Consortium (CDISC) data standards are mature, globally recognized, and heavily used by the pharmaceutical industry for regulatory submissions. The CDISC RWD Connect Initiative aims to better understand the barriers to implementing CDISC standards for RWD and to identify the tools and guidance needed to more easily implement them. Objective The aim of this study is to understand the barriers to implementing CDISC standards for RWD and to identify the tools and guidance that may be needed to implement CDISC standards more easily for this purpose. Methods We conducted a qualitative Delphi survey involving an expert advisory board with multiple key stakeholders, with 3 rounds of input and review. Results Overall, 66 experts participated in round 1, 56 in round 2, and 49 in round 3 of the Delphi survey. Their inputs were collected and analyzed, culminating in group statements. It was widely agreed that the standardization of RWD is highly necessary, and the primary focus should be on its ability to improve data sharing and the quality of RWE. The priorities for RWD standardization included electronic health records, such as data shared using Health Level 7 Fast Health care Interoperability Resources (FHIR), and the data stemming from observational studies. With different standardization efforts already underway in these areas, a gap analysis should be performed to identify the areas where synergies and efficiencies are possible and then collaborate with stakeholders to create or extend existing mappings between CDISC and other standards, controlled terminologies, and models to represent data originating across different sources. Conclusions There are many ongoing data standardization efforts around human health data–related activities, each with different definitions, levels of granularity, and purpose. Among these, CDISC has been successful in standardizing clinical trial-based data for regulation worldwide. However, the complexity of the CDISC standards and the fact that they were developed for different purposes, combined with the lack of awareness and incentives to use a new standard and insufficient training and implementation support, are significant barriers to setting up the use of CDISC standards for RWD. The collection and dissemination of use cases, development of tools and support systems for the RWD community, and collaboration with other standards development organizations are potential steps forward. Using CDISC will help link clinical trial data and RWD and promote innovation in health data science.
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Affiliation(s)
- Rhonda Facile
- Clinical Data Interchange Standards Consortium, Austin, TX, United States
| | | | - Mengchun Gong
- Digital Health China Technologies, Bejing, China.,Institute of Health Management, Southern Medical University, Guangzhou, China
| | - Qingna Li
- Institute of Clinical Pharmacology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine of National Medical Products Administration, Beijing, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Vaishali Popat
- Food and Drug Administration, Center for Drug Evaluation Research, Silver Spring, MD, United States
| | - Frank Pétavy
- European Medicines Agency, Amsterdam, Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers - University of Amsterdam, Amsterdam, Netherlands
| | | | - Daisuke Koide
- Department of Biostatistics & Bioinformatics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshiki I Saito
- National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Sam Hume
- Clinical Data Interchange Standards Consortium, Austin, TX, United States
| | - Frank Rockhold
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States
| | - Wenjun Bao
- JMP Life Sciences, SAS Institute Inc, Cary, NC, United States
| | - Sue Dubman
- Clinical Data Interchange Standards Consortium, Austin, TX, United States
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27
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Überall MA, Bösl I, Hollanders E, Sabatschus I, Eerdekens M. Localized peripheral neuropathic pain: topical treatment with lidocaine 700 mg medicated plaster in routine clinical practice. Pain Manag 2022; 12:521-533. [PMID: 35001660 DOI: 10.2217/pmt-2021-0117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: To provide real-world evidence for the effectiveness and tolerability of lidocaine 700 mg medicated plaster (LMP) in localized peripheral neuropathic pain (l-PNP) treatment compared with first-line oral medications (OM). Patients & methods: This was a noninterventional, retrospective 6-month cohort study in patients refractory to at least one recommended OM, using anonymized medical care data from the German Pain eRegistry. Treatment groups were matched by propensity scoring, considering seven predefined confounding factors. The primary effectiveness end point was the absolute change in average pain intensity index from baseline at weeks 4, 12 and 24 of treatment and over the treatment period. Results: A total of 3081 datasets were retained per treatment group. LMP provided superior pain reductions and significantly greater improvements in pain-related impairments of daily living and quality of life with significantly better tolerability (p < 0.001 for all parameters) than OM. Conclusion: These real-world data confirm the effectiveness and good tolerability of LMP for l-PNP treatment under routine medical care.
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28
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Edwards AC, Ohlsson H, Mościcki E, Crump C, Sundquist J, Kendler KS, Sundquist K. Alcohol use disorder and non-fatal suicide attempt: findings from a Swedish National Cohort Study. Addiction 2022; 117:96-105. [PMID: 34159695 PMCID: PMC10481507 DOI: 10.1111/add.15621] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/09/2020] [Accepted: 06/09/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Alcohol use disorder (AUD) is associated with increased risk of non-fatal suicide attempt. We aimed to measure the strength and mechanistic nature of the association between AUD and increased suicide attempt and determine any causal pathways and/or shared risk factors. DESIGN We used Cox proportional hazards models in population-level and co-relative analyses to evaluate the risk of first non-fatal suicide attempt as a function of previous AUD. SETTING AND PARTICIPANTS We used continuously updated longitudinal nationwide Swedish registry data on native Swedes born from 1950 to 1970 (n = 2 229 619) and followed from age 15 until 2012. MEASUREMENTS AUD and suicide attempt were identified using International Classification of Diseases (ICD)-8, ICD-9, and ICD-10 codes. AUD was also identified using pharmacy and criminal records. Genetic and family environmental risks were derived based on relatedness via the Multi-Generation Register and shared residency via the Population and Housing Census and the Total Population Register. FINDINGS AUD was robustly associated with suicide attempt in crude models (hazard ratio [HR] = 15.24 [95% CI: 14.92, 15.56]). In models adjusted for sociodemographic factors and psychiatric comorbidity, the association was attenuated: for women, HRs declined gradually across time, ranging from 5.55 (3.72, 8.29) during the observation period that ranged from age 15 to 19 years to 1.77 (1.65, 1.90) at age 40 or older. For men, the corresponding figures were 6.12 (4.07, 9.19) and 1.83 (1.72, 1.94); in contrast to women, risk of suicide attempt among men increased from age 15 to 29 before declining. In co-relative models, a residual association remained, consistent with a causal path from AUD to suicide attempt. CONCLUSIONS In Sweden, alcohol use disorder appears to be an important predictor of suicide attempt even in the context of other psychiatric disorders. The observed association is likely the result of features that jointly impact risk of alcohol use disorder and suicide attempts (genetic liability, psychiatric illness, and childhood stressors) and a potentially causal pathway, acting independently or in conjunction with one another.
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Affiliation(s)
- Alexis C. Edwards
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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29
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Willers A, Swol J, van Kuijk SMJ, Buscher H, McQuilten Z, Ten Cate H, Rycus PT, McKellar S, Lorusso R, Tonna JE. HEROES V-V-HEmorRhagic cOmplications in Veno-Venous Extracorporeal life Support-Development and internal validation of multivariable prediction model in adult patients. Artif Organs 2021; 46:932-952. [PMID: 34904241 DOI: 10.1111/aor.14148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/08/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND During extracorporeal life support (ECLS), bleeding is one of the most frequent complications, associated with high morbidity and increased mortality, despite continuous improvements in devices and patient care. Risk factors for bleeding complications in veno-venous (V-V) ECLS applied for respiratory support have been poorly investigated. We aim to develop and internally validate a prediction model to calculate the risk for bleeding complications in adult patients receiving V-V ECLS support. METHODS Data from adult patients reported to the extracorporeal life support organization (ELSO) registry between the years 2010 and 2020 were analyzed. The primary outcome was bleeding complications recorded during V-V ECLS. Multivariable logistic regression with backward stepwise elimination was used to develop the predictive model. The performance of the model was tested by discriminative ability and calibration with receiver operating characteristic curves and visual inspection of the calibration plot. RESULTS In total, 18 658 adult patients were included, of which 3 933 (21.1%) developed bleeding complications. The prediction model showed a prediction of bleeding complications with an AUC of 0.63. Pre-ECLS arrest, surgical cannulation, lactate, pO2 , HCO3 , ventilation rate, mean airway pressure, pre-ECLS cardiopulmonary bypass or renal replacement therapy, pre-ECLS surgical interventions, and different types of diagnosis were included in the prediction model. CONCLUSIONS The model is based on the largest cohort of V-V ECLS patients and reveals the most favorable predictive value addressing bleeding events given the predictors that are feasible and when compared to the current literature. This model will help identify patients at risk of bleeding complications, and decision making in terms of anticoagulation and hemostatic management.
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Affiliation(s)
- Anne Willers
- ECLS Center, Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Justyna Swol
- Department of Pulmonology, Paracelsus Medical University, Nuremberg, Germany
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Hergen Buscher
- Department of Intensive Care Medicine, Center of Applied Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Zoe McQuilten
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne Australia Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Hugo Ten Cate
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Center for Thrombosis and Hemostasis (CTH), Gutenberg University Medical Center, Mainz, Germany.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Peter T Rycus
- Extracorporeal Life Support Organization, Ann Arbor, Michigan, USA
| | - Stephen McKellar
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Roberto Lorusso
- ECLS Center, Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah, USA.,Division of Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA
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Granger E, Davies G, Keogh RH. Treatment patterns in people with cystic fibrosis: have they changed since the introduction of ivacaftor? J Cyst Fibros 2021; 21:316-322. [PMID: 34497037 PMCID: PMC9097695 DOI: 10.1016/j.jcf.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/11/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
Longitudinal treatment patterns among the ivacaftor-treated cystic fibrosis population in the UK differ from those seen in a contemporary cohort of individuals untreated due to their genotype, despite minimal differences between the genotype groups prior to the introduction of ivacaftor. People who are treated with ivacaftor were less likely to continue other treatments such as inhaled antibiotics, dornase alfa, hypertonic saline, chronic oral antibiotics and supplementary feeding, compared to people who are not treated with ivacaftor. The differences in use of dornase alfa and hypertonic saline solution between ivacaftor-treated and non-ivacaftor-treated people, are larger for people with higher lung function.
Background In late 2012, ivacaftor became available in the UK for people with cystic fibrosis (CF) aged 6 years and over with a G551D mutation. Long-term changes in treatment patterns have not previously been reported. We investigated long-term treatment patterns in people with CF with a G551D mutation who took ivacaftor and compared these with non-ivacaftor-treated cohorts using the UK Cystic Fibrosis Registry. Methods Using 2007-2018 data we compared treatment patterns between four cohorts: 1: ivacaftor-treated; 2: ivacaftor era (2013-2018), ineligible genotype (no G551D mutation); 3: pre-ivacaftor era (2007-2012), eligible genotype (G551D mutation); 4: pre-ivacaftor era, ineligible genotype. Treatments included: inhaled antibiotics, dornase alfa, hypertonic saline, chronic oral antibiotics and supplementary feeding. Results Up to 2012 the percentages of people taking each treatment were similar between the two cohorts defined by genotype and tended to increase by year with a similar slope. Once ivacaftor was introduced, the use of other treatments tended to decrease or remain stable by year for the ivacaftor-treated cohort, whereas it remained stable or increased in the non-ivacaftor-treated cohort. This led to differences in treatment use between the two cohorts in the ivacaftor-era, which became more marked over time. Conclusions We have shown a clear divergence in treatment patterns since the introduction of ivacaftor in a number of key treatments widely used in CF. Further research is needed to investigate whether the differences in treatment patterns are associated with changes in health outcomes.
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Affiliation(s)
- Emily Granger
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom.
| | - Gwyneth Davies
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London WC1N 1EH, United Kingdom
| | - Ruth H Keogh
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom; Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom
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Überall MA, Eerdekens M, Hollanders E, Bösl I, Sabatschus I. Lidocaine 700 mg medicated plaster for postherpetic neuralgia: real-world data from the German Pain e-Registry. Pain Manag 2021; 12:195-209. [PMID: 34372662 DOI: 10.2217/pmt-2021-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Aim: To provide real-world evidence for the effectiveness and tolerability of lidocaine 700 mg medicated plaster (LMP) compared with oral systemic first-line medications (OSM) in postherpetic neuralgia treatment. Patients & methods: Retrospective cohort study in patients refractory to at least one recommended OSM (single drug or a combination of drugs) using anonymized routine medical care data from the German Pain e-Registry. A matched pair approach using propensity score matching was employed. Results: A total of 1711 data sets of postherpetic neuralgia patients were identified per treatment group. The majority (>60%) had experienced pain for more than a year and reported a high burden of pain and reduced quality of life. Six months of LMP treatment provided significantly greater pain reductions, improvements in pain-related impairments and quality of life than OSM treatment (p < 0.001 for all parameters). Drug-related adverse events and treatment discontinuation due to drug-related adverse events also occurred less frequently under LMP treatment (p < 0.001). Conclusion: These real-world data confirm the effectiveness and good tolerability of LMP under routine medical care. The treatment was significantly more effective when compared with first-line oral systemic medications.
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Ito S, Iwanaga M, Nosaka K, Imaizumi Y, Ishitsuka K, Amano M, Utsunomiya A, Tokura Y, Watanabe T, Uchimaru K, Tsukasaki K. Epidemiology of adult T-cell leukemia-lymphoma in Japan: An updated analysis, 2012-2013. Cancer Sci 2021; 112:4346-4354. [PMID: 34355480 PMCID: PMC8486190 DOI: 10.1111/cas.15097] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/23/2021] [Accepted: 08/01/2021] [Indexed: 01/08/2023] Open
Abstract
Adult T‐cell leukemia‐lymphoma (ATL) is a T‐cell malignancy that is endemic to Japan. In this latest nationwide study of ATL, we collected the data from 4 nationwide registries of patients diagnosed in 2012‐2013; the Hematology Blood Disease, the Skin Cancer Society, the Hospital‐Based Cancer Registries, and information from the hospitals that participated in the Japanese nationwide survey of ATL in 2010‐2011. In the present study, 2614 patients with ATL were diagnosed based on the registries, and 117 departments registered 1042 patients. Among these patients, 984 were eligible for analysis. The median age at diagnosis was 69 y. A larger proportion of patients with ATL older than 70 y was diagnosed with the lymphoma subtype, and more than half of the patients with ATL in the metropolitan areas were born in the human T‐cell leukemia virus type I (HTLV‐1)‐endemic areas of Kyushu/Okinawa, which are almost identical to the findings in our 2010‐2011 study. Additionally, we identified that patients with ATL migrated from the endemic areas for HTLV‐1 to the non‐endemic metropolitan areas. The present study was able to reduce the burden of searching each hospital and to update the clinico‐epidemiological characteristics of a large number of patients with ATL in Japan, suggesting the usefulness and feasibility of the novel data collection method. The establishment of a more sophisticated database management system for ATL is necessary for future continuous surveys.
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Affiliation(s)
- Shigeki Ito
- Hematology & Oncology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Masako Iwanaga
- Department of Clinical Epidemiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Kisato Nosaka
- Department of Hematology, Kumamoto University School of Medicine, Kumamoto, Japan
| | | | - Kenji Ishitsuka
- Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan
| | - Masahiro Amano
- Department of Dermatology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Atae Utsunomiya
- Department of Hematology, Imamura General Hospital, Kagoshima, Japan
| | - Yoshiki Tokura
- Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiki Watanabe
- Department of Practical Management of Medical Information, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kaoru Uchimaru
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Kunihiro Tsukasaki
- Department of Hematology, International Medical Center, Saitama Medical University, Saitama, Japan
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Chen M, Surbhi S, Bailey JE. Association of Weight Loss With Type 2 Diabetes Remission Among Adults in Medically Underserved Areas: A Retrospective Cohort Study. Am J Health Promot 2021; 36:29-37. [PMID: 34128392 DOI: 10.1177/08901171211024426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the association between weight loss and type 2 diabetes remission among vulnerable populations living in medically underserved areas of the Mid-Southern United States. DESIGN Quantitative, retrospective cohort study. SETTING 114 ambulatory sites and 5 adults' hospitals in the Mid-South participating in a regional diabetes registry. PARTICIPANTS 9,900 adult patients with type 2 diabetes, stratified by remission status, with 1 year of baseline electronic medical record data, and 1 year of follow-up data for the 2015-2018 study period. MEASURES The outcomes were diabetes remissions, categorized as any remission, partial remission, and complete remission based on the guidelines of the American Diabetes Association. The exposure was weight loss, calculated by the change in the Body Mass Index (BMI) as a proxy measure. ANALYSIS χ2 tests, Fisher's exact tests, and the Mann-Whitney U-test were used to examine the differences in patient characteristics by remission status across the 3 remission categories, as appropriate. Multiple multivariable logistic regressions adjusting for confounders were performed to estimate the adjusted odds ratios (aORs) for the associations between weight loss and diabetes remission. RESULTS Among 9,900 patients identified, a reduction of 0.3 kg/m2 (standard deviation: 2.5) in the average BMI from the baseline to the follow-up was observed. 10.8% achieved any type of remission, with 9.8% for partial and 1.0% for complete remissions. Greater weight loss was significantly associated with an increased likelihood of any (aOR = 1.07, 95% confidence interval (CI), 1.06-1.08), partial (aOR 1.06, 95% CI, 1.04-1.07), and complete diabetes remission (aOR 1.10, 95% CI, 1.07-1.13). CONCLUSIONS Weight loss is significantly associated with diabetes remission among patients living in medically underserved areas, but complete remission is rare.
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Affiliation(s)
- Ming Chen
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institute of Health Outcome and Policy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satya Surbhi
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institute of Health Outcome and Policy, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Medicine-General Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James E Bailey
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institute of Health Outcome and Policy, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Medicine-General Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Min ST, Roohullah A, Tognela A, Jalali A, Lee M, Wong R, Shapiro J, Burge M, Yip D, Nott L, Zimet A, Lee B, Dean A, Steel S, Wong HL, Gibbs P, Lim SHS. Patient demographics and management landscape of metastatic colorectal cancer in the third-line setting: Real-world data in an australian population. Asia Pac J Clin Oncol 2021; 18:e56-e63. [PMID: 33870631 DOI: 10.1111/ajco.13553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Colorectal cancer is the third most common cancer and second leading cause of cancer mortality in Australia, thus carrying a significant disease burden. AIMS This analysis aims to explore real-world treatment landscape of metastatic colorectal cancer in the third-line setting. METHODS We retrospectively analysed treatment of recurrent and advanced colorectal cancer (TRACC) registry database from 2009 onwards. Patients treated with palliative intent who progressed after two lines of therapies were included. One treatment line was defined as any combination of systemic therapy given until progression. RESULTS Out of 1820 patients treated palliatively, 32% (590 patients) met study criteria. Of these, 43% (254 patients) proceeded to third-line therapy, equating to 14% of all metastatic patients. In KRAS mutant or unknown tumours (97 patients), fluoropyrimidine (FP)-oxaliplatin combination was the most common choice (51%), followed by FP-irinotecan (15%), trifluridine/tipiracil (11%), mono-chemotherapy (10%), regorafenib (5%) and others (7%). Majority of FP-doublet (83%) was given as rechallenge. In 157 patients with KRAS wildtype disease, monotherapy with EGFR inhibitor was most commonly used (41%), followed by EGFR inhibitor with chemotherapy (20%), FP-doublet (18%), mono-chemotherapy (6%), trifluridine/tipiracil (6%), regorafenib (1%) and others (8%). Median overall survival was 7.1 months (range 0.4-41.2), and median time on third-line treatment was 3 months (range 0.1-40). CONCLUSIONS In real-world Australian population, treatment choices differed based on KRAS status and will likely change with the availability of newer drugs on the pharmaceutical benefits scheme. Survival outcomes are comparable to newer agents in clinical trials for select patients.
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Affiliation(s)
- Sandy Tun Min
- Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia
| | - Aflah Roohullah
- Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Annette Tognela
- Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Azim Jalali
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Oncology, Western Health, St Albans, Victoria, Australia
| | - Margaret Lee
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Oncology, Western Health, St Albans, Victoria, Australia.,Department of Medical Oncology, Eastern Health, Box Hill, Victoria, Australia
| | - Rachel Wong
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Oncology, Eastern Health, Box Hill, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia.,Epworth Health Care, Box Hill, Victoria, Australia
| | - Jeremy Shapiro
- Department of Medicine, Monash University, Clayton, Victoria, Australia.,Cabrini Haematology and Oncology Centre, Malvern, Victoria, Australia
| | - Matthew Burge
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Desmond Yip
- Department of Medical Oncology, Canberra and Calvary Hospitals, Garran, Australia Capital Territory, Australia
| | - Louise Nott
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Allan Zimet
- Epworth HealthCare, Richmond, Victoria, Australia
| | - Belinda Lee
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The Northern Hospital, Epping, Victoria, Australia
| | - Andrew Dean
- Department of Medical Oncology, St John of God Hospital, Subiaco, Western Australia, Australia
| | - Simone Steel
- Peninsula Private Hospital, Frankston, Victoria, Australia
| | - Hui-Li Wong
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Oncology, Western Health, St Albans, Victoria, Australia.,Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie Hui-Su Lim
- Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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Bauer L, Woiczinski M, Thorwächter C, Melsheimer O, Weber P, Grupp TM, Jansson V, Steinbrück A. Secondary Patellar Resurfacing in TKA: A Combined Analysis of Registry Data and Biomechanical Testing. J Clin Med 2021; 10:1227. [PMID: 33809605 DOI: 10.3390/jcm10061227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 01/07/2023] Open
Abstract
The German Arthroplasty registry (EPRD) has shown that different prosthesis systems have different rates of secondary patellar resurfacing: four years after implantation, the posterior-stabilized (PS) Vega prosthesis has a 3.2% risk of secondary patellar resurfacing compared to the cruciate-retaining (CR) Columbus prosthesis at 1.0% (both Aesculap AG, Tuttlingen, Germany). We hypothesized that PS implants have increased retropatellar pressure and a decreased retropatellar contact area compared to a CR design, which may lead to an increased likelihood of secondary patellar resurfacing. Eight fresh frozen specimens (cohort 1) were tested with an established knee rig. In addition, a possible influence of the registry-based patient collective (cohort 2) was investigated. No significant differences were found in patient data–cohort 2-(sex, age). A generally lower number of PS system cases is noteworthy. No significant increased patella pressure could be detected with the PS design, but a lower contact area was observed (cohort 1). Lower quadriceps force (100°–130° flexion), increased anterior movement of the tibia (rollback), greater external tilt of the patella, and increasing facet pressure in the Vega PS design indicate a multifactorial cause for a higher rate of secondary resurfacing which was found in the EPRD patient cohort and might be related to the PS’ principle function.
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Ciminelli G, Garcia-Mandicó S. COVID-19 in Italy: An Analysis of Death Registry Data. J Public Health (Oxf) 2021; 42:723-730. [PMID: 32935849 PMCID: PMC7543414 DOI: 10.1093/pubmed/fdaa165] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 11/19/2022] Open
Abstract
Background There are still many unknowns about COVID-19. We do not know its exact mortality rate nor the speed through which it spreads across communities. This lack of evidence complicates the design of appropriate response policies. Methods We source daily death registry data for 4100 municipalities in Italy’s north and match them to Census data. We augment the dataset with municipality-level data on a host of co-factors of COVID-19 mortality, which we exploit in a differences-in-differences regression model to analyze COVID-19-induced mortality. Results We find that COVID-19 killed more than 0.15% of the local population during the first wave of the epidemic. We also show that official statistics vastly underreport this death toll, by about 60%. Next, we uncover the dramatic effects of the epidemic on nursing home residents in the outbreak epicenter: in municipalities with a high share of the elderly living in nursing homes, COVID-19 mortality was about twice as high as in those with no nursing home intown. Conclusions A pro-active approach in managing the epidemic is key to reduce COVID-19 mortality. Authorities should ramp-up testing capacity and increase contact-tracing abilities. Adequate protective equipment should be provided to nursing home residents and staff.
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Affiliation(s)
- Gabriele Ciminelli
- Finance and Economics, Asia School of Business, 2 Jalan Dato Onn, 50480 Kuala Lumpur, Malaysia.,MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142, USA
| | - Sílvia Garcia-Mandicó
- Organisation for the Economic Cooperation and Development, 2 rue du Conseiller Collignon, Paris, France
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Nyström A, Haargaard B, Rosensvärd A, Tornqvist K, Magnusson G. The Swedish National Pediatric Cataract Register (PECARE): incidence and onset of postoperative glaucoma. Acta Ophthalmol 2020; 98:654-661. [PMID: 32274899 DOI: 10.1111/aos.14414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim was to report cumulative incidence and time of onset of postoperative glaucoma in a paediatric early cataract surgery cohort. METHODS Data were retrieved from the Pediatric Cataract Register (PECARE), a prospective register of Swedish cataract operations before 8 years of age. All eyes with surgery between January 2007 and December 2014 and a registered follow-up were included. Cataracts caused by uveitis, trauma or coexisting congenital glaucoma were excluded. Glaucoma was defined as early onset if diagnosed within a year after surgery and late onset if diagnosed later. RESULTS The study included 288 eyes in 207 children (106 girls), 81 with bilateral and 126 with unilateral cataracts, with a mean follow-up of 3.31 ± 1.77 years. Of the 288, 168 (58.3%) had surgery before 3 months of age; most of these 92.3% (155/168) were defined as dense, 208 (72.2%) were below 1 year of age. Cumulative incidence of surgically treated glaucoma among individuals was 23.7% (49/207). Median time to glaucoma onset was 0.91 years (range: 0.05-4.97 years) for eyes. Early-onset glaucoma was found in 98 % (63/64), and late onset in 2% (1/64). CONCLUSION In this paediatric cataract cohort, a majority of eyes had surgery before 3 months of age (58.3%). Secondary glaucoma-onset peaked within the first postoperative year, with a cumulative incidence of 23.7%. Surgery performed after the first month of life, resulted in a lower glaucoma rate. Long-term follow-up will reveal whether the low rate of late-onset glaucoma with early surgery will last, and if so, the consequences.
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Affiliation(s)
- Alf Nyström
- Department of Ophthalmology Region Västra Götaland Sahlgrenska University Hospital Mölndal Sweden
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | | | - Annika Rosensvärd
- Division of Ophthalmology and Vision Department of Clinical Neuroscience Karolinska Institute St Erik Eye Hospital Stockholm Sweden
| | - Kristina Tornqvist
- Department of Clinical Sciences Ophthalmology Lund University Lund Sweden
| | - Gunilla Magnusson
- Department of Ophthalmology Region Västra Götaland Sahlgrenska University Hospital Mölndal Sweden
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Joling KJ, Janssen O, Francke AL, Verheij RA, Lissenberg-Witte BI, Visser PJ, van Hout HPJ. Time from diagnosis to institutionalization and death in people with dementia. Alzheimers Dement 2020; 16:662-671. [PMID: 32072728 PMCID: PMC7984226 DOI: 10.1002/alz.12063] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/14/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Reliable estimates of time from diagnosis until institutionalization and death in people with dementia from routine nationally representative databases are lacking. METHODS We selected 9230 people with dementia and 24,624 matched controls from family physicians' electronic records linked with national administrative databases to analyze time until institutionalization and death and associated factors. RESULTS Median time from recorded diagnosis until institutionalization and until death for people with dementia was 3.9 and 5.0 years, respectively, which was considerably shorter than for controls. Once institutionalized, median time to death was longer for persons with dementia (2.5 years) than for controls (1.2 years). Older age and receiving home care were the strongest predictors of shorter time until institutionalization and death in people with dementia. Gender, cohabitation, migration status, frailty, polypharmacy, and dementia medication were other significant factors. DISCUSSION The estimates could help to inform patients, their families, and policymakers about probable trajectories.
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Affiliation(s)
- Karlijn J Joling
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Olin Janssen
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Anneke L Francke
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Robert A Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pieter-Jelle Visser
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Hein P J van Hout
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Prospero CJ, Trachtenberg FL, Pemberton VL, Pasquali SK, Anderson BR, Ash KE, Bainton J, Dunbar-Masterson C, Graham EM, Hamstra MS, Hollenbeck-Pringle D, Jacobs JP, Jacobs ML, John R, Lambert LM, Oster ME, Swan E, Waldron A, Nathan M. Lessons learned in the use of clinical registry data in a multi-centre prospective study: the Pediatric Heart Network Residual Lesion Score Study. Cardiol Young 2019; 29:930-938. [PMID: 31204627 PMCID: PMC6715515 DOI: 10.1017/s1047951119001148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Using existing data from clinical registries to support clinical trials and other prospective studies has the potential to improve research efficiency. However, little has been reported about staff experiences and lessons learned from implementation of this method in pediatric cardiology. OBJECTIVES We describe the process of using existing registry data in the Pediatric Heart Network Residual Lesion Score Study, report stakeholders' perspectives, and provide recommendations to guide future studies using this methodology. METHODS The Residual Lesion Score Study, a 17-site prospective, observational study, piloted the use of existing local surgical registry data (collected for submission to the Society of Thoracic Surgeons-Congenital Heart Surgery Database) to supplement manual data collection. A survey regarding processes and perceptions was administered to study site and data coordinating center staff. RESULTS Survey response rate was 98% (54/55). Overall, 57% perceived that using registry data saved research staff time in the current study, and 74% perceived that it would save time in future studies; 55% noted significant upfront time in developing a methodology for extracting registry data. Survey recommendations included simplifying data extraction processes and tailoring to the needs of the study, understanding registry characteristics to maximise data quality and security, and involving all stakeholders in design and implementation processes. CONCLUSIONS Use of existing registry data was perceived to save time and promote efficiency. Consideration must be given to the upfront investment of time and resources needed. Ongoing efforts focussed on automating and centralising data management may aid in further optimising this methodology for future studies.
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Affiliation(s)
- Carol J. Prospero
- Nemours Cardiac Center, Alfred I. duPont Hospital for
Children, Wilmington, DE USA
| | | | | | - Sara K. Pasquali
- Division of Pediatric Cardiology, Department of Pediatrics,
University of Michigan C.S. Mott Children’s Hospital, Ann Arbor, MI USA
| | - Brett R. Anderson
- Division of Pediatric Cardiology, New York
Presbyterian/Morgan Stanley Children’s Hospital, New York, NY USA
| | - Kathleen E. Ash
- Division of Pediatric Cardiology, Cincinnati
Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Jessica Bainton
- Division of Pediatric Cardiology, The Hospital for Sick
Children, Toronto, ON Canada
| | | | - Eric M. Graham
- Division of Pediatric Cardiology, Medical University of
South Carolina, Charleston, SC USA
| | - Michelle S. Hamstra
- Division of Pediatric Cardiology, Cincinnati
Children’s Hospital Medical Center, Cincinnati, OH USA
| | | | - Jeffrey P. Jacobs
- Department of Surgery, Johns Hopkins All
Children’s Hospital, Saint Petersburg, FL USA
| | - Marshall L. Jacobs
- Division of Cardiac Surgery, Johns Hopkins Heart and
Vascular Institute, Baltimore, MD USA
| | - Rija John
- Division of Congenital Heart Surgery, Texas
Children’s Hospital, Houston, TX USA
| | - Linda M. Lambert
- Division of Pediatric Cardiothoracic Surgery, University
of Utah, Salt Lake City, UT USA
| | - Matthew E. Oster
- Division of Pediatric Cardiology, Emory University School
of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA USA
| | - Elizabeth Swan
- Division of Pediatric Cardiology, Riley Hospital for
Children, Indianapolis, IN USA
| | - Abigail Waldron
- Division of Cardiology,
Children’s Hospital Philadelphia, Philadelphia, PA USA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children’s
Hospital, Boston, MA USA
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Borzych-Duzalka D, Shroff R, Ariceta G, Yap YC, Paglialonga F, Xu H, Kang HG, Thumfart J, Aysun KB, Stefanidis CJ, Fila M, Sever L, Vondrak K, Szabo AJ, Szczepanska M, Ranchin B, Holtta T, Zaloszyc A, Bilge I, Warady BA, Schaefer F, Schmitt CP. Vascular Access Choice, Complications, and Outcomes in Children on Maintenance Hemodialysis: Findings From the International Pediatric Hemodialysis Network (IPHN) Registry. Am J Kidney Dis 2019; 74:193-202. [PMID: 31010601 DOI: 10.1053/j.ajkd.2019.02.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 02/12/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Arteriovenous fistulas (AVFs) have been recommended as the preferred vascular access for pediatric patients on maintenance hemodialysis (HD), but data comparing AVFs with other access types are scant. We studied vascular access choice, placement, complications, and outcomes in children. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 552 children and adolescents from 27 countries on maintenance HD followed up prospectively by the International Pediatric HD Network (IPHN) Registry between 2012 and 2017. PREDICTOR Type of vascular access: AVF, central venous catheter (CVC), or arteriovenous graft. OUTCOME Infectious and noninfectious vascular access complication rates, dialysis performance, biochemical and hematologic parameters, and clinical outcomes. ANALYTICAL APPROACH Univariate and multivariable linear mixed models, generalized linear mixed models, and proportional hazards models; cumulative incidence functions. RESULTS During 314 cumulative patient-years, 628 CVCs, 225 AVFs, and 17 arteriovenous grafts were placed. One-third of the children with an AVF required a temporary CVC until fistula maturation. Vascular access choice was associated with age and expectations for early transplantation. There was a 3-fold higher living related transplantation rate and lower median time to transplantation of 14 (IQR, 6-23) versus 20 (IQR, 14-36) months with CVCs compared with AVFs. Higher blood flow rates and Kt/Vurea were achieved with AVFs than with CVCs. Infectious complications were reported only with CVCs (1.3/1,000 catheter-days) and required vascular access replacement in 47%. CVC dysfunction rates were 2.5/1,000 catheter-days compared to 1.2/1,000 fistula-days. CVCs required 82% more revisions and almost 3-fold more vascular access replacements to a different site than AVFs (P<0.001). LIMITATIONS Clinical rather than population-based data. CONCLUSIONS CVCs are the predominant vascular access choice in children receiving HD within the IPHN. Age-related anatomical limitations and expected early living related transplantation were associated with CVC use. CVCs were associated with poorer dialysis efficacy, higher complication rates, and more frequent need for vascular access replacement. Such findings call for a re-evaluation of pediatric CVC use and practices.
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Affiliation(s)
- Dagmara Borzych-Duzalka
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Gema Ariceta
- Hospital Universitario Materno-Infantil Vall D Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Fabio Paglialonga
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda, Osp. Maggiore Policlinico, Milano, Italy
| | - Hong Xu
- Fundan University, Shanghai, China
| | - Hee Gyung Kang
- Kidney Center for Children and Adolescents, Seoul, Korea
| | | | - Karabay Bayazit Aysun
- Department of Pediatric Nephrology, Cukurova University, Faculty of Medicine, Adana, Turkey
| | | | - Marc Fila
- Pediatric Nephrology Unit, CHU Arnaud de Villeneuve-Université de Montpellier, Montpellier, France
| | - Lale Sever
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Attila J Szabo
- MTA-SE Pediatric and Nephrology Research Group, Budapest, Hungary
| | | | - Bruno Ranchin
- Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France
| | - Tuula Holtta
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | | | - Ilmay Bilge
- Istanbul University Medical Faculty; Koc University, School of Medicine, Istanbul, Turkey
| | | | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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Affiliation(s)
- Prakash Deedwania
- Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, Fresno, California.
| | - Tushar Acharya
- Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Indregard AMR, Knardahl S, Nielsen MB. Emotional Dissonance, Mental Health Complaints, and Sickness Absence Among Health- and Social Workers. The Moderating Role of Self-Efficacy. Front Psychol 2018; 9:592. [PMID: 29740375 PMCID: PMC5928644 DOI: 10.3389/fpsyg.2018.00592] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/09/2018] [Indexed: 12/13/2022] Open
Abstract
Health- and social workers are frequently exposed to emotionally demanding work situations that require emotion regulation. Studies have demonstrated a direct relationship between emotion regulation and health complaints and sickness absence. In order to prevent health complaints and to reduce sickness absence among health- and social workers, there is need for greater attention to mechanisms explaining when and how emotionally demanding work situations are related to employee health and sickness absence. The overarching aim of this study was therefore to examine the moderating role of generalized self-efficacy on the association between emotional dissonance, employee health (mental distress and exhaustion), and registry based sickness absence. The sample consisted of 937 health- and social workers. Data on emotional dissonance, generalized self-efficacy, exhaustion, and mental distress was collected through questionnaires, whereas official registry data were used to assess sickness absence. A two-step hierarchical regression analysis showed that emotional dissonance was significantly associated with exhaustion, mental distress, and sickness absence, after adjusting for sex, age, and occupation. Interaction analyses with simple slope tests found that self-efficacy moderated the association between emotional dissonance and both exhaustion and mental distress, but not the association with sickness absence. This study shows that health- and social workers who frequently experience emotional dissonance report higher levels of exhaustion and mental distress, and have a higher risk of medically certified sickness absence. Further, health- and social workers with lower self-efficacy beliefs are apparently more sensitive to the degree of emotional dissonance and experienced higher levels of exhaustion and mental distress.
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Noack PS, Moore JA, Poon M. Advanced Imaging Reduces Cost Compared to Standard of Care in Emergency Department of Triage of Acute Chest Pain. Health Serv Res 2017; 53:2384-2405. [PMID: 29131324 DOI: 10.1111/1475-6773.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate medical costs of novel therapies in complex medical settings using registry data. DATA SOURCE/STUDY SETTING Primary data, from 2008 to 2010. We used patient registry data to evaluate cost and quality performance of coronary computed tomography angiography (CCTA) in triaging chest pain patients in our tertiary care emergency department and to model financial performance under Medicare's two midnight rule. STUDY DESIGN Using generalized linear modeling, we retrospectively compared estimated expenditures for evaluation of low-to-intermediate-risk chest pain for demographic and medically risk matched samples of 894 patients each, triaged with CCTA or local standard of care (SOC) using Medicare reimbursement as a proxy. DATA COLLECTION/EXTRACTION METHODS Predefined data elements were downloaded from the hospital mainframe into the CCTA registry, where they were validated and maintained electronically. PRINCIPLE FINDINGS We found that predicted standard of care costs were 2.5 times higher on the initial visit and 1.98 times higher over 30 days (p < .001) than those using CCTA. Predicted cost was 1.6 times higher when we applied our two midnight rule model (p < .001). CONCLUSION Rapid assessment of treatment using registry data is a promising means of analyzing cost performance in complex health care environments.
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Affiliation(s)
- Pamela S Noack
- Northwell Health, Non-Invasive Cardiology, Lenox Hill Heart and Vascular Institute, New York, NY
| | - Jhanna A Moore
- Department of Radiology, Mount Sinai St. Luke's and Mount Sinai West, New York, NY
| | - Michael Poon
- Northwell Health, Non-Invasive Cardiology, Lenox Hill Heart and Vascular Institute, New York, NY
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Pyles LA, Lilly CL, Mullett CJ, Polak ES, Elliott EM, Neal WA. LDL cholesterol level in fifth-grade schoolchildren associates with stature. J Lipid Res 2017; 58:2197-2201. [PMID: 28870972 DOI: 10.1194/jlr.p078816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/16/2017] [Indexed: 11/20/2022] Open
Abstract
Short stature is associated with increased LDL-cholesterol levels and coronary artery disease in adults. We investigated the relationship of stature to LDL levels in children in the West Virginia Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project to determine whether the genetically determined inverse relationship observed in adults would be evident in fifth graders. A cross-sectional survey of schoolchildren was assessed for cardiovascular risk factors. Data collected at school screenings over 18 years in WV schools were analyzed for 63,152 fifth-graders to determine relationship of LDL to stature with consideration of age, gender, and BMI. The first (shortest) quartile showed an LDL level of 93.6 mg/dl compared with an LDL level of 89.7 mg/dl for the fourth (tallest) quartile. Each incremental increase of 1 SD of height lowered LDL by 0.049 mg/dl (P < 0.0001). Multivariate analysis showed LDL to vary inversely as a function of the first (lowest) quartile of height after controlling for gender, median age, BMI percentile for age and gender, and year of screening. The odds ratio for LDL ≥ 130 mg/dl for shortest versus tallest quartile is 1.266 (95% CL 1.162-1.380). The odds ratio for LDL ≥ 160 mg/dl is 1.456 (95% CL 1.163-1.822). The relationship between short stature and LDL, noted in adults, is confirmed in childhood.
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Affiliation(s)
- Lee A Pyles
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Christa L Lilly
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV.,School of Public Health, West Virginia University School of Medicine, Morgantown, WV
| | - Charles J Mullett
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Emily S Polak
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Eloise M Elliott
- College of Physical Education and Sports Sciences, West Virginia University School of Medicine, Morgantown, WV
| | - William A Neal
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
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Krakow EF, Hemmer M, Wang T, Logan B, Arora M, Spellman S, Couriel D, Alousi A, Pidala J, Last M, Lachance S, Moodie EEM. Tools for the Precision Medicine Era: How to Develop Highly Personalized Treatment Recommendations From Cohort and Registry Data Using Q-Learning. Am J Epidemiol 2017; 186:160-172. [PMID: 28472335 DOI: 10.1093/aje/kwx027] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 08/02/2017] [Indexed: 01/01/2023] Open
Abstract
Q-learning is a method of reinforcement learning that employs backwards stagewise estimation to identify sequences of actions that maximize some long-term reward. The method can be applied to sequential multiple-assignment randomized trials to develop personalized adaptive treatment strategies (ATSs)-longitudinal practice guidelines highly tailored to time-varying attributes of individual patients. Sometimes, the basis for choosing which ATSs to include in a sequential multiple-assignment randomized trial (or randomized controlled trial) may be inadequate. Nonrandomized data sources may inform the initial design of ATSs, which could later be prospectively validated. In this paper, we illustrate challenges involved in using nonrandomized data for this purpose with a case study from the Center for International Blood and Marrow Transplant Research registry (1995-2007) aimed at 1) determining whether the sequence of therapeutic classes used in graft-versus-host disease prophylaxis and in refractory graft-versus-host disease is associated with improved survival and 2) identifying donor and patient factors with which to guide individualized immunosuppressant selections over time. We discuss how to communicate the potential benefit derived from following an ATS at the population and subgroup levels and how to evaluate its robustness to modeling assumptions. This worked example may serve as a model for developing ATSs from registries and cohorts in oncology and other fields requiring sequential treatment decisions.
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Abstract
OBJECTIVE To investigate differences in suicide risk among immigrant population in Norway compared with native Norwegians, with respect to associated country group of origin. METHODS Based on the entire national population, a nested case-control design was adopted using Norwegian national longitudinal registers to obtain 23 073 suicide cases having occurred in 1969-2012 and 373 178 controls. Odds ratios (ORs) for suicide were estimated using conditional logistic regression analysis adjusting for socio-economic factors. RESULTS Compared with native Norwegians, suicide risk was significantly lower in first- and second-generation immigrants but higher in Norwegian-born with one foreign-born parent and foreign-born individuals with at least one Norwegian-born parent. When stratifying data by country group of origin, first-generation immigrants had lower ORs in most of the strata. Subjects born in Asia and in Central and South America with at least one Norwegian-born parent had a significantly higher risk of suicide. The observed results remained mostly unchanged in the analyses controlled for socio-economic status. CONCLUSIONS Suicide risk is lower in first- and second-generation immigrants but higher in subjects born in Norway with one foreign-born parent and those born abroad with at least one Norwegian-born parent, with notable differences by country group of origin.
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Affiliation(s)
- Q Puzo
- National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - L Mehlum
- National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - P Qin
- National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Oslo, Norway
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47
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Ricci DR, de Vries J, Blanc R. Role of preliminary registry data in development of a clinical trial for an innovative device: a small but integral piece of a health policy initiative. J Mark Access Health Policy 2017; 5:1283106. [PMID: 28321285 PMCID: PMC5345587 DOI: 10.1080/20016689.2017.1283106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 06/06/2023]
Abstract
Establishing a national health policy at a macro level involves the integration of a series of health initiatives across a spectrum of activities, including clinical care. Evaluation of the safety and efficacy of a new medical device ultimately evolves to testing in humans. The pathway to a formal prospective clinical trial includes a stepwise appreciation of pre-clinical data and detailed analysis of data obtained from preliminary registries, where information about appropriate patient selection and use of the device is obtained. Evaluation of procedural and follow-up efficacy and safety data in a preliminary series of cases, chosen to simulate published data, allows the design and conduct of clinical trials that are required to verify preliminary observations, closing the loop on one aspect of modifying health policy decisions.
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Affiliation(s)
- Donald R. Ricci
- Division of Cardiology, University of British Columbia, Vancouver, B.C., Canada
- Evasc Medical Systems Corporation, Vancouver, B.C., Canada
| | - Joost de Vries
- Department of Neurosurgery, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Raphael Blanc
- Assistant Chief of Interventional Radiology, Ophthalmological Foundation A. de Rothschild, Paris, France
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Abstract
OBJECTIVES To investigate whether implementation of municipal acute bed units (MAUs) resulting from the Norwegian Coordination Reform (2012) was associated with reductions in hospital admissions, particularly for the elderly. DESIGN A municipality-based retrospective comparative cohort study using monthly population-based registry data analysed with fixed-effects log-log regressions. SETTING Norwegian municipalities and hospitals. POPULATION All patients admitted to secondary hospital care in Norway between 2010 and 2014, excluding psychiatric admissions, with additional focus on admission type and elderly age subgroups. MAIN OUTCOME MEASURES Monthly admission rates in total and by age group for all patients, patients admitted with acute conditions and with acute conditions at internal medicine departments. RESULTS The introduction of MAUs was associated with a small yet significant overall negative effect on hospital admissions. The reduction in all admissions was significant for the entire population (-1.2%, 95% CI -2.0% to -0.0%) and slightly stronger for those aged 80 years and above (-1.9%, 95% CI -3.0% to -1.0%). The more detailed analysis of the elderly population aged 80 years and above revealed that effects were affected by the institutional characteristics of the MAUs. The significant effects ranged between -1.6% and -8.6%, depending on the availability of physicians on duty at the MAUs, the MAUs location or combinations thereof. CONCLUSIONS Introduction of MAUs following implementation of the Norwegian Coordination Reform in 2012 was associated with a significant reduction in hospital admissions primarily for the elderly. Our findings suggest that this type of intermediate care is a viable option in an effort to alleviate the burden on hospitals by reducing the acute secondary care admission volume. Further examinations focused on cost-effectiveness, health status of patients, number of patients treated at the MAUs and comparing other intermediate care alternatives would all add important perspectives to the issue.
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Affiliation(s)
- Jayson O Swanson
- Department of Health Economics and Health Management, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Terje P Hagen
- Department of Health Economics and Health Management, Institute of Health and Society, University of Oslo, Oslo, Norway
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Berg L, Bäck K, Vinnerljung B, Hjern A. Parental alcohol-related disorders and school performance in 16-year-olds-a Swedish national cohort study. Addiction 2016; 111:1795-803. [PMID: 27178010 PMCID: PMC5089658 DOI: 10.1111/add.13454] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/29/2016] [Accepted: 05/09/2016] [Indexed: 11/28/2022]
Abstract
AIMS To study the links between parental alcohol-related disorders and offspring school performance and, specifically, whether associations vary by gender of parent or child and whether associations are mediated by other adverse psychosocial circumstances commonly appearing together with parental alcohol problems, such as parental mental health problems or criminal behaviour. DESIGN Register study in a national cohort. SETTING Sweden. PARTICIPANTS A total of 740 618 individuals born in Sweden in 1990-96. MEASUREMENTS Parental hospital admissions for alcohol-related disorders and school performance in their offspring, in the final year of compulsory school at age 15-16 years was analysed in relation to socio-demographic confounders and psychosocial covariates, using linear and logistic regressions. FINDINGS Both mothers' and fathers' alcohol-related hospital admissions were associated with lower Z-scores of grades and national mathematics tests scores. After adjustment for parental education and socio-demographic confounders, beta-coefficients of Z-scores of grades were -0.42 [95% confidence interval (CI) = -0.45, -0.39] and -0.42 (95% CI = -0.43, -0.40), and beta-coefficients of mathematics tests scores were -0.36 (95% CI = -0.39, -0.33) and -0.31 (95% CI = -0.33, -0.29), for mothers' and fathers' alcohol-related disorders, respectively. Adjusted odds ratios (ORs) for not being eligible for secondary school were 1.99 (95% CI = 1.84-2.15) and 2.04 (95% CI = 1.95-2.15) for mothers' and fathers' alcohol-related disorders, respectively. Adjusting the analyses for psychosocial factors in the family almost eradicated the statistical effects of parental alcohol-related disorders on offspring school performance to beta-coefficients of 0.03 to -0.10 and ORs of 0.89-1.15. The effect of a mother's alcohol-related hospital admission on school performance was stronger in girls than in boys, whereas no gender differences were seen for a father's alcohol-related hospital admission. CONCLUSIONS In Sweden, alcohol-related disorders in both mothers and fathers are associated with lower school performance in their children at age 15-16 years, with most of the statistical effects being attributed to psychosocial circumstances of the family, such as parental psychiatric disorders, drug use and criminality and receipt of social or child welfare interventions.
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Affiliation(s)
- Lisa Berg
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden.
| | - Karin Bäck
- Department of SödersjukhusetKarolinska InstitutetStockholmSweden
| | - Bo Vinnerljung
- Department of Social WorkStockholm UniversityStockholmSweden
| | - Anders Hjern
- Centre for Health Equity StudiesStockholm University/Karolinska InstitutetStockholmSweden,Clinical Epidemiology, Department of MedicineKarolinska InstitutetStockholmSweden
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50
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Reule S, Sexton DJ, Solid CA, Chen SC, Collins AJ, Foley RN. ESRD from autosomal dominant polycystic kidney disease in the United States, 2001-2010. Am J Kidney Dis 2014; 64:592-9. [PMID: 25134777 DOI: 10.1053/j.ajkd.2014.05.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/30/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is amenable to early detection and specialty care. Thus, while important to patients with the condition, end-stage renal disease (ESRD) from ADPKD also may be an indicator of the overall state of nephrology care. STUDY DESIGN Retrospective cohort study of temporal trends in ESRD from ADPKD and pre-renal replacement therapy (RRT) nephrologist care, 2001-2010 (n = 23,772). SETTING & PARTICIPANTS US patients who initiated maintenance RRT from 2001 through 2010 (n = 1,069,343) from US Renal Data System data. PREDICTOR ESRD from ADPKD versus from other causes for baseline characteristics and clinical outcomes; interval 2001-2005 versus 2006-2010 for comparisons of cohort of patients with ESRD from ADPKD. OUTCOMES Death, wait-listing for kidney transplant, kidney transplantation. MEASUREMENTS US census data were used as population denominators. Poisson distribution was used to compute incidence rates (IRs). Incidence ratios were standardized to rates in 2001-2002 for age, sex, and race/ethnicity. Patients with and without ADPKD were matched to compare clinical outcomes. Poisson regression was used to calculate IRs and adjusted HRs for clinical events after inception of RRT. RESULTS General population incidence ratios in 2009-2010 were unchanged from 2001-2002 (incidence ratio, 1.02). Of patients with ADPKD, 48.1% received more than 12 months of nephrology care before RRT; preemptive transplantation was the initial RRT in 14.3% and fistula was the initial hemodialysis access in 35.8%. During 4.9 years of follow-up, patients with ADPKD were more likely to be listed for transplantation (IR, 11.7 [95% CI, 11.5-12.0] vs 8.4 [95% CI, 8.2-8.7] per 100 person-years) and to undergo transplantation (IR, 9.8 [95% CI, 9.5-10.0] vs 4.8 [95% CI, 4.7-5.0] per 100 person-years) and less likely to die (IR, 5.6 [95% CI, 5.4-5.7] vs 15.5 [95% CI, 15.3-15.8] per 100 person-years) than matched controls without ADPKD. LIMITATIONS Retrospective nonexperimental registry-based study of associations; cause-and-effect relationships cannot be determined. CONCLUSIONS Although outcomes on dialysis therapy are better for patients with ADPKD than for those without ADPKD, access to predialysis nephrology care and nondeclining ESRD rates may be a cause for concern.
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Affiliation(s)
- Scott Reule
- Department of Medicine, University of Minnesota, Minneapolis, MN; United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Donal J Sexton
- Department of Medicine, University of Minnesota, Minneapolis, MN; United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Craig A Solid
- United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Shu-Cheng Chen
- United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Allan J Collins
- Department of Medicine, University of Minnesota, Minneapolis, MN; United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Robert N Foley
- Department of Medicine, University of Minnesota, Minneapolis, MN; United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN.
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