scholarly journals Utilization of Health Services Among Adults With RecurrentClostridium difficileInfection: A 12-Year Population-Based Study

2016 ◽  
Vol 38 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Jennifer L. Kuntz ◽  
Jennifer M. Baker ◽  
Patricia Kipnis ◽  
Sherian Xu Li ◽  
Vincent Liu ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Case Control Study ◽  
Population Based ◽  
Severe Illness ◽  
Population Based Study ◽  
Utilization Of Health Services ◽  
Nested Case Control ◽  
The Impact ◽  
Test Result ◽  
Control Study

BACKGROUNDConsiderable efforts have been dedicated to developing strategies to prevent and treat recurrentClostridium difficileinfection (rCDI); however, evidence of the impact of rCDI on patient healthcare utilization and outcomes is limited.OBJECTIVETo compare healthcare utilization and 1-year mortality among adults who had rCDI, nonrecurrent CDI, or no CDI.METHODSWe performed a nested case-control study among adult Kaiser Foundation Health Plan members from September 1, 2001, through December 31, 2013. We identified CDI through the presence of a positive laboratory test result and divided patients into 3 groups: patients with rCDI, defined as CDI in the 14–57 days after initial CDI; patients with nonrecurrent CDI; and patients who never had CDI. We conducted 3 matched comparisons: (1) rCDI vs no CDI; (2) rCDI vs nonrecurrent CDI; (3) nonrecurrent CDI vs no CDI. We followed patients for 1 year and compared healthcare utilization between groups, after matching patients on age, sex, and comorbidity.RESULTSWe found that patients with rCDI consistently have substantially higher levels of healthcare utilization in various settings and greater 1-year mortality risk than both patients who had nonrecurrent CDI and patients who never had CDI.CONCLUSIONSPatients who develop an initial CDI are generally characterized by excess underlying, severe illness and utilization. However, patients with rCDI experience even greater adverse consequences of their disease than patients who do not experience rCDI. Our results further support the need for continued emphasis on identifying and using novel approaches to prevent and treat rCDI.Infect Control Hosp Epidemiol.2016;1–8

scholarly journals Impact of changes to cervical screening guidelines on age and interval at which women are tested: Population-based study

2020 ◽  
pp. 096914132095344
Author(s):  
Alejandra Castanon ◽  
Shama Sheikh ◽  
Philippa Pearmain ◽  
Peter Sasieni
Keyword(s):  
Case Control Study ◽  
Screening Programme ◽  
Cervical Screening ◽  
Population Based ◽  
Birth Cohorts ◽  
Population Based Study ◽  
Screening Guidelines ◽  
Kaplan Meier ◽  
The Impact ◽  
Control Study

Background English cervical screening programme guidelines changed between 2009 and 2012. We explore the impact on the age and intervals at which women receive a cytology test. Methods Eligible women were controls from a population-based case–control study in England. Tests taken between 1980 and 2017 were extracted from the call/recall database. Using the Kaplan–Meier estimator by birth cohort and age at (or time since) last test, we explore proportions tested since or prior to a given age, years since previous test, and interval following a negative test. Results Screening histories from 46,037 women were included. Proportion tested by age 26 has increased from 55% among birth cohorts 1978–1979 to 67% among those born 1990–1991, despite more recent cohorts only having received one invitation (instead of two) prior to age 26. The proportion of women tested at aged 28 with a test three years earlier increased by 20% (from 36% in 1997–2006 to 56% in 2012–2017) whereas the proportion tested at ages 23–27 without a prior test increased from 34% to 80%. The age at last test prior to exiting the programme has decreased: among those born 1928–1931 86% had a test aged 60–65, but only 71% of those born 1947–1951. Conclusion Clear programme guidance alongside quality assurance has improved the cervical screening programme by standardising the age and intervals at which women are screened.

scholarly journals Environmental asbestos exposure and clustering of malignant mesothelioma in community: a spatial analysis in a population-based case–control study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
C. Airoldi ◽  
C. Magnani ◽  
F. Lazzarato ◽  
D. Mirabelli ◽  
S. Tunesi ◽  
...  
Keyword(s):  
Spatial Variation ◽  
Malignant Mesothelioma ◽  
Case Control Study ◽  
Disease Risk ◽  
Population Based ◽  
Case Control ◽  
Contour Plot ◽  
Increased Risk ◽  
The Impact ◽  
Control Study

Abstract Background Neighborhood exposure to asbestos increases the risk of developing malignant mesothelioma (MM) in residents who live near asbestos mines and asbestos product plants. The area of Casale Monferrato (Northwest Italy) was impacted by several sources of asbestos environmental pollution, due to the presence of the largest Italian asbestos cement (AC) plant. In the present study, we examined the spatial variation of MM risk in an area with high levels of asbestos pollution and secondly, and we explored the pattern of clustering. Methods A population-based case–control study conducted between 2001 and 2006 included 200 cases and 348 controls. Demographic and occupational data along with residential information were recorded. Bivariate Kernel density estimation was used to map spatial variation in disease risk while an adjusted logistic model was applied to estimate the impact of residential distance from the AC plant. Kulldorf test and Cuzick Edward test were then performed. Results One hundred ninety-six cases and 322 controls were included in the analyses. The contour plot of the cases to controls ratio showed a well-defined peak of MM incidence near the AC factory, and the risk decreased monotonically in all directions when large bandwidths were used. However, considering narrower smoothing parameters, several peaks of increased risk were reported. A constant trend of decreasing OR with increasing distance was observed, with estimates of 10.9 (95% CI 5.32–22.38) and 10.48 (95%CI 4.54–24.2) for 0–5 km and 5–10 km, respectively (reference > 15 km). Finally, a significant (p < 0.0001) excess of cases near the pollution source was identified and cases are spatially clustered relative to the controls until 13 nearest neighbors. Conclusions In this study, we found an increasing pattern of mesothelioma risk in the area around a big AC factory and we detected secondary clusters of cases due to local exposure points, possibly associated to the use of asbestos materials.

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