scholarly journals A population based study of surgeon characteristics associated with the uptake of contemporary techniques in renal surgery

2013 ◽  
Vol 7 (9-10) ◽  
pp. 576 ◽  
Author(s):  
Stanley A Yap ◽  
Shabbir M.H. Alibhai ◽  
David Margel ◽  
Robert Abouassaly ◽  
Narhari Timilshina ◽  
...  
Keyword(s):  
Regression Models ◽  
Surgical Techniques ◽  
Population Based ◽  
Academic Status ◽  
Renal Surgery ◽  
Population Based Study ◽  
Logistic Regression Models ◽  
Ontario Cancer Registry ◽  
Renal Tumours ◽  
Underlying Mechanisms

Introduction: We have witnessed the slow uptake of many contemporary techniques in the surgical management of renal tumours. We sought to evaluate surgeon-level characteristics associated with the uptake of laparoscopy, partial nephrectomy (PN) and adrenal-sparing approaches in surgically managing these tumours.Methods: Using the Ontario Cancer Registry, we identified surgeons treating renal cell carcinoma (RCC) in the province of Ontario, Canada between 2002 and 2004. We then classified individuals within this cohort as either high or low utilizers of laparoscopy, PN or adrenal-sparing approaches. Further variables analyzed included academic status, surgeon graduation year and surgical volume status. We then used univariable and multivariable logistic regression models to assess predictors of uptake.Results: We evaluated a total of 108 surgeons for their uptake of both laparoscopy and adrenal-sparing approaches and 94 surgeonsfor their uptake of PN. We identified 32 surgeons (30%) as high users of laparoscopy. Predictors of uptake of laparoscopy included graduation year after 1990 (odds ratio [OR] 4.81, confidence interval [CI] 1.57-14.8) and high-surgeon volume (OR 4.33, CI1.60-10.4). We identified 41 surgeons (44%) as high users of PN. The only predictor of uptake of PN was academic status (OR 5.83,CI 1.96-17.3). We identified 69 surgeons (65%) as high users of adrenal-sparing approaches, but did not identify any significant predictors for uptake in this group.Discussion: We identify unique factors contributing to the uptake of distinct surgical techniques in the management of RCC. This information sheds lights on the underlying mechanisms and helps us understand how to further encourage the dissemination of these practices.

scholarly journals Correlates of Adverse Outcomes in Abdominally Obese Individuals: Findings from the Five-Year Followup of the Population-Based Study of Health in Pomerania

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Nele Friedrich ◽  
Harald J. Schneider ◽  
Ulrich John ◽  
Marcus Dörr ◽  
Sebastian E. Baumeister ◽  
...  
Keyword(s):  
Abdominal Obesity ◽  
Regression Models ◽  
Kidney Diseases ◽  
Premature Death ◽  
Population Based ◽  
Serum Glucose ◽  
Adverse Outcomes ◽  
Population Based Study ◽  
Logistic Regression Models ◽  
Increased Risk

Background. Abdominal obesity is a major risk factor of cardiovascular disease (CVD), type 2 diabetes (T2DM), and premature death. However, it has not been resolved which factors predispose for the development of these adverse obesity-related outcomes in otherwise healthy individuals with abdominal obesity.Methods. We studied 1,506 abdominal obese individuals (waist-to-height ratio (WHtR) ≥ 0.5) free of CVD or T2DM from the population-based Study of Health in Pomerania and assessed the incidence of CVD or T2DM after a five-year followup. Logistic regression models were adjusted for major cardiovascular risk factors and liver, kidney diseases, and sociodemographic status.Results. During follow-up time, we observed 114 and 136 new T2DM and CVD cases, respectively. Regression models identified age, waist circumference, serum glucose, and liver disease as predictors of T2DM. Regarding CVD, only age, unemployment, and a divorced or widowed marital status were significantly associated with incident CVD. In this subgroup of obese individuals blood pressure, serum glucose, or lipids did not influence incidence of T2DM or CVD.Conclusion. We identified various factors associated with an increased risk of incident T2DM and CVD among abdominally obese individuals. These findings may improve the detection of high-risk individuals and help to advance prevention strategies in abdominal obesity.

scholarly journals Perinatal use and discontinuation of disease-modifying anti-rheumatic drugs and biologics in women with rheumatoid arthritis: a cohort study

Rheumatology ◽  
2019 ◽  
Vol 59 (7) ◽  
pp. 1514-1521
Author(s):  
Nevena Rebić ◽  
Eric C Sayre ◽  
Enav Z Zusman ◽  
Neda Amiri ◽  
Corisande Baldwin ◽  
...  
Keyword(s):  
Maternal Age ◽  
Regression Models ◽  
Birth Outcome ◽  
First Trimester ◽  
Population Based ◽  
Singleton Pregnancy ◽  
Population Based Study ◽  
Logistic Regression Models ◽  
Medication Discontinuation ◽  
Synthetic Dmards

Abstract Objectives To characterize the utilization and discontinuation of medications before, during and after pregnancy among women with RA. Methods We used population-based administrative data to identify women with RA who had a singleton pregnancy ending in delivery between 1 January 2002 and 31 December 2012. We assessed the utilization of RA medications, namely, conventional synthetic DMARDs, biologics, glucocorticosteroids and NSAIDs, across six windows spanning 24 and 12 months before the start of pregnancy, each trimester of pregnancy and 12 months post-pregnancy. We defined medication discontinuation as no prescription in a given window following a prescription in the preceding window and evaluated predictors using logistic regression models, calculating adjusted odds ratios (ORs) and 95% CIs. Results We studied 1730 pregnancies in 1301 women with RA (mean age at delivery 31.4 ± 5.4 years). We observed substantial medication discontinuation, particularly in the first trimester, with discontinuation of antimalarials in 57.3% of patients, azathioprine 59.1%, sulfasalazine 69.5% and biologics 50.8%. Factors inversely associated with discontinuation of antimalarials in the first trimester were maternal age [OR 0.90 (95% CI 0.86, 0.95)] and number of rheumatology visits [OR 0.86 (95% CI 0.75, 0.97)] and for biologics, prior adverse birth outcome [OR 0.22 (95% CI 0.05, 0.95)]. Conclusion Our population-based study shows frequent discontinuation of medications for RA, particularly in the first trimester. Findings indicate a need to educate women with RA who are planning pregnancy on the benefits and risks of medications during pregnancy.

Acute care utilization (ACU) among women receiving adjuvant chemotherapy for early breast cancer (EBC).

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 65-65 ◽  
Author(s):  
Katherine Enright ◽  
Eva Grunfeld ◽  
Lingsong Yun ◽  
Rahim Moineddin ◽  
Susan Faye Dent ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Geographic Location ◽  
Population Level ◽  
Population Based ◽  
Care Utilization ◽  
Population Based Study ◽  
Logistic Regression Models ◽  
Ontario Cancer Registry ◽  
Acute Care Utilization ◽  
The Impact

65 Background: Adjuvant chemotherapy is considered standard care for patients with lymph node (LN) positive and high risk LN negative EBC. While toxicities of chemotherapy are documented in clinical trials, the impact of toxicities on ACU at a population level is unknown. We undertook a population based study of ACU in patients undergoing adjuvant chemotherapy for EBC compared with controls. Methods: All EBC patients diagnosed 01/07 – 12/09 in Ontario, Canada, were identified from the Ontario Cancer Registry. Pt records were linked deterministically to provincial healthcare databases. All patients received ≥1 cycle of adjuvant chemotherapy. EBC cases (n = 4,718) were matched to non-cancer controls (n = 4,718) on age and geographic location. ACUs (emergency room or hospitalizations) within 30 days of chemotherapy were identified. If the primary reason for visit was a common toxicity of chemotherapy, the visit was considered chemotherapy associated (CA). All cause and CA visits were compared between cases and controls. Logistic regression models were used to identify covariates associated with ACU. Results: ACU was significantly higher in EBC pts compared with controls for both all cause (42.1% vs 9.1%, p<.001) and CA (30.7% vs 2.4%, p<.001) visits. Fever was the most common CA toxicity (22.9% vs 1.2%, p<.001). Taxanes were significantly associated with increased ACU compared with anthracycline only. Conclusions: ACU is common among EBC receiving chemotherapy and significantly higher than among controls. Interventions aimed at mitigating CA toxicity, particularly with the use of taxanes may reduce ACUs. [Table: see text]

Monitoring acute care utilization (ACU) during adjuvant chemotherapy for early breast cancer (EBC) as a measure of quality.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 220-220
Author(s):  
Katherine Enright ◽  
Eva Grunfeld ◽  
Lingsong Yun ◽  
Rahim Moineddin ◽  
Susan Faye Dent ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Care Delivery ◽  
Geographic Location ◽  
Population Based ◽  
Care Utilization ◽  
Population Based Study ◽  
Logistic Regression Models ◽  
Ontario Cancer Registry ◽  
Acute Care Utilization

220 Background: Serious chemotherapy associated (CA) toxicities resulting in ACU are a concern when administering adjuvant chemotherapy for EBC. Monitoring ACU during adjuvant chemotherapy may serve as a measure of quality of cancer care delivery. We undertook a population based study of ACU in patients undergoing adjuvant chemotherapy for EBC compared with controls. Methods: All EBC patients diagnosed 01/07 – 12/09 in Ontario, Canada were identified from the Ontario Cancer Registry. Patient records were linked deterministically to provincial healthcare databases. All patients received ≥1 cycle of adjuvant chemotherapy. EBC cases (n = 4,718) were matched to non-cancer controls (n = 4,718) on age and geographic location. ACUs (emergency room or hospitalizations) within 30 days of chemotherapy were identified. If the primary reason for visit was a common toxicity of chemotherapy, the visit was considered chemotherapy associated (CA). All cause and CA visits were compared between cases and controls. Logistic regression models were used to identify covariates associated with ACU. Results: ACU was significantly higher in EBC pts compared with controls for both all cause (42.1% vs. 9.1%, p<.001) and CA (30.7% vs. 2.4%, p<.001) visits. Fever was the most common CA toxicity (22.9% vs. 1.2%,p<.001). Taxanes were significantly associated with increased ACU compared with anthracycline only (see Table). Conclusions: Serious chemotherapy associated toxicity resulting in ACU is common among EBC patients receiving chemotherapy. Interventions aimed at mitigating CA toxicity, particularly with the use of taxanes may reduce ACUs and improve quality of care. [Table: see text]

scholarly journals Dietary and lifestyle inflammatory scores are associated with increased risk of metabolic syndrome in Iranian adults

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Hossein Farhadnejad ◽  
Karim Parastouei ◽  
Hosein Rostami ◽  
Parvin Mirmiran ◽  
Fereidoun Azizi
Keyword(s):  
Metabolic Syndrome ◽  
Positive Association ◽  
Population Based ◽  
Population Based Study ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Confounding Variables ◽  
Adjusted Model ◽  
Diet And Lifestyle

Abstract Background In the current study, we aimed to investigate the association of dietary inflammation scores (DIS) and lifestyle inflammation scores (LIS) with the risk of metabolic syndrome (MetS) in a prospective population-based study. Methods A total of 1625 participants without MetS were recruited from among participants of the Tehran Lipid and Glucose Study(2006–2008) and followed a mean of 6.1 years. Dietary data of subjects were collected using a food frequency questionnaire at baseline to determine LIS and DIS. Multivariable logistic regression models, were used to calculate the odds ratio (ORs) and 95 % confidence interval (CI) of MetS across tertiles of DIS and LIS. Results Mean ± SD age of individuals (45.8 % men) was 37.5 ± 13.4 years. Median (25–75 interquartile range) DIS and LIS for all participants was 0.80 (− 2.94, 3.64) and 0.48 (− 0.18, − 0.89), respectively. During the study follow-up, 291 (17.9 %) new cases of MetS were identified. Based on the age and sex-adjusted model, a positive association was found between LIS (OR = 7.56; 95% CI 5.10–11.22, P for trend < 0.001) and risk of MetS, however, the association of DIS and risk of MetS development was not statistically significant (OR = 1.30;95% CI 0.93–1.80, P for trend = 0.127). In the multivariable model, after adjustment for confounding variables, including age, sex, body mass index, physical activity, smoking, and energy intake, the risk of MetS is increased across tertiles of DIS (OR = 1.59; 95% CI 1.09–2.33, P for trend = 0.015) and LIS(OR = 8.38; 95% CI 5.51–12.7, P for trend < 0.001). Conclusions The findings of the current study showed that greater adherence to LIS and DIS, determined to indicate the inflammatory potential of diet and lifestyle, are associated with increased the risk of MetS.

Women’s Autonomy and Support for Wife Beating: Findings From a Population-Based Survey in Jordan

2010 ◽  
Vol 25 (3) ◽  
pp. 409-419 ◽  
Author(s):  
Natalia Linos ◽  
Marwan Khawaja ◽  
Mohannad Al-Nsour
Keyword(s):  
Regression Models ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Married Women ◽  
Wife Beating ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Hypothetical Scenario ◽  
Population Based Survey

The aim of this study is to examine attitudes among married women toward wife beating and to investigate the hypothesis that female individual empowerment is associated with such attitudes within a broader context of societal patriarchy in Jordan. The study uses data from a cross-sectional survey of a representative sample of married women (n = 5,390) conducted in 2002. Associations between acceptance of wife beating and several women’s empowerment variables, including decision-making power, as well as other risk factors were assessed, using odds ratios from binary logistic regression models. The key finding is that the vast majority (87.5%) of Jordanian women believe that wife beating is justified in at least one hypothetical scenario, and justification is negatively associated with empowerment variables and some demographic, geographic, and socioeconomic factors.

scholarly journals Association between Eating Away from Home and Hyperuricemia: A Population-Based Nationwide Cross-Sectional Study in China

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Zifeng Liu ◽  
Xiaoting Su ◽  
Mianli Xiao ◽  
Peien Zhou ◽  
Jianwei Guo ◽  
...  
Keyword(s):  
Regression Models ◽  
Population Based ◽  
Cross Sectional Study ◽  
Noncommunicable Diseases ◽  
Sectional Study ◽  
Nutrition Survey ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Health And Nutrition ◽  
Home Food

Hyperuricemia (HU) is a risk factor for different kinds of chronic noncommunicable diseases, and eating away from home (EAFH) may play an important role in their development, which has been ignored greatly so far. This study aimed to investigate the association between EAFH and HU in different models. A cross-sectional study involving 8,322 participants of the China Health and Nutrition Survey (CHNS) was conducted. Logistic regression models were used to analyze the data. We found that participants who consumed more away-from-home food had a higher risk for HU, and the adjusted odds ratio (aOR) and 95% confidence interval (CI) (for each increment in grades of EAFH) were 1.11 (1.02, 1.20) in a multiadjusted model (adjusted for age, gender, province, net individual income, body mass index, smoking, leisure-time physical activities, energy intake, and sleep duration). As for stratified analyses, the aOR (95% CI) of EAFH was 1.12 (1.01, 1.24) for men and 1.06 (0.92, 1.21) for women. Similar results can be found in the middle-aged and obese population, with aOR (95% CI) of EAFH as 1.17 (1.05, 1.30) and 1.15 (1.03, 1.29), respectively. In conclusion, EAFH is positively associated with the prevalence of HU.

Regional Variations in Trends for Multiple Births: A Population-Based Evaluation in France, 1972–2003

2007 ◽  
Vol 10 (2) ◽  
pp. 406-415 ◽  
Author(s):  
Babak Khoshnood ◽  
Béatrice Blondel
Keyword(s):  
Logistic Regression ◽  
Regression Models ◽  
Population Based ◽  
Multiple Births ◽  
Same Sex ◽  
Regional Variations ◽  
Logistic Regression Models ◽  
Hierarchical Logistic Regression ◽  
Country Level ◽  
Infertility Treatments

AbstractThe aim of the study was to assess, using population-based data, trends and regional variations in multiple births during the period of increasing use and changes in practice patterns for infertility treatments. National data for 24,554,977 births (live births and stillbirths) were used, including 569,423 twins during the period 1972 to 2003, and 14,599 triplets for 1984 to 2003. Statistical analyses included age-adjusted hierarchical logistic regression models for twin births and separate analyses for triple, same-sex, and different-sex twin births. Due to confidentiality considerations, the only variable available for adjustment was maternal age. Regionallevel variations were estimated using median odds ratios based on random-intercept hierarchical logistic regression models. Overall, twin births increased from 18.1 per 1000 births (95% confidence interval [CI] 17.9–18.2) in 1972 to 1975 to 29.9 per 1000 (95% CI 29.7–30.1) in 2000 to 2003. Twin births increased progressively across all regions, whereas triple births reached a peak in the early 1990s and decreased thereafter. Trends for both twin and triple births varied significantly across regions. Both trends and regional variations were greater for different-sex as compared with same-sex twin births. Regional variations in the proportion of multiple births increased in the case of twin births and decreased for triple births. Differences in multiple births at the regional level in France were comparable to country-level differences observed across several western and northern European countries. Regional differences in multiple births need to be monitored and used to inform policies aimed at regulating the use of infertility treatments.

scholarly journals General and central obesity operate differently as predictors of falls requiring medical care in older women: a population-based cohort study in Spain

2020 ◽  
Author(s):  
Ygor Hermenegildo-López ◽  
Helena Sandoval-Insausti ◽  
Carolina Donat-Vargas ◽  
Jose Ramón Banegas ◽  
Fernando Rodríguez-Artalejo ◽  
...  
Keyword(s):  
Waist Circumference ◽  
Medical Care ◽  
Older Women ◽  
Abdominal Obesity ◽  
Regression Models ◽  
Population Based ◽  
Normal Weight ◽  
General Obesity ◽  
Logistic Regression Models ◽  
Overweight Women

Abstract Objectives to examine the association of general and abdominal obesity with falls, falls requiring medical care and falls with fractures in older women. Design a population-based prospective cohort of 1,185 women aged ≥60 in Spain, followed up from 2008 to 2010 through 2012. Measures weight, height and waist circumference were measured at baseline using standardised techniques. Participants were classified according to body mass index as normal weight (&lt;25), overweight (25–29.9) and general obesity (≥30). Abdominal obesity was defined as waist circumference &gt;88 cm. In 2012, participants reported the falls experienced in the previous year. Logistic regression models were mutually adjusted for general and abdominal obesity and for main confounders. Results in this cohort of older women, a total of 336 women experienced falls, 168 of them had falls requiring medical care and 64 falls with fractures. For falls, no association was found with general obesity nor abdominal obesity. However, compared with normal weight, overweight women had a decreased risk for falls requiring medical care [odds ratio (OR) 0.57; 95% confidence interval (CI) 0.34–0.94] and for falls with fractures (OR 0.27; 95% CI 0.12–0.63). The corresponding values for general obesity were 0.44 (0.24–0.81) and 0.30 (0.11–0.82). Abdominal obesity was positively associated with falls requiring medical care (OR 1.82; 95% CI 1.12–2.94) and falls with fractures (OR 2.75; 95% CI 1.18–6.44). Conclusions in older women, general obesity may protect from falls requiring medical care and falls with fractures. On the contrary, abdominal obesity increased the risk of suffering from types of falls.

scholarly journals A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation

2020 ◽  
Vol 31 (5) ◽  
pp. 1107-1117 ◽  
Author(s):  
Robert J. Ellis ◽  
Sharon J. Del Vecchio ◽  
Kevin M.J. Gallagher ◽  
Danielle N. Aliano ◽  
Neil Barber ◽  
...  
Keyword(s):  
High Risk ◽  
Kidney Cancer ◽  
Regression Models ◽  
Population Based ◽  
Risk Category ◽  
Shared Decision ◽  
Clinical Tool ◽  
Kidney Tumors ◽  
Logistic Regression Models ◽  
Clinically Significant

BackgroundClinically significant CKD following surgery for kidney cancer is associated with increased morbidity and mortality, but identifying patients at increased CKD risk remains difficult. Simple methods to stratify risk of clinically significant CKD after nephrectomy are needed.MethodsTo develop a tool for stratifying patients’ risk of CKD arising after surgery for kidney cancer, we tested models in a population-based cohort of 699 patients with kidney cancer in Queensland, Australia (2012–2013). We validated these models in a population-based cohort of 423 patients from Victoria, Australia, and in patient cohorts from single centers in Queensland, Scotland, and England. Eligible patients had two functioning kidneys and a preoperative eGFR ≥60 ml/min per 1.73 m2. The main outcome was incident eGFR <45 ml/min per 1.73 m2 at 12 months postnephrectomy. We used prespecified predictors—age ≥65 years old, diabetes mellitus, preoperative eGFR, and nephrectomy type (partial/radical)—to fit logistic regression models and grouped patients according to degree of risk of clinically significant CKD (negligible, low, moderate, or high risk).ResultsAbsolute risks of stage 3b or higher CKD were <2%, 3% to 14%, 21% to 26%, and 46% to 69% across the four strata of negligible, low, moderate, and high risk, respectively. The negative predictive value of the negligible risk category was 98.9% for clinically significant CKD. The c statistic for this score ranged from 0.84 to 0.88 across derivation and validation cohorts.ConclusionsOur simple scoring system can reproducibly stratify postnephrectomy CKD risk on the basis of readily available parameters. This clinical tool’s quantitative assessment of CKD risk may be weighed against other considerations when planning management of kidney tumors and help inform shared decision making between clinicians and patients.

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