Pharmacotherapy for Obesity—Trends Using a Population Level National Database

Abstract The progression and asymmetry of age-related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aimed to model the progression and asymmetry of hearing loss in the older old using a representative, national database. This was a cross-sectional, multicentered US epidemiologic analysis using the National Health and Nutrition Examination Study (NHANES) 2005-2006, 2009-2010, and 2011-2012 cycles. Subjects included non-institutionalized, civilian adults 80 years and older (n=621). Federal security clearance was granted to access publicly-restricted age data. Outcome measures included pure-tone average air conduction thresholds and the 4-frequency pure tone average (PTA). 621 subjects were 80 years old or older (mean=84.2 years, range=80-104 years), representing 10,600,197 Americans. Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year2 (95% CI = 0.0049, 0.0055). Compounded over a lifetime, the velocity of hearing loss would increase five-fold, from 0.2 dB loss/year at age 20 to 1 dB loss/year at age 100. This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. There was no change in the asymmetry of hearing loss with increasing age over 80 years (linear regression coefficient of asymmetry over age=0.07 (95% CI=-0.01, 0.24). In conclusion, hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100, becoming near-universal. These population-level statistics will guide treatment and policy recommendations for hearing health in the older old.

Download Full-text

The epidemiology of juvenile onset recurrent respiratory papillomatosis derived from a population level national database

The Laryngoscope ◽

10.1002/lary.20901 ◽

2010 ◽

Vol 120 (6) ◽

pp. 1233-1245 ◽

Cited By ~ 57

Author(s):

Paolo Campisi ◽

Michael Hawkes ◽

Kim Simpson RN ◽

Keyword(s):

Population Level ◽

Recurrent Respiratory Papillomatosis ◽

National Database ◽

Juvenile Onset

Download Full-text

Comparing rates and characteristics of ambulance attendances related to extramedical use of pharmaceutical opioids in Australia: a protocol for a retrospective observational study

BMJ Open ◽

10.1136/bmjopen-2019-029170 ◽

2019 ◽

Vol 9 (5) ◽

pp. e029170 ◽

Cited By ~ 6

Author(s):

Suzanne Nielsen ◽

Rose Crossin ◽

Melissa Middleton ◽

Catherine Martin ◽

James Wilson ◽

...

Keyword(s):

Observational Study ◽

Multinomial Logistic Regression ◽

Population Level ◽

Abuse Liability ◽

National Database ◽

Eastern Health ◽

Public Health Importance ◽

Level Indicator ◽

Human Research Ethics ◽

Clinical Records

Introduction and aimsExtramedical use of, and associated harms with pharmaceutical opioids are common. Analysis of coded ambulance clinical records provides a unique opportunity to examine a national population-level indicator of relative harms. This protocol describes an observational study with three aims: (1) to compare supply adjusted rates of pharmaceutical opioid-related ambulance attendances for buprenorphine, codeine, fentanyl, oxycodone, oxycodone-naloxone, morphine, pethidine, tramadol and tapentadol; (2) to compare presentation characteristics for these commonly used pharmaceutical opioids and (3) to describe the context surrounding ambulance presentations related to oxycodone, a widely used opioid with an established abuse liability, and tapentadol, a more recent ‘atypical’ opioid on the Australian market, with fewer studies that have directly examined signals of extramedical use.MethodTrained coders extract data from clinical records for ambulance presentations relating to extramedical use of commonly used pharmaceutical opioids. These data form the basis of a large, national database that captures alcohol-related and drug-related harms. Supply adjusted rates of presentations will be examined using Poisson regression. Multinomial logistic regression will be used to compare severity and other characteristics of attendances relating to different pharmaceutical opioids. Tapentadol-related and oxycodone-related cases will be qualitatively examined to understand the situationally specific contexts of the ambulance attendances outside of the characteristics captured in routinely coded variables.Ethics and disseminationEthics approval related to analysis of ambulance attendance data was obtained from the Eastern Health Human Research Ethics Committee (E122 08–09), with an amendment specific to the qualitative analysis. Findings will be submitted for peer review in 2019. The understanding of risk profiles in real-world settings is of international public health importance. The analysis and publication of findings from this national dataset of clinical records will provide one of the most nuanced analyses to date of relative harms across nine pharmaceutical opioids over a 6-year period.

Download Full-text

Hospitalization of unintentional fall injuries in Kuwait: a national database study

BMC Public Health ◽

10.1186/s12889-021-11358-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Islam Kamal Ibrahim ◽

Fatima AlAsoomi

Keyword(s):

Accidental Falls ◽

Unintentional Injury ◽

Population Level ◽

Female Gender ◽

Public Hospitals ◽

National Database ◽

Inpatient Service ◽

Hospital Inpatient ◽

Age Group ◽

Inpatient Hospitalizations

Abstract Background Accidental falls are a major cause of morbidity placing pressure on hospital capacity and utilizing costly services. Evaluating the burden of falls is key for planning, implementation, and evaluation of prevention strategies. To date, no studies have been published on accidental falls at the population level in Kuwait. We studied the burden of accidental falls on public hospital inpatient capacity in Kuwait and identified the subgroups with the highest utilization of inpatient service days. Methods From the national database of inpatient hospitalizations, we selected hospitalizations of patients admitted to Kuwait’s public hospitals for unintentional injury caused by an accidental fall from 1 January through 31 December 2016. We studied the number of inpatient service days (bed days), length of stay (LOS), and number of hospitalizations by age group, gender, and nationality. Mann–Whitney, Kruskal-Wallis, and Chi square tests were used for comparison. Logistic regression was used to quantify the risk of prolonged LOS and fractures among fall-related hospitalizations. Results Accidental falls were responsible for 2.9% of inpatient hospitalizations, 3.7% of inpatient service days (61,140 days) with an ALOS of 9.1 days in Kuwait’s public hospitals in 2016. Accidental falls were responsible for 4.6% of older adult service days, and an even higher 5.6% of older women service days. In the age group 13–64, fall-related service days for non-Kuwaitis (5.7%) were more than triple those for Kuwaitis (1.8%) with a substantial percentage among male non-Kuwaitis (8.1%). The risk factors for exceeding the national ALOS for fall-related hospitalizations were female gender (OR 1.36), age 65 and older (OR 9.72), age 13–64 (OR 5.20), being non-Kuwaiti (OR 1.39), sustaining a femur fracture (OR 11.67), and undergoing surgery (OR 2.63). Fall-related hospitalizations associated with a higher risk of fractures were females (OR 1.22), patients 65 years and older (OR 5.09), patients aged 13–64 (OR 3.65), and non-Kuwaitis (OR 1.28). Conclusions Accidental falls impose a considerable burden on inpatient service utilization in Kuwait. This varies by age, gender, and nationality. To reduce this burden, prevention programs should target working-age non-Kuwaiti males and older females.

Download Full-text

Survival in Middle Ear Malignancy: A Population-Based Analysis Based on the SEER Database

Otolaryngology ◽

10.1177/0194599820980708 ◽

2021 ◽

pp. 019459982098070

Author(s):

Usman Alam ◽

Iram Shafqat ◽

Sara Ahsan ◽

Jose Alonso ◽

Albert Y. Han ◽

...

Keyword(s):

Middle Ear ◽

Population Level ◽

Population Based ◽

National Database ◽

Seer Database ◽

Disease Specific Survival ◽

Distant Disease ◽

Histologic Subtype ◽

Average Survival ◽

Disease Specific

Objective The purpose of this study was to investigate the clinical features and survival outcomes of patients with middle ear malignancies at a population level. Study Design Retrospective cohort study with data from a national database. Setting National database of middle ear malignancy. Methods Records of patients diagnosed with a middle ear malignancy from 1973 to 2016 were extracted from the SEER database (Surveillance, Epidemiology, and End Results). SPSS (version 27; IBM) was used to conduct 5-year survival analysis. Results The average survival for all 431 patients was 61.4 months. Five-year disease-specific survival for squamous cell carcinoma (SCCA), adenocarcinoma, other carcinoma, and noncarcinoma subtypes varied significantly at 54.6%, 82.1%, 71.8%, and 82.6%, respectively ( P < .0001). There was an improved 5-year survival for patients with adenocarcinoma who received surgery versus those who did not (91.7% vs 65.1%; P = .023, log-rank). Five-year disease-specific survival was significantly better in patients aged <55 years (mean ± SD, 77.8% ± 0.39%) as compared with those >70 years (55.1% ± 5.1%) and those aged 55 to 69 years (60.2% ± 4.9%; P < .01 and P < .001, respectively, log-rank). Patients with SCCA were significantly older than those with adenocarcinoma ( P < .0001). Noncarcinoma subtypes were more likely to present with local disease, as opposed to regional or distant disease, when compared with SCCA ( P = .0027). Conclusion Prognosis and treatment outcomes for primary middle ear malignancies depend on histologic subtype and age at diagnosis. The noncarcinoma and adenocarcinoma subtypes carry the best prognoses. Patients with adenocarcinoma were most likely to benefit from surgery.

Download Full-text

Utilization rates of tissue plasminogen activator and mechanical thrombectomy in patients with acute stroke and underlying malignancy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014480 ◽

2019 ◽

Vol 11 (8) ◽

pp. 768-771 ◽

Cited By ~ 2

Author(s):

Lorenzo Rinaldo ◽

Harry J Cloft ◽

Leonardo Rangel Castilla ◽

Alejandro A Rabinstein ◽

Waleed Brinjikji

Keyword(s):

Acute Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Mechanical Thrombectomy ◽

Population Level ◽

National Database ◽

Intravenous Tissue Plasminogen Activator ◽

Underlying Malignancy ◽

Tissue Plasminogen ◽

Iv Tpa

ObjectiveRelatively little is known about the effect of malignancy on patient outcomes after acute ischemic stroke (AIS) or utilization rates of stroke interventions in this population. We aimed to assess the effect of underlying malignancy on outcomes and treatment of AIS at a population level.MethodsOutcomes after AIS between patients with and without malignancy were compared using a national database of hospital reported outcomes.ResultsThere were 351 institutions reporting the outcomes of 3 18 127 admissions for AIS. Of these admissions, 16 141 patients carried a pre-existing diagnosis of malignancy at the time of admission. Administration of intravenous tissue plasminogen activator (IV tPA) was less common in patients with malignancy compared with patients without malignancy (7.3% vs 10.7%; P<0.001) but there was no difference in the rate of mechanical thrombectomy (3.1% vs 3.1%; P=0.967). Mortality rates were higher among patients with malignancy (7.1% vs 3.7%; P<0.001), a relationship which persisted when analysis was restricted to patients receiving IV tPA (10.8% vs 6.1%; P<0.001) or thrombectomy (20.3% vs 13.5%; P<0.001). Rates of both IV tPA administration (2.5% vs 10.5%; P<0.001) and mechanical thrombectomy (2.1% vs 5.4%; P<0.001) were lower in patients with brain malignancy relative to patients with malignancy of non-CNS origin.ConclusionA diagnosis of malignancy on admission for acute stroke was associated with a higher rate of mortality. Malignancy was also associated with a lower rate of IV tPA administration but no difference in mechanical thrombectomy utilization.

Download Full-text

Applying Item Response Theory Modeling to Identify Social (Pragmatic) Communication Disorder

Journal of Speech Language and Hearing Research ◽

10.1044/2020_jslhr-19-00284 ◽

2020 ◽

Vol 63 (6) ◽

pp. 1916-1932 ◽

Cited By ~ 1

Author(s):

Haiying Yuan ◽

Christine Dollaghan

Keyword(s):

Item Response Theory ◽

Item Response ◽

Sensitivity And Specificity ◽

Social Communication ◽

National Database ◽

Communication Disorder ◽

Social Communication Questionnaire ◽

Autism Research ◽

The Social ◽

Pragmatic Communication

Purpose No diagnostic tools exist for identifying social (pragmatic) communication disorder (SPCD), a new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition category for individuals with social communication deficits but not the repetitive, restricted behaviors and interests (RRBIs) that would qualify them for a diagnosis of autism spectrum disorder (ASD). We explored the value of items from a widely used screening measure of ASD for distinguishing SPCD from typical controls (TC; Aim 1) and from ASD (Aim 2). Method We applied item response theory (IRT) modeling to Social Communication Questionnaire–Lifetime ( Rutter, Bailey, & Lord, 2003 ) records available in the National Database for Autism Research. We defined records from putative SPCD ( n = 54), ASD ( n = 278), and TC ( n = 274) groups retrospectively, based on National Database for Autism Research classifications and Autism Diagnostic Interview–Revised responses. After assessing model assumptions, estimating model parameters, and measuring model fit, we identified items in the social communication and RRBI domains that were maximally informative in differentiating the groups. Results IRT modeling identified a set of seven social communication items that distinguished SPCD from TC with sensitivity and specificity > 80%. A set of five RRBI items was less successful in distinguishing SPCD from ASD (sensitivity and specificity < 70%). Conclusion The IRT modeling approach and the Social Communication Questionnaire–Lifetime item sets it identified may be useful in efforts to construct screening and diagnostic measures for SPCD.

Download Full-text