Geographic variation in diagnostic and treatment interval, cancer stage and mortality among colorectal patients – An international comparison between Denmark and Scotland using data-linked cohorts

2021 ◽  
Vol 74 ◽  
pp. 102004
Author(s):  
Peter Murchie ◽  
Alina Zalounina Falborg ◽  
Melanie Turner ◽  
Peter Vedsted ◽  
Line F. Virgilsen
Keyword(s):  
Geographic Variation ◽  
International Comparison ◽  
Interval Cancer ◽  
Cancer Stage ◽  
Treatment Interval ◽  
Using Data

scholarly journals Time Intervals Under the Lens at Sweden’s First Diagnostic Center for Primary Care Patients With Nonspecific Symptoms of Cancer. A Comparison With Matched Control Patients

2020 ◽  
Vol 10 ◽  
Author(s):  
Jan Sundquist ◽  
Karolina Palmér ◽  
Stefan Rydén ◽  
Charlotta Sävblom ◽  
Jianguang Ji ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Diagnosis ◽  
Matched Control ◽  
Interval Cancer ◽  
Control Group ◽  
Matched Pairs ◽  
Tumor Type ◽  
Time Intervals ◽  
Treatment Interval ◽  
Diagnostic Center

IntroductionFast-track referral pathways for patients with nonspecific, serious symptoms have been implemented in several countries. Our objective was to analyze time intervals in the diagnostic routes of patients diagnosed with cancer at Sweden’s first Diagnostic Center (DC) for nonspecific symptoms and compare with time intervals of matched control patients.MethodsAdult patients with nonspecific symptoms that could not be explained by an initial investigation in primary care were eligible for referral to the DC. Patients diagnosed with cancer were matched with patients at another hospital within the same healthcare organization. We aimed for two control patients per DC-patient and matched on tumor type, age and sex. Five time intervals were compared: 1) patient interval (first symptom—primary care contact), 2) primary care interval (first visit—referral to the DC/secondary care), 3) diagnostic interval (first visit—cancer diagnosis), 4) information interval (cancer diagnosis—patient informed) and 5) treatment interval (cancer diagnosis—treatment start). Comparisons between groups and matched cohort analyses were made.ResultsSixty-four patients (22.1%) were diagnosed with cancer at the DC, of which eight were not matchable. Forty-two patients were matched with two controls and 14 were matched with one control. There were no significant differences in patient-, primary care-, or diagnostic intervals between the groups. The information interval was shorter at the DC compared to the control group (difference between matched pairs 7 days, p = 0.001) and the treatment interval was also shorter at the DC with significant differences in the matched analysis (difference between matched pairs 13 days, p = 0.049). The findings remained the same in four sensitivity analyses, made to compensate for differences between the groups.ConclusionsUp to diagnosis, we could not detect significant differences in time intervals between the DC and the control group. However, the shorter information and treatment intervals at the DC should be advantageous for these patients who will get timely access to treatment or palliative care. Due to limitations regarding comparability between the groups, the results must be interpreted with caution and further research is warranted.Trial registrationClinicalTrials.gov-ID: NCT01709539. Registration-date: October 18, 2012.

Geographic Variation in Medicaid Acceptance Across Michigan Primary Care Practices in the Era of the Affordable Care Act

2017 ◽  
Vol 75 (5) ◽  
pp. 633-650 ◽  
Author(s):  
Renuka Tipirneni ◽  
Karin V. Rhodes ◽  
Rodney A. Hayward ◽  
Richard L. Lichtenstein ◽  
HwaJung Choi ◽  
...  
Keyword(s):  
Primary Care ◽  
Geographic Variation ◽  
Affordable Care Act ◽  
Policy Makers ◽  
Lower Baseline ◽  
Before And After ◽  
Care Practices ◽  
The Affordable Care Act ◽  
Using Data ◽  
Primary Care Practices

Coverage and access have improved under the Affordable Care Act, yet it is unclear whether recent gains have reached those regions within states that were most in need of improved access to care. We examined geographic variation in Medicaid acceptance among Michigan primary care practices before and after Medicaid expansion in the state, using data from a simulated patient study of primary care practices. We used logistic regression analysis with time indicators to assess regional changes in Medicaid acceptance over time. Geographic regions with lower baseline (<50%) Medicaid acceptance had significant increases in Medicaid acceptance at 4 and 8 months post-expansion, while regions with higher baseline (≥50%) Medicaid acceptance did not experience significant changes in Medicaid acceptance. As state Medicaid expansions continue to be implemented across the country, policy makers should consider the local dynamics of incentives for provider participation in Medicaid.

Geographic variation in the shoot productivity of bog shrubs and some environmental correlates

1982 ◽  
Vol 60 (4) ◽  
pp. 340-348 ◽  
Author(s):  
R. J. Reader
Keyword(s):  
Geographic Variation ◽  
Multiple Regression Equation ◽  
Water Conductivity ◽  
Environmental Correlates ◽  
Latitudinal Transect ◽  
Shoot Production ◽  
Labrador Tea ◽  
Variation Explained ◽  
Using Data ◽  
Range Of Values

The pattern of geographic variation in the annual shoot production of the three bog shrubs (leatherleaf (Chamaedaphne calyculata), bog laurel (Kalmia polifolia), and Labrador tea (Ledum groenlandicum) was examined using data collected at eight peatland sites along an 800-km latitudinal transect. Productivity varied significantly among sites, with L. groenlandicum exhibiting the greatest range of values (114–505 mg/shoot), followed by K. polifolia (83–341) and C. calyculata (73–241). This variation could be best interpreted by including both climatic and substrate variables in a multiple regression equation. The combination of three site variables (heat sum, depth to standing water, and water conductivity) accounted for between 63 and 86% of the observed variation in shoot productivity. Adding four other variables increased the percentage of variation explained to between 95 and 99%.

scholarly journals Association of retroperitoneal fibrosis with malignancy and its outcomes

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Sang Jin Lee ◽  
Jung Su Eun ◽  
Min Jung Kim ◽  
Yeong Wook Song ◽  
Young Mo Kang
Keyword(s):  
General Population ◽  
Cancer Diagnosis ◽  
Medical Records ◽  
Retroperitoneal Fibrosis ◽  
Interval Cancer ◽  
Cancer Type ◽  
Cancer Stage ◽  
Retroperitoneal Mass ◽  
The Relationship ◽  
Age And Sex

Abstract Introduction Retroperitoneal fibrosis (RPF) is characterized by a highly fibrotic retroperitoneal mass and encompasses the idiopathic form and secondary to malignancies. Because we have limited knowledge whether RPF is associated with malignancy, we aimed to investigate the relationship between RPF and malignancy and to compare the characteristics and prognosis of cancers among patients with RPF. Methods Medical records of 111 patients diagnosed as having RPF were reviewed and 38 cases of cancer, confirmed by biopsy, were identified. Standardized incidence ratios (SIRs) were calculated for cancers and stratified according to cancer type and RPF-cancer diagnosis interval. Cancer characteristics and outcomes were compared between RPF-cancer diagnosis intervals. Results The average age at RPF diagnosis was 59.2 ± 15.0 years, and 69.4% of the patients were male. The cancer SIRs in patients with RPF relative to age- and sex-matched individuals in the general population was 2.2 (1.6–3.1). SIRs of renal pelvis cancer and multiple myeloma were significantly higher than in the general population. When stratified by RPF-cancer intervals, the SIR for cancer was 9.9 within 1 year of RPF diagnosis, while no significant increase in the SIR was found after 1 year from RPF diagnosis. Cancer stage was more advanced at the time of diagnosis in patients within a 1-year interval for RPF than those with cancer within a >5-year interval, with a correspondingly increased mortality in the former patients. Conclusions RPF was significantly associated with malignancy, particularly those diagnosed within 1 year of RPF diagnosis. Cancer stages at diagnosis were more advanced and the mortality rate was higher in patients within a 1-year interval between RPF and cancer diagnosis than in those with a >5-year interval between diagnoses.

scholarly journals Monitoring Interval Cancers in Breast Screening Programmes: The East Anglian Experience

1995 ◽  
Vol 2 (4) ◽  
pp. 180-185 ◽  
Author(s):  
Nicholas Day ◽  
Jenny McCann ◽  
Corinne Camilleri-Ferrante ◽  
Peter Britton ◽  
Graham Hurst ◽  
...  
Keyword(s):  
United Kingdom ◽  
Breast Cancer Mortality ◽  
Interval Cancer ◽  
Contributory Factor ◽  
Interval Cancers ◽  
East Anglia ◽  
The United Kingdom ◽  
Cancer Rates ◽  
Screening Mammograms ◽  
Using Data

Interval cancer rates are a major determinant of the success of a screening programme. In the Swedish two county study, on which the United Kingdom programme is based, a 39% reduction in mortality was observed in screened women aged 50–64. Using data from the Swedish study, the relationship between interval cancer incidence and the likely future effect on breast cancer mortality was quantified. In East Anglia, as elsewhere in the United Kingdom, interval cancers rates are nearly double those obtained in Sweden: interval cancer rates in the first, second, and third years respectively, after a negative screen were 24%, 59%, and 79% of the expected underlying incidence in the absence of screening. The corresponding figures from the two county study were 17%, 30%, and 56%. From these it was estimated that the mortality reduction in East Anglia will be 21%, which is lower than the 35% observed in invited women in this age group in the Swedish two county study and the 25% specified in the Health of the Nation target. In a rereading exercise, using screening mammograms from women who were screen normal, who had screen detected cancers, or who subsequently developed interval cancers, four out of five radiologists recommended recall for around 70% of the original mammograms (classed as screen normal at time of screening) from 33 interval cancers. This suggests that sensitivity is a contributory factor to the higher interval cancer rates in East Anglia.

Polar Magnetic Field Reversals of the Sun in Maunder Minimum

2000 ◽  
Vol 179 ◽  
pp. 193-196
Author(s):  
V. I. Makarov ◽  
A. G. Tlatov
Keyword(s):  
Magnetic Field ◽  
Maunder Minimum ◽  
The Sun ◽  
Annual Rings ◽  
Field Reversal ◽  
Polar Magnetic Field ◽  
Pine Trees ◽  
Using Data ◽  
Magnetic Field Reversal

AbstractA possible scenario of polar magnetic field reversal of the Sun during the Maunder Minimum (1645–1715) is discussed using data of magnetic field reversals of the Sun for 1880–1991 and the14Ccontent variations in the bi-annual rings of the pine-trees in 1600–1730 yrs.

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