Looking beyond the mean in grief trajectories: A prospective, population-based cohort study

Abstract Purpose Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death were limited and had inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. Methods This cohort study included adult cancer patients from 2012–2018, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Results Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects utilized life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR]: 0.82; 95% confidence interval [CI]: 0.80–0.84). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.43, 95% CI: 0.41–0.45), endotracheal intubation (AOR = 0.87, 95%CI: 0.85–0.89), and defibrillation (AOR = 0.52, 95%CI: 0.48–0.57). Conclusion EOL discussions correlated with a lower utilization of life-sustaining treatments during the last three months of life among cancer patients. Our study supports the importance of providing these discussions to cancer patients to better align care with preferences during the EOL treatment.

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Abstract 017: Meal Intervals And Weight Trajectories In Adults Using The Daily24 Mobile Application: A Prospective Cohort Study

Circulation ◽

10.1161/circ.143.suppl_1.017 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Di Zhao ◽

Thomas Woolf ◽

Lindsay Martin ◽

Eliseo Guallar ◽

Harold Lehmann ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Weight Change ◽

Prospective Cohort ◽

Mobile Application ◽

Population Based ◽

Randomized Controlled Studies ◽

The Mean ◽

Weight Decrease ◽

Weight Trajectories

Background: Small pilot and randomized controlled studies suggest that time-restricted feeding may decrease body weight. However, the role of meal timing and intervals, measured using mobile applications, has not been examined in larger population-based studies. The objective of this study is to evaluate the association between meal intervals and weight trajectories among adults from a population-based clinical cohort. Methods: Multi-site prospective cohort study of adults recruited from three health systems. Over the 6-month study period, 547 participants downloaded and used the Daily24 mobile application to record the timing of meals and sleep for at least one day. Intervals were calculated as the average of all available daily entries for each participant. We obtained information on weight and comorbidities at each outpatient visit from electronic health records available for up to 10 years prior to until 10 months after baseline. We used mixed linear regression to model weight trajectories. Results: The mean (SD) baseline (at consent) age was 51.1 (15.0) years and body mass index (BMI) 30.8 (7.8) kg/m 2 ; 77.9% were women and 77.5% were White. Average time in the cohort was 5.9 years prior to and 0.3 years after baseline. The mean interval from first to last meal was 11.5 (2.3) hours. The associations between meal intervals and weight trajectories are shown in the Table . The number of meals per day was positively associated with weight change before baseline, and number of snacks and drinks per day was inversely associated with weight change after baseline. Each additional occasion of snacks and drinks was associated with a 3.20 kg weight decrease (95% CI 1.41 to 4.99). None of the other associations were statistically significant. Conclusions: Number of daily meals was positively associated with weight change in previous periods, while the number of daily snacks and drinks was inversely associated with weight trajectory. The intervals from first to last meal was not associated with weight change.

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The Age of Natural Menopause and Related Factors among the Population of the Tabari Cohort.

10.21203/rs.2.11410/v1 ◽

2019 ◽

Author(s):

Marzieh Zamaniyan ◽

Mahmood Moosazadeh ◽

Sepideh Peyvandi ◽

Kaveh Jaefari ◽

Reza Goudarzi ◽

...

Keyword(s):

Cohort Study ◽

Population Based ◽

Breastfeeding Duration ◽

Chi Square ◽

Related Factors ◽

Natural Menopause ◽

Blood Samples ◽

Related Data ◽

Confounding Variables ◽

The Mean

Abstract Background: Age of menopause is affected by several factors. In this study we aimed to identify the age of natural menopause and its related factors in a large-scaled population-based cohort study in Iran. Methods: In this study, we utilized a subset of data collected in enrollment phase of Tabari cohort study (TCS). Reproductive history and other related data were collected using structural questionnaire. Blood samples were collected form all participants. We analyzed data using chi-square, independent t-test and ANOVA as well as multivariate linear regression model. Results: Among all participants of Tabari cohort, 2753 were menopause women. The mean age of natural and induced menopause was 49.2±4.7 and 43.2 ± 6.4 respectively (P = 0.001). Our finding showed that number of pregnancy, breastfeeding duration, education, residency, thyroid disease and body mass index affect age of menopause. After adjustment for confounding variables, number of pregnancy remained significantly associated with late menopause. Conclusion: Results of the present study showed that number of pregnancy was positively associated with menopausal age.

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SAT-400 Pregnancy Outcome in Women with Hypoparathyroidism:Aswedishpopulation-Based Cohort Study

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1415 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Sigridur Bjornsdottir ◽

Bart Lyman Clarke ◽

Outi Makitie ◽

Tim Spelman ◽

Olle Kampe

Keyword(s):

Cohort Study ◽

Cesarean Section ◽

Pregnancy Outcomes ◽

Population Based ◽

Elective Cesarean Section ◽

Control Group ◽

National Patient Register ◽

National Patient ◽

Elective Cesarean ◽

The Mean

Abstract Context: The majority of patients with hypoparathyroidism (HypoPT) are women. It is not known whether the presence of hypoparathyroidism influences the pregnancy outcomes. Sweden has excellent conditions for research in this area, with high-quality population-based registers covering essentially all inpatient care and birth records. In this study, data were linked from the Swedish National Patient Register and Swedish Medical Birth Register to examine the potential influence of maternal hypoPT on the number of childbirths and various pregnancy outcomes. Design and Setting: Population-based cohort study in Sweden. Patients: Through the Swedish National Patient Register and the Total Population Register, we identified 1267 women with HypoPT and 12 670 age-matched controls who gave birth between 1997 and 2016. Results: There was no significant difference in mean age at delivery for women with HypoPT (32 (SD, 5.2)) years and controls (32.5 (5.0)). There were significantly more women with HypoPT who smoked at baseline (p= 0.007) and within 3 months of pregnancy (p=0.022) compared to controls. Significantly more women with HypoPT had part time work or were not working during pregnancy compared to controls (p = 0.002). The mean number of infants per woman was 0.30 (SD, 0.62) in the HypoPT group and 0.33 (SD, 0.60) in the control group (p=0.644). Compared with the control group, the risk of elective cesarean section was higher in the HypoPT group (p=0.002). However, there was no difference in the proportion of women undergoing an acute cesarean section between cases and controls (p=0.754). The mean pregnancy duration in women with HypoPT was 38.87 (2.11) weeks compared to 39.23 (2.04) weeks for the controls (p= 0.001). Infants born to mothers with HypoPT were significantly shorter (p=0.016), but no difference was seen in weight or head circumference compared to infants born to controls. No difference was observed in prevalence of small- or large-for gestational age compared to controls. There were no differences between groups with respect to infant sex or Apgar scores at 1, 5 and 10 min, congenital malformations or stillbirth. There was furthermore no difference in pain medication use by mothers during delivery between the groups (p=0,733). Conclusion: The majority of women with HypoPT had normal pregnancy outcomes, and the overall risks must be considered to be low. Still, our findings are of importance for antenatal counseling in women with HypoPT as their risk for elective cesarean section was significantly higher compared with controls. Their children were shorter and the higher rate of smoking among HypoPT women may be an additional risk factor.

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The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy: A population-based cohort study

Digestive and Liver Disease ◽

10.1016/j.dld.2013.08.129 ◽

2014 ◽

Vol 46 (2) ◽

pp. 176-181 ◽

Cited By ~ 24

Author(s):

Bernard Denis ◽

Erik André Sauleau ◽

Isabelle Gendre ◽

Catherine Exbrayat ◽

Christine Piette ◽

...

Keyword(s):

Cohort Study ◽

Gold Standard ◽

Population Based ◽

The Mean

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Incidence and predictors of kyphotic deformity following resection of cervical intradural tumors in adults: a population-based cohort study

Acta Neurochirurgica ◽

10.1007/s00701-020-04416-4 ◽

2020 ◽

Vol 162 (11) ◽

pp. 2905-2913

Author(s):

Charles Tatter ◽

Alexander Fletcher-Sandersjöö ◽

Oscar Persson ◽

Gustav Burström ◽

Per Grane ◽

...

Keyword(s):

Cohort Study ◽

Tumor Resection ◽

Population Based ◽

Magnetic Resonance Images ◽

Secondary Outcome ◽

Posterior Fixation ◽

Intradural Tumor ◽

Common Diagnosis ◽

The Mean

Abstract Background The first line of treatment for most cervical intradural tumors is surgical resection through laminotomy or laminectomy. This may cause a loss of posterior pulling force leading to kyphosis, which is associated with decreased functional outcome. However, the incidence and predictors of kyphosis in these patients are poorly understood. Object To assess the incidence of posterior fixation (PF), as well as predictors of radiological kyphosis, following resection of cervical intradural tumors in adults. Methods A population-based cohort study was conducted on adult patients who underwent intradural tumor resection via cervical laminectomy with or without laminoplasty between 2005 and 2017. Primary outcome was kyphosis requiring PF. Secondary outcome was radiological kyphotic increase, measured by the change in the C2–C7 Cobb angle between pre- and postoperative magnetic resonance images. Results Eighty-four patients were included. Twenty-four percent of the tumors were intramedullary, and the most common diagnosis was meningioma. The mean laminectomy range was 2.4 levels, and laminoplasty was performed in 40% of cases. No prophylactic PF was performed. During a mean follow-up of 4.4 years, two patients (2.4%) required delayed PF. The mean radiological kyphotic increase after surgery was 3.0°, which was significantly associated with laminectomy of C2 and C3. Of these, C3 laminectomy demonstrated independent risk association. Conclusions There was a low incidence of delayed PF following cervical intradural tumor resection, supporting the practice of not performing prophylactic PF. Kyphotic increase was associated with C2 and C3 laminectomy, which could help identify at-risk patients were targeted follow-up is indicated.

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Fibromyalgia-Like Syndrome Associated with Parkinson’s Disease—A Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm8081118 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1118

Author(s):

Ran Abuhasira ◽

Yair Zlotnik ◽

Anat Horev ◽

Gal Ifergane

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cohort Study ◽

Medical Records ◽

Population Based ◽

Treatment Resistant ◽

Distinct Subgroup ◽

Prevalence Of Depression ◽

The Mean ◽

Epidemiological Characteristics

Parkinson’s disease (PD) and fibromyalgia (FM) are two relatively common disorders that are considered distinct diagnoses. The aim of this study was to investigate the epidemiological characteristics of patients with both PD and FM, as well as their comorbidities and medication use. We performed a population-based retrospective cohort study in Israel from 2000 to 2015. We identified patients with PD according to a refined medication tracer algorithm and patients with FM according to their medical records. Using the algorithm, we identified 2606 patients diagnosed with PD, 60 of them (2.3%) were also diagnosed with FM. Most of the patients were females (88.3%) and the mean age of FM diagnosis was 63.95 ± 12.27 years. These patients had a higher prevalence of depression, anxiety, and dementia. Of the patients diagnosed with PD + FM, 46 (76.7%) were diagnosed with FM after the diagnosis of PD. Patients with PD + FM used analgesics of distinct kinds in higher rates, as well as more anti-PD medications. We suggest that patients with PD + FM represent a distinct subgroup with a fibromyalgia-like syndrome associated with Parkinson’s disease (FLISPAD). Their PD is more treatment resistant, and they take more medications, both analgesics and anti-PD.

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Dementia and vagotomy in Taiwan: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2017-019582 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019582 ◽

Cited By ~ 5

Author(s):

Shih-Yi Lin ◽

Cheng-Li Lin ◽

I-Kuan Wang ◽

Cheng-Chieh Lin ◽

Chih-Hsueh Lin ◽

...

Keyword(s):

Cohort Study ◽

Population Based ◽

Truncal Vagotomy ◽

Incidence Density ◽

Secondary Outcome ◽

Diagnosis Of Dementia ◽

The Mean ◽

Artery Disease ◽

Incidence Density Rate ◽

Density Rate

ObjectiveTruncal vagotomy is associated with a decreased risk of subsequent Parkinson disease (PD), although the effect of vagotomy on dementia is unclear. In response, we investigated the risk of dementia in patients who underwent vagotomy.SettingPopulation-based cohort study.ParticipantsA total of 155 944 patients who underwent vagotomy (vagotomy cohort) and 155 944 age-matched, sex-matched and comorbidity-matched controls (non-vagotomy cohort) were identified between 2000 and 2011.Primary and secondary outcome measuresAll patient data were tracked until the diagnosis of dementia, death or the end of 2011. The cumulative incidence of subsequent dementia and HRs were calculated.ResultsThe mean ages of the study patients in the vagotomy and non-vagotomy cohorts were 56.6±17.4 and 56.7±17.3 years, respectively. The overall incidence density rate for dementia was similar in the vagotomy and non-vagotomy cohorts (2.43 and 2.84 per 1000 person-years, respectively). After adjustment for age, sex and comorbidities such as diabetes, hypertension, hyperlipidaemia, stroke, depression, coronary artery disease and PD, the patients in the vagotomy cohort were determined to not be at a higher risk of dementia than those in the non-vagotomy cohort (adjusted HR=1.09, 95% CI 0.87 to 1.36). Moreover, the patients who underwent truncal vagotomy were not associated with risk of dementia (adjusted HR=1.04, 95% CI 0.87 to 1.25), compared with the patients who did not undergo vagotomy.ConclusionVagotomy, either truncal or selective, is not associated with risk of dementia.

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Venous Thromboembolism Following Major Surgery and Risk of Recurrence: A Population-Based Cohort Study

Blood ◽

10.1182/blood.v118.21.5243.5243 ◽

2011 ◽

Vol 118 (21) ◽

pp. 5243-5243

Author(s):

Dimple Kondal ◽

Susan R. Kahn ◽

Vicky Tagalakis

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

General Surgery ◽

Research Funding ◽

Population Based ◽

Major Surgery ◽

Adjusted Relative Risk ◽

Post Discharge ◽

Risk Of Recurrence ◽

The Mean

Abstract Abstract 5243 Background: Venous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) is a common complication of major surgery. Little is known of the risk of recurrent VTE following postoperative VTE. Objectives: We used the administrative health claims (RAMQ) and hospital discharge (MED ECHO) databases of Quebec, Canada to conduct a population-based retrospective cohort study to describe the time to VTE following general surgery and to assess the risk of VTE recurrence among patients with surgery-provoked VTE. Methods: Using a previously defined cohort of individuals who had a first-time discharge diagnosis of VTE between January 1996 and December 2004 in MED ECHO, which systematically records information on all hospital admissions in the province of Quebec, we identified patients who had undergone major surgery in the 3 months prior to the VTE. Subjects were followed from the time of incident VTE until first VTE recurrence, death, or end of study (December 31, 2005). Results: Our study population consisted of 9629 patients with new VTE up to 3 months following major surgery. The mean age was 63.9 years (SD=15.2) and 53% were female. General surgery (32%) was the most common procedure. The mean time to VTE after surgery was 29.5 days (SD=62.6) with 30% of events diagnosed after discharge. The 5-year adjusted cumulative risk of recurrence was 7.9%. Patients with VTE diagnosed after discharge had an adjusted relative risk of recurrence of 1.43 (95% confidence interval (1.21, 1.69)) compared to patients with VTE diagnosed before discharge. Conclusions: Our results suggest that surgery-provoked VTE occurs frequently after discharge and is associated with an elevated risk of recurrence, and that patients with post-discharge VTE are at a higher risk of recurrence than patients with VTE diagnosed before discharge. Thromboprophylaxis strategies post-discharge should be considered in this population. Disclosures: Tagalakis: Sanofi Aventis: Research Funding; Pfizer: Research Funding.

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Abstract P135: Varenicline and the Risk of Adverse Cardiovascular Events: A Population-Based Cohort Study

Circulation ◽

10.1161/circ.129.suppl_1.p135 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Kristian B Filion ◽

Sophie Dell'Aniello ◽

Maria Eberg ◽

Christel Renoux ◽

Stella S Daskalopoulou ◽

...

Keyword(s):

Smoking Cessation ◽

Cohort Study ◽

Cardiovascular Events ◽

Proportional Hazards Model ◽

Population Based ◽

Cox Proportional Hazards Model ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Increased Risk ◽

The Mean

Background: Clinical trial results suggest that varenicline is the most efficacious smoking cessation therapy. However, its cardiovascular safety is controversial, with recent meta-analyses providing conflicting results. Our objective was to compare the effect of varenicline to that of bupropion on the risk of cardiovascular events. Methods: We conducted a population-based cohort study of new users of varenicline or bupropion using data extracted from the UK’s Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics. Our primary endpoint was a composite of myocardial infarction, coronary revascularization, stroke, and all-cause mortality. An ‘as-treated’ analysis with a Cox proportional hazards model was used, with patients censored 7 days after the end of their last prescription or upon switching smoking cessation drugs. In secondary analyses, we compared varenicline and bupropion to nicotine replacement therapy (NRT) in pairwise comparisons. All analyses used high-dimensional propensity scores to adjust for potential confounding. Results: Our primary cohort included 90,522 varenicline users and 12,640 bupropion users. The mean age was 44 years, and 48% were men. The mean treatment duration was 45 days. A total of 128 events occurred among varenicline users, and 15 occurred among bupropion users. Although estimates suggest that varenicline may modestly increase the risk of cardiovascular events compared to bupropion, they were accompanied by wide 95% CIs (Table). Both varenicline and bupropion users had significantly lower risks of cardiovascular events than NRT users (Table). Conclusions: While we cannot exclude a modestly increased risk of cardiovascular events with varenicline relative to bupropion, such events remain rare, and both varenicline and bupropion are associated with a decreased risk of cardiovascular events compared with NRT. The long-term benefits obtained due to the increased smoking abstinence with varenicline likely outweigh any increased cardiovascular risk.

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