Comorbidities and risk factors associated with newly diagnosed epilepsy in the U.S. pediatric population

2017 ◽  
Vol 75 ◽  
pp. 230-236 ◽  
Author(s):  
Ahyuda Oh ◽  
David J. Thurman ◽  
Hyunmi Kim
2020 ◽  
Vol 11 ◽  
Author(s):  
Nan Li ◽  
Jing Li ◽  
Yanyan Chen ◽  
Chaojia Chu ◽  
Xin Zhang ◽  
...  

2020 ◽  
Author(s):  
Yelena Rozenfeld ◽  
Jennifer Beam ◽  
Haley Maier ◽  
Whitney Haggerson ◽  
Karen Boudreau ◽  
...  

Abstract Background By mid-May 2020, there were over 1.5 million cases of (SARS-CoV-2) or COVID-19 across the U.S. with new confirmed cases continuing to rise following the re-opening of most states. Prior studies have focused mainly on clinical risk factors associated with serious illness and mortality of COVID-19. Emerging risk factors in the U.S., including clinical, sociodemographic, and environmental variables associated with contraction of COVID-19 have not been widely studied to assess disparities across populations. Methods A multivariable statistical model was used to identify predictors associated with COVID-19 contraction in the study population of 34,503 patients, comparing laboratory confirmed positive and negative COVID-19 cases in the Providence Health System (U.S.) between February 28 and April 27, 2020. Publicly available data were utilized as approximations for social determinants of health, and patient-level clinical and sociodemographic factors were extracted from the electronic medical record. Results Higher risk of contraction was associated with older age (OR 1.69; 95% CI 1.41-2.02, p<0.0001), male gender (OR 1.32; 95% CI 1.21-1.44, p<0.0001), Asian race (OR 1.43; 95% CI 1.18-1.72, p= 0.0002), Black/African American race (OR 1.51; 95% CI 1.25-1.83, p<0.0001), Latino ethnicity (OR 2.07; 95% CI 1.77-2.41, p<0.0001), non-English language (OR 2.09; 95% CI 1.7-2.57, p<0.0001), high school education or less (OR 1.02; 95% CI 1.01-1.14, p=0.04), residing in a neighborhood with financial insecurity (OR 1.10; 95% CI 1.01-1.25, p=0.04), low air quality (OR 1.01; 95% CI 1.0-1.04, p=0.05), housing insecurity (OR 1.32; 95% CI 1.16-1.5, p< 0.0001) or transportation insecurity (OR 1.11; 95% CI 1.02-1.23, p=0.03), and living in senior living communities (OR 1.69; 95% CI 1.23-2.32, p= 0.001). Conclusions Risks associated with COVID-19 contraction reflect disparities across age, race, ethnicity, language, socioeconomic status, and living conditions. Health promotion and disease prevention strategies should prioritize groups most vulnerable to contraction and address structural inequities that contribute to risk through social and economic policy.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yilin Cai ◽  
Zheng Dai ◽  
Sijin Wen ◽  
Ruchi Bhandari

Abstract Background The surge of methamphetamine use has been a complicating factor compounding the steeply increasing number of drug overdose deaths in the U.S. Infection from blood-borne viruses including hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV, related to methamphetamine use continue to grow. This study aims to examine the risk factors associated with HBV, HCV and HIV among people who used methamphetamine. Methods People who ever used methamphetamine were identified from five National Health and Nutrition Examination Survey (NHANES) cohorts, 2007 to 2016. The outcome was either positive or negative for blood-borne viruses as identified from laboratory tests. Weighted statistics for the combined ten years of data were calculated by multiplying the weighted variable for laboratory measurements by 0.2. We examined the association of sexual activities (sexual partners, sexual identity), drug use behaviors (poly-drug use, injection drug use, frequency of drug use, age started using methamphetamine), demographics, and socio-economic status with blood-borne viruses using bivariate and multivariable logistic regression models. Results There were 1132 participants representing approximately 11,996,319 persons who ever used methamphetamine in the U.S. Blood-borne viruses’ positive rate was 13.0 per 100,000. Multivariable logistic regression analyses showed significant associations of blood-borne infections with age 40–49 years (vs. age 20–29 years, adjusted odds ratio 4.77, 95% CI 1.11–20.55), age 50–59 years (vs. age 20–29 years, 10.25, 2.40–43.82), living within poverty index 1–1.9 (vs. poverty index > = 2, 2.55; 1.19–5.49), living below the poverty threshold (vs. poverty index > = 2, 2.55; 1.11–5.86), having lower than high school education (vs. equal or higher than high school education, 3.13; 1.51–6.46), sexual identity as other than heterosexual (vs. heterosexual, 5.60; 1.72–18.28), using methamphetamine and heroin and cocaine (vs. using methamphetamine alone, 4.24; 1.06–16.92), injection drug use (vs. no injection drug use, 3.15; 1.61–6.16), and started using methamphetamine at age above 25 (vs. started using methamphetamine at age between 10 and 17, 2.09; 1.01–4.35). Conclusions Among people who use methamphetamine, those who use polysubstance, or who inject substances, are in urgent need for vaccination and interventions to avoid further harm from blood borne infections.


2018 ◽  
Vol 183 (5-6) ◽  
pp. e188-e193 ◽  
Author(s):  
Baris Gun ◽  
Robert Dean ◽  
Beatrice Go ◽  
Catherine Richardson ◽  
Brian R Waterman

Abstract INTRODUCTION Sternoclavicular joint (SCJ) dislocations, although uncommon, are observed in patients with ligamentous laxity as well as those who experience traumatic injuries. The incidence and epidemiology of this costly and debilitating injury to our relatively young and active military population have not previously been reported. The purpose of this study is to consider and quantify the non-modifiable risk factors associated with this injury. METHODS Using Defense Medical Epidemiological Database, first-time occurrences, from 2006 to 2015 for the ICD-9-CM code 839.61 (closed dislocation of the SCJ), were obtained and further categorized by gender, race, age, rank, and branch of service. Race was classified based on self-reporting of patients into White, Black, or other categories. Age was divided into the categories of less than 20 yr, 20–24 yr, 25–29 yr, 30–34 yr, 35–39 yr, and greater than 40 yr. Rank was categorized as junior enlisted (E-1 to E-4), senior enlisted (E-5 to E-9), junior officer (O-1 to O-3), and senior officer (O-4 to O-10). Branch of service includes Army, Navy, Air Force, and Marines. Multivariate data analysis was performed to obtain rate per 1,000 person-years as well as adjusted rate (adjusted for age group, gender, race, rank, and service) to isolate risk factors. RESULTS Between 2006 and 2015, 427 cases of closed SCJ dislocations occurred among an at-risk population of 13,772,342 person-years for an unadjusted incidence rate (IR) of 0.031 per 1,000 person-years. The annual unadjusted IR ranged from 0.017 in 2006 to 0.059 in 2014 with the greatest increase occurring between 2006 and 2007 representing 61% increase in the rate of injuries. Males were almost twice as likely to sustain these injuries compared with females (adjusted rate ratio 1.73; 95% confidence interval [CI] 1.23, 2.43). Age was not found to be a risk factor for the development of these injuries with IRs for each age group overlapping with 95% CI for all other age groups. Similarly, the other category for race was also not found to be a statistically significant risk factor. Junior Officers (adjusted rate 0.017; 95% CI 0.011, 0.025) were found least likely to suffer from these injuries with Junior Enlisted (0.034; 95% CI 0.030, 0.040) and Senior Enlisted (0.032; 95% CI 0.028, 0.037) most at risk. Being in the Navy (0.019; 95% CI 0.015, 0.025) was found to be most protective compared with Air Force (0.032; 95% CI 0.026, 0.039), Army (0.036; 95% CI 0.031, 0.041), and Marines (0.036; 95% CI 0.028, 0.045). DISCUSSION and CONCLUSION Annual unadjusted IR of SCJ dislocations readily increased from 2006 to 2014. Statistically significant risk factors, for suffering a closed SCJ dislocation, identified by our study, were male sex, enlisted rank, and branch of service other than Navy. Age and race were not found to have a statistically significant risk. These results can shed light on non-modifiable risk factors for dislocations of the SCJ and can be used in other studies to aid in reducing injury burden on the U.S. Military.


1985 ◽  
Vol 19 (10) ◽  
pp. 723-728 ◽  
Author(s):  
Allen F. Shaughnessy

Metoclopramide, a dopamine antagonist, is approved in the U.S. for the treatment of various gastrointestinal disorders. Its use has been investigated in a wide variety of diseases, including those not involving the intestinal tract. Although more study is required before routine clinical use of metoclopramide can be advocated, it may be effective in the treatment of tardive dyskinesia, in decreasing the risk factors associated with anesthetic-related aspiration, and as an adjunct in the treatment of gastric bezoars. It also may be used safely in patients with Parkinson's disease. The use of metoclopramide in the treatment of neurogenic bladder, orthostatic hypotension, tumor-associated gastroparesis, nonprolactinemic amenorrhea, failure to thrive, Tourette's syndrome, anorexia nervosa, and hiccups, as well as an adjunct to migraine therapy, has been investigated, but sufficient evidence has not been accumulated to advocate the use of metoclopramide in these disorders.


2008 ◽  
Vol 21 (7) ◽  
pp. 771-777 ◽  
Author(s):  
A. C. Carlsson ◽  
P. E. Wandell ◽  
U. de Faire ◽  
M.-L. Hellenius

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5338-5338
Author(s):  
Sung-Nan Pei ◽  
Kuan-Chih Huang ◽  
Ming-Chung Wang ◽  
Ching-Yuan Kuo ◽  
Ming-Chun Ma ◽  
...  

Abstract Background: Follicular Lymphoma (FL) has been relatively uncommon in Asia. Information on prognostic risk factors are scarce in the Asian population. We evaluated patients with FL in a tertiary medical center in Taiwan to gain better understanding of real world treatment and risk factors affecting outcome. Purpose: To evaluate clinical outcomes and risk factors associated with outcome in patients with FL in Taiwan. Methods: We conducted a retrospective cohort study using electronic medical records from Kaohsiung Chang Gung Memorial Hospital, a major regional hospital in southern Taiwan, from 01 January 2008 to 31 December 2017. Newly diagnosed patients with FL were enrolled from 01 Jan 2008 to 31 Dec 2013. All eligible patients were followed-up until study end, loss to follow-up or until death, whichever occurred first. Event-free survival (EFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Risk factors of EFS and OS were identified using Cox proportional hazards model. A significant association was set at p<0.01. Results: A total of 67 patients with newly diagnosed FL were included in the cohort analysis, accounting for 13.7% (67/489) patients with B cell non-Hodgkin lymphoma during the enrolment period. Median follow-up time was 60 months. At diagnosis, median age was 58 years (range 28-95), 56.7% (38/67) of patients were female, and 68.7% (46/67) had Stage III-IV disease. There were 37.3% (25/67) of patients with bone marrow involvement and 22.4% (15/67) with involvement of more than one extra-nodal site. The percentage of patients with low, intermediate and high-risk FL was 32.8%, 25.4%, 38.8%, respectively by FLIPI-1, and 13.4%, 44.8%, 26.9% by FLIPI-2. 72% (48/67) of patients received first-line treatment with regimens that included rituximab, cyclophosphamide, vincristine, prednisolone ± doxorubicin. Of these, 54.2% (26/48) of patients demonstrated complete response and 37.5% (18/48) had a partial response. A further 22.4% (15/67) patients received other treatments and 6.0% (4/67) patients did not receive any treatment. Progression of disease within 24 months after commencing treatment occurred in 32.8% of patients. The 5-year EFS and OS for all patients were 48.6% and 76.2%, respectively (Figure). A higher relapse rate was associated with the presence of B symptoms (HR 6.1; 95% confidence interval [CI] 2.8-13.2), ECOG score ≥2 (HR 5.7; 95% CI 1.7-19.6), FLIPI-2 score ≥3 (HR 5.5; 95% CI 1.4-20.6), large cell transformation (HR 4.1; 95% CI 1.66-10.6), elevated β2 microglobulin (HR 4.0; 95% CI 1.8-9.1), age >70 years (HR 3.6; 95% CI 1.7-7.5), involvement of more than one extra-nodal site (HR 3.5; 95% CI 1.6-7.6) and elevated LDH (HR 2.5; 95% CI 1.3-5.1) (Table 2). Conclusion: Most patients with FL in this tertiary center in Taiwan were at an advanced disease stage at diagnosis. While the majority responded to conventional chemotherapy, one-half of patients progressed within 5 years. Involvement of extra-nodal sites, B symptoms, older age (>70) higher FLIPI-2 score, elevated β2 microglobulin and ECOG score ≥2 were identified as risk factors for earlier relapse and death. Disclosures Pei: Janssen Research & Development, LLC: Research Funding. Huang:Janssen Research & Development, LLC: Employment. Rothwell:Janssen Research & Development, LLC: Employment, Equity Ownership. Qiu:Janssen Research & Development, LLC: Employment, Equity Ownership. Liu:Janssen Research & Development, LLC: Employment, Equity Ownership.


Sign in / Sign up

Export Citation Format

Share Document