scholarly journals LO25: Characteristics of frequent users of emergency departments in Alberta and Ontario, Canada: an administrative data study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S16-S16
Author(s):  
R. Rosychuk ◽  
A. Chen ◽  
S. Fielding ◽  
X. Hu ◽  
P. McLane ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Regression Models ◽  
Income Quintile ◽  
Control Groups ◽  
Frequent Users ◽  
Logistic Regression Models ◽  
Random Samples ◽  
High System ◽  
Disproportionate Number ◽  
And Control

Introduction: Frequent users to emergency departments (EDs) are a diverse group of patients with a disproportionate number of ED presentations. This study aimed to compare sociodemographic and clinical characteristics of adult high system users (HSUs) and control groups in two provinces. Methods: Cohorts of HSUs were created for Alberta and Ontario by identifying the patients with the top 10% of ED presentations in the National Ambulatory Care Reporting System during April 2015 to March 2016. Random samples of patients not in the HSU groups were selected in each province as controls (4:1 ratio). Sociodemographic and presentation data (e.g., Canadian Triage and Acuity Scale [CTAS], disposition) were extracted and compared using separate logistic regression models. Results: In Alberta, 101,250 HSU patients made 686,918 ED presentations (median [med] = 5 interquartile range [IQR] 4,7 presentations per patient), compared with 401,923 controls who made 560,765 ED presentations (med = 1 IQR 1,2 per patient). HSUs were more likely to be female (odds ratio (OR) = 1.20 95% confidence interval (CI) 1.18,1.22), older (OR = 1.03 per 5y 95%CI 1.03,1.03), live closer to hospital (OR = 1.02 per 100km 95%CI 1.00,1.03), and be from the lowest income quintile (OR = 1.39 95%CI 1.37,1.42) than controls. In Ontario, 478,424 HSUs made 2,222,487 ED presentations (med = 4 IQR 3,5 per patient) and 1,714,037 controls made 2,114,070 ED presentations (med = 1 IQR 1,1 per patient). Ontario HSUs were also more likely to be female (OR = 1.13 95%CI 1.12,1.14), older (OR = 1.03 per 5y 95%CI 1.03,1.03), and from the lowest income quintile (OR = 1.41 95%CI 1.40,1.42) than controls, but were less likely to live closer to hospital (OR = 0.93 per 100km 95%CI 0.92, 0.93). Higher acuity was seen in Ontario (CTAS 1/2 vs. others OR = 1.05 95%CI 1.04,1.06) but not for Alberta (CTAS 1/2 vs others OR = 0.75, 95%CI 0.74,0.76). Discharges were less likely in the HSUs compared to controls (Alberta OR = 0.89 95%CI 0.88,0,90; Ontario OR = 0.65 95%CI 0.65,0.66). HSUs were more likely to leave without being seen (Alberta OR = 1.10 95%CI 1.07,1.13; Ontario OR = 1.37 95%CI 1.35,1.40) and against medical advice (Alberta OR = 1.47 95%CI 1.41,1.53; Ontario OR = 1.67 95%CI 1.63,1.71). Conclusion: HSUs were more likely to be female, older, and poorer than controls. Ontario HSUs had higher acuity than the other groups. Disposition differed for HSUs and controls. Further study is required to identify ways to safely reduce ED utilization by HSUs.

scholarly journals Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anqi Chen ◽  
Scott Fielding ◽  
X. Joan Hu ◽  
Patrick McLane ◽  
Andrew McRae ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Flow Characteristics ◽  
Initial Assessment ◽  
Cox Models ◽  
Lengths Of Stay ◽  
Random Samples ◽  
High System ◽  
And Control

Abstract Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

scholarly journals The Association between Plasma Concentration of Phytoestrogens and Hypertension within the Korean Multicenter Cancer Cohort

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4366
Author(s):  
Juyeon Lee ◽  
Ju-Young Kang ◽  
Kwang-Pil Ko ◽  
Sue-Kyung Park
Keyword(s):  
Regression Models ◽  
Case Control Study ◽  
Time Resolved ◽  
Logistic Regression Models ◽  
Hypertension Risk ◽  
Prevention Of Hypertension ◽  
Nested Case Control ◽  
And Control ◽  
Control Study ◽  
The Continuum

In order to examine the association between plasma phytoestrogen concentration (genistein, daidzein, equol and enterolactone) and hypertension, we conducted a nested case–control study for 229 hypertension cases including 112 prehypertension and 159 healthy controls derived from the Korean Multi-center Cancer Cohort (KMCC). The concentration of plasma phytoestrogens was measured using time-resolved fluoroimmunoassay. We assessed the association between plasma phytoestrogens and hypertension using logistic regression models using odds ratio (OR) and 95% confidence interval (95%CI). The highest tertile of plasma equol and enterolactone concentration exhibited a significantly decreased risk of hypertension (equol, OR = 0.34, 95%CI 0.20–0.57; enterolactone, OR = 0.32, 95%CI 0.18–0.57), compared with the lowest tertile. Equol and enterolactone showed reduced ORs for prehypertension (the highest tertile relative to the lowest tertile, OR = 0.50, 95%CI 0.26–0.96; OR = 0.38, 95%CI 0.19–0.75, respectively) and hypertension (OR = 0.42, 95%CI 0.22–0.81; OR = 0.28, 95%CI 0.14–0.54, respectively). There was a stronger association in hypertension (the highest tertile relative to the lowest tertile in obesity vs. non-obesity; equol, OR = 0.06 vs. 0.63; enterolactone, OR = 0.07 vs. 0.46; both p-heterogeneity < 0.01). This study suggests that equol and enterolactone may contribute to prevent primarily prehypertension and hypertension, and control cardiovascular disease (CVD) based on the continuum of hypertension and CVD. Further study to assess hypertension risk based on useful biomarkers, including phytoestrogens, may contribute to primary prevention of hypertension.

scholarly journals Socioeconomic disadvantage and onset of childhood chronic disabling conditions: a cohort study

2014 ◽  
Vol 100 (4) ◽  
pp. 317-322 ◽  
Author(s):  
Nick Spencer ◽  
Lyndall Strazdins
Keyword(s):  
Household Income ◽  
Regression Models ◽  
Temporal Relationship ◽  
Socioeconomic Disadvantage ◽  
Income Quintile ◽  
Material Hardship ◽  
Logistic Regression Models ◽  
Family Finances ◽  
Reported Data ◽  
Over Time

ObjectiveTo study the temporal relationship between socioeconomic disadvantage and onset of chronic disabling conditions in childhood.MethodUsing parent reported data from the Longitudinal Study of Australian Children, we compared children who developed a chronic disabling condition between the ages of 6/7 and 10/11 years with children without a chronic disabling condition at either age. Logistic regression models assessed association between onset of chronic disabling condition and household income quintiles at 6/7 years, adjusting for confounders. To study the consequences of chronic disabling condition onset for family finances, a linear regression model was fitted on change in household income adjusted for income at 6/7. We compared prevalence of family material hardship in the two groups between 6/7 and 10/11.ResultsOf 4010 children present in both waves, complete data were available for 3629 of whom 233 (6.4%) developed a chronic disabling condition between 6/7 and 10/11. After adjustment for confounding, the children from the lowest income quintile were more than twice as likely to develop a chronic disabling condition as those from the highest income quintile. Onset of a chronic disabling condition was associated with a relatively smaller increase in household income over time, but no change in hardship prevalence.ConclusionsFamily socioeconomic disadvantage when children are aged 6/7 is associated with their development of a chronic disabling condition over the next 4 years and with adverse effects on household income.

scholarly journals Association Between Serum Cadmium and Arsenic Levels with Bladder Cancer: A Case-control Study

2021 ◽  
Vol 14 (7) ◽  
Author(s):  
Vahid Moazed ◽  
Elham Jafari ◽  
Mohammad Reza Ebadzadeh ◽  
Amin Pourzare ◽  
Hamid Reza Gharehchahi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Regression Models ◽  
Case Control Study ◽  
Case Control ◽  
P Value ◽  
Control Groups ◽  
Significant Difference ◽  
The Mean ◽  
And Control ◽  
Control Study

Background: Bladder cancer is the second most common cancer of the genitourinary system and the eighth cause of cancer death. In addition to known risk factors such as smoking and urinary stones, trace elements are also effective in causing bladder cancer and other cancers. Objectives: This study was conducted to determine the association between bladder cancer and the carcinogens cadmium and arsenic. Methods: This case-control study was conducted on 40 patients with bladder cancer admitted to Shahid Bahonar Hospital and a control group of 40 healthy individuals in Kerman, Iran, in 2018. The serum levels of arsenic and cadmium were measured by atomic absorptiometry. The paired t-test and chi-square tests were employed to assess the difference between cases and controls groups. An unadjusted and 2 multivariable conditional regression models were separately adjusted on sex, family cancer history, residence, occupation, and smoking and were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) to assess the association between arsenic and cadmium levels and bladder cancer. The statistical software SPSS version 26 and R software version 3.6.3 were used to perform the statistical analyses. Results: The mean cadmium level was 2.99 ± 1.45 and 2.59 ± 0.46 in the case and control groups, respectively, with no statistically significant difference between the groups (P = 0.100). The mean arsenic level was 2.12 ± 1.04 and 1.43 ± 0.73 in the case and control groups, respectively, demonstrating a statistically significant difference between the groups (P = 0.001). Unadjusted and adjusted conditional logistic regression models indicated significant association between arsenic levels and bladder cancer (unadjusted: odds ratio (OR) (95% CI): 0.66 (0.46 - 0.94), P-value = 0.022; adjusted: OR (95% CI): 0.64 (0.44 - 0.92), P-value = 0.018). Conclusions: Overall, cadmium and arsenic levels are higher in patients with bladder cancer, with a statistically significant difference for arsenic. However, these elements are not interrelated and are not related to other factors.

Police Use of Force and Injury: Multilevel Predictors of Physical Harm to Subjects and Officers

2020 ◽  
pp. 109861112097296
Author(s):  
Matthew J. Hickman ◽  
Jared N. Strote ◽  
Robert M. Scales ◽  
William S. Parkin ◽  
Peter A. Collins
Keyword(s):  
Regression Models ◽  
Use Of Force ◽  
Level Variation ◽  
Physical Force ◽  
Injury Rates ◽  
Police Use Of Force ◽  
Logistic Regression Models ◽  
Frequent Use ◽  
And Control ◽  
Superior Level

The police must on occasion use physical force and weapons in order to apprehend and control subjects and fulfil the police function. It is inevitable that some of these interactions will result in injuries to both subjects and officers, with a range of both tangible and intangible harms and costs. It is therefore important to study injuries related to the use of force with an eye toward identifying opportunities to minimize injury and reduce the harms and costs. Injuries to both subjects and officers were examined in a sample of more than 10,000 use of force incidents drawn from 81 agencies located in 8 states. In addition to describing injury rates across a broad spectrum of situational and agency characteristics, we present multilevel logistic regression models predicting subject and officer injury. Among key findings, we report that the likelihood of injury for both subjects and officers is lower when force incidents end quickly and with the minimal necessary superior level of force relative to subject resistance, and higher for both subjects and officers when subjects flee. At the agency level, we find that the likelihood of injury varies by agency size and type. Finally, we explored possible higher-level variation and found that agencies in the sample from Midwestern states (primarily Wisconsin) have substantially lower injury rates that appear to be associated with their less frequent use of weapons and greater reliance on low-level physical force tactics, as compared to agencies in the sample from Western and other states.

Conjugated Linoleic Acid Causes a Marked Increase in Liver α-Tocopherol and Liver α-Tocopherol Transfer Protein in C57BL/6 J Mice

2010 ◽  
Vol 80 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Pei-Min Chao ◽  
Wan-Hsuan Chen ◽  
Chun-Huei Liao ◽  
Huey-Mei Shaw
Keyword(s):  
Antioxidant Enzymes ◽  
Linoleic Acid ◽  
Conjugated Linoleic Acid ◽  
Thiobarbituric Acid ◽  
Control Group ◽  
Thiobarbituric Acid Reactive Substances ◽  
Control Groups ◽  
Protein Levels ◽  
Transfer Protein ◽  
And Control

Conjugated linoleic acid (CLA) is a collective term for the positional and geometric isomers of a conjugated diene of linoleic acid (C18:2, n-6). The aims of the present study were to evaluate whether levels of hepatic α-tocopherol, α-tocopherol transfer protein (α-TTP), and antioxidant enzymes in mice were affected by a CLA-supplemented diet. C57BL/6 J mice were divided into the CLA and control groups, which were fed, respectively, a 5 % fat diet with or without 1 g/100 g of CLA (1:1 mixture of cis-9, trans-11 and trans-10, cis-12) for four weeks. α-Tocopherol levels in plasma and liver were significantly higher in the CLA group than in the control group. Liver α-TTP levels were also significantly increased in the CLA group, the α-TTP/β-actin ratio being 2.5-fold higher than that in control mice (p<0.01). Thiobarbituric acid-reactive substances were significantly decreased in the CLA group (p<0.01). There were no significant differences between the two groups in levels of three antioxidant enzymes (superoxide dismutase, glutathione peroxidase, and catalase). The accumulation of liver α-tocopherol seen with the CLA diet can be attributed to the antioxidant potential of CLA and the ability of α-TTP induction. The lack of changes in antioxidant enzyme protein levels and the reduced lipid peroxidation in the liver of CLA mice are due to α-tocopherol accumulation.

The Prospects and Risks Connected with Increasing the Level of Self-Organisation in Students

2020 ◽  
pp. 75-81
Author(s):  
Svetlana Alexandrovna Kosareva ◽  
Keyword(s):  
Higher Education ◽  
Professional Competence ◽  
Initial Level ◽  
Education Institution ◽  
Diagnostic Methods ◽  
Study Guide ◽  
Learning Approaches ◽  
Control Groups ◽  
Self Organisation ◽  
And Control

The paper describes the method for increasing the level of self-organisation in students which has been developed by the author. It also contains the method testing results and presents the prospects and risks teachers could face while applying the method in a higher education institution. The purpose of this study is to find out the prospects and risks of applying the method for increasing the level of self-organisation in students and to determine the ways of reducing the risks. Methodology. The author points out the learning approaches which were the basis of developing the method and describes diagnostic methods for determining students’ self-organisation levels. The work focused on increasing each student’s initial level consists of a theoretical and a practical part and includes project activities on creating a study guide. The results of the study. The method developed proved to be effective. It was established by diagnosing the final level of self-organisation in students in the experimental and control groups. The paper considers the advantages of the method among which there is universal character, flexibility, improvements to teacher’s and students’ professional competence, etc. At the same time it is necessary to be aware of the risks due to the increased amount of teacher’s work and the fact that students’ work within the project tends to be monotonous. In conclusion, the prospects of the method for increasing the level of self-organisation in students are related to its advantages and the final results of the work. The risks of its use can be reduced with the help of the measures proposed in the paper.

Sri Lankan Cleft Lip and Palate Study Model Analysis: Clefts of the Secondary Palate

1993 ◽  
Vol 30 (2) ◽  
pp. 227-230 ◽  
Author(s):  
Andrew Mccance ◽  
David Roberts-Harry ◽  
Martyn Sherriff ◽  
Michael Mars ◽  
William J.B. Houston
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Model Analysis ◽  
Control Group ◽  
Tooth Size ◽  
Sri Lankan ◽  
Control Groups ◽  
Secondary Palate ◽  
Comparable Control ◽  
And Control

The study models of a group of adult Sri Lankan patients with clefts of the secondary palate were investigated. Tooth-size and arch-dimension comparisons were made with a comparable control group. Significant differences were found between the cleft and control groups in tooth sizes, chord lengths, and arch widths. The cleft group dimensions were generally smaller than those of the control group. Overjets were larger in the cleft group.

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