scholarly journals The Burden of Seizures in Manitoba Children: A Population-Based Study

2004 ◽  
Vol 31 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Anita L. Kozyrskyj ◽  
Asuri N. Prasad
Keyword(s):  
Health Care ◽  
Urban Areas ◽  
Census Data ◽  
Population Based ◽  
Care Utilization ◽  
Published Data ◽  
Prevalence Rates ◽  
Seizure Disorders ◽  
Urban Rural ◽  
The Impact

Background:Population-based studies are necessary to better understand the risk factors for developing seizure disorders and the impact of these conditions on children. We undertook an assessment of the prevalence of seizure disorders in a population of children on the basis of health care utilization records.Methods:Using Manitoba’s population-based prescription and health care data for 1998/99, the prevalence of children with seizure disorders, on the basis of at least one physician visit or hospitalization for epilepsy or a prescription for an antiepileptic drug, was determined by age, urban/rural region and socioeconomic status. The latter was measured as neighbourhoods stratified by income quintiles according to Census data.Results:Age-specific prevalence rates for seizure disorders in Manitoba children, determined from health care administrative records, were similar to published data on the prevalence of epilepsy, with one exception. Prevalence rates in adolescents were higher than those reported in the literature. No statistically significant differences in prevalence rates were observed between urban and rural populations. However, a higher prevalence was found among children of all ages living in lower socioeconomic neighbourhoods in urban areas, which presented as a gradient of increased prevalence with decreased levels of income.Conclusion:Population-based health care administrative data can be used to describe the geographical distribution of seizure disorders. Our data suggest that the burden of seizure disorders is not evenly distributed among children.

Specialized cardiological care may be overutilized in urban areas of Québec

2011 ◽  
Vol 19 (4) ◽  
pp. 731-737
Author(s):  
Alan A Cohen ◽  
Alain Vanasse ◽  
Josiane Courteau ◽  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Population Level ◽  
Population Based ◽  
Care Utilization ◽  
Service Usage ◽  
Health Service Usage ◽  
Specialized Care ◽  
Urban Rural ◽  
Revascularization Procedures

Background: Urban/rural differences in secondary cardiovascular disease (CVD) events have previously been observed for Québec. These differences could be attributable to differential utilization of specialized cardiological care, such as revascularization procedures and visits to cardiologists; if this were the case, policies to increase utilization in rural areas would be indicated. Design: This is a population-based cohort study. Methods: We analysed mortality and hospital re-admission in Québec within 1 year after an initial cardiovascular event in relation to urban/rural location and specialized care utilization, controlling for demography, comorbidities, and cumulative hospitalization. Results: Analysis showed higher hospital re-admissions and slightly lower CVD mortality in rural areas, as well as less use of specialized care in rural areas. However, urban/rural differentials were not attributable to differences in utilization of care. Paradoxically, comorbidities were lower among patients who saw specialists. Conclusions: Ultimately, urban/rural differences in secondary CVD outcomes were not attributable to differences in care utilization or our measures of underlying health status, and were likely due to cultural or lifestyle factors that are both hard to model and hard to change through policy. There appears to be overutilization of specialized care in urban areas, an issue which requires further study. Our results suggest that substantial caution is required when interpreting health service usage data and that critical factors in the relationship between specialized cardiological care and outcomes are still poorly understood at a population level.

scholarly journals Period Prevalence of Epilepsy in Children in BC: A Population-Based Study

2009 ◽  
Vol 36 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Veronica Schiariti ◽  
Kevin Farrell ◽  
Jill S. Houbé ◽  
Sarka Lisonkova
Keyword(s):  
Health Care ◽  
Socioeconomic Status ◽  
Health Care Utilization ◽  
Program Planning ◽  
Epileptic Seizures ◽  
Population Based ◽  
Care Utilization ◽  
Prevalence Rates ◽  
Period Prevalence ◽  
Utilization Data

Background:Most estimates of the prevalence of seizure disorders in Canada derive from national surveys which differ in sampling and case-finding methods. This study used health care utilization data to make a population-based estimate of the prevalence of epileptic seizures and of epilepsy in children in British Columbia (BC).Methods:All BC residents between 0-19 years-of-age in 2002-3 enrolled in the Medical Services Plan were included. Epileptic seizures were defined using ICD-9 codes; health care utilization data was obtained from BC Linked Health Database. The period prevalence of epileptic seizures and of epilepsy was determined by age, urban/rural region and socioeconomic status.Results:8,125 of 1,013,816 children were identified as having an epileptic seizure of which 5,621 were classified as epilepsy - 5.5 per 1,000 children (95% CI: 5.4-5.7). The prevalence of epilepsy in infants and preschoolers was higher than that reported in the literature. A higher prevalence of epilepsy was observed also among those with low socioeconomic status. A higher prevalence of epilepsy was observed in those health regions with a higher proportion of First Nations and a lower prevalence was observed in health regions with a higher proportion of visible minorities.Conclusions:Age-specific prevalence rates in BC children for epilepsy, determined from population-based administrative records, were similar to published data except in children under five years. We found a gradient of increased prevalence with decreased level of income. Prevalence rates based on utilization data have the potential to guide program planning for children with epileptic seizures.

The Impact of Behavioral Feeding Intervention on Health Care Utilization

2011 ◽  
Vol 40 (4) ◽  
pp. 282-296 ◽  
Author(s):  
Nancy F. Bandstra ◽  
William B. Crist ◽  
Anne Napier-Phillips ◽  
Gordon Flowerdew
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Care Utilization ◽  
The Impact

scholarly journals P070: Mixed effectiveness of emergency department diversion strategies: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S102
Author(s):  
S.W. Kirkland ◽  
A. Soleimani ◽  
B.H. Rowe ◽  
A.S. Newton
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Services ◽  
Grey Literature ◽  
Study Data ◽  
Care Utilization ◽  
Alternative Source ◽  
Increased Risk ◽  
The Impact

Introduction: Diverting patients away from the emergency department (ED) has been proposed as a solution for reducing ED overcrowding. The objective of this systematic review is to examine the effectiveness of diversion strategies designed to either direct patients seeking care at an ED to an alternative source of care. Methods: Seven electronic databases and grey literature were searched. Randomized/controlled clinical trials and cohort studies assessing the effectiveness of pre-hospital and ED-based diversion interventions with a comparator were eligible for inclusion. Two reviewers independently screened the studies for relevance, inclusion, and risk of bias. Intervention effects are reported as proportions (%) or relative risks (RR) with 95% confidence intervals (CI). Methodological and clinical heterogeneity prohibited pooling of study data. Results: From 7,306 citations, ten studies were included. Seven studies evaluated a pre-hospital diversion strategy and three studies evaluated an ED-based diversion strategy. The impact of diversion on subsequent health services was mixed. One study of paramedic practitioners reported increased ED attendance within 7 days (11.9% vs. 9.5%; p=0.049) but no differences in return visits for similar conditions (75.2% vs. 72.1%; p=0.64). The use of paramedic practitioners was associated with an increased risk of subsequent contact with health care services (RR=1.21, 95% CI 1.06, 1.38), while the use of deferred care was associated with no increase in risk of subsequently seeking physician care (RR=1.09, 95% CI 0.23, 5.26). While two studies reported that diverted patients were at significantly reduced risk for hospitalization, two other studies reported no significant differences between diverted or standard care patients. Conclusion: The evidence regarding the impact of pre-hospital and ED-based diversion on ED utilization and subsequent health care utilization is mixed. Additional high-quality comparative effectiveness studies of diversion strategies are required prior to widespread implementation.

The Association of Antibiotic (ATB) exposure prior to immune checkpoint inhibitor (ICI) treatment on early emergency room and hospitalization utilization: A population-based study.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 304-304
Author(s):  
Lawson Eng ◽  
Rinku Sutradhar ◽  
Yue Niu ◽  
Ning Liu ◽  
Ying Liu ◽  
...  
Keyword(s):  
Emergency Room ◽  
Acute Care ◽  
Therapeutic Option ◽  
Population Based ◽  
Dose Effect ◽  
Care Utilization ◽  
Comorbidity Score ◽  
Logistic Regression Models ◽  
Acute Care Utilization ◽  
The Impact

304 Background: ICIs are becoming a common therapeutic option for many solid tumors. Prior studies have shown that ATB exposure can negatively impact ICI outcomes through gut microbiome changes leading to poorer overall survival; however, less is known about the potential impact of ATB exposure on toxicities from ICI. We undertook a population-based retrospective cohort study in patients receiving ICIs to evaluate the impact of ATB exposure on early acute care use, defined as emergency department visit or hospitalization, within 30 days of initiation of ICI therapy. Methods: Administrative data was utilized to identify a cohort of cancer patients > 65 years of age receiving ICIs from June 2012 to October 2018 in Ontario, Canada. We linked databases deterministically to obtain socio-demographic and clinical co-variates, ATB prescription claims and acute care utilization. Patients were censored if they died within 30 days of initiating ICI therapy. The impact of ATB exposure within 60 days prior to starting ICI on early acute care use was evaluated using multi-variable logistic regression models, adjusted for age, gender, rurality, recent hospitalization within 60 days prior to starting ICI and comorbidity score. Results: Among 2737 patients (median age 73 years), 43% received Nivolumab, 41% Pembrolizumab and 13% Ipilimumab, most commonly for lung cancer (53%) or melanoma (34%). Of these patients, 19% had ATB within 60 days prior to ICI with a median ATB treatment duration of 9 days (SD = 13). 647 (25%) patients had an acute care episode within 30 days of starting ICIs; 182 (7%) patients passed away within 30 days without acute care use and were censored from further analyses. Any ATB exposure within 60 days prior to ICI was associated with greater likelihood of acute care use (aOR = 1.34 95% CI [1.07-1.67] p = 0.01). A dose effect was seen based on weeks of ATB exposure within 60 days prior to ICI (aOR = 1.12 per week [1.04-1.21] p = 0.004) and early acute care use. ATB class analysis identified that exposure to penicillins (aOR = 1.54 [1.11-2.15] p = 0.01) and fluoroquinolones (aOR = 1.55 [1.11-2.17] p = 0.01) within 60 days of starting ICIs were associated with a greater likelihood of acute care use, while there was no significant association between cephalosporin exposure and early acute care use (p > 0.05). Conclusions: Exposure to ATBs, specifically fluoroquinolones and penicillins, prior to ICI therapy is associated with greater likelihood of hospitalization or emergency room visits within 30 days after initiation of ICIs, even after adjustment for relevant co-variates including age, comorbidity score and recent hospitalization prior to ICI initiation. Further studies are required to better understand the mechanisms of recent ATB exposure on early acute care use among patients receiving ICIs.

Prevalence of Metabolic Syndrome Among Adolescents in India: a Population-Based Study

2021 ◽  
Author(s):  
Sowmya Ramesh ◽  
Ransi Ann Abraham ◽  
Avina Sarna ◽  
Harshpal S Sachdev ◽  
Nizamuddin Khan ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Urban Areas ◽  
Census Data ◽  
Healthy Lifestyle ◽  
Hdl Cholesterol ◽  
Population Based ◽  
Multivariate Logistic Regression Model ◽  
Public Health Issue ◽  
Bivariate Analysis ◽  
Nutrition Survey

Abstract Background: In India, the prevalence of overweight among adolescents is on the rise, setting the stage for an increase in metabolic syndrome (MS). This paper presents the national prevalence of MS in adolescents in India. Methods: A nationally representative data of adolescents (10–19 years) from the Comprehensive National Nutrition Survey was used. MS was defined based on the NCEP–ATP III criteria for adolescents. Bivariate analysis was used to report socio-demographic differentials in prevalence and to assess interstate variability. Multivariate logistic regression model was constructed to measure the association between socio-demographic characteristics and prevalence of MS. Census data from 2011 was projected to 2017 to calculate burden.Results: The prevalence of MS was 5.2% among adolescents. 11.9%, 15.4%, 26.0%, 31.9% and 3.7% had central obesity, high blood pressure, hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, respectively. The prevalence was higher among males (5.7% vs. 4.7%, adjusted odds ratio (AOR): 1.3, 95% confidence interval [CI]: 1.0, 1.6), those residing in urban areas (7.9% vs 4.2%, AOR: 1.4, 95% CI: 1.1, 1.8), and from wealthier households as compared to their counterparts (8.3% vs. 2.4%, AOR: 3.4, 95% CI: 2.1, 5.5). There was wide interstate variability in the prevalence of MS (0.5% – 16.5%). In 2017, 14.2 million adolescents had MS in India.Conclusions: The prevalence of MS among adolescents in India is low and clustered in urban areas and richer households. Early prevention interventions promoting a healthy lifestyle, especially in high prevalence areas, are needed to keep MS from becoming a public health issue.

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