Clinical and socio-economic predictors of work participation in adult CHD patients

AbstractBackground:Adults with CHD have reduced work participation rates compared to adults without CHD. We aimed to quantify employment rate among adult CHD patients in a population-based registry and to describe factors and barriers associated with work participation.Methods:We retrospectively identified adults with employment information in the North Carolina Congenital Heart Defects Surveillance Network. Employment was defined as any paid work in a given year. Logistic regression was used to examine patients’ employment status during each year.Results:The registry included 1,208 adult CHD patients with a health care encounter between 2009 and 2013, of whom 1,078 had ≥1 year of data with known employment status. Overall, 401 patients (37%) were employed in their most recent registry year. On multivariable analysis, the odds of employment decreased with older age and were lower for Black as compared to White patients (odds ratio = 0.78; 95% confidence interval: 0.62, 0.98; p = 0.030), and single as compared to married patients (odds ratio = 0.50; 95% confidence interval: 0.39, 0.63; p < 0.001).Conclusion:In a registry where employment status was routinely captured, only 37% of adult CHD patients aged 18–64 years were employed, with older patients, Black patients, and single patients being less likely to be employed. Further work is needed to consider how enhancing cardiology follow-up for adults with CHD can integrate support for employment.

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Primary Uterine Cancer in Maryland: Impact of Distance on Access to Surgical Care at High-Volume Hospitals

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31829ea002 ◽

2013 ◽

Vol 23 (7) ◽

pp. 1244-1251 ◽

Cited By ~ 11

Author(s):

Camille C. Gunderson ◽

Ana I. Tergas ◽

Aimee C. Fleury ◽

Teresa P. Diaz-Montes ◽

Robert L. Giuntoli

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Uterine Cancer ◽

Multivariable Analysis ◽

Community Setting ◽

Surgical Care ◽

High Volume ◽

High Volume Hospital ◽

To Receive ◽

Zip Code

ObjectiveTo evaluate the influence of distance on access to high-volume surgical treatment for patients with uterine cancer in Maryland.MethodsThe Maryland Health Services Cost Review Commission database was retrospectively searched to identify primary uterine cancer surgical cases from 1994 to 2010. Race, type of insurance, year of surgery, community setting, and both surgeon and hospital volume were collected. Geographical coordinates of hospital and patient’s zip code were used to calculate primary independent outcomes of distance traveled and distance from nearest high-volume hospital (HVH). Logistic regression was used to calculate odds ratios and confidence intervals.ResultsFrom 1994 to 2010, 8529 women underwent primary surgical management of uterine cancer in Maryland. Multivariable analysis demonstrated white race, rural residence, surgery by a high-volume surgeon and surgery from 2003 to 2010 to be associated with both travel 50 miles or more to the treating hospital and residence 50 miles or more from the nearest HVH (allP< 0.05). Patients who travel 50 miles or more to the treating hospital are more likely to have surgery at a HVH (odds ratio, 6.03; 95% confidence interval, 4.67–7.79) In contrast, patients, who reside ≥50 miles from a HVH, are less likely to have their surgery at an HVH. (odds ratio, 0.37; 95% confidence interval, 0.32–0.42).ConclusionIn Maryland, 50 miles or more from residence to the nearest HVH is a barrier to high-volume care. However, patients who travel 50 miles or more seem to do so to receive care by a high-volume surgeon at an HVH. In Maryland, Nonwhites are more likely to live closer to an HVH and more likely to use these services.

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Responses to the Physical Activity Guidelines and Dissemination Strategies for Behavior Change in a Representative Sample of US Adults

Journal of Physical Activity and Health ◽

10.1123/jpah.2021-0136 ◽

2021 ◽

pp. 1-10

Author(s):

Malorie Polster ◽

Erin E. Dooley ◽

Kate Olscamp ◽

Katrina L. Piercy ◽

April Oh

Keyword(s):

Physical Activity ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Information Source ◽

Population Based ◽

Multiple Sources ◽

Physical Activity Guidelines ◽

Logistic Regressions ◽

National Trends

Background: Dissemination of the Physical Activity Guidelines for Americans (Guidelines) is needed, but how individuals respond to the Guidelines is not well understood. This surveillance study describes US adults’ reported responses to and information sources for hearing about the Guidelines and explores relationships between how respondents heard about the Guidelines and their reported response(s). Methods: Data were analyzed from the population-based 2019 Health Information National Trends Survey 5 Cycle 3. Population-weighted proportions of response were calculated. Among those who had heard about the Guidelines, binary logistic regressions examined associations between the reported response(s) and the information source and number of sources reported. Results: The analytical sample included 5047 adults. Nearly 65% of US adults reported hearing about the Guidelines, and 29% reported a behavioral response (eg, increased physical activity). Hearing about the Guidelines through health professionals (adjusted odds ratio = 2.30, 95% confidence interval, 1.45–3.65) or social media (adjusted odds ratio = 1.89, 95% confidence interval, 1.20–2.96) (vs other sources) was associated with reporting increasing physical activity. Hearing from multiple sources (vs one source) was associated with reporting increasing physical activity (adjusted odds ratio = 1.97, 95% confidence interval, 1.18–3.31). Conclusion: Findings suggest dissemination of the Guidelines across multiple channels may promote greater changes in physical activity.

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Comparing Telephone Counseling With Reminding to Promote On-Time Repeated Mammography: A Randomized Trial in a Cohort With 4 Years Follow-Up

Health Education & Behavior ◽

10.1177/1090198119886347 ◽

2019 ◽

Vol 47 (1) ◽

pp. 37-46

Author(s):

Mary E. Costanza ◽

Roger Luckmann ◽

Christine Frisard ◽

Mary Jo White ◽

Caroline Cranos

Keyword(s):

Confidence Interval ◽

Randomized Trial ◽

Odds Ratio ◽

Multivariable Analysis ◽

Telephone Counseling ◽

Long Term Effects ◽

Time Points ◽

Reminder Call ◽

Screening Mammograms

Background. Long-term continuous adherence to biennial screening mammograms as guidelines recommend remains low. Limited evidence suggests that reminder calls may increase short-term adherence as much as telephone counseling, but research is needed comparing the long-term effects of these two approaches. Purpose. To compare the impacts of two telephone outreach interventions and mailed reminders on 4-year continuous mammography adherence. Method. A cohort of 3,215 women, age 50 to 81 years, was selected from 30,160 women from a 4-year randomized trial of three interventions to promote biennial mammography: reminder letter only (LO), letter plus reminder call (RC), and two letters plus educational material and a counseling call (CC). Women selected remained eligible for the trial all 4 years and received annual interventions as needed. The proportion with a mammogram in the last 24 months was determined at baseline and four annual time points. Results. Continuous adherence at all four time points was higher in the RC (78.8%) and CC arms (78.8%) than in the LO arm (75.1%; p < .001). Multivariable analysis confirmed this finding: CC (odds ratio = 1.27; 95% confidence interval = [1.01, 1.61]) and RC (odds ratio = 1.23; 95% confidence interval = [0.98, 1.56]). Only 27.8% of women eligible for an initial counseling call actually received counseling. Conclusions. Compared with letters alone, outreach calls can modestly increase continuous mammography adherence among insured women with consistent primary care. Telephone counseling was no more effective than a reminder call, possibly due to limited acceptance of counseling calls by women who may find them unwelcome or unnecessary.

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Population-Based Study of Risk of AKI with Levetiracetam

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.07490618 ◽

2018 ◽

Vol 14 (1) ◽

pp. 17-26 ◽

Cited By ~ 3

Author(s):

Kevin Yau ◽

Jorge G. Burneo ◽

Racquel Jandoc ◽

Eric McArthur ◽

Flory Tsobo Muanda ◽

...

Keyword(s):

Confidence Interval ◽

Serum Creatinine ◽

Odds Ratio ◽

Primary Outcome ◽

Case Reports ◽

Population Based ◽

Regulatory Agencies ◽

Population Based Study ◽

Outpatient Prescription ◽

Diagnosis Codes

Background and objectivesRegulatory agencies warn about the risk of AKI with levetiracetam use on the basis of information from case reports. We conducted this study to determine whether new levetiracetam use versus nonuse is associated with a higher risk of AKI.Design, setting, participants, & measurementsThis was a population-based retrospective cohort study of adults with epilepsy in Ontario, Canada. Patients who received a new outpatient prescription for levetiracetam between January 1, 2004 and March 1, 2017 were matched to two nonusers on stage of CKD, recorded seizure in the prior 90 days, and logit of a propensity score for levetiracetam use. The primary outcome was a hospital encounter (emergency department visit or hospitalization) with AKI within 30 days of cohort entry. Secondary outcomes were AKI within 180 days and change in the concentration of serum creatinine. We assessed the primary outcome using health care diagnosis codes. We evaluated the change in the concentration of serum creatinine in a subpopulation with laboratory measurements.ResultsWe matched 3980 levetiracetam users to 7960 nonusers (mean age 55 years, 51% women). Levetiracetam use was not significantly associated with a higher risk of AKI within 30 days (13 [0.33%] events in levetiracetam users and 21 [0.26%] events in nonusers [odds ratio, 1.24; 95% confidence interval, 0.62 to 2.47]). Similarly, there was no significant association with AKI within 180 days (odds ratio, 0.70; 95% confidence interval, 0.43 to 1.13). The change in the concentration of serum creatinine did not significantly differ between levetiracetam users and nonusers.ConclusionsIn this population-based study levetiracetam use was not associated with a higher risk of AKI.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_12_11_Yau_Podcast.mp3

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Readmissions and complications in breast ductal carcinoma in situ: A retrospective study comparing screen- and non-screen-detected patients

Women s Health ◽

10.1177/1745506520965899 ◽

2020 ◽

Vol 16 ◽

pp. 174550652096589

Author(s):

Julieta Politi ◽

María Sala ◽

Laia Domingo ◽

María Vernet-Tomas ◽

Marta Román ◽

...

Keyword(s):

Breast Cancer ◽

Confidence Interval ◽

Ductal Carcinoma In Situ ◽

Odds Ratio ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Screening Program ◽

Population Based ◽

Mammographic Screening

Objective: Population-wide mammographic screening programs aim to reduce breast cancer mortality. However, a broad view of the harms and benefits of these programs is necessary to favor informed decisions, especially in the earliest stages of the disease. Here, we compare the outcomes of patients diagnosed with breast ductal carcinoma in situ in participants and non-participants of a population-based mammographic screening program. Methods: A retrospective cohort study of all patients diagnosed with breast ductal carcinoma in situ between 2000 and 2010 within a single hospital. A total of 211 patients were included, and the median follow-up was 8.4 years. The effect of detection mode (screen-detected and non-screen-detected) on breast cancer recurrences, readmissions, and complications was evaluated through multivariate logistic regression analysis. Results: In the majority of women, breast ductal carcinoma in situ was screen-detected (63.5%). Screen-detected breast ductal carcinoma in situ was smaller in size compared to those non-screen-detected (57.53% < 20 mm versus 78.03%, p = 0.002). Overall, breast-conserving surgery was the most frequent surgery (86.26%); however, mastectomy was higher in non-screen-detected breast ductal carcinoma in situ (20.78% versus 9.7%, p = 0.024). Readmissions for mastectomy were more frequent in non-screen-detected breast ductal carcinoma in situ. Psychological complications, such as fatigue, anxiety, and depression, had a prevalence of 15% within our cohort. Risk of readmissions and complications was higher within the non-screen-detected group, as evidenced by an odds ratio = 6.25 (95% confidence interval = 1.95–19.99) for readmissions and an odds ratio = 2.41 (95% confidence interval = 1.95–4.86) for complications. Conclusions: Our findings indicate that women with breast ductal carcinoma in situ breast cancer diagnosed through population-based breast cancer screening program experience a lower risk of readmissions and complications than those diagnosed outside these programs. These findings can help aid women and health professionals make informed decisions regarding screening.

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A beef-associated outbreak of Salmonella Typhimurium DT104 in The Netherlands with implications for national and international policy

Epidemiology and Infection ◽

10.1017/s0950268807007972 ◽

2007 ◽

Vol 135 (6) ◽

pp. 890-899 ◽

Cited By ~ 29

Author(s):

M. KIVI ◽

A. HOFHUIS ◽

D. W. NOTERMANS ◽

W. J. B. WANNET ◽

M. E. O. C. HECK ◽

...

Keyword(s):

The Netherlands ◽

Confidence Interval ◽

Odds Ratio ◽

Fold Increase ◽

Population Based ◽

International Policy ◽

Matched Case ◽

Foodborne Infections ◽

Matched Case Control Study ◽

Control Study

SUMMARYA ten-fold increase in Salmonella Typhimurium DT104 cases in The Netherlands during September–November 2005 prompted an outbreak investigation. A population-based matched case-control study included 56 cases and 100 controls. Risk factors for infection were consumption of a pre-processed raw beef product (odds ratio 4·2, 95% confidence interval 1·5–12·0) and of food from mobile caterers (odds ratio 4·9, 95% confidence interval 1·1–22·1). Bacterial molecular typing established a link with another DT104 outbreak in Denmark caused by beef from a third European country. The incriminated beef was traced in The Netherlands and sampling yielded DT104 of the outbreak-associated molecular type. We concluded that this outbreak was caused by imported contaminated beef. Consumers should be informed about presence of raw meat in pre-processed food products. Optimal utilization of international networks and testing and traceability of foodstuffs has the potential to prevent foodborne infections.

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Do Multivitamin Supplements Attenuate the Risk for Diabetes-Associated Birth Defects?

PEDIATRICS ◽

10.1542/peds.111.s1.1146 ◽

2003 ◽

Vol 111 (Supplement_1) ◽

pp. 1146-1151

Author(s):

Adolfo Correa ◽

Lorenzo Botto ◽

Yecai Liu ◽

Joseph Mulinare ◽

J. David Erickson

Keyword(s):

Confidence Interval ◽

Birth Defects ◽

Odds Ratio ◽

Case Control Study ◽

Maternal Diabetes ◽

Population Based ◽

Increased Risk ◽

Periconceptional Period ◽

Multivitamin Supplements ◽

Control Study

Objective. To evaluate whether the risk for birth defects associated with maternal diabetes is attenuated by use of multivitamin supplements during the periconceptional period. Methods. In the population-based Atlanta Birth Defects Case-Control Study, we identified case infants who had nonsyndromic birth defects that were reported to be associated with diabetes (n = 3278) and were born during 1968–1980 to residents of metropolitan Atlanta. Controls were infants without birth defects (n = 3029). Maternal diabetes was defined as reported diabetes with onset before the date of birth of the index infant, and periconceptional use of multivitamins was defined as reported regular use of multivitamin supplements from 3 months before pregnancy through the first 3 months of pregnancy. Results. Offspring of mothers with diabetes had an increased risk for selected birth defects. However, the increased risk was limited to offspring of mothers who had diabetes and had not taken multivitamins during the periconceptional period (odds ratio: 3.93; 95% confidence interval: 1.79–8.63). Offspring of mothers who had diabetes and had taken multivitamins during the periconceptional period had no increased risk for birth defects (odds ratio: 0.15; 95% confidence interval: 0.00–1.99). Conclusions. Periconceptional use of multivitamin supplements may reduce the risk for birth defects among offspring of mothers with diabetes.

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Association of hemoglobin with incidence of in-hospital cardiac arrest in patients with acute coronary syndrome complicated by cardiogenic shock

Journal of International Medical Research ◽

10.1177/0300060519857021 ◽

2019 ◽

Vol 47 (9) ◽

pp. 4151-4162

Author(s):

Tiancheng Xu ◽

Dongjie Liang ◽

Shengjie Wu ◽

Xiaodong Zhou ◽

Ruiyu Shi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Confidence Interval ◽

Cardiogenic Shock ◽

Odds Ratio ◽

Protective Factor ◽

Multivariable Analysis ◽

Hemoglobin Concentration ◽

Coronary Syndrome ◽

Hospital Cardiac Arrest

Objective This study was performed to investigate the association of the admission hemoglobin level with the incidence of in-hospital cardiac arrest (IHCA) in patients with acute coronary syndrome (ACS) complicated by cardiogenic shock (CS). Methods In this retrospective study, we reviewed the medical records of consecutive patients with ACS complicated by CS admitted to the coronary care unit from January 2014 to October 2017. Logistic regression models were carried out to evaluate the association between hemoglobin and the incidence of IHCA. Interaction and subgroup analyses were also performed. Results In total, 211 patients were included in the study, and 61 (28.9%) patients developed IHCA. In the multivariable analysis, hemoglobin was a strong independent predictor of IHCA (odds ratio, 0.971; 95% confidence interval, 0.954–0.989). In the fully adjusted model, patients in the higher hemoglobin tertile were less likely to develop IHCA than patients in the lowest hemoglobin tertile (odds ratio, 0.194; 95% confidence interval, 0.071–0.530). The relationship remained stable in most subgroups except patients aged ≥70 years. Conclusion In patients with ACS complicated by CS, the incidence of IHCA is related to the hemoglobin concentration, and a high hemoglobin concentration is a protective factor against the development of IHCA.

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Gastroenteritis in older people living in the community: results of two Australian surveys

Epidemiology and Infection ◽

10.1017/s0950268811002834 ◽

2012 ◽

Vol 140 (11) ◽

pp. 2028-2036 ◽

Cited By ~ 8

Author(s):

M. D. KIRK ◽

G. V. HALL ◽

N. BECKER

Keyword(s):

Food Safety ◽

Confidence Interval ◽

Older People ◽

Elderly People ◽

Odds Ratio ◽

Multivariable Analysis ◽

The Elderly ◽

The State ◽

National Surveys

SUMMARYWe analysed two large national surveys conducted in 2001 and 2008 to examine incidence and outcomes of gastroenteritis in older Australians. A case was someone reporting ⩾3 loose stools or ⩾1 episode of vomiting in 24 h, excluding non-infectious causes. We compared cases arising in the elderly (⩾65 years) and in other adults (20–64 years). Elderly people experienced 0·33 [95% confidence interval (CI) 0·24–0·42] episodes of gastroenteritis/person per year, compared to 0·95 (95% CI 0·74–1·15) in other adults. Elderly cases reported less stomach cramps, fever and myalgia than younger cases, and were more likely to be hospitalized, although this was not statistically significant. In multivariable analysis, gastroenteritis in elderly people was associated with travelling within the state (odds ratio 1·35, 95% CI 1·07–1·71). Elderly people were less concerned about food safety than other adults. Older Australians were less likely to report gastroenteritis and experienced different symptoms and outcomes from other adults.

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Development and Validation of a Simple and Easy-to-Employ Electronic Algorithm for Identifying Clinical Methicillin-Resistant Staphylococcus aureus Infection

Infection Control and Hospital Epidemiology ◽

10.1086/676437 ◽

2014 ◽

Vol 35 (6) ◽

pp. 692-698 ◽

Cited By ~ 13

Author(s):

Westyn Branch-Elliman ◽

Judith Strymish ◽

Kalpana Gupta

Keyword(s):

Staphylococcus Aureus ◽

Confidence Interval ◽

Odds Ratio ◽

Multivariable Analysis ◽

Simple Algorithm ◽

Electronic System ◽

Surveillance Systems ◽

Methicillin Resistant ◽

Sterile Site ◽

Mrsa Infection

Background.With growing demands to track and publicly report and compare infection rates, efforts to utilize automated surveillance systems are increasing. We developed and validated a simple algorithm for identifying patients with clinical methicillin-resistant Staphylococcus aureus (MRSA) infection using microbiologic and antimicrobial variables. We also estimated resource savings.Methods.Patients who had a culture positive for MRSA at any of 5 acute care Veterans Affairs hospitals were eligible. Clinical infection was defined on the basis of manual chart review. The electronic algorithm defined clinical MRSA infection as a positive non-sterile-site culture with receipt of MRSA-active antibiotics during the 5 days prior to or after the culture.Results.In total, 246 unique non-sterile-site cultures were included, of which 168 represented infection. The sensitivity (43.4%–95.8%) and specificity (34.6%–84.6%) of the electronic algorithm varied depending on the combination of antimicrobials included. On multivariable analysis, predictors of algorithm failure were outpatient status (odds ratio, 0.23 [95% confidence interval, 0.10–0.56]) and respiratory culture (odds ratio, 0.29 [95% confidence interval, 0.13–0.65]). The median cost was $2.43 per chart given 4.6 minutes of review time per chart.Conclusions.Our simple electronic algorithm for detecting clinical MRSA infections has excellent sensitivity and good specificity. Implementation of this electronic system may streamline and standardize surveillance and reporting efforts.Infect Control Hosp Epidemiol 2014;35(6):692–698

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