Physician-related predictors of referral for multidisciplinary paediatric obesity management: a population-based study

2021 ◽  
Author(s):  
Nicole D Gehring ◽  
Maryam Kebbe ◽  
Sarah Rathwell ◽  
Arnaldo Perez ◽  
Chenhui Peng ◽  
...  
Keyword(s):  
Management Strategies ◽  
Family Physicians ◽  
Population Level ◽  
Population Based ◽  
Overweight And Obesity ◽  
Obesity Management ◽  
Logistic Regression Models ◽  
Physician Characteristics ◽  
Paediatric Obesity ◽  
Multivariable Regression

Abstract Background It is recommended that primary care-based physicians refer children with overweight and obesity to multidisciplinary paediatric obesity management, which can help to improve weight and health. Objective To determine predictors of referral to multidisciplinary paediatric obesity management. Methods This retrospective, population-level study included physicians who could refer 2–17 years old with a body mass index ≥85th percentile to one of three multidisciplinary paediatric obesity management clinics in Alberta, Canada. Physician demographic and procedural data were obtained from Practitioner Claims and Provider Registry maintained by Alberta Health from January 2014 to December 2017. Physician characteristics were compared based on whether they did or did not refer children for obesity management. Univariable and multivariable logistic regression models analysed associations between physician characteristics and referral making. Results Of the 3863 physicians (3468 family physicians, 395 paediatricians; 56% male; 49.3 ± 12.2 years old; 22.3 ± 12.6 years since graduation) practicing during the study period, 1358 (35.2%) referred at least one child for multidisciplinary paediatric obesity management. Multivariable regression revealed that female physicians (versus males) [odds ratio (OR): 1.68, 95% confidence interval (CI): 1.46–1.93; P < 0.0001], paediatricians (versus family physicians) (OR: 4.89, 95% CI: 3.85–6.21; P < 0.0001) and urban-based physicians (versus non-urban-based physicians) (OR: 2.17, 95% CI: 1.79–2.65; P < 0.0001) were more likely to refer children for multidisciplinary paediatric obesity management. Conclusions Approximately one-third of family physicians and paediatricians referred children for multidisciplinary paediatric obesity management. Strategies are needed to improve referral practices for managing paediatric obesity, especially among male physicians, family physicians and non-urban-based physicians as they were less likely to refer children.

scholarly journals Disease and weight loss: a prospective study of middle-aged and older adults in Costa Rica and England

2015 ◽  
Vol 57 (4) ◽  
pp. 312 ◽  
Author(s):  
Laura Blue ◽  
Noreen Goldman ◽  
Luis Rosero-Bixby
Keyword(s):  
Weight Loss ◽  
Statistical Power ◽  
Healthy Aging ◽  
Disease Onset ◽  
Population Level ◽  
Population Based ◽  
Logistic Regression Models ◽  
Measured Weight ◽  
Aging Study ◽  
A Prospective Study

Objective. To determine whether disease predicts weight loss in population-based studies, as this may confound the relationship between weight and mortality. Materials and methods. We used longitudinal data from the Costa Rican Longevity and Healthy Aging Study (CRELES) and the English Longitudinal Study of Ageing (ELSA). We defined two overlapping outcomes of measured weight loss between waves: >1.0 point of body mass index (BMI) and >2.0 BMI points. Logistic regression models estimated the associations with disease, adjusting for age (range 52-79), sex, smoking, and initial BMI. Results. In ELSA, onset of diabetes, cancer, or lung disease is associated with loss >2.0 points (respectively, OR=2.25 [95%CI: 1.34-3.80]; OR=2.70 [95%CI: 1.49-4.89]; OR=1.82 [95%CI: 1.02-3.26]). In CRELES, disease-onset reports are not associated with weight loss at 5% significance, but statistical power to detect associations is poor. Conclusion. Although it is known that some diseases cause weight loss, at the population level these associations vary considerably across samples.

Acute care utilization (ACU) among women receiving adjuvant chemotherapy for early breast cancer (EBC).

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 65-65 ◽  
Author(s):  
Katherine Enright ◽  
Eva Grunfeld ◽  
Lingsong Yun ◽  
Rahim Moineddin ◽  
Susan Faye Dent ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Geographic Location ◽  
Population Level ◽  
Population Based ◽  
Care Utilization ◽  
Population Based Study ◽  
Logistic Regression Models ◽  
Ontario Cancer Registry ◽  
Acute Care Utilization ◽  
The Impact

65 Background: Adjuvant chemotherapy is considered standard care for patients with lymph node (LN) positive and high risk LN negative EBC. While toxicities of chemotherapy are documented in clinical trials, the impact of toxicities on ACU at a population level is unknown. We undertook a population based study of ACU in patients undergoing adjuvant chemotherapy for EBC compared with controls. Methods: All EBC patients diagnosed 01/07 – 12/09 in Ontario, Canada, were identified from the Ontario Cancer Registry. Pt records were linked deterministically to provincial healthcare databases. All patients received ≥1 cycle of adjuvant chemotherapy. EBC cases (n = 4,718) were matched to non-cancer controls (n = 4,718) on age and geographic location. ACUs (emergency room or hospitalizations) within 30 days of chemotherapy were identified. If the primary reason for visit was a common toxicity of chemotherapy, the visit was considered chemotherapy associated (CA). All cause and CA visits were compared between cases and controls. Logistic regression models were used to identify covariates associated with ACU. Results: ACU was significantly higher in EBC pts compared with controls for both all cause (42.1% vs 9.1%, p<.001) and CA (30.7% vs 2.4%, p<.001) visits. Fever was the most common CA toxicity (22.9% vs 1.2%, p<.001). Taxanes were significantly associated with increased ACU compared with anthracycline only. Conclusions: ACU is common among EBC receiving chemotherapy and significantly higher than among controls. Interventions aimed at mitigating CA toxicity, particularly with the use of taxanes may reduce ACUs. [Table: see text]

scholarly journals Leading from the Middle: Replication of a Re-Engagement Program for Veterans with Mental Disorders Lost to Follow-Up Care

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
David E. Goodrich ◽  
Nicholas W. Bowersox ◽  
Kristen M. Abraham ◽  
Jeffrey P. Burk ◽  
Stephanie Visnic ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Management Strategies ◽  
Premature Mortality ◽  
Population Level ◽  
Population Based ◽  
Care Utilization ◽  
Outreach Program ◽  
Care Providers ◽  
Functional Impairments ◽  
Process Data

Objectives. Persons with mental disorders experience functional impairments and premature mortality. Limited continuity of care may contribute to disparities in this group. We describe the replication of an evidence-based outreach program (Re-Engage) to reconnect Veterans with mental disorders into care who have dropped out of services.Methods. Using the Enhanced Replicating Effective Programs framework, population-based registries were used to identify Veterans lost-to-care, and providers used this information to determine Veteran disposition and need for care. Providers recorded Veteran preferences, health status, and care utilization, and formative process data was collected to document implementation efforts.Results. Among Veterans who dropped out of care(n=126), the mean age was 49 years, 10% were women, and 29% were African-American. Providers determined that 39% of Veterans identified for re-engagement were deceased, hospitalized, or ineligible for care. Of the remaining 68 Veterans, outreach efforts resulted in contact with 20, with 7 returning to care. Providers averaged 14.2 hours over 4 months conducting re-engagement services and reported that gaining facility leadership support and having service agreements for referrals were essential for program implementation.Conclusions. Population-level, panel management strategies to re-engage Veterans with mental disorders are potentially feasible if practices are identified to facilitate national rollout.

scholarly journals Stunting, wasting, overweight and their coexistence among children under 7 years in the context of the social rapidly developing: Findings from a population-based survey in nine cities of China in 2016

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245455
Author(s):  
Ya-Qin Zhang ◽  
Hui Li ◽  
Hua-Hong Wu ◽  
Xin-Nan Zong
Keyword(s):  
Population Level ◽  
Population Based ◽  
Overweight And Obesity ◽  
Public Health Issue ◽  
Cluster Sampling ◽  
Cross Sectional Survey ◽  
Body Proportion ◽  
Cross Sectional ◽  
Growth Standards ◽  
Overweight Or Obesity

The prevalence of stunting, wasting, overweight and their coexistence are various in different populations and they also have changed with social developing and environmental improving. In this paper, we aimed to analyze the prevalence of stunting, wasting, overweight and their coexistence in some developed regions of China. Data were collected in a population-based cross-sectional survey by a multi-stage cluster sampling method in nine cities located in the northern, central, and southern region of China in 2016. Children under seven years (n = 110,491) were measured. WHO growth standards were used to assess the growth status. Stunting, underweight, wasting, overweight and obesity were considered as the primary forms of malnutrition (includes undernutrition and overnutrition) for infant or young children at population-levels. The prevalence of stunting, underweight, wasting, and overweight or obesity were respectively 0.7%, 0.6%, 1.2%, and 7.6%. Most of these children (95.4%) suffered from one form of malnutrition, and only 0.2% of them concurrently stunted and wasted, 0.4% concurrently stunted and overweight, 1.7% concurrently stunted and underweight, 2.3% concurrently underweight and wasted. Among stunted children, 91.2% were appropriate body proportion, and only 2.3% were wasted, 6.5% were overweight or obesity. Among overweight or obese children, only 0.6% were stunted, whereas, 15.8% were high stature and 83.6% were the appropriate ranges of stature. Sex, age, urban/suburban, and region were associated with these primary forms of malnutrition in the multivariate logistic analysis. In conclusion, we found that the coexistence of stunting and overweight was not common at both population-level and individual-level. The situation for undernutrition had significantly improved, and overweight may be the leading public health issue for children under seven years in the nine cities of China.

scholarly journals Poor Awareness of Hypertension in France: The CONSTANCES Population-Based Study

2020 ◽  
Vol 33 (6) ◽  
pp. 543-551
Author(s):  
Goël Fenech ◽  
Alexandre Vallée ◽  
Michelle Cherfan ◽  
Sofiane Kab ◽  
Marcel Goldberg ◽  
...  
Keyword(s):  
Associated Factors ◽  
Female Gender ◽  
Population Based ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Average Blood Pressure ◽  
Hypertension Awareness ◽  
Multivariable Regression ◽  
Using Data ◽  
Sectional Analysis

Abstract OBJECTIVES We aimed to assess the hypertension (HTN) awareness and associated factors in France. METHODS We conducted a cross-sectional analysis using data from the CONSTANCES population-based cohort involving 87,808 volunteer participants included between 2012 and 2018. HTN was defined as average blood pressure (BP) over 140/90 or use of BP medication, awareness as self-reported HTN. Multivariable logistic regression models were used to identify the associated factors. RESULTS Overall, 27,160 hypertensive participants (men = 16,569) above 18 years old were analyzed. Hypertension awareness rate was 37.5%. In the multivariable regression model, awareness was predicted by female gender, age, prior cardiovascular disease (CVD), presence of diabetes mellitus (DM), presence of chronic kidney disease (CKD), level of education, and obesity or overweight. Older participants (P &lt; 0.001), females (P &lt; 0.001), participants with comorbidities (P &lt; 0.001), were more likely to be aware when compared with younger participants, males and participants without comorbidities, respectively. The unawareness among participants without cardiometabolic factors (CMF, i.e., CVD, DM, CKD) was higher than participants with CMF (67% vs. 41%, respectively, P &lt; 0.001). Moreover, some differences appeared in both genders in the association between awareness of HTN and health and lifestyle factors. CONCLUSION Our findings show that HTN awareness is low. Particular attention should be given to young men without comorbidities as these characteristics were predictors of poor awareness. Immediate action is required to improve HTN awareness in France.

Studying Populations of Online Communities

2019 ◽  
pp. 173-193
Author(s):  
Benjamin Mako Hill ◽  
Aaron Shaw
Keyword(s):  
Online Communities ◽  
Information Diffusion ◽  
Diffusion Processes ◽  
Empirical Studies ◽  
Population Level ◽  
Study Groups ◽  
Population Based ◽  
Large Majority ◽  
Community Processes ◽  
Published Research

While the large majority of published research on online communities consists of analyses conducted entirely within individual communities, this chapter argues for a population-based approach, in which researchers study groups of similar communities. For example, although there have been thousands of papers published about Wikipedia, a population-based approach might compare all wikis on a particular topic. Using examples from published empirical studies, the chapter describes five key benefits of this approach. First, it argues that population-level research increases the generalizability of findings. Next, it describes four processes and dynamics that are only possible to study using populations: community-level variables, information diffusion processes across communities, ecological dynamics, and multilevel community processes. The chapter concludes with a discussion of a series of limitations and challenges.

scholarly journals Prevalence and predictors of persistent HIV viremia and viral rebound following universal test and treat: a population-based study

2021 ◽  
Author(s):  
M Kate Grabowski ◽  
Eshan U Patel ◽  
Gertrude Nakigozi ◽  
Victor Ssempijja ◽  
Robert Ssekubugu ◽  
...  
Keyword(s):  
Population Level ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Viral Rebound ◽  
Hiv Viral Load ◽  
Test And Treat ◽  
Universal Test ◽  
Persistent Viremia ◽  
Universal Test And Treat

Abstract Background There are limited data on individual HIV viral load (VL) trajectories at the population-level following the introduction of universal test and treat (UTT) in sub-Saharan Africa. Methods HIV VLs were assessed among HIV-positive participants at three population-based surveys in four Ugandan fishing communities surveyed between November 2011 and August 2017. The unit of analysis was a visit-pair (two consecutive person-visits), which were categorized as exhibiting durable VL suppression, new/renewed suppression, viral rebound, or persistent viremia. Adjusted relative risks (adjRRs) and 95%CIs of persistent viremia were estimated using multivariate Poisson regression. Results There were 1,346 HIV-positive participants (n=1,883 visit-pairs). The population-level prevalence of durable VL suppression increased from 29.7% to 67.9% during UTT rollout, viral rebound declined from 4.4% to 2.7%, and persistent viremia declined from 20.7% to 13.3%. Younger age (15-29 vs. 40-49 years, adjRR=1.80 [95%CI=1.19-2.71]), male sex (adjRR=2.09 [95%CI=1.47-2.95]), never being married (vs. currently married; adjRR=1.88 [95%CI=1.34-2.62]), and recent migration to the community (vs. long-term resident; adjRR=1.91 [95%CI=1.34-2.73]) were factors associated with persistent viremia. Conclusions Despite increases in durable VL suppression during roll-out of UTT in hyperendemic communities, a substantial fraction of the population, whose risk profile tended to be younger, male, and mobile, remained persistently viremic.

scholarly journals Associations between Free Sugar and Sugary Beverage Intake in Early Childhood and Adult NAFLD in a Population-Based UK Cohort

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 290
Author(s):  
Ahlia Sekkarie ◽  
Jean A. Welsh ◽  
Kate Northstone ◽  
Aryeh D. Stein ◽  
Usha Ramakrishnan ◽  
...  
Keyword(s):  
Total Energy ◽  
Hepatic Steatosis ◽  
Population Based ◽  
Free Sugar ◽  
Alcoholic Fatty Liver ◽  
Free Sugars ◽  
Logistic Regression Models ◽  
Sugar Intake ◽  
Sugary Beverages ◽  
Alcoholic Fatty Liver Disease

(1) Background: High sugar intake is prevalent among children and is associated with non-alcoholic fatty liver disease (NAFLD). The purpose of this study is to determine if a high intake of free sugars and sugary beverages (SB) in childhood is associated with NAFLD in adulthood; (2) Methods: At 24 years, 3095 participants were assessed for severe hepatic steatosis (controlled attenuation parameter >280 dB/m) and had dietary data collected via a food frequency questionnaire at age three years. Multiple logistic regression models adjusted for total energy intake, potential confounders, and a mediator (offspring body mass index (BMI) at 24 years); (3) Results: Per quintile increase of free sugar intake association with severe hepatic steatosis at 24 years after adjusting for total energy was odds ratio (OR):1.07 (95% CL: 0.99–1.17). Comparing the lowest vs. the highest free sugar consumers, the association was OR:1.28 (95% CL: 0.88–1.85) and 1.14 (0.72, 1.82) after full adjustment. The OR for high SB consumption (>2/day) compared to <1/day was 1.23 (95% CL: 0.82–1.84) and OR: 0.98 (95% CL: 0.60–1.60) after full adjustment; (4) Conclusions: High free sugar and SB intake at three years were positively but weakly associated with severe hepatic steatosis at 24 years. These associations were completely attenuated after adjusting for confounders and 24-year BMI.

Sign in / Sign up

Export Citation Format

Share Document