scholarly journals Outcome Assessment in Epidemiological Studies of Low-Dose Radiation Exposure and Cancer Risks: Sources, Level of Ascertainment, and Misclassification

2020 ◽  
Vol 2020 (56) ◽  
pp. 154-175 ◽  
Author(s):  
Martha S Linet ◽  
Mary K Schubauer-Berigan ◽  
Amy Berrington de González
Keyword(s):  
Outcome Assessment ◽  
Low Dose ◽  
International Classification Of Diseases ◽  
Epidemiological Studies ◽  
Cancer Risks ◽  
Low Dose Radiation ◽  
Loss To Follow Up ◽  
Classification Of Diseases

Abstract Background Outcome assessment problems and errors that could lead to biased risk estimates in low-dose radiation epidemiological studies of cancer risks have not been systematically evaluated. Methods Incidence or mortality risks for all cancers or all solid cancers combined and for leukemia were examined in 26 studies published in 2006–2017 involving low-dose (mean dose ≤100 mGy) radiation from environmental, medical, or occupational sources. We evaluated the impact of loss to follow-up, under- or overascertainment, outcome misclassification, and changing classifications occurring similarly or differentially across radiation dose levels. Results Loss to follow-up was not reported in 62% of studies, but when reported it was generally small. Only one study critically evaluated the completeness of the sources of vital status. Underascertainment of cancers (“false negatives”) was a potential shortcoming for cohorts that could not be linked with high-quality population-based registries, particularly during early years of exposure in five studies, in two lacking complete residential history, and in one with substantial emigration. False positives may have occurred as a result of cancer ascertainment from self- or next-of-kin report in three studies or from enhanced medical surveillance of exposed patients that could lead to detection bias (eg, reporting precancer lesions as physician-diagnosed cancer) in one study. Most pediatric but few adult leukemia studies used expert hematopathology review or current classifications. Only a few studies recoded solid cancers to the latest International Classification of Diseases or International Classification of Diseases for Oncology codes. These outcome assessment shortcomings were generally nondifferential in relation to radiation exposure level except possibly in four studies. Conclusion The majority of studies lacked information to enable comprehensive evaluation of all major sources of outcome assessment errors, although reported data suggested that the outcome assessment limitations generally had little effect on risk or biased estimates towards the null except possibly in four studies.

Abstract 14682: Impact of Atrial Fibrillation in Aortic Stenosis Patients: Insights From the United States Readmissions Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shashank Shekhar ◽  
Anas M Saad ◽  
Toshiaki Isogai ◽  
Mohamed M Gad ◽  
Keerat Ahuja ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Stenosis ◽  
Hospital Mortality ◽  
Large Scale ◽  
International Classification Of Diseases ◽  
The United States ◽  
Large Scale Data ◽  
Classification Of Diseases

Introduction: Even though atrial fibrillation (AF) is present in >30% of patients with aortic stenosis (AS), it is not typically included in the decision-making algorithm for the timing or need for aortic valve replacement (AVR), either by transcatheter (TAVR) or surgical (SAVR) approaches. Large scale data on how AF affects outcomes of AS patients remain scarce. Methods: From the Nationwide Readmissions Database (NRD), we retrospectively identified AS patients aged ≥18years, with and without AF admitted between January and June in 2016 and 2017 (to allow for a six month follow up), using the International Classification of Diseases-10 th revision codes. Multivariable logistic regression was performed to examine the predictors of in-hospital mortality during index hospitalization. In-hospital complications and 6 month in-hospital mortality during any readmission after being discharged alive were compared in patients with and without AF, for patients undergoing TAVR, SAVR or no-AVR. Results: We identified 403,089 AS patients, of which 41% had AF. Patients with AF were older (median age in years: 83 vs. 79) and were more frequently females (52% vs. 48%; p<0.001). Table summarizes outcomes of AS patients with and without AF. TAVR in patients with AF was associated with higher in-hospital mortality and follow-up mortality as compared to patients without AF. Although AF did not influence in-hospital mortality in SAVR population, follow-up mortality was also significantly higher after SAVR in patients with AF compared to patients without AF. For patients not undergoing AVR, in-hospital and follow-up mortality were higher in AF population compared to no AF and was higher than patients undergoing AVR (Table). Conclusions: AF is associated with worse outcomes in patients with AS irrespective of treatment (TAVR, SAVR or no-AVR). More studies are needed to understand the implications of AF in AS population and whether earlier treatment of AS in patients with AF can improve outcomes.

scholarly journals Progress of Diabetic Severity and Risk of Dementia

2015 ◽  
Vol 100 (8) ◽  
pp. 2899-2908 ◽  
Author(s):  
Wei-Che Chiu ◽  
Wen-Chao Ho ◽  
Ding-Lieh Liao ◽  
Meng-Hung Lin ◽  
Chih-Chiang Chiu ◽  
...  
Keyword(s):  
Severity Index ◽  
International Classification Of Diseases ◽  
Population Based ◽  
International Classification ◽  
Diabetic Patients ◽  
Research Database ◽  
Classification Of Diseases ◽  
New Onset

Context: Diabetes is a risk factor for dementia, but the effects of diabetic severity on dementia are unclear. Objective: The purpose of this study was to investigate the association between the severity and progress of diabetes and the risk of dementia. Design and Setting: We conducted a 12-year population-based cohort study of new-onset diabetic patients from the Taiwan National Health Insurance Research Database. The diabetic severity was evaluated by the adapted Diabetes Complications Severity Index (aDCSI) from the prediabetic period to the end of follow-up. Cox proportional hazard regressions were used to calculate the hazard ratios (HRs) of the scores and change in the aDCSI. Participants: Participants were 431,178 new-onset diabetic patients who were older than 50 years and had to receive antidiabetic medications. Main Outcome: Dementia cases were identified by International Classification of Diseases, ninth revision, code (International Classification of Diseases, ninth revision, codes 290.0, 290.1, 290.2, 290.3, 290.4, 294.1, 331.0), and the date of the initial dementia diagnosis was used as the index date. Results: The scores and change in the aDCSI were associated with the risk of dementia when adjusting for patient factors, comorbidity, antidiabetic drugs, and drug adherence. At the end of the follow-up, the risks for dementia were 1.04, 1.40, 1.54, and 1.70 (P &lt; .001 for trend) in patients with an aDCSI score of 1, 2, 3, and greater than 3, respectively. Compared with the mildly progressive patients, the adjusted HRs increased as the aDCSI increased (2 y HRs: 1.30, 1.53, and 1.97; final HRs: 2.38, 6.95, and 24.0 with the change in the aDCSI score per year: 0.51–1.00, 1.01–2.00, and &gt; 2.00 vs &lt; 0.50 with P &lt; .001 for trend). Conclusions: The diabetic severity and progression reflected the risk of dementia, and the early change in the aDCSI could predict the risk of dementia in new-onset diabetic patients.

scholarly journals Dental Calculus Is Associated with Death from Heart Infarction

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Birgitta Söder ◽  
Jukka H. Meurman ◽  
Per-Östen Söder
Keyword(s):  
Cardiac Death ◽  
International Classification Of Diseases ◽  
Dental Calculus ◽  
Chi Square ◽  
Heart Infarction ◽  
Classification Of Diseases ◽  
The Difference ◽  
The Relationship

Objectives. We studied whether the amount of dental calculus is associated with death from heart infarction in the dental infection—atherosclerosis paradigm.Materials. Participants were 1676 healthy young Swedes followed up from 1985 to 2011. At the beginning of the study all subjects underwent oral clinical examination including dental calculus registration scored with calculus index (CI). Outcome measure was cause of death classified according to WHO International Classification of Diseases. Unpairedt-test, Chi-square tests, and multiple logistic regressions were used.Results. Of the 1676 participants, 2.8% had died during follow-up. Women died at a mean age of 61.5 years and men at 61.7 years. The difference in the CI index score between the survivors versus deceased patients was significant by the year 2009 (P<0.01). In multiple regression analysis of the relationship between death from heart infarction as a dependent variable and CI as independent variable with controlling for age, gender, dental visits, dental plaque, periodontal pockets, education, income, socioeconomic status, and pack-years of smoking, CI score appeared to be associated with 2.3 times the odds ratio for cardiac death.Conclusions. The results confirmed our study hypothesis by showing that dental calculus indeed associated statistically with cardiac death due to infarction.

scholarly journals Incidence of COVID-19 in patients exposed to chloroquine and hydroxychloroquine: results from a population-based prospective cohort in Catalonia, Spain, 2020

2021 ◽  
Vol 26 (9) ◽  
Author(s):  
Rosa Maria Vivanco-Hidalgo ◽  
Israel Molina ◽  
Elisenda Martinez ◽  
Ramón Roman-Viñas ◽  
Adrián Sánchez-Montalvá ◽  
...  
Keyword(s):  
Care Service ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Health Administration ◽  
Risk Of Infection ◽  
Control Cohort ◽  
Male Population ◽  
Classification Of Diseases

Background Several clinical trials have assessed the protective potential of chloroquine and hydroxychloroquine. Chronic exposure to such drugs might lower the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or severe coronavirus disease (COVID-19). Aim To assess COVID-19 incidence and risk of hospitalisation in a cohort of patients chronically taking chloroquine/hydroxychloroquine. Methods We used linked health administration databases to follow a cohort of patients with chronic prescription of hydroxychloroquine/chloroquine and a control cohort matched by age, sex and primary care service area, between 1 January and 30 April 2020. COVID-19 cases were identified using International Classification of Diseases 10 codes. Results We analysed a cohort of 6,746 patients (80% female) with active prescriptions for hydroxychloroquine/chloroquine, and 13,492 controls. During follow-up, there were 97 (1.4%) COVID-19 cases in the exposed cohort and 183 (1.4%) among controls. The incidence rate was very similar between the two groups (12.05 vs 11.35 cases/100,000 person-days). The exposed cohort was not at lower risk of infection compared with controls (hazard ratio (HR): 1.08; 95% confidence interval (CI): 0.83–1.44; p = 0.50). Forty cases (0.6%) were admitted to hospital in the exposed cohort and 50 (0.4%) in the control cohort, suggesting a higher hospitalisation rate in the former, though differences were not confirmed after adjustment (HR: 1·46; 95% CI: 0.91–2.34; p = 0.10). Conclusions Patients chronically exposed to chloroquine/hydroxychloroquine did not differ in risk of COVID-19 nor hospitalisation, compared with controls. As controls were mainly female, findings might not be generalisable to a male population.

scholarly journals A kórházi adatlapok jelentéseinek alkalmazhatósága epidemiológiai elemzésekre az ischaemiás cerebrovascularis betegségek példája alapján

2015 ◽  
Vol 156 (38) ◽  
pp. 1540-1546 ◽  
Author(s):  
András Ajtay ◽  
Ferenc Oberfrank ◽  
Dániel Bereczki
Keyword(s):  
Health Care Financing ◽  
International Classification Of Diseases ◽  
Epidemiological Studies ◽  
Insurance Fund ◽  
Cerebral Infarcts ◽  
Hospital Report ◽  
Single Payer ◽  
Classification Of Diseases ◽  
Icd 10

Introduction: In single-payer health care financing systems data extracted from hospital report forms submitted for reimbursement purposes may be used for epidemiological investigations. Aim: Based on data submitted by 14 neurological wards in Central Hungary the authors examined the reliability of these reports. Method: Analyses were performed for the 3-digit codes of the 10th version of the International Classification of Diseases for cerebral infarcts (ICD-10 I63+I64) reported for the National Health Insurance Fund. Results: The number of cases in individual hospitals changed between a decrease by 35% and an increase by 73% from the first to the second half of the year 2012, reflecting changes in the size of the catchment area of the hospitals in July 2012. Of those with an ICD-10 I63 or I64 discharge diagnosis 54–84% had acute stroke. Neurological wards cared for 34–98% of all stroke patients. The diagnoses submitted for reimbursement purposes corresponded in over 99% to the diagnoses in the hospital discharge reports. Inaccuracies occurred in a larger proportion (about 20%) in coding the DRG financing categories. Conclusions: Databases created from hospital reports submitted for reimbursement purposes can be used reliably in Hungary for stroke epidemiological studies. Orv. Hetil., 2015, 156(38), 1540–1546.

scholarly journals Urgent and non-emergent telehealth care for seniors: Findings from a multi-site impact study

2021 ◽  
pp. 1357633X2110043
Author(s):  
Paul Bernstein ◽  
Kelly J Ko ◽  
Juhi Israni ◽  
Alexandria O Cronin ◽  
Michael M Kurliand ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
Geographic Region ◽  
Impact Study ◽  
Healthcare Organizations ◽  
Global Pandemic ◽  
Classification Of Diseases ◽  
Episodes Of Care ◽  
Study Population

Introduction The global pandemic has raised awareness of the need for alternative ways to deliver care, notably telehealth. Prior to this study, research has been mixed on its effectiveness and impact on downstream utilization, especially for seniors. Our multi-institution study of more than 300,000 telehealth visits for seniors evaluates the clinical outcomes and healthcare utilization for urgent and non-emergent symptoms. Methods We conducted a retrospective cohort study from November 2015 to March 2019, leveraging different models of telehealth from three health systems, comparing them to in-person visits for urgent and non-emergent needs of seniors based on International Classification of Diseases, 10th edition diagnoses. The study population was adults aged 60 years or older who had access to telehealth and were affiliated with and resided in the geographic region of the healthcare organization providing telehealth. The primary outcomes of interest were visit resolution and episodes of care for those that required follow-up. Results In total, 313,516 telehealth visits were analysed across three healthcare organizations. Telehealth encounters were successful in resolving urgent and non-emergent needs in 84.0–86.7% of cases. When visits required follow-up, over 95% were resolved in less than three visits for both telehealth and in-person cohorts. Discussion While in-person visits have traditionally been the gold standard, our results suggest that when deployed within the confines of a patient’s existing primary care and health system provider, telehealth can be an effective alternative to in-person care for urgent and non-emergent needs of seniors without increasing downstream utilization.

scholarly journals Medicaid Eligibility and Time to Re-incarceration Among Previously Incarcerated Subjects With Schizophrenia

10.36469/9845 ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 97-107
Author(s):  
Chris Kozma ◽  
Michael Dickson ◽  
Jacqueline Pesa ◽  
Carmela J. Benson
Keyword(s):  
Cox Regression ◽  
International Classification Of Diseases ◽  
Cumulative Number ◽  
Federal Law ◽  
Classification Of Diseases ◽  
Medicaid Eligibility ◽  
The Relationship ◽  
Lower Hazard

Background: Many persons with severe mental illness qualify for Medicaid coverage. However, under federal law, states must either suspend or terminate eligibility once they are incarcerated. We hypothesize that prompt re-acquisition of Medicaid eligibility following release from incarceration lowers the risk of re-incarceration. Objectives: To assess the relationship between Medicaid eligibility and risk of re-incarceration among previously incarcerated schizophrenia diagnosed subjects. Methods: Study subjects were selected between January 1, 2006 and September 30, 2011 from a single state Medicaid database that was combined with department of corrections data. Subjects were included if they had a schizophrenia diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification [ICD- 9-CM] code 295.xx), were between the ages of 18 and 62, and had been released from incarceration. Covariates included age, race, gender, marital status, and reason for incarceration. Time to Medicaid eligibility after release from incarceration, cumulative days of eligibility, and whether they were eligible on the re-incarceration date were evaluated in independent models. One and three-year Cox Regression models analyses (p&lt;0.05) were used to evaluate the hazard for re-incarceration. Results: The 932 subjects were 26.5% white, 73.7% male and were, on average, 37.6 years old on their index date (i.e., incarceration release date). They were 73.5% single or divorced and 12.7% were incarcerated for a substance abuse violation. In the 1-year follow-up period, 110 subjects (11.8%) were re-incarcerated. In the 3-year follow-up period 209 (22.4%) were re-incarcerated. Age (in years) was the only significant predictor of re-incarceration for the 1-year models (hazard ratio [HR]=0.976; confidence interval [CI]=0.957, 0.994). Eligibility was a significant predictor in the 3-year follow-up models. A longer ‘time to first eligibility’ (HR=1.046; CI=1.017, 1.075 was associated with a greater hazard for re-incarceration. Being eligible at the time of re-incarceration (HR=0.659; CI=0.498, 0.870) was associated with a lower hazard, and the cumulative number of months of eligibility (HR=0.978; CI=0.958, 0.997) and age were associated with a lower hazard for re-incarceration (HR=0.986; CI=0.973, 0.999). Conclusions: Access to Medicaid health services post-release may reduce the risk of re-incarceration.

scholarly journals Diagnostic classification of psychiatric disorders and familial-genetic research

1999 ◽  
Vol 1 (3) ◽  
pp. 191-196
Keyword(s):  
Psychiatric Disorders ◽  
Genetic Research ◽  
International Classification Of Diseases ◽  
Epidemiological Studies ◽  
Classification Systems ◽  
Detailed Knowledge ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
Icd 10

The validity of diagnostic definitions in psychiatry is directly related to the extent to which their etiology can be specified. However, since detailed knowledge of causal or susceptibility factors is lacking for most psychiatric disorders with a known or suspected familial-genetic origin, the current widely accepted classification systems largely fail to achieve this ideal. To illustrate this problem, this paper looks at the difficulties posed by the criteria for schizophrenia as laid down in the International Classification of Diseases, 10th revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), and highlights the discrepancies between the majority of diagnostic boundaries and the various phenotype aggregation patterns observed in family studies. Progress in our understanding of psychiatric disorders requires to be firmly based on the findings of epidemiological studies as well as on a clear appreciation of the limitations of classification tools.

scholarly journals Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Rationale and Framework for the Monograph and Overview of Eligible Studies

2020 ◽  
Vol 2020 (56) ◽  
pp. 97-113 ◽  
Author(s):  
Amy Berrington de Gonzalez ◽  
Robert D Daniels ◽  
Elisabeth Cardis ◽  
Harry M Cullings ◽  
Ethel Gilbert ◽  
...  
Keyword(s):  
Ionizing Radiation ◽  
Dose Response ◽  
Low Dose ◽  
Biological Effects ◽  
Epidemiological Studies ◽  
Solid Cancer ◽  
Systematic Bias ◽  
Cancer Risks ◽  
Low Dose Radiation ◽  
Dose Uncertainty

Abstract Whether low-dose ionizing radiation can cause cancer is a critical and long-debated question in radiation protection. Since the Biological Effects of Ionizing Radiation report by the National Academies in 2006, new publications from large, well-powered epidemiological studies of low doses have reported positive dose-response relationships. It has been suggested, however, that biases could explain these findings. We conducted a systematic review of epidemiological studies with mean doses less than 100 mGy published 2006–2017. We required individualized doses and dose-response estimates with confidence intervals. We identified 26 eligible studies (eight environmental, four medical, and 14 occupational), including 91 000 solid cancers and 13 000 leukemias. Mean doses ranged from 0.1 to 82 mGy. The excess relative risk at 100 mGy was positive for 16 of 22 solid cancer studies and 17 of 20 leukemia studies. The aim of this monograph was to systematically review the potential biases in these studies (including dose uncertainty, confounding, and outcome misclassification) and to assess whether the subset of minimally biased studies provides evidence for cancer risks from low-dose radiation. Here, we describe the framework for the systematic bias review and provide an overview of the eligible studies.

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