scholarly journals Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032930
Author(s):  
Annemarie Schop ◽  
Karlijn Stouten ◽  
Jurgen Riedl ◽  
Ron van Houten ◽  
Joost van Rosmalen ◽  
...  
Keyword(s):  
General Practice ◽  
Cohort Study ◽  
Iron Deficiency ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Iron Deficiency Anaemia ◽  
Newly Diagnosed ◽  
Deficiency Anaemia ◽  
Increased Risk

ObjectivesTo describe all iron deficiency anaemia (IDA)–related causes during follow-up of patients newly diagnosed with IDA and to assess whether a delayed colorectal cancer (CRC) diagnosis influences survival.Design and settingRetrospective cohort study of patients from general practices in the Dordrecht area, the Netherlands.ParticipantsMen and women aged ≥50 years with a new diagnosis of IDA (ie, no anaemia 2 years previously).MethodFrom February 2007 to February 2018, all relevant data were collected from the files of the referral hospital. Early IDA-related cause was defined as established within 18 weeks after IDA diagnosis. Cox proportional-hazards regression was used to analyse survival of patients with CRC diagnosis.Results587 patients with IDA were included with a median follow-up of 4.6 years. Early and late IDA-related causes could be established in 32% and 8% of patients, respectively. Early and late CRC was found in 8% and 2% of patients, respectively, and were located mainly right sided. After adjustment for age, gender and TNM classification, mortality risk was lower in patients with IDA with early CRC diagnosis, but not significantly (HR 0.30, 95% CI 0.09 to 1.02).ConclusionEven with extended follow-up, the cause of IDA remains elusive in the majority of patients with IDA in general practice. However, patients with IDA are at increased risk for in particular right-sided CRC and a late diagnosis of CRC appears to have a detrimental effect on survival in patients with IDA.

Progression of castrate-resistant (CR) disease in nonmetastatic (M0) prostate cancer (PC) patients: A retrospective cohort study using data from the Henry Ford Health System (HFHS).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15147-e15147
Author(s):  
Jennifer Beebe-Dimmer ◽  
Karynsa Cetin ◽  
Cecilia Yee ◽  
Lois Lamerato ◽  
Scott Stryker ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Specific Antigen ◽  
Population Based ◽  
Entire Cohort ◽  
Increased Risk ◽  
Diverse Patient Population

e15147 Background: Androgen deprivation therapy (ADT) is the cornerstone treatment of advanced PC, but is frequently used in the M0 setting. After a variable period of hormone-sensitivity, most patients develop CR disease (rising prostate-specific antigen [PSA] despite ongoing ADT). These men are at increased risk of developing bone metastases (BMT), particularly in those with higher serum PSA and shorter PSA doubling time (DT). The epidemiology and natural history of M0 CRPC has not been well-studied in a population-based setting. Methods: A retrospective cohort study was conducted using HFHS administrative data and included 691 men diagnosed with M0 PC between 1996 and 2005, who received ADT, with serial PSA measurements to determine CR. Patient records through 12/31/2008 were reviewed for outcomes of interest. CRPC was defined as 2 consecutive PSA rises, with “high risk” defined as PSA ≥8 ng/mL or PSA DT ≤10 months (mos) after the development of CRPC (Smith MR et al. Lancet 379:39-46, 2012). The risk of BMT was estimated for the entire cohort and for the CRPC and high-risk CRPC subsets. Results: Of the 691 patients included in the cohort (median age: 73 years, 48% African American), 98% received only GnRH agonists and 2% had orchiectomy. Median follow-up for the entire cohort after ADT initiation was 49 mos (IQR=45). 101 patients (15%) met criteria for CRPC during follow-up, with a median of 18 mos on active ADT prior to CRPC development (IQR=14). Of CRPC patients, 85% met criteria for high-risk (of those, 16% had PSA ≥8 ng/mL, 12% had PSA DT ≤10 mos, and 72% had both). Among all patients, 12% (n=82) developed BMT during follow-up, with 42% (n=36) of the high-risk CRPC subset developing BMT. Median time from high-risk CRPC to BMT was 9 mos (IQR=17). Conclusions: The HFHS resource allowed for our investigation of PSA characteristics corresponding to disease progression in a racially diverse patient population. A substantial proportion of M0 PC patients on ADT will eventually develop CR disease. Once a patient has CRPC, the risk of BMT is relatively high.

scholarly journals Association between CVDs and initiation and adherence to statin treatment in patients with newly diagnosed hypercholesterolaemia: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e045375
Author(s):  
In Sun Ryou ◽  
Jooyoung Chang ◽  
Joung Sik Son ◽  
Ahryoung Ko ◽  
Seulggie Choi ◽  
...  
Keyword(s):  
Cohort Study ◽  
National Health ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Statin Treatment ◽  
Health Screening ◽  
Secondary Outcome ◽  
Newly Diagnosed ◽  
Increased Risk ◽  
Late Initiation

ObjectivesTo evaluate the association between incident cardiovascular disease (CVD) and initiation and adherence to statin treatment for primary prevention of CVD in patients with newly diagnosed hypercholesterolaemia.DesignA population-based retrospective cohort study.SettingThis study used National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) from Republic of Korea.ParticipantsThis study included 11 320 participants without previous history of CVD aged between 40 and 79 years who had elevated total cholesterol level (more than 240 mg/dL) and had initiated statin treatment within 24 months of the national health screening from 2004 to 2012 identified in the NHIS-HEALS.Primary and secondary outcome measuresThe primary outcome, CVD, was defined as first-ever admission or death due to ischaemic heart disease, acute myocardial infarction, revascularisation or stroke, or December 31 2013. The HRs of CVD according to statin adherence were calculated according to stratification by Systematic COronary Risk Evaluation.ResultsEarly statin initiation significantly lowered risk of CVD outcomes compared with late initiation (HR of late statin user, 1.24; 95% CI 1.02 to 2.51). Among early initiators, statin discontinuers had a significantly higher risk for CVD compared with persistent users (HR, 1.71; 95% CI 1.10 to 2.67), while statin reinitiators had an attenuated risk increase (HR 1.34, 95% CI 0.79 to 2.30).ConclusionsAmong statin users with newly diagnosed hypercholesterolaemia, early statin initiation is associated with lower CVD risk compared with late initiation. Furthermore, statin discontinuation is associated with increased risk of CVD, but reinitiation attenuated the risk.

scholarly journals Mortality from Parkinson’s disease and other causes among a workforce manufacturing paraquat: an updated retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
John Andrew Tomenson ◽  
Clive Campbell
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Causes Of Death ◽  
Death Certificates ◽  
Female Workers ◽  
Increased Risk

Abstract Background Epidemiological studies of the association between Parkinson’s disease (PD) and paraquat (PQ) exposure have given inconsistent findings. The aim of the study was to update information on the risk of PD and mortality from major causes of death among a UK workforce who manufactured PQ by extending the follow-up by seven and a half years. Methods This retrospective cohort study included all employees who had ever worked on any of the four plants at Widnes, UK where PQ was manufactured between 1961 and 1995. The 926 male and 42 female workers were followed through 31 December 2017. Mortalities for males were compared with national and local rates, including rates for PD as a mentioned cause of death. Results A total of 394 male and 21 female workers had died by end of follow-up. Four death certificates of male workers mentioned PD, including two deaths that were due to PD. At least 6 death certificates of male employees would have been expected to have mentioned PD (SMR = 0.67; 95% CI 0.18–1.72). Reduced mortalities compared with local rates were found for major causes of death. Conclusions The study provided no evidence of an increased risk of PD, or increased mortalities from other causes among PQ production workers whose exposure to PQ on a daily basis was at least comparable to that of a PQ sprayer or mixer/loader.

scholarly journals Diagnostics in anaemia of chronic disease in general practice: a real-world retrospective cohort study

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101597 ◽  
Author(s):  
Annemarie Schop ◽  
Karlijn Stouten ◽  
Ron van Houten ◽  
Jürgen Riedl ◽  
Joost van Rosmalen ◽  
...  
Keyword(s):  
General Practice ◽  
Cohort Study ◽  
Chronic Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Iron Supplementation ◽  
Oral Iron ◽  
Newly Diagnosed ◽  
Anaemia Of Chronic Disease ◽  
Underlying Causes

BackgroundLimited research has been performed that focused on the diagnosis of the underlying cause of anaemia of chronic disease (ACD) in general practice or on prevalence data of the underlying causes of ACD in general practice, although this is one of the most common types of anaemia.AimTo clarify the diagnostic strategies of GPs in patients newly diagnosed with ACD and to determine the most common underlying causes.Design & settingRetrospective cohort study.MethodPatients newly diagnosed with ACD were selected based on laboratory criteria. ACD was defined as confirmed anaemia and ferritin levels above 100 μg/l combined with decreased iron and/or reduced transferrin. Additional medical information on patients was obtained from the electronic medical files of the GP and/or the referral hospital.ResultsOf the 267 analysed patients with ACD, additional investigations were performed in 205 patients (77%); in 31 patients (12%) the cause was apparent at the time of diagnosis, and for 31 patients (12%) no additional investigations were requested. In 210 (79%) of the 267 patients, an underlying cause was established, with infection (n = 68, 32%), autoimmune disease (n = 51, 24%) and malignancy (n = 48, 23%) as the most frequently observed etiologies. In 35 (13%) of the ACD patients, oral iron supplementation was prescribed by the GP. This was mainly done in patients with severe anaemia or less enhanced ferritin levels.ConclusionFor most patients with newly diagnosed ACD, the GP undertakes additional investigations to establish underlying causes. However, the cause of ACD remains unknown in a small proportion of patients. The use of oral iron supplementation in these patients requires caution.

scholarly journals Trends in cardiovascular disease in Scottish military veterans: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044465
Author(s):  
Beverly P Bergman ◽  
Daniel F Mackay ◽  
Jill P Pell
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Military Veterans ◽  
Military Health ◽  
Increased Risk ◽  
The Difference

ObjectivesTo examine the risk of cardiovascular disease (CVD) in Scottish military veterans in comparison with people who had never served in long-term follow-up to 2017, and to compare the findings with our earlier study to 2012 to assess trends.DesignRetrospective cohort study with up to 37 years follow-up.SettingPseudo-anonymised extract of computerised Scottish National Health Service records and national vital records.Participants78 000 veterans and 253 000 people with no record of service matched for age, sex and area of residence.Outcome measuresRisk of first occurrence of acute myocardial infarction, peripheral arterial disease and stroke in veterans compared with non-veterans, overall and by sex and birth cohort.ResultsA first episode of CVD was recorded in 5.7% of veterans and 4.8% of non-veterans overall, Cox proportional HR 1.16, 95% CIs 1.12 to 1.20, p=0.001. The difference was only significant for men, and for veterans born before 1960, and was highest in veterans with the shortest service. In all categories, the difference in risk was less than at the end of 2012.ConclusionsThe excess burden of CVD in veterans which was evident at the end of 2012 has reduced in the following 5 years from 23% to 16% overall. The increased risk continues to affect only those veterans born prior to 1960, suggesting that improvements in military health promotion since 1978, when veterans born from 1960 joined the armed forces, have had an important and ongoing beneficial effect on the long-term health of veterans.

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