Long-term retreatment rates of cerebral aneurysms in a population-level cohort

2018 ◽  
Vol 11 (4) ◽  
pp. 367-372
Author(s):  
Taylor Daileda ◽  
Farhaan S Vahidy ◽  
Peng Roc Chen ◽  
Hooman Kamel ◽  
Conrad W Liang ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Population Level ◽  
Surgical Clipping ◽  
Treatment Practices ◽  
Level Data ◽  
Treatment Type ◽  
Retreatment Rate ◽  
Procedure Codes ◽  
Index Treatment

BackgroundThe likelihood of retreatment in patients undergoing procedures for cerebral aneurysms (CAs) has an important role in deciding the optimal treatment type. Existing determinations of retreatment rates, particularly for unruptured CAs, may not represent current clinical practice.ObjectiveTo use population-level data to examine a large cohort of patients with treated CAs over a 10-year period to estimate retreatment rates for both ruptured and unruptured CAs and explore the effect of changing treatment practices.MethodsWe used administrative data from all non-federal hospitalizations in California (2005–2011) and Florida (2005–2014) and identified patients with treated CAs. Surgical clipping (SC) and endovascular treatments (ETs) were defined by corresponding procedure codes and an accompanying code for ruptured or unruptured CA. Retreatment was defined as subsequent SC or ET.ResultsAmong 19 482 patients with treated CAs, ET was performed in 12 007 (62%) patients and SC in 7475 (38%). 9279 (48%) patients underwent treatment for unruptured CAs and 10203 (52%) for ruptured. Retreatment after 90 days occurred in 1624 (8.3%) patients (11.2% vs 3.7%, ET vs SC). Retreatment rates for SC were greater in unruptured than in ruptured aneurysms (4.6% vs 3.1%), but the opposite was true for ET (10.6% vs 11.8%). 85% of retreatments were within 2 years of the index treatment. Retreatment was associated with age (OR=0.99, 95% CI 0.98 to 0.99), female sex (OR=1.5, 95% CI 1.3 to 1.7), Hispanic versus white race (OR=0.86, 95% CI 0.75 to 0.98), and ET versus SC (OR=3.25, 95% CI 2.85 to 3.71). The adjusted 2-year retreatment rate decreased from 2005 to 2012 for patients with unruptured CAs treated with ET (11% to 8%).ConclusionsRetreatment rates for CAs treated with ET were greater than those for SC. However, for patients with unruptured CAs treated with ET, we identify a continuous decline in retreatment rate over the past decade.

scholarly journals Hurricane-induced demographic changes in a non-human primate population

2020 ◽  
Vol 7 (8) ◽  
pp. 200173
Author(s):  
Dana O. Morcillo ◽  
Ulrich K. Steiner ◽  
Kristine L. Grayson ◽  
Angelina V. Ruiz-Lambides ◽  
Raisa Hernández-Pacheco
Keyword(s):  
Population Level ◽  
Matrix Population Models ◽  
Individual Level ◽  
Animal Populations ◽  
Level Data ◽  
Climatic Event ◽  
Free Ranging ◽  
Human Primate ◽  
Population Fitness

Major disturbance events can have large impacts on the demography and dynamics of animal populations. Hurricanes are one example of an extreme climatic event, predicted to increase in frequency due to climate change, and thus expected to be a considerable threat to population viability. However, little is understood about the underlying demographic mechanisms shaping population response following these extreme disturbances. Here, we analyse 45 years of the most comprehensive free-ranging non-human primate demographic dataset to determine the effects of major hurricanes on the variability and maintenance of long-term population fitness. For this, we use individual-level data to build matrix population models and perform perturbation analyses. Despite reductions in population growth rate mediated through reduced fertility, our study reveals a demographic buffering during hurricane years. As long as survival does not decrease, our study shows that hurricanes do not result in detrimental effects at the population level, demonstrating the unbalanced contribution of survival and fertility to population fitness in long-lived animal populations.

scholarly journals Using Population-Level Data to Assess Need for and Use of Long-Term Services and Supports in California

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 504-504
Author(s):  
Kathryn Kietzman ◽  
Lei Chen ◽  
Rebecca Allen
Keyword(s):  
Service Use ◽  
Population Level ◽  
Routine Care ◽  
California Health Interview Survey ◽  
Care Needs ◽  
Level Data ◽  
Share Data ◽  
Report Data ◽  
Services And Supports

Abstract In response to aging and disability stakeholder advocacy in California, the state’s 2018-19 budget included support for the development of a study of Californians with needs for long-term services and supports (LTSS). Existing data on LTSS most typically represents those who already use specific programs or services. Yet many programs do not uniformly collect and report data, or have little capacity to share data across different delivery systems. In response to these gaps, we developed a 15-minute follow-on survey to the 2019-2020 California Health Interview Survey (CHIS), gathering statewide population-level data to assess LTSS needs and use by Californians 18 years of age and older. This paper reports on preliminary findings from the 2019 CHIS-LTSS survey conducted with a sample of 1097 respondents. Screening questions identified respondents reporting difficulties with concentrating, remembering, or making decisions (60%), performing basic daily activities such as dressing or bathing (26%), or getting out of the house to shop or to see the doctor (52%). Nearly half of respondents (45%) reported needing help with routine care needs while 16% needed help with personal care needs. Additional findings illustrate specific LTSS needs, service use, consequences of unmet needs, financial concerns, and consumer experiences. At a time when California policy makers, program planners, and advocates are engaged in implementing a 10-year Master Plan for Aging, these findings can be used to identify and address gaps in the types of services and supports that are essential to meet the LTSS needs of older adults and people with disabilities.

Corporal Punishment and the Law in Global Perspective

2019 ◽  
pp. 292-320 ◽  
Author(s):  
Joan E. Durrant
Keyword(s):  
New Zealand ◽  
Public Education ◽  
Corporal Punishment ◽  
Large Scale ◽  
Population Level ◽  
Global Perspective ◽  
Violence Against Children ◽  
Level Data ◽  
Primary Focus

Debates over corporal punishment’s effectiveness have come to an end. No study has shown it to have long-term benefits, while many have demonstrated its substantial and wide-ranging risks. Today, the primary focus is on ending it. The increasing recognition of children as rights-bearers is leading an ever-growing number of countries to legally prohibit corporal punishment of children. These laws are intended to foster recognition of children’s rights to protection from all violence, reduce approval and use of corporal punishment, and lower the threshold for tolerance of violence against children. Population-level data from Sweden, Germany, and New Zealand indicate that these changes are taking place. Additional research suggests that a combination of prohibition and large-scale public education is the most effective route to ending the corporal punishment of children.

scholarly journals Hurricane-induced demographic changes in a nonhuman primate population

2020 ◽  
Author(s):  
Dana O. Morcillo ◽  
Ulrich K. Steiner ◽  
Kristine L. Grayson ◽  
Angelina V. Ruiz-Lambides ◽  
Raisa Hernández-Pacheco
Keyword(s):  
Nonhuman Primate ◽  
Population Level ◽  
Matrix Population Models ◽  
Individual Level ◽  
Animal Populations ◽  
Level Data ◽  
Climatic Event ◽  
Free Ranging ◽  
Population Fitness

AbstractMajor disturbance events can have large impacts on the demography and dynamics of animal populations. Hurricanes are one example of an extreme climatic event, predicted to increase in frequency due to climate change, and thus expected to be a considerable threat to population viability. However, little is understood about the underlying demographic mechanisms shaping population response following these extreme disturbances. Here, we analyze 45 years of the most comprehensive free-ranging nonhuman primate demographic dataset to determine the effects of major hurricanes on the variability and maintenance of long-term population fitness. For this, we use individual-level data to build matrix population models and perform perturbation analyses. Despite reductions in population growth rate mediated through reduced fertility, our study reveals a demographic buffering during hurricane years. As long as survival does not decrease, our study shows that hurricanes do not result in detrimental effects at the population level, demonstrating the unbalanced contribution of survival and fertility to population fitness in long-lived animal populations.

The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

2020 ◽  
Vol 133 (1) ◽  
pp. 182-189
Author(s):  
Tae-Jin Song ◽  
Seung-Hun Oh ◽  
Jinkwon Kim
Keyword(s):  
Statin Therapy ◽  
Coil Embolization ◽  
Primary Outcome ◽  
Cox Regression ◽  
Cerebral Aneurysms ◽  
Time Dependent ◽  
Lipid Lowering ◽  
Surgical Clipping ◽  
The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

Enhancing community welfare through improved water quality: a case for applying staggered pollution charges in the river Musi sub-basin of Andhra Pradesh, India

Water Policy ◽  
2005 ◽  
Vol 7 (5) ◽  
pp. 469-483
Author(s):  
Tishya Chatterjee
Keyword(s):  
Andhra Pradesh ◽  
Relevant Literature ◽  
Pollution Prevention ◽  
Economic Benefits ◽  
Environmental Damage ◽  
Marginal Costs ◽  
Community Acceptance ◽  
Level Data ◽  
Over Time

In conditions of severe water-pollution and dormant community acceptance of accumulating environmental damage, the regulator's role goes beyond pollution prevention and more towards remediation and solutions based on the community's long-term expectations of economic benefits from clean water. This paper suggests a method to enable these benefits to become perceptible progressively, through participatory clean-up operations, supported by staggered pollution charges. It analyses the relevant literature on pollution prevention and applies a cost-based “willingness to pay” model, using primary basin-level data of total marginal costs. It develops a replicable demand-side approach imposing charge-standard targets over time in urban-industrial basins of developing countries.

scholarly journals Population-Level Prevalence, Bother, and Treatment Behavior for Urinary Incontinence in an Eastern European Country: Findings from the LUTS POLAND Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2314
Author(s):  
Mikolaj Przydacz ◽  
Marcin Chlosta ◽  
Piotr Chlosta
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Rural Areas ◽  
Eastern European Country ◽  
Population Level ◽  
Eastern European ◽  
Level Data ◽  
Urban And Rural Areas ◽  
Eastern European Countries

Objectives: Population-level data are lacking for urinary incontinence (UI) in Central and Eastern European countries. Therefore, the objective of this study was to estimate the prevalence, bother, and behavior regarding treatment for UI in a population-representative group of Polish adults aged ≥ 40 years. Methods: Data for this epidemiological study were derived from the larger LUTS POLAND project, in which a group of adults that typified the Polish population were surveyed, by telephone, about lower urinary tract symptoms. Respondents were classified by age, sex, and place of residence. UI was assessed with a standard protocol and established International Continence Society definitions. Results: The LUTS POLAND survey included 6005 completed interviews. The prevalence of UI was 14.6–25.4%; women reported a greater occurrence compared with men (p < 0.001). For both sexes, UI prevalence increased with age. Stress UI was the most common type of UI in women, and urgency UI was the most prevalent in men. We did not find a difference in prevalence between urban and rural areas. Individuals were greatly bothered by UI. For women, mixed UI was the most bothersome, whereas for men, leak for no reason was most annoying. More than half of respondents (51.4–62.3%) who reported UI expressed anxiety about the effect of UI on their quality of life. Nevertheless, only around one third (29.2–38.1%) of respondents with UI sought treatment, most of whom received treatment. Persons from urban and rural areas did not differ in the degrees of treatment seeking and treatment receiving. Conclusion: Urinary incontinence was prevalent and greatly bothersome among Polish adults aged ≥ 40 years. Consequently, UI had detrimental effects on quality of life. Nonetheless, most affected persons did not seek treatment. Therefore, we need to increase population awareness in Poland about UI and available treatment methods, and we need to ensure adequate allocation of government and healthcare system resources.

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