scholarly journals Factors Associated with Colonoscopy Performed in Nonhospital Settings

2010 ◽  
Vol 24 (7) ◽  
pp. 419-424 ◽  
Author(s):  
Othman Alharbi ◽  
Linda Rabeneck ◽  
Lawrence F Paszat ◽  
Duminda N Wijeysundera ◽  
Rinku Sutradhar ◽  
...  
Keyword(s):  
Outcome Measure ◽  
High Volume ◽  
Population Based ◽  
Income Quintile ◽  
Physician Specialty ◽  
Cross Sectional ◽  
Health Administrative Data ◽  
Factors Associated ◽  
Sectional Analysis

BACKGROUND: Colonoscopy is being increasingly performed in facilities outside of hospitals. Regulation of these facilities is variable, and concerns regarding the quality of procedures in nonhospital (NH) settings have been raised. Further study is needed to better understand endoscopic practice in these facilities.OBJECTIVES: To describe NH-based colonoscopy practice in Ontario from 1993 to 2005, and to identify patient (age, sex, income quintile and comorbidity) and physician (specialty and colonoscopy volume) factors associated with this practice.METHODS: The present study was a population-based, cross-sectional analysis using health administrative data from Ontario adults who underwent at least one outpatient colonoscopy between 1993 and 2005. A total of 1,240,781 patients underwent 1,917,714 colonoscopies. The main outcome measure was the receipt of colonoscopy in an NH facility.RESULTS: An increase in NH-based colonoscopy from 10.0% in 1993 to 15.1% in 2005 (P<0.0001) was found. In the multivariate model, younger, healthier men living in higher income areas were significantly more likely to undergo NH-based colonoscopy. Surgeons and other practitioners (eg, nongastroenterologists and noninternists) were significantly more likely to practice in NH settings. Physicians in the highest colonoscopy volume quintile were 25 times more likely to practice in NH settings than those in the lowest volume quintile (P<0.0001).CONCLUSION: Rates of NH-based colonoscopy are rising in Ontario. High-volume endoscopists and surgeons are most likely to practice in NH settings. Given its increasing use, further study of the practice and the regulation of NH colonoscopy is warranted.

scholarly journals A Population-based Analysis of Outpatient Colonoscopy in Adults Assisted by an Anesthesiologist

2009 ◽  
Vol 111 (4) ◽  
pp. 734-740 ◽  
Author(s):  
Othman Alharbi ◽  
Linda Rabeneck ◽  
Lawrence F. Paszat ◽  
Duminda N. Wijeysundera ◽  
Rinku Sutradhar ◽  
...  
Keyword(s):  
Confidence Interval ◽  
High Volume ◽  
The United States ◽  
Population Based ◽  
Income Quintile ◽  
Community Hospitals ◽  
Cross Sectional ◽  
Institution Type ◽  
Academic Hospitals ◽  
Sectional Analysis

Background The use of propofol to sedate patients for colonoscopy, generally administered by an anesthesiologist in North America, is increasingly popular. In the United States, regional use of anesthesiologist-assisted endoscopy appears to correlate with local payor policy. This study's objective was to identify nonpayor factors (patient, physician, institution) associated with anesthesiologist assistance at colonoscopy. Methods The authors performed a population-based cross-sectional analysis using Ontario health administrative data, 1993-2005. All outpatient colonoscopies performed on adults were identified. Hierarchical multivariable modeling was used to identify patient (age, sex, income quintile, comorbidity), physician (specialty, colonoscopy volume), and institution (type, volume) factors associated with receipt of anesthesiologist-assisted colonoscopy. Results During the study period, 1,838,879 colonoscopies were performed on 1,202,548 patients. The proportion of anesthesiologist-assisted colonoscopies rose from 8.4% in 1993 to 19.1% in 2005 (P &lt; 0.0001). In the hierarchical model, patients in low-volume community hospitals were five times more likely to receive anesthesiologist-assisted colonoscopy than patients in high-volume community hospitals (odds ration 4.9; 95% confidence interval 4.4-5.5). Less than 1% of colonoscopies in academic hospitals were anesthesiologist-assisted. Compared to gastroenterologists, surgeons were more likely to perform anesthesiologist-associated colonoscopy (odds ratio 1.7; 95% confidence interval 1.1-2.6). Conclusions In Ontario, rates of anesthesiologist-assisted colonoscopy have risen dramatically. Institution type was most strongly associated with this practice. Further investigation is needed to determine the most appropriate criteria for the use of anesthesiology services during colonoscopy.

scholarly journals Population-based assessment of patient and provider characteristics influencing pediatric outpatient antibiotic use in a high antibiotic-prescribing state

2020 ◽  
Vol 41 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Sophie E. Katz ◽  
Milner Staub ◽  
Youssoufou Ouedraogo ◽  
Christopher D. Evans ◽  
Marion A. Kainer ◽  
...  
Keyword(s):  
High Volume ◽  
Antibiotic Use ◽  
Population Based ◽  
Antibiotic Prescribing ◽  
Physician Specialty ◽  
Provider Type ◽  
Cross Sectional ◽  
Specific Patient ◽  
Provider Characteristics ◽  
Assistant Physician

AbstractObjective:To identify patient and provider characteristics associated with high-volume antibiotic prescribing for children in Tennessee, a state with high antibiotic utilization.Design:Cross-sectional, retrospective analysis of pediatric (aged <20 years) outpatient antibiotic prescriptions in Tennessee using the 2016 IQVIA Xponent (formerly QuintilesIMS) database.Methods:Patient and provider characteristics, including county of prescription fill, rural versus urban county classification, patient age group, provider type (nurse practitioner, physician assistant, physician, or dentist), physician specialty, and physician years of practice were analyzed.Results:Tennessee providers wrote 1,940,011 pediatric outpatient antibiotic prescriptions yielding an antibiotic prescribing rate of 1,165 per 1,000 population, 50% higher than the national pediatric antibiotic prescribing rate. Mean antibiotic prescribing rates varied greatly by county (range, 39–2,482 prescriptions per 1,000 population). Physicians wrote the greatest number of antibiotic prescriptions (1,043,030 prescriptions, 54%) of which 56% were written by general pediatricians. Pediatricians graduating from medical school prior to 2000 were significantly more likely than those graduating after 2000 to be high antibiotic prescribers. Overall, 360 providers (1.7% of the 21,798 total providers in this dataset) were responsible for nearly 25% of both overall and broad-spectrum antibiotic prescriptions; 20% of these providers practiced in a single county.Conclusions:Fewer than 2% of providers account for 25% of pediatric antibiotic prescriptions. High antibiotic prescribing for children in Tennessee is associated with specific patient and provider characteristics that can be used to design stewardship interventions targeted to the highest prescribing providers in specific counties and specialties.

Maternal Characteristics and Migraine Pharmacotherapy During Pregnancy: Cross-Sectional Analysis of Data from a Large Cohort Study

Cephalalgia ◽  
2009 ◽  
Vol 29 (12) ◽  
pp. 1267-1276 ◽  
Author(s):  
K Nezvalová-Henriksen ◽  
O Spigset ◽  
H Nordeng
Keyword(s):  
Body Mass Index ◽  
Odds Ratio ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Narcotic Analgesics ◽  
Cross Sectional ◽  
Maternal Characteristics ◽  
Factors Associated ◽  
Large Cohort Study ◽  
Sectional Analysis

Little is known about factors associated with migraine pharmacotherapy during pregnancy. Of 60 435 pregnant women in a population-based cohort, 3480 (5.8%) reported having migraine during the first 5 months of pregnancy. Of these, 2525 (72.6%) reported using migraine pharmacotherapy, mostly non-narcotic analgesics (54.1%) and triptans (25.4%). After adjustment for sociodemographic factors and comorbidities in logistic regression analysis, high pregestational body mass index [odds ratio (OR) 1.3, 95% confidence interval (CI) 1.2, 1.4], sleep < 5 h (OR 1.6, 95% CI 1.3, 1.9), being on sick-leave (OR 1.3, 95% CI 1.2, 1.5) and acute back/shoulder/neck pain (OR 0.6, 95% CI 0.6, 0.7) were associated with migraine pharmacotherapy during pregnancy. Many women need drug treatment for migraine during pregnancy, and the choice of pharmacotherapy during this period may be influenced by maternal sociodemographic factors and comorbidities.

scholarly journals Factors associated with the quality of the diet of residents of a rural area in Southern Brazil

2018 ◽  
Vol 52 ◽  
pp. 6s ◽  
Author(s):  
Mayra Pacheco Fernandes ◽  
Renata Moraes Bielemann ◽  
Anaclaudia Gastal Fassa
Keyword(s):  
Rural Area ◽  
Multinomial Logistic Regression ◽  
Economic Status ◽  
Population Based ◽  
Cross Sectional Study ◽  
Older Individuals ◽  
Southern Brazil ◽  
Cross Sectional ◽  
Factors Associated

OBJECTIVE: To identify factors associated with a better quality of the diet of residents of a rural area in Southern Brazil. METHODS: This is a population-based, cross-sectional study with individuals aged 18 years or over living in the rural area of Pelotas, State of Rio Grande do Sul, Brazil. Food consumption was evaluated by a food frequency questionnaire of thirteen items, related to the consumption in the last week. We evaluated quality of the diet using the Adult Diet Quality Index (IQD-A). Healthy food received increasing scores while unhealthy food received decreasing scores, according to consumption frequency, amounting to scores from zero to 30. The total score was divided into tertiles. Individuals of the third tertile were classified with better quality of the diet. We investigated the association between quality of the diet and independent variables using multinomial logistic regression. RESULTS: We interviewed 1,519 individuals with mean IQD-A of 17.1 points (SD = 3.3) and a median of 17.0 (range of 10 to 25 points). Although the population studied kept the consumption of staple foods, the intake of industrialized food such as soft drinks, artificial juices, and unhealthy foods such as sweets was high. Older individuals presented seven times (95%CI 4.20–12.48) more chance of having a better quality of the diet. Women, individuals with higher economic status, those who worked in the sale of animals, or those who had diabetes were approximately twice as likely to be in the group with the best quality of the diet. Individuals whose families worked with fishing presented a 70% lower chance of being in the group of better quality of the diet. CONCLUSIONS: We identified that men, younger adults, individuals of lower socioeconomic level, and fishing families were in the group of higher vulnerability for the consumption of a diet with worse quality. Thus, public policies, especially educational policies, are needed to promote healthy eating in this group.

Multimorbidity patterns and quality of life across European populations: Results from SHARE database

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
T T Makovski ◽  
B Poblador Plou ◽  
M Schnell ◽  
S Stranges ◽  
M Zeegers ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Large Population ◽  
Population Based ◽  
Common Disease ◽  
Cross Sectional ◽  
Complex Needs ◽  
Disease Patterns ◽  
Suboptimal Care ◽  
Sectional Analysis

Abstract An increasing number of people living with multimorbidity may receive suboptimal care since health systems are not well prepared to respond to their complex needs. Identifying which conditions most commonly group together could support better care for patients with multiple diseases. This is particularly critical for conditions that have the most deteriorating effect on quality of life (QoL). The aim of the study was to: 1) identify multimorbidity patterns in Europe and 2) assess their impact on QoL. This was a cross-sectional analysis performed on the Survey of Health, Ageing and Retirement in Europe (SHARE) among adults aged 50+, in eighteen countries (n = 67,179). The Control, Autonomy, Self-Realization and Pleasure (CASP-12v1) scale assessed QoL. Exploratory factor analysis (using 17 conditions) based on tetra-choric correlations, was applied to identify multimorbidity patterns. Associations between patterns and QoL were estimated with multilevel mixed-effects linear regression. The analyses were adjusted for socio-economic, clinical and psycho-social factors, and stratified by sex. Three multimorbidity patterns were found: 1) cardio-metabolic [frequency in men (27.7%); women (25.9%)], 2) psycho-geriatric [1.4%; 0.3%] and 3) mixed [11.7%; 17.4%]. Sample adequacy was confirmed by the Kaiser-Meyer-Olkin test [0.81; 0.84, for men and women, respectively]. The patterns showed slight sex differences. The frequency of all patterns increased with age, while patterns overlapped significantly in the population. The psycho-geriatric pattern had the most deteriorating effect on QoL [-4.5(95%CI:-6.2;-2.8) for men; -5.0(95%CI: -9.5; -0.5) for women]. Recognizing the most common disease patterns may allow more targeted planning and provision of care, including development of clinical guidelines, enhancing collaboration between health professionals, and creation of prevention plans to reduce complications and preserve the best QoL for patients with multimorbidity. Key messages First large population-based study on multimorbidity patterns and their impact on QoL across Europe, using SHARE database. The findings can serve to support better care for multimorbid patients.

scholarly journals Patient-level Characteristics and Inequitable Access to Inpatient Electroconvulsive Therapy for Depression: A Population-based Cross-sectional Study: Caractéristiques au niveau du patient et accès inéquitable à la thérapie électroconvulsive pour patients hospitalisés

2020 ◽  
pp. 070674372093564
Author(s):  
Tyler S. Kaster ◽  
Daniel M. Blumberger ◽  
Tara Gomes ◽  
Rinku Sutradhar ◽  
Zafiris J. Dasklakis ◽  
...  
Keyword(s):  
Postsecondary Education ◽  
Electroconvulsive Therapy ◽  
Bipolar Depression ◽  
Patient Characteristics ◽  
Population Based ◽  
Income Quintile ◽  
Clinical Factors ◽  
Cross Sectional ◽  
Factors Associated ◽  
Patient Level

Objective: A variety of patient characteristics drive the use of electroconvulsive therapy (ECT) in depression. However, the extent to which each characteristic influences the receipt of ECT, and whether they are appropriate, is unknown. The aim of this study is to identify patient-level characteristics associated with receiving inpatient ECT for depression. Method: We identified all psychiatric inpatients with a major depressive episode admitted to hospital ≥3 days in Ontario, Canada (2009 to 2017). The association between patient-level characteristics at admission and receipt of inpatient ECT was determined using logistic regression, where a generalized estimating equations approach accounted for repeat admissions. Results: The cohort included 53,174 inpatients experiencing 75,429 admissions, with 6,899 admissions involving ECT (9.2%). Among demographic factors, age was most associated with ECT—younger adults had reduced (OR = 0.30, 95%CI, 0.24 to 0.37; 18 to 25 years) while older adults had increased (OR = 3.08, 95%CI, 2.41 to 3.93; 85+ years) odds compared to middle-aged adults (46 to 55 years). The likelihood of ECT was greater for individuals who were married/partnered, had postsecondary education, and resided in the highest neighborhood income quintile. Among clinical factors, illness polarity was most associated with receiving ECT—bipolar depression had reduced odds of receiving ECT (OR = 0.62, 95%CI, 0.57 to 0.69) The likelihood of receiving ECT was greater in psychotic depression, more depressive symptoms, and incapable to consent to treatment and was reduced with comorbid substance use disorders and several medical comorbidities. Conclusions: Nearly 1 in 10 admissions for depression in Ontario, Canada, involve ECT. Many clinical factors associated with receiving inpatient ECT were concordant with clinical guidelines; however, nonclinical factors associated with its use warrant investigation of their impact on equitable access to ECT.

Modifiable factors associated with patient-reported pain during and after screening colonoscopy

Gut ◽  
2017 ◽  
Vol 67 (11) ◽  
pp. 1958-1964 ◽  
Author(s):  
Marek Bugajski ◽  
Paulina Wieszczy ◽  
Geir Hoff ◽  
Maciej Rupinski ◽  
Jaroslaw Regula ◽  
...  
Keyword(s):  
Population Based ◽  
Screening Colonoscopy ◽  
Case Volume ◽  
Cross Sectional ◽  
Propofol Sedation ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Modifiable Factors ◽  
Patient Reported ◽  
Sectional Analysis

ObjectivePain associated with colonoscopy is a major burden for patients. We investigated modifiable factors associated with patient-reported pain during and after colonoscopy.DesignThis cross-sectional analysis included database records from 23 centres participating in a population-based colonoscopy screening programme in Poland. Colonoscopies were performed under three sedation modalities: none, benzodiazepine-opioid sedation or propofol sedation. We used Gastronet (a validated tool) to assess patients’ pain during and after colonoscopy; pain was scored on a four-point scale (no, little, moderate or severe pain), with moderate to severe defined as painful. We used multivariate logistic regression models to estimate ORs for painful colonoscopy and calculated risk-adjusted ratios of painful colonoscopies per endoscopist and compared it to the mean rate.ResultsOf 35 216 screening colonoscopies in 2014 and 2015 included in our study, 22 725 (64.5%) patients returned valid Gastronet questionnaires. The proportion of examinations described as causing pain during (after) the procedure was 22.5% (14.2%) for unsedated, 19.9% (13.5%) for benzodiazepine-opioid sedation and 2.5% (7.5%) for propofol sedation. Propofol sedation, higher case volume of endoscopists, newest endoscope generation and adequate bowel preparation were significantly associated with lower odds of painful colonoscopy. Pain scores after colonoscopy showed similar associations. Adjusted pain rates during and after colonoscopy varied 11 and over 23-fold, respectively, between endoscopists.ConclusionWe identified several independent, modifiable factors associated with pain during and after colonoscopy, of which individual endoscopist was the most important. Dedicated training should be considered to decrease variability among endoscopists.

scholarly journals The association between serum alanine aminotransferase and hypertension: A national based cross-sectional analysis among over 21 million Chinese adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiajing Jia ◽  
Ying Yang ◽  
Fangchao Liu ◽  
Minjin Zhang ◽  
Qin Xu ◽  
...  
Keyword(s):  
Alanine Aminotransferase ◽  
Elevated Serum ◽  
Population Based ◽  
Reproductive Age ◽  
Chinese Adults ◽  
Cross Sectional ◽  
Serum Alanine Aminotransferase ◽  
Cross Sectional Analysis ◽  
Registration Data ◽  
Sectional Analysis

Abstract Background Inconsistent results were found in the association between serum alanine aminotransferase (ALT) and hypertension among population-based studies. This study evaluated the association between ALT and hypertension among Chinese reproductive-age population by utilizing registration data from National Free Pre-pregnancy Checkups Project in 2016–2017. Methods The 21,103,790 registered participants were eligible for analysis, including women who were 20–49 years old and men who were 20–59 years old with available data for ALT and blood pressure (BP). Logistic regression was conducted to estimate odds ratio (OR) for the association between ALT and hypertension as a binary outcome. Linear regression was used to examine the association between ALT and BP as a continuous outcome. Results In total, 4.21% of the participants were hypertensive, and 11.67% had elevated ALT (> 40 U/L). Hypertension prevalence was 3.63% and 8.56% among participants with normal and elevated ALT levels. A strong linear relationship was found between serum ALT levels and the odds of hypertension after adjustment for potential confounders. The multivariable-adjusted ORs for hypertension were 1, 1.22 (1.21, 1.22), 1.67 (1.65 1.68), 1.78 (1.76, 1.80), and 1.92 (1.90, 1.94) in participants with ALT levels of ≤ 20, 20.01–40, 40.01–60, 60.01–80, and > 80 U/L, respectively. Systolic and diastolic BPs rose by 1.83 and 1.20 mmHg on average, for each 20 U/L increase in ALT (P for trend < 0.001). The association was consistent among subgroups and tended to be stronger among populations who are overweight (body mass index ≥ 24 kg/m2) (χ2 = 52,228, P < 0.001), alcohol drinking (χ2 = 100,730, P < 0.001) and cigarette smoking (χ2 = 105,347, P < 0.001). Conclusions Our cross-sectional analysis suggested a linear association between serum ALT and hypertension or BP, which indicated that abnormal liver metabolism marked by elevated serum ALT could play a role in hypertension or elevated BP condition.

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