scholarly journals Ambulatory Care Fragmentation and Incident Stroke

2021 ◽  
Author(s):  
Lisa M. Kern ◽  
Joanna B. Ringel ◽  
Mangala Rajan ◽  
Lisandro D. Colantonio ◽  
Lawrence P. Casalino ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Racial Differences ◽  
Secondary Analysis ◽  
Poor Health ◽  
Fee For Service ◽  
Self Rated Health ◽  
Poisson Models ◽  
Stroke Study ◽  
History Of ◽  
Adjusted Rate

Background More fragmented ambulatory care (ie, care spread across many providers without a dominant provider) has been associated with excess emergency department and inpatient care. We sought to determine whether more fragmented ambulatory care is associated with an increase in the hazard of incident stroke, overall and stratified by health status and by race. Methods and Results We conducted a secondary analysis of data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study (2003–2016), including participants aged ≥65 years who had linked Medicare fee‐for‐service claims and no history of stroke (N=12 510). We measured fragmentation of care with the reversed Bice‐Boxerman index. We used Poisson models to determine the association between fragmentation and adjudicated incident stroke. The average age of participants was 70.5 years; 53% were women, 32% were Black participants, and 16% were participants with fair or poor health. Overall, the adjusted rate of incident stroke was similar for high versus low fragmentation (8.2 versus 8.1 per 1000 person‐years, respectively; P =0.89). Among participants with fair or poor self‐rated health, having high versus low fragmentation was associated with a trend toward a higher adjusted rate of incident strokes (14.8 versus 10.4 per 1000 person‐years, respectively; P =0.067). Among Black participants with fair or poor self‐rated health, having high versus low fragmentation was associated with a higher adjusted rate of strokes (19.3 versus 10.3 per 1000 person‐years, respectively; P =0.02). Conclusions Highly fragmented ambulatory care is independently associated with incident stroke among Black individuals with fair or poor health.

scholarly journals Differences in ambulatory care fragmentation by race

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa M. Kern ◽  
Mangala Rajan ◽  
Lisandro D. Colantonio ◽  
Evgeniya Reshetnyak ◽  
Joanna Bryan Ringel ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Racial Differences ◽  
Household Income ◽  
Emergency Department Visits ◽  
Future Research ◽  
First Year ◽  
Fee For Service ◽  
Tobit Regression ◽  
Annual Household Income

Abstract Background More fragmented ambulatory care (i.e., care spread across many providers without a dominant provider) has been associated with more subsequent healthcare utilization (such as more tests, procedures, emergency department visits, and hospitalizations) than less fragmented ambulatory care. It is not known if race and socioeconomic status are associated with fragmented ambulatory care. Methods We conducted a longitudinal analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, using the REGARDS baseline visit plus the first year of follow-up. We included participants ≥65 years old, who had linked fee-for-service Medicare claims, and ≥ 4 ambulatory visits in the first year of follow-up. We used Tobit regression to determine the associations between race, annual household income, and educational attainment at baseline and fragmentation score in the subsequent year (as measured with the reversed Bice-Boxerman Index). Covariates included other demographic characteristics, medical conditions, medication use, health behaviors, and psychosocial variables. Additional analyses categorized visits by the type of provider (primary care vs. specialist). Results The study participants (N = 6799) had an average age of 73.0 years, 53% were female, and 30% were black. Nearly half had low annual household income (<$35,000) and 41% had a high school education or less. Overall, participants had a median of 10 ambulatory visits to 4 providers in the 12 months following their baseline study visit. Participants in the highest quintile of fragmentation scores had a median of 11 visits to 7 providers. Black race was associated with an absolute adjusted 3% lower fragmentation score compared to white race (95% confidence interval (2% lower to 4% lower; p < 0.001). This difference was explained by blacks seeing fewer specialists than whites. Income and education were not independent predictors of fragmentation scores. Conclusions Among Medicare beneficiaries, blacks had less fragmented ambulatory care than whites, due to lower utilization of specialty care. Future research is needed to determine the effect of fragmented care on health outcomes for blacks and whites.

Abstract P254: Willingness to Restart Statins: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Gabriel S Tajeu ◽  
Lisandro D Colantonio ◽  
Rikki M Tanner ◽  
Keri L Monda ◽  
Ricardo Dent ◽  
...  
Keyword(s):  
Risk Factors ◽  
Side Effects ◽  
Racial Differences ◽  
Statin Treatment ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Stroke Study ◽  
History Of ◽  
Regards Study ◽  
Or History

Introduction: Many patients who discontinue statins due to side effects can restart treatment without the return of side effects. However, statin rechallenge is often met with resistance. Statins are associated with a larger absolute cardiovascular disease (CVD) risk reduction among high risk individuals, but it is unclear whether individuals with higher CVD risk are more willing to be rechallenged. Methods: Between 2014 and 2016, 12,604 participants in theREasons for Geographic and Racial Differences in Stroke study completed a study examination and a questionnaire about their experiences with statins. Of 6,947 participants who reported ever having taken a statin, this analysis included the 688 (9.9%) who reported having discontinued treatment due to side effects and who were not currently taking a statin. We asked participants whether they would be willing to restart a statin, and among those who answered no, we asked whether they were willing to restart at a lower dose or less frequently. Data from the study examination were used to define CVD risk factors and 10-year predicted CVD risk was calculated using the Pooled Cohort risk equations. Results: Participant mean age was 62.4 years, 29.6% were African American, and 66.4% were women. Overall, 26.0% (n=179) of participants were willing to be rechallenged with a statin (Table) . After adjustment for sociodemographic characteristics, older age, cigarette smoking, hypertension, diabetes, or history of CVD were not associated with an increased willingness to be rechallenged with a statin (Table) . Higher 10-year predicted CVD risk was also not associated with willingness to be rechallenged. Conclusions: Over a quarter of participants who discontinued statin treatment due to side effects were willing to be rechallenged. The presence of CVD risk factors and higher predicted CVD risk were not associated with increased willingness to be rechallenged with a statin.

Young Male with Bilateral ICA Dissection: Beyond CADISS Trial

2021 ◽  
pp. 251660852098428
Author(s):  
Vikas Bhatia ◽  
Chirag Jain ◽  
Sucharita Ray ◽  
jay Kumar
Keyword(s):  
Management Strategies ◽  
Young Male ◽  
Acute Onset ◽  
The Body ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke Study ◽  
History Of

Objective: To report a case of young male with stroke and bilateral internal carotid artery (ICA) dissection. Background: Cervical Artery Dissection in Stroke Study trial has provided some insight on management of patients with ICA dissection. However, there is a need to modify the management strategies as per specific clinical scenario. Design/Methods: Case report and literature review. Results: A 45-year-old male presented with 1 month old history of acute onset numbness of right half of the body with slurring of speech. Computed tomography angiography showed complete occlusion of left cervical ICA just beyond origin with presence of fusiform dilatation and spiral flap in right extracranial cervical ICA. The patient was started on antiplatelets and taken for endovascular procedure using 2-mesh-based carotid stents. Patient was discharged after 3 days on antiplatelet therapy. At 1-year follow-up, there were no fresh symptoms. Conclusion: This case emphasizes the role of successful endovascular management of carotid dissection in a young male. These clinical situations may not be fully represented in trials, and a case-based approach is required.

scholarly journals Fifteen-year trends in self-reported racism and link with health and well-being of African Canadian adolescents: a secondary data analysis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Helen U. Okoye ◽  
Elizabeth Saewyc
Keyword(s):  
British Columbia ◽  
Health Outcomes ◽  
Racial Discrimination ◽  
Secondary Analysis ◽  
Secondary Data ◽  
Well Being ◽  
Public Health Action ◽  
Extreme Stress ◽  
Self Rated Health ◽  
African Canadian

Abstract Background We assessed the prevalence and trends in racial discrimination among African Canadian adolescents in British Columbia. The association between racial discrimination and self-rated health, access to mental health services, substance use, suicidal thoughts and attempts, experience of extreme stress, among others were examined within the 2018 dataset. Methods Secondary analysis used the data collected from African Canadian adolescents (n = 2448) as part of the British Columbia Adolescent Health Surveys (2003–2018). We examined whether racial discrimination increased, decreased, or remained stable over time. We evaluated experiences of racial discrimination for all adolescents, and then disaggregated analyses for boys, girls, immigrant, and Canadian-born African adolescents. We used Rao-Scott’s adjusted chi-square to test differences in racial discrimination and adjusted logistic regressions to test trends across survey years, widening or narrowing gaps in racial discrimination, as well as the link to health outcomes. Results Racial discrimination was significantly different across the survey years (Adjusted F = 4.60, p < .01), with the highest percentage of adolescents reporting past year racial discrimination in 2018 (29.9%) and the lowest percentage in 2013 (21.3%). Girls and immigrant African Canadian adolescents were more likely to have experienced racial discrimination. However, girls and Canadian-born adolescents had the highest odds of reporting racial discrimination in 2018 compared to 2003, AOR = 1.85, and 1.58, respectively. The findings reveal significant differences in the experiences of racial discrimination for boys and girls, as well as for immigrant and Canadian-born African adolescents. Significant differences were noted in the link between racial discrimination and self-rated health and engaging in behaviours that might expose them to health risks. The worst negative health outcomes were found for boys and immigrant African Canadian adolescents. Conclusion The study suggests that more than 1 in 4 African Canadian adolescents in British Columbia report racial discrimination, which is an increasing trend in recent years. Those who reported racial discrimination also had the worst adverse health outcomes. There is a need for more public health action to reduce racism, create awareness about the negative health impacts, and provide better support for African Canadian adolescents.

scholarly journals Placing women in Cytogenetics: Lore Zech and the chromosome banding technique

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Felicitas Söhner ◽  
Nils Hansson
Keyword(s):  
Peer Group ◽  
Secondary Analysis ◽  
Qualitative Evaluation ◽  
Banding Technique ◽  
Karolinska Institute ◽  
New Era ◽  
Human Cytogenetics ◽  
History Of ◽  
Witness Interviews

Abstract Background Scholars agree that Torbjörn Caspersson’s lab at the Institute of Medical Cell Research and Genetics at the Karolinska Institute, Sweden, played a key role in the first description of the so-called Q-banding technique. It laid the foundation for a new era of cytogenetic diagnostics and had a lasting impact in several areas of biology and medicine. Methods Based on a mixed-method approach, essential aspects of the history of human cytogenetics are considered via primary and secondary analysis of biographical interviews as well as the qualitative evaluation of bibliometrics. Drawing on interviews with colleagues of lab member Lore Zech (1923–2013) and contemporary publications, this paper illuminates the role of and contribution by Zech: To what extent is the discovery attached to her and what does her legacy look like today? Results The analysis of the contemporary witness interviews with colleagues, students and junior researchers shows that Lore Zech was a committed member of Caspersson's research group. In addition, memoirs by contemporary colleagues describe her outstanding skills in microscopy. The different sources paint a multifaceted picture. In addition to the historians' patterns of interpretation, different legacies can also be found within the peer group. Conclusions We argue that Zech represent the type of scientist who, although her research was acknowledged with several prizes, so far has not been part of the canon of pioneers of international cytogenetics.

scholarly journals How birth outcomes among a cohort of Guatemalan women with a history of prior cesarean vary by mode or birth across different interpregnancy intervals

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Margo S. Harrison ◽  
Ana Garces ◽  
Lester Figueroa ◽  
Jamie Westcott ◽  
Michael Hambidge ◽  
...  
Keyword(s):  
Mode Of Delivery ◽  
Secondary Analysis ◽  
Vaginal Birth ◽  
Global Network ◽  
Vaginal Birth After Cesarean ◽  
Cesarean Birth ◽  
Dilation And Curettage ◽  
History Of ◽  
Interpregnancy Intervals ◽  
Hospital Births

Abstract Objectives Our objectives were to analyze how pregnancy outcomes varied by cesarean birth as compared to vaginal birth across varying interpregnancy intervals (IPI) and determine if IPI modified mode of birth. Methods This secondary analysis used data from a prospective registry of home and hospital births in Chimaltenango, Guatemala from January 2017 through April 2020, through the Global Network for Women’s and Children’s Health Research. Bivariate comparisons and multivariable logistic regression were used to answer our study question, and the data was analyzed with STATA software v.15.1. Results Of 26,465 Guatemalan women enrolled in the registry, 2794 (10.6%) had a history of prior cesarean. 560 (20.1%) women delivered by vaginal birth after cesarean with the remaining 2,233 (79.9%) delivered by repeat cesarean. Repeat cesarean reduced the risk of needing a dilation and curettage compared to vaginal birth after cesarean, but this association did not vary by IPI, all p-values > p = 0.05. Repeat cesarean delivery, as compared to vaginal birth after cesarean, significantly reduced the likelihood a woman breastfeeding within one hour of birth (AOR ranged from 0.009 to 0.10), but IPI was not associated with the outcome. Regarding stillbirth, repeat cesarean birth reduced the likelihood of stillbirth as compared to vaginal birth (AOR 0.2), but again IPI was not associated with the outcome. Conclusion Outcomes by mode of delivery among a Guatemalan cohort of women with a history of prior cesarean birth do not vary by IPI.

scholarly journals A Variance Gamma model for Rugby Union matches

2020 ◽  
Vol 17 (1) ◽  
pp. 67-75
Author(s):  
John Fry ◽  
Oliver Smart ◽  
Jean-Philippe Serbera ◽  
Bernhard Klar
Keyword(s):  
Three Dimensional ◽  
Rugby Union ◽  
Three Dimensional Model ◽  
Gamma Model ◽  
Variance Gamma ◽  
Poisson Models ◽  
History Of ◽  
Bonus Points ◽  
Variance Gamma Model ◽  
Special Case

Abstract Amid much recent interest we discuss a Variance Gamma model for Rugby Union matches (applications to other sports are possible). Our model emerges as a special case of the recently introduced Gamma Difference distribution though there is a rich history of applied work using the Variance Gamma distribution – particularly in finance. Restricting to this special case adds analytical tractability and computational ease. Our three-dimensional model extends classical two-dimensional Poisson models for soccer. Analytical results are obtained for match outcomes, total score and the awarding of bonus points. Model calibration is demonstrated using historical results, bookmakers’ data and tournament simulations.

scholarly journals Divergent poststroke outcomes for black patients

Neurology ◽  
2019 ◽  
Vol 93 (18) ◽  
pp. e1664-e1674 ◽  
Author(s):  
James F. Burke ◽  
Chunyang Feng ◽  
Lesli E. Skolarus
Keyword(s):  
Racial Differences ◽  
Care Setting ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Fee For Service ◽  
Primary Analysis ◽  
Skilled Nursing ◽  
Black Patients ◽  
Postacute Care ◽  
White Patients

ObjectiveTo explore racial differences in disability at the time of first postdischarge disability assessment.MethodsThis was a retrospective cohort study of all Medicare fee-for-service beneficiaries hospitalized with primary ischemic stroke (ICD-9,433.x1, 434.x1, 436) or intracerebral hemorrhage (431) diagnosed from 2011 to 2014. Racial differences in poststroke disability were measured in the initial postacute care setting (inpatient rehabilitation facility, skilled nursing facility, or home health) with the Pseudo-Functional Independence Measure. Given that assignment into postacute care setting may be nonrandom, patient location during the first year after stroke admission was explored.ResultsA total of 390,251 functional outcome assessments (white = 339,253, 87% vs black = 50,998, 13%) were included in the primary analysis. At the initial functional assessment, black patients with stroke had greater disability than white patients with stroke across all 3 postacute care settings. The difference between white and black patients with stroke was largest in skilled nursing facilities (black patients 1.8 points lower than white patients, 11% lower) compared to the other 2 settings. Conversely, 30-day mortality was greater in white patients with stroke compared to black patients with stroke (18.4% vs 12.6% [p < 0.001]) and a 3 percentage point difference in mortality persisted at 1 year. Black patients with stroke were more likely to be in each postacute care setting at 30 days, but only very small differences existed at 1 year.ConclusionsBlack patients with stroke have 30% lower 30-day mortality than white patients with stroke, but greater short-term disability. The reasons for this disconnect are uncertain, but the pattern of reduced mortality coupled with increased disability suggests that racial differences in care preferences may play a role.

Abstract TP207: Sex Differences in Cardiovascular Risk Profiles of Patients with Diabetes in the Greater Cincinnati/ Northern Kentucky Stroke Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Tracy E Madsen ◽  
Jane C Khoury ◽  
Kathleen Alwell ◽  
Charles J Moomaw ◽  
Stacie L Demel ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Stroke Risk ◽  
Negative Impact ◽  
Age Difference ◽  
Risk Profiles ◽  
Chi Square ◽  
Adult Age ◽  
Stroke Study ◽  
Patients With Diabetes ◽  
History Of

Introduction: Diabetes mellitus (DM) carries a greater stroke risk for females than males, possibly because of a difference in cardiovascular risk profiles between females and males with DM. Our aim was to compare the sex-specific risk factor profiles for patients with DM with those without DM among patients with acute ischemic stroke (AIS) in the Greater Cincinnati/ Northern Kentucky Stroke Study (GCNKSS). Methods: The GCNKSS ascertained cases of AIS in 2005 and 2010 among adult (age ≥20 years) residents of a biracial population of 1.3 million. Past and current stroke risk factors, obtained via chart review, were compared between those with and without DM using chi-square to examine bivariate differences and multiple logistic regression to examine sex-specific profiles. P < 0.05 was considered statistically significant. Results: There were 3515 patients with incident AIS; 1919 (55%) were female, 697 (20%) were black, and 1146 (33%) had DM. A lower proportion of females with DM were over 65 years old compared with those without DM. The proportion of males >65 with DM was not significantly different from that of males without DM. Among both females and males with DM, significantly more were Black, obese, and had histories of hypertension, high cholesterol, CAD and myocardial infarction compared to those without DM. In sex-specific adjusted analyses, women with DM were significantly less likely to be over 65 and more likely to have CAD than women without DM, whereas age and CAD were not significant factors in differentiating the profiles of men with and without DM. Conclusions: The result that females had their strokes at a younger age if they had a history of DM, and that no such age difference existed in males, suggests that DM is more severe and has a greater negative impact on females than males. As opposed to males, females with DM were also more likely to have CAD compared to those without DM, consistent with a possible sex difference in the association between DM and vascular disease.

Abstract P181: Contribution of C-Reactive Protein to Racial Disparities in Incident Hypertension: The REasons for Geographic And Racial Differences in Stroke Study (REGARDS)

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Timothy B Plante ◽  
D L Long ◽  
George Howard ◽  
April P Carson ◽  
Virginia J Howard ◽  
...  
Keyword(s):  
Racial Differences ◽  
Medication Use ◽  
Dietary Factors ◽  
C Reactive Protein ◽  
Incident Hypertension ◽  
Black And White ◽  
Reactive Protein ◽  
Stroke Study ◽  
Diet Pattern ◽  
The Impact

Introduction: In the US, blacks are at higher risk of hypertension than whites. The single largest contributor to this disparity is the Southern Diet pattern. Inflammation biomarkers are associated with risk of hypertension, and C-reactive protein (CRP) is higher in blacks than whites. We studied whether elevated CRP in blacks relative to whites contributes to the racial disparity in hypertension in blacks. Methods: We included 6,548 black and white men and women age ≥45 years from the REGARDS cohort without hypertension at baseline ('03-'07) and who completed visit 2 in '13-'16. Incident hypertension was defined as BP ≥140/90 mm Hg or hypertension medication use at visit 2. Using logistic regression, the black:white odds ratio (OR) for incident hypertension was calculated adjusting for age, sex, race, and baseline SBP. We assessed the percent change in the black:white OR for incident hypertension after adding CRP. The 95% CI was calculated using 1,000 bootstrapped samples. We determined the impact of known hypertension risk factors and anti-inflammatory medications on the percent mediation by CRP. Results: Hypertension developed in 46% of blacks and 33% of whites. Adjusting for demographics, the black:white OR (95% CI) was 1.51, which was reduced to 1.46, a 9.3% reduction (95% CI 5.4%, 13.2%) by CRP (Table). In models including exercise, waist circumference, BMI, and depressive symptoms, the percent mediation by CRP was 3.7% (1.0%, 6.4%). Similar patterns were seen for models incorporating socioeconomic factors and medication use. After adding Southern diet pattern and dietary Na/K ratio, CRP no longer attenuated the association (1.3% mediation; -1.5, 4.1). Conclusions: CRP significantly attenuated the black-white difference in incident hypertension; however, once dietary factors were accounted for, CRP had no impact on the black:white difference in incident hypertension. Thus, inflammation as measured by CRP, may be part of the reason that dietary factors influence the black:white disparity in incident hypertension.

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