Youth and Young Adult Victims of Interpersonal Violence at LA County + USC Medical Center: A Review of Epidemiology and Recidivism

Youth and young adult interpersonal violence (IPV) is a unique clinical challenge which merits study. This study defined the demographics and clinical outcomes of youth and young adult victims of IPV presenting to our hospital while examining violent injury recidivism. We reviewed patients aged 10 to 30 years admitted to our trauma bay as a victim of gunshot wound (GSW), stabbing wound, or blunt assault from 1998 to 2015 (n = 12,549). Logistic regression analysis was conducted to compare patient mortality across demographic characteristics, and Cox proportional hazards regression was used to determine risk factors for recidivism. Male (92%) and Hispanic patients (75%) constituted the majority of admissions. We observed differences in the mortality rate by gender (9% in males vs 5% in females, P < 0.001), race/ethnicity (5% non-Hispanic white vs 9% Hispanic, P = 0.001), insurance status (3% insured vs 10% uninsured, P < 0.001), and mechanism of injury (13% GSW, 2% stabbing wound, and 0.3% blunt assault, P < 0.001). Male gender, younger age, GSW, and amphetamine placed patients at higher risk for IPV recidivism ( P < 0.05). This study demonstrates the need to better understand how demographics and economics are associated with youth and young adult IPV. In addition, future IPV prevention and intervention initiatives can be tailored to suit the unique needs of our population.

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Abdominal Obesity in Comparison with General Obesity and Risk of Developing Rheumatoid Arthritis in Women

The Journal of Rheumatology ◽

10.3899/jrheum.200056 ◽

2020 ◽

pp. jrheum.200056

Author(s):

Nathalie E. Marchand ◽

Jeffrey A. Sparks ◽

Sara K. Tedeschi ◽

Susan Malspeis ◽

Karen H. Costenbader ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Abdominal Obesity ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Health Study ◽

General Obesity ◽

Middle Aged ◽

Covariate Data ◽

Cox Proportional Hazards Models ◽

Younger Age

Objective Being overweight or obese increases rheumatoid arthritis (RA) risk among women, particularly among those diagnosed at a younger age. Abdominal obesity may contribute to systemic inflammation more than general obesity; thus, we investigated whether abdominal obesity, compared to general obesity, predicted RA risk in 2 prospective cohorts: the Nurses’ Health Study (NHS) and NHS II. Methods We followed 50,682 women (1986–2014) in NHS and 47,597 women (1993–2015) in NHS II, without RA at baseline. Waist circumference (WC), BMI, health outcomes, and covariate data were collected through biennial questionnaires. Incident RA cases and serologic status were identified by chart review. We examined the associations of WC and BMI with RA risk using time-varying Cox proportional hazards models. We repeated analyses restricted to age ≤ 55 years. Results During 28 years of follow-up, we identified 844 incident RA cases (527 NHS, 317 NHS II). Women with WC > 88 cm (35 in) had increased RA risk (HR 1.22, 95% CI 1.06–1.41). A similar association was observed for seropositive RA, which was stronger among young and middle-aged women. Further adjustment for BMI attenuated the association to null. In contrast, BMI was associated with RA (HRBMI ≥ 30 vs < 25 1.33, 95% CI 1.05–1.68) and seropositive RA, even after adjusting for WC, and, as in WC analyses, this association was stronger among young and middle-aged women. Conclusion Abdominal obesity was associated with increased RA risk, particularly for seropositive RA, among young and middle-aged women; however, it did not independently contribute to RA risk beyond general obesity.

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Comorbid Medical Conditions as Predictors of Overall Survival in Glioblastoma Patients

Scientific Reports ◽

10.1038/s41598-019-56574-w ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Matthew T. Carr ◽

Camille J. Hochheimer ◽

Andrew K. Rock ◽

Alper Dincer ◽

Lakshmi Ravindra ◽

...

Keyword(s):

Proportional Hazards ◽

Medical Center ◽

Multivariable Analysis ◽

Cox Proportional Hazards ◽

Individual Characteristic ◽

Prior History ◽

Central Nervous System Tumor ◽

Medical Conditions ◽

Characteristic Analysis ◽

History Of

AbstractGlioblastoma (GBM) is an aggressive central nervous system tumor with a poor prognosis. This study was conducted to determine any comorbid medical conditions that are associated with survival in GBM. Data were collected from medical records of all patients who presented to VCU Medical Center with GBM between January 2005 and February 2015. Patients who underwent surgery/biopsy were considered for inclusion. Cox proportional hazards regression modeling was performed to assess the relationship between survival and sex, race, and comorbid medical conditions. 163 patients met inclusion criteria. Comorbidities associated with survival on individual-characteristic analysis included: history of asthma (Hazard Ratio [HR]: 2.63; 95% Confidence Interval [CI]: 1.24–5.58; p = 0.01), hypercholesterolemia (HR: 1.95; 95% CI: 1.09–3.50; p = 0.02), and incontinence (HR: 2.29; 95% CI: 0.95–5.57; p = 0.07). History of asthma (HR: 2.22; 95% CI: 1.02–4.83; p = 0.04) and hypercholesterolemia (HR: 1.99; 95% CI: 1.11–3.56; p = 0.02) were associated with shorter survival on multivariable analysis. Surgical patients with GBM who had a prior history of asthma or hypercholesterolemia had significantly higher relative risk for mortality on individual-characteristic and multivariable analyses.

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Sodium Fluctuations and Mortality in a General Hospitalized Population

Kidney & Blood Pressure Research ◽

10.1159/000500916 ◽

2019 ◽

Vol 44 (4) ◽

pp. 604-614 ◽

Cited By ~ 3

Author(s):

Gianmarco Lombardi ◽

Pietro Manuel Ferraro ◽

Luca Calvaruso ◽

Alessandro Naticchia ◽

Silvia D’Alonzo ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Admission ◽

Hospital Stay ◽

Proportional Hazards ◽

Medical Center ◽

Cerebrovascular Diseases ◽

Linear Increase ◽

Cox Proportional Hazards ◽

Hospital Death ◽

Cox Proportional Hazards Models

Background/Aims: Aim of our study was to describe the association between natremia (Na) fluctuation and hospital mortality in a general population admitted to a tertiary medical center. Methods: We performed a retrospective observational cohort study on the patient population admitted to the Fondazione Policlinico A. Gemelli IRCCS Hospital between January 2010 and December 2014 with inclusion of adult patients with at least 2 Na values available and with a normonatremic condition at hospital admission. Patients were categorized according to all Na values recorded during hospital stay in the following groups: normonatremia, hyponatremia, hypernatremia, and mixed dysnatremia. The difference between the highest or the lowest Na value reached during hospital stay and the Na value read at hospital admission was used to identify the maximum Na fluctuation. Cox proportional hazards models were used to estimate hazard ratios (HRs) for in-hospital death in the groups with dysnatremias and across quartiles of Na fluctuation. Covariates assessed were age, sex, highest and lowest Na level, Charlson/Deyo score, cardiovascular diseases, cerebrovascular diseases, dementia, congestive heart failure, severe kidney disease, estimated glomerular filtration rate, and number of Na measurements during hospital stay. Results: 46,634 admissions matched inclusion criteria. Incident dysnatremia was independently associated with in-hospital mortality (hyponatremia: HR 3.11, 95% CI 2.53, 3.84, p < 0.001; hypernatremia: HR 5.12, 95% CI 3.94, 6.65, p < 0.001; mixed-dysnatremia: HR 4.94, 95% CI 3.08, 7.92, p < 0.001). We found a higher risk of in-hospital death by linear increase of quartile of Na fluctuation (p trend <0.001) irrespective of severity of dysnatremia (HR 2.34, 95% CI 1.55, 3.54, p < 0.001, for the highest quartile of Na fluctuation compared with the lowest). Conclusions: Incident dysnatremia is associated with higher hospital mortality. Fluctuation of Na during hospital stay is a prognostic marker for hospital death independent of dysnatremia severity.

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Mortality of multiple myeloma diagnosed peri-hospitalization.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e20553 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e20553-e20553

Author(s):

Sam Rubinstein ◽

Elizabeth Sigworth ◽

Sandip Chaugai ◽

Qingxia M Chen ◽

Robert F. Cornell ◽

...

Keyword(s):

Multiple Myeloma ◽

Proportional Hazards ◽

Medical Center ◽

Staging System ◽

Outpatient Setting ◽

Cox Proportional Hazards ◽

Early Mortality ◽

Related Complication ◽

Exact Test ◽

Before And After

e20553 Background: Although modern therapeutics for multiple myeloma (MM) have resulted in improved overall survival (OS) in recent years, patients who present with an acute disease-related complication often have poor outcomes. We sought to compare the OS of patients diagnosed with MM in or shortly after hospitalization with those diagnosed in the outpatient setting. Methods: Patients treated for MM at Vanderbilt University Medical Center (VUMC) between 2000 and 2018 were included. OS was computed from date of diagnosis; patients still alive were censored at date last known alive or of last follow-up. Baseline laboratory and cytogenetic data were used to calculate Revised International Staging System (R-ISS) stage; age was also recorded. Dates of inpatient notes and encounter codes were identified and compared to date of diagnosis to identify patients diagnosed within 30 days of an inpatient stay; patients whose first encounter at VUMC was 30 days or more after their diagnosis date were excluded. Cox proportional hazards modeling was performed to investigate the effects of a diagnosis within 30 days of an inpatient encounter controlling for age and R-ISS on OS. Time-dependent coefficients were included to investigate the effects of a peri-hospitalization diagnosis on OS before and after 90 days. Mortality at 90 days for each group was compared using Fisher’s exact test. Results: A total of 681 patients were included, of whom 81 (11.8%) were diagnosed peri-hospitalization. Patients diagnosed peri-hospitalization had inferior OS within the first 90 days (adjusted HR 8.38, 95% CI 4.22-16.66, p < .001), but not after 90 days (Table). 90-day mortality for patients diagnosed peri-hospitalization was higher than for those not diagnosed peri-hospitalization (21.0% v. 3.3%, p < 0.001). Conclusions: Patients diagnosed with MM peri-hospitalization had high early mortality in this study, although patients surviving more than 90 days have similar mortality to those diagnosed as outpatients. Many factors could account for this finding, such as irreversible renal failure or immobility due to MM, hospital-related complications, or more aggressive MM phenotype. Predictive models of early mortality in MM should account for inpatient status at diagnosis. [Table: see text]

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Relationship between Melanoma Stage at the Diagnosis and Survival During a period of 30 Years (1982-2011)

International Journal of Medicine and Surgery ◽

10.15342/ijms.v5ri.190 ◽

2018 ◽

Vol 5 ◽

Author(s):

Talal M Alkhaldi ◽

Sakhr A Dawari ◽

Sami A Aldaham

Keyword(s):

Cutaneous Melanoma ◽

Proportional Hazards ◽

Secondary Analysis ◽

Cox Proportional Hazards ◽

P Value ◽

Chi Square ◽

Primary Cutaneous Melanoma ◽

Kaplan Meier ◽

Hispanic Patients ◽

The U.S

Melanoma is a malignant tumor of melanocytes, and is a potentially aggressive cancer. The incidence of melanoma is rising at a greater rate than any other cancer in the U.S. The aim of this study was to examine the association between melanoma stage at the time of diagnosis and survival among U.S. adult melanoma patients during 1982-2011. This was a secondary analysis of a non-concurrent cohort study conducted on 185219 U.S. adult patients who were diagnosed with primary cutaneous melanoma between 1982-2011. Chi-square, Kaplan-Meier, and Cox proportional hazards regression were used to analyze the data. Significance was assessed using p-value and 95% confidence interval. Men had more cutaneous melanoma. Black non-Hispanic patients were diagnosed less frequently. Patients who were married or in a domestic partnership were most likely to be diagnosed. The adjusted HR for distant melanoma was 141-fold that of in situ (95% CI 126.38-157.19). The adjusted HR was the highest in the first decade of diagnosis (1.7; 95% CI 1.6 1.75). In conclusion, survival is highly affected by melanoma stage at diagnosis. Black non-Hispanic patients had the lowest hazard ratio of all races. The sample size was large, which enhances the generalizability to the U.S. population.

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Outcomes in Critically Ill Patients Sedated with Intravenous Lormetazepam or Midazolam: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10184091 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4091

Author(s):

Björn Weiss ◽

David Hilfrich ◽

Gerald Vorderwülbecke ◽

Maria Heinrich ◽

Julius J. Grunow ◽

...

Keyword(s):

Cohort Study ◽

Critically Ill ◽

Retrospective Cohort Study ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Medical Center ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model

The benzodiazepine, midazolam, is one of the most frequently used sedatives in intensive care medicine, but it has an unfavorable pharmacokinetic profile when continuously applied. As a consequence, patients are frequently prolonged and more deeply sedated than intended. Due to its distinct pharmacological features, including a cytochrome P450-independent metabolization, intravenous lormetazepam might be clinically advantageous compared to midazolam. In this retrospective cohort study, we compared patients who received either intravenous lormetazepam or midazolam with respect to their survival and sedation characteristics. The cohort included 3314 mechanically ventilated, critically ill patients that received one of the two drugs in a tertiary medical center in Germany between 2006 and 2018. A Cox proportional hazards model with mortality as outcome and APACHE II, age, gender, and admission mode as covariates revealed a hazard ratio of 1.75 [95% CI 1.46–2.09; p < 0.001] for in-hospital mortality associated with the use of midazolam. After additionally adjusting for sedation intensity, the HR became 1.04 [95% CI 0.83–1.31; p = 0.97]. Thus, we concluded that excessive sedation occurs more frequently in critically ill patients treated with midazolam than in patients treated with lormetazepam. These findings require further investigation in prospective trials to assess if lormetazepam, due to its ability to maintain light sedation, might be favorable over other benzodiazepines for sedation in the ICU.

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Testing the efficacy of a hospital-based violence intervention programme: protocol and design

Injury Prevention ◽

10.1136/injuryprev-2020-044026 ◽

2020 ◽

pp. injuryprev-2020-044026

Author(s):

Christopher St. Vil ◽

Erin C Hall ◽

Mildred Sheppard ◽

Mallory Williams

Keyword(s):

Proportional Hazards ◽

Positive Impact ◽

Cox Proportional Hazards ◽

Randomised Control Trial ◽

Institutional Review Boards ◽

Intervention Programme ◽

Violent Injury ◽

Treatment As Usual ◽

Violence Intervention ◽

Trauma Recidivism

IntroductionHospital-based violence intervention programmes (HBVIPs) are a promising strategy to reduce trauma recidivism and promote safety among victims of violent injury. While previous studies have demonstrated cost-effectiveness and positive impact on the lives of victims, there are a number of key limitations in the study designs of this evidence base. This study seeks to address the methodological shortcomings of previous research, determine the efficacy of HBVIPs using a randomised control study design, and provide a better understanding of successful service allocation within an HBVIP.Methods and analysisThe current study is 1 of 12 demonstration projects being implemented around the country with the purpose of bolstering the ability to provide effective, culturally appropriate and trauma-informed services for boys and men harmed by violence. We propose a randomised control trial in which male victims of violence receive one of two interventions: treatment as usual versus enhanced services. The purpose is to determine which intervention leads to reductions in trauma recidivism over the period of 1 year from contact with the programme. Differences will also be monitored on measures of mental health, quality of life and attitudes towards violence. Analyses employed will include Kaplan-Meier analysis and Cox proportional hazards regression with death and recidivism being the outcomes of interest.Ethics and disseminationStudy procedures have been approved by the Institutional Review Boards of the University at Buffalo and four hospitals. Results will be submitted for publication in peer-reviewed journals.

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Improved survival for patients with AIDS-related Kaposi's sarcoma.

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.9.1910 ◽

1994 ◽

Vol 12 (9) ◽

pp. 1910-1916 ◽

Cited By ~ 32

Author(s):

S A Miles ◽

H Wang ◽

R Elashoff ◽

R T Mitsuyasu

Keyword(s):

Prognostic Factors ◽

Kaposi's Sarcoma ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Model ◽

Medical Center ◽

Kaposi’S Sarcoma ◽

Cell Number ◽

Cox Proportional Hazards ◽

Cd4 Cell

PURPOSE We retrospectively analyzed all patients with AIDS-related Kaposi's sarcoma (AIDS-KS) seen at one large California medical center to delineate factors that may have contributed to a relative decline in survival. METHODS Potential prognostic factors were analyzed individually, using the Cox proportional hazards regression model, for their association with survival. After a stepwise Cox regression procedure was applied to those factors that showed a significant effect on survival, a subset of factors that best predicted survival was identified. We then quantified the effect of the year of diagnosis on survival using a univariate Cox model. Next, we combined the year of diagnosis with the subset of prognostic factors previously identified into the Cox model to examine survival after adjustment for the prognostic factors. Survival distribution was estimated by the Kaplan-Meier method, and the 95% confidence interval for the median survival was computed using the modified reflected method. RESULTS In 688 patients, we identified four baseline variables that best predicted survival: CD4 cell number, hematocrit, number of KS lesions, and body mass index (BMI). Adjusted for these predictive factors, there was a significant improvement in survival for patients with AIDS-KS over the last 6 years. CONCLUSION Contrary to prior reports, survival has increased for patients with AIDS-KS. The apparent increase in observed mortality is most likely due to a decline in the CD4 cell number at presentation.

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Persistence With Human Immunodeficiency Virus Pre-exposure Prophylaxis in the United States, 2012–2017

Clinical Infectious Diseases ◽

10.1093/cid/ciaa037 ◽

2020 ◽

Cited By ~ 1

Author(s):

Ya-Lin A Huang ◽

Guoyu Tao ◽

Dawn K Smith ◽

Karen W Hoover

Keyword(s):

Human Immunodeficiency Virus ◽

Proportional Hazards ◽

Patient Characteristics ◽

The United States ◽

Cox Proportional Hazards ◽

Research Database ◽

Female Sex ◽

Younger Age ◽

Immunodeficiency Virus ◽

Exposure Prophylaxis

Abstract Background Daily oral pre-exposure prophylaxis (PrEP) is highly effective in preventing human immunodeficiency virus (HIV) infection if used adherently throughout periods of HIV risk. We estimated PrEP persistence among cohorts of persons with commercial or Medicaid insurance. Methods We analyzed data from the IBM MarketScan Research Database to identify persons aged 18–64 years who initiated PrEP between 2012 and 2017. We assessed PrEP persistence by calculating the time period that each person continued filling PrEP prescriptions until there was a gap in prescription fills > 30 days. We used Kaplan-Meier time-to-event methods to estimate the proportion of PrEP users who persisted with PrEP at 3, 6, and 12 months after initiation, and constructed Cox proportional hazards models to determine patient characteristics associated with nonpersistence. Results We studied 11 807 commercially insured and 647 Medicaid insured persons with PrEP prescriptions. Commercially insured patients persisted for a median time of 13.7 months (95% confidence interval [CI], 13.3–14.1), compared to 6.8 months (95% CI, 6.1–7.6) among Medicaid patients. Additionally, female sex, younger age, residence in rural location, and black race were associated with shorter persistence. After adjusting for covariates, we found that female sex (hazard ratio [HR], 1.81 [95% CI, 1.56–2.11]) and younger age (18–24 years: HR, 2.38 [95% CI, 2.11–2.69]) predicted nonpersistence. Conclusions More than half of commercially insured persons who initiated PrEP persisted with it for 12 months, compared to a third of those with Medicaid. A better understanding of reasons for nonpersistence is important to support persistent PrEP use and to develop interventions designed for the diverse needs of at-risk populations.

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Impact of hepatic function and tumor extent on survival in patients with unresectable hepatocellular carcinoma treated with liver-directed therapies.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.358 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 358-358

Author(s):

Marisa E. Hill ◽

Sanjib Basu ◽

Bulent Arslan

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Liver Function ◽

Proportional Hazards ◽

Medical Center ◽

Cox Proportional Hazards ◽

Rank Test ◽

Unresectable Hepatocellular Carcinoma ◽

The Difference ◽

Tumor Extent

358 Background: Transarterial chemoembolization (TACE) has demonstrated survival advantage over best supportive care in patients with unresectable hepatocellular carcinoma (HCC), and non-randomized data suggests that survival in HCC treated with yttrium-90 radioembolization (90Y) is similar to that achieved with TACE. Eighty to 90% of patients with HCC have underlying cirrhosis, so survival analyses of liver-directed treatments (LDT) should take into account both tumor extent and liver function. Methods: We conducted a retrospective study to evaluate the effect of tumor extent and liver function on the survival of patients treated with TACE and/or 90Y for HCC. Patients with unresectable HCC treated at Rush University Medical Center between 2002 and 2014 were analyzed. Liver function parameters prior to first treatment were recorded for each patient, and survival measured from time of first treatment to death or last follow up was calculated. Statistical inference for overall survival was performed using Kaplan-Meier method, log-rank test, and Cox proportional hazards regression model. Results: The difference in overall survival between patients with unilobar disease and with bilobar disease (n=35 and 23, median survival of 19.4 and 12.8 months, respectively) was not found to be significant (p=0.838). However, the difference in overall survival among patients with Child Pugh A (n=22, median not reached), B (n=30, median= 11.4 months) and C (n=6, median=3.8 months) cirrhosis was strongly significant (p < 0.001). In a multivariate Cox proportional hazards analysis, the association of Child class (coded on an integer scale) with overall survival, adjusted by the extent of the disease, continued to be strongly significant (HR=1.93, p < 0.001). Conclusions: Liver function may be just as important a determinant of survival in patients undergoing liver directed treatments for HCC as is extent of disease. Larger, prospective studies are needed to confirm this hypothesis.

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