Risk of Perforation in the Era of Nonemergent Management for Acute Appendicitis

2019 ◽  
Vol 85 (11) ◽  
pp. 1209-1212
Author(s):  
Kristen M. Westfall ◽  
Anthony G. Charles
Keyword(s):  
Relative Risk ◽  
Acute Appendicitis ◽  
Poisson Regression ◽  
Clinical Laboratory ◽  
Signs And Symptoms ◽  
Regression Modeling ◽  
Cost Of Care ◽  
Bivariate Analysis ◽  
Increased Risk ◽  
Risk Of Rupture

Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to perforation. Recently, studies have suggested nonemergent management of acute appendicitis. Our study aimed to determine changes in risk of rupture and complications in patients with appendicitis, with increasing time from symptom onset to treatment. Retrospective study of patients aged ≥18 years presenting to the University of North Carolina Hospitals with signs and symptoms of acute appendicitis who subsequently underwent appendectomy from 2011 to 2015 was performed. Demographic, clinical, laboratory, and pathologic data were reviewed. Bivariate analysis was performed to assess variables associated with increased risk of perforation. Poisson regression modeling was completed to evaluate the risk of perforation and postoperative abscess based on time from symptoms to treatment. Within our database of 1007 patients, the mean time from onset of symptoms to operative intervention was 3.24 ± 2.2 days. Modified Poisson regression modeling demonstrated the relative risk for perforation increases by 9% (RR 1.09, P < 0.001) for each day delay. Age (RR 1.03), male gender (RR 1.50), temperature on admission (RR 1.32), and the presence of fecalith (RR 1.89) statistically significantly increased the risk of perforation. Furthermore, for each day delay, there is an 8% increased risk of postoperative abscess (RR 1.08, P = 0.027). The relative risk for appendiceal perforation is 9 per cent per day delay with a resultant 8 per cent increased risk of postoperative abscess. Thus, appendectomy for acute appendicitis should remain an emergent procedure, given that delays in operative management lead to complications and increases in cost of care.

Adenocarcinoma of the Appendix in Elderly: Diagnostic dilemma

2020 ◽  
Vol 01 ◽  
Author(s):  
Heba Nofal ◽  
Hayder Al-Masari ◽  
Marwan Mohammed Rashed ◽  
Reham Ainawi ◽  
Desh Idnani ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Laparoscopic Appendectomy ◽  
Signs And Symptoms ◽  
Morbidity And Mortality ◽  
Diagnostic Dilemma ◽  
Increased Risk

: Acute appendicitis in elderly continue to be a diagnostic dilemma as it raises both the suspicion of malignancy and increased risk of morbidity and mortality. Cancers of the appendix are rare and most of them are found accidentally on appendectomies performed for acute appendicitis. When reviewed, majority of the tumors were carcinoid, adenoma, and lymphoma. Adenocarcinomas of appendix are only 0.08% of all cancers and the treatment remains controversial. This paper presents a case of 75-year-old female presented to emergency (ER) with signs and symptoms mimicking acute appendicitis, laparoscopic appendectomy was planned after a CT scan was done as it was suggesting acute appendicitis. The specimen then was sent foe pathology lab and a diagnosis of adenocarcinoma of the appendix was made.

scholarly journals Season of birth and risk of rotavirus diarrhoea in children aged <5 years

2009 ◽  
Vol 137 (7) ◽  
pp. 957-960 ◽  
Author(s):  
C. J. ATCHISON ◽  
C. C. TAM ◽  
B. A. LOPMAN
Keyword(s):  
Relative Risk ◽  
Poisson Regression ◽  
Regression Models ◽  
Cumulative Risk ◽  
First Year ◽  
Season Of Birth ◽  
Increased Risk ◽  
Second Year ◽  
First Year Of Life ◽  
Rotavirus Infections

SUMMARYThis study investigates whether a child's risk of rotavirus diarrhoea is associated with season of birth in England and Wales, countries where rotavirus infections are highly seasonal. Poisson regression models were fitted to weekly counts of laboratory-confirmed rotavirus infections from children aged <5 years born between 1998 and 2007. In the first year of life, the risk of a laboratory-confirmed rotavirus infection was significantly higher for children born in summer compared with winter [relative risk (RR) 2·13, 95% confidence interval (CI) 2·07–2·19]. In the second to fifth years of life, the pattern reversed (second year of life: RR 0·73, 95% CI 0·71–0·75). The cumulative risk up to age 5 years remained significantly higher for children born in summer compared with winter due to the increased risk for summer births during their first year of life. Maternal immunity and age-specific levels of exposure to rotavirus could explain our findings.

scholarly journals Epidemiologic Methods to Estimate Insufficient Sleep in the US Population

2020 ◽  
Vol 17 (24) ◽  
pp. 9337
Author(s):  
Girardin Jean-Louis ◽  
Arlener D. Turner ◽  
Azizi Seixas ◽  
Peng Jin ◽  
Diana M. Rosenthal ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Relative Risk ◽  
Poisson Regression ◽  
Population Level ◽  
Regression Modeling ◽  
Explanatory Role ◽  
Insufficient Sleep ◽  
Relative Risks ◽  
Health And Nutrition ◽  
Hispanic White

This study explored the divergence in population-level estimates of insufficient sleep (<6 h) by examining the explanatory role of race/ethnicity and contrasting values derived from logistic and Poisson regression modeling techniques. We utilized National Health and Nutrition Examination Survey data to test our hypotheses among 20–85 year-old non-Hispanic Black and non-Hispanic White adults. We estimated the odds ratios using the transformed logistic regression and Poisson regression with robust variance relative risk and 95% confidence intervals (CI) of insufficient sleep. Comparing non-Hispanic White (10176) with non-Hispanic Black (4888) adults (mean age: 50.61 ± 18.03 years, female: 50.8%), we observed that the proportion of insufficient sleepers among non-Hispanic Blacks (19.2–26.1%) was higher than among non-Hispanic Whites (8.9–13.7%) across all age groupings. The converted estimated relative risk ranged from 2.12 (95% CI: 1.59, 2.84) to 2.59 (95% CI: 1.92, 3.50), while the estimated relative risks derived directly from Poisson regression analysis ranged from 1.84 (95% CI: 1.49, 2.26) to 2.12 (95% CI: 1.64, 2.73). All analyses indicated a higher risk of insufficient sleep among non-Hispanic Blacks. However, the estimates derived from logistic regression modeling were considerably higher, suggesting the direct estimates of relative risk ascertained from Poisson regression modeling may be a preferred method for estimating population-level risk of insufficient sleep.

Lower perception of pharmacological treatment increases risk of non-adherence to medication

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
CB Graversen ◽  
JB Valentin ◽  
ML Larsen ◽  
S Riahi ◽  
T Holmberg ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
Poisson Regression ◽  
Drug Class ◽  
Angiotensin Receptor Blockers ◽  
Adverse Outcomes ◽  
Adherence To Medication ◽  
Increased Risk ◽  
Patient Reported ◽  
High Level

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data. Purpose To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD. Methods This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega. Results Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67). Conclusion Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class. Abstract Figure. Figre: Multiple adjusted analyses

scholarly journals Circadian misalignment is associated with a high cardiovascular risk among shift workers: is this an opportunity for prevention in occupational settings?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Gamboa Madeira ◽  
C Reis ◽  
T Paiva ◽  
T Roenneberg
Keyword(s):  
Relative Risk ◽  
Sex Education ◽  
Shift Work ◽  
Bivariate Analysis ◽  
Work Schedules ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Great Opportunity ◽  
Circadian Misalignment ◽  
Social Jetlag

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Fundação para a Ciência e Tecnologia (FCT) and Fundo Social Europeu (FSE) Introduction Atypical work schedules encompass more than 20% of the European workforce. The link between shift work and cardiovascular disease (CVD) has been extensively studied being lifestyle behaviours, sleep disruption and circadian misalignment the key mechanisms involved. Social Jetlag (SJL) has been proposed as a proxy for circadian misalignment in epidemiological studies, once it takes into account  individual’s chronotype and working schedules. Therefore we hypothesize that, among  workers under fixed atypical work schedules, those with a greater SJL have a higher CVD risk. Methods A cross-sectional observational study was conducted among blue-collar workers of one retail company. Fixed working schedules were early morning, late evening, and night work. Sociodemographic, occupational, lifestyle and sleep data were collected through questionnaire. SJL was quantified by the difference for mid-sleep points on work- and free-days. Even though SJL is a continuous variable, 3 categories have been used (≤2h; 2-4h; ≥4h). Blood pressure (BP) and the total cholesterol (TC) were assessed. The CVD risk was estimated according to the relative risk SCORE chart. A relative risk≥3 was considered "high CVD risk". Descriptive statistics and bivariate analysis according to the CVD risk (high vs other) was performed. The relationship between SJL and high CVD risk was analysed through logistic binary regression using generalized linear models adjusted for age, sex, education, Body Mass Index, consumptions, sleep duration and quality plus work schedule and seniority. Results Of the 301 workers, 56.1% were male with a mean age of 33.0 ± 9.4years. Average SJL was 1:57 ± 1:38hours with the majority of workers experiencing ≤2h (59.4%) and 8% (n = 24) more than 4h. Less than a half had hypercholesterolemia (48.8%), overweight (37.9%)or hypertensive values (10.6%), however 50.5% were currently smokers. We found a significant trend for hypertension (p = 0.006) and smoking prevalence (p = 0.043) among ordinal SJL categories. A relative "high CVD risk" was found in 20.3% of the sample (n = 61). These workers were significantly older (p &lt; 0.001), less educated (p = 0.003) and slept less hours on workdays (p = 0.021). In the multiple regression analysis, SJL was an independent risk factor for a "high CVD risk" (p = 0.029).The odds of having a "high CVD risk" increased almost thirty per cent  per each additional hour of SJL (OR = 1.29; 95% CI:1.03-1.63), even after adjusting for sociodemographic, lifestyle, sleep and working features. Conclusions We found compelling evidence that a greater SJL was associated with a bigger chance of high CVD risk. From this innovative perspective, the focus is not just on the working schedule itself but also on the worker’s chronotype. These findings suggest that interventions aimed to reduce Social Jetlag, especially in extreme chronotypes and working schedules, poses a great opportunity to minimize the cardiovascular health impact of shift work.

Do Children Who Experience Laryngospasm Have an Increased Risk of Upper Respiratory Tract Infection?

1996 ◽  
Vol 85 (3) ◽  
pp. 475-480. ◽  
Author(s):  
Mark S. Schreiner ◽  
Irene O'Hara ◽  
Dorothea A. Markakis ◽  
George D. Politis
Keyword(s):  
Confidence Interval ◽  
Respiratory Infection ◽  
Odds Ratio ◽  
Signs And Symptoms ◽  
Control Group ◽  
Upper Respiratory Tract ◽  
Upper Respiratory Infection ◽  
Airway Surgery ◽  
Increased Risk ◽  
Upper Respiratory

Background Laryngospasm is the most frequently reported respiratory complication associated with upper respiratory infection and general anesthesia in retrospective studies, but prospective studies have failed to demonstrate any increase in risk. Methods A case-control study was performed to examine whether children with laryngospasm were more likely to have an upper respiratory infection on the day of surgery. The parents of all patients (N = 15,183) who were admitted through the day surgery unit were asked if their child had an active or recent (within 2 weeks of surgery) upper respiratory infection and were questioned about specific signs and symptoms to determine if the child met Tait and Knight's definition of an upper respiratory infection. Control subjects were randomly selected from patients whose surgery had occurred within 1 day of the laryngospasm event. Results Patients who developed laryngospasm (N = 123) were 2.05 times (95% confidence interval 1.21-3.45) more likely to have an active upper respiratory infection as defined by their parents than the 492 patients in the control group (P &lt; or = 0.01). The development of laryngospasm was not related to Tait and Knight's definition for an upper respiratory infection or to recent upper respiratory infection. Children with laryngospasm were more likely to be younger (odds ratio = 0.92, 95% confidence interval 0.87-0.99), to be scheduled for airway surgery (odds ratio = 2.08, 95% confidence interval 1.21-3.59), and to have their anesthesia supervised by a less experienced anesthesiologist (odds ratio = 1.69, 95% confidence interval 1.04-2.7) than children in the control group. Conclusion Laryngospasm was more likely to occur in children with an active upper respiratory infection, children who were younger, children who were undergoing airway surgery, and children whose anesthesia were supervised by less experienced anesthesiologists. Understanding the risk factors and the magnitude of the likely risk should help clinicians make the decision as to whether to anesthetize children with upper respiratory infection.

scholarly journals RESTING HEART RATE MODERATES THE RELATIONSHIP BETWEEN NEUROPSYCHIATRIC SYMPTOMS, MCI, AND ALZHEIMER’S DISEASE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S641-S641
Author(s):  
Shanna L Burke
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Heart Rate ◽  
Relative Risk ◽  
Neuropsychiatric Symptoms ◽  
Cognitive Status ◽  
Resting Heart Rate ◽  
Data Set ◽  
Increased Risk ◽  
The Relationship

Abstract Little is known about how resting heart rate moderates the relationship between neuropsychiatric symptoms and cognitive status. This study examined the relative risk of NPS on increasingly severe cognitive statuses and examined the extent to which resting heart rate moderates this relationship. A secondary analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was undertaken, using observations from participants with normal cognition at baseline (13,470). The relative risk of diagnosis with a more severe cognitive status at a future visit was examined using log-binomial regression for each neuropsychiatric symptom. The moderating effect of resting heart rate among those who are later diagnosed with mild cognitive impairment (MCI) or Alzheimer’s disease (AD) was assessed. Delusions, hallucinations, agitation, depression, anxiety, elation, apathy, disinhibition, irritability, motor disturbance, nighttime behaviors, and appetite disturbance were all significantly associated (p&lt;.001) with an increased risk of AD, and a reduced risk of MCI. Resting heart rate increased the risk of AD but reduced the relative risk of MCI. Depression significantly interacted with resting heart rate to increase the relative risk of MCI (RR: 1.07 (95% CI: 1.00-1.01), p&lt;.001), but not AD. Neuropsychiatric symptoms increase the relative risk of AD but not MCI, which may mean that the deleterious effect of NPS is delayed until later and more severe stages of the disease course. Resting heart rate increases the relative risk of MCI among those with depression. Practitioners considering early intervention in neuropsychiatric symptomology may consider the downstream benefits of treatment considering the long-term effects of NPS.

scholarly journals Development of Postpartum Depression in Pregnant Women with Preeclampsia: A Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Li Chen ◽  
Xiaodan Wang ◽  
Qian Ding ◽  
Nan Shan ◽  
Hongbo Qi
Keyword(s):  
Postpartum Depression ◽  
Infant Development ◽  
Survey Methodology ◽  
Depression Scale ◽  
Bivariate Analysis ◽  
Increased Risk ◽  
Normal Women ◽  
Medical University ◽  
Support Methods ◽  
The Relationship

Background. Postpartum depression (PPD) and preeclampsia (PE) are both common diseases in obstetrics that affect maternal health and infant development. However, the relationship between the two diseases still requires clarification. Objective. The purpose of this study was to (1) determine the incidence rate of PPD in patients with PE and (2) identify the association between the prevalence of PPD and the severity of PE. Methods. We conducted a retrospective analysis of women with and without PE who delivered between January 1, 2017, and August 30, 2018, in the First Affiliated Hospital of Chongqing Medical University. We used a questionnaire survey methodology that included the Edinburgh Postnatal Depression Scale (EPDS) to test the influence of PE on the development of new-onset PPD in the 6 weeks after delivery. We determined PPD based on a score ≥10 on the EPDS. Bivariate analysis was used to compare data between the two groups. Results. A total of 180 women participated in this study. Thirty-five people screened positive for PPD, while the remaining 145 screened negative. The prevalence of PPD was 26.67% (24/90) in patients with PE, which was two times the prevalence in normal women (12.22%). Multiple logistic regression showed that women who had PE had nearly 3-fold increased odds of PPD compared to normal women and the risk of PPD increased with the aggravation of PE. Patients with severe PE had a more than 4-fold increased risk of screening positive for PPD. Conclusion. PE was independently associated with PPD. Furthermore, the risk of PPD seemed to increase with the aggravation of PE. Thus, additional prevention efforts and support methods should be provided for women with PE to reduce the incidence of PPD.

Fatigue: Has It Affected Your Compassion?

2017 ◽  
Vol 36 (5) ◽  
pp. 289-293
Author(s):  
Bobbi S. Greiner ◽  
Gail A. Poskey
Keyword(s):  
Risk Factors ◽  
Compassion Fatigue ◽  
Work Productivity ◽  
Signs And Symptoms ◽  
Poor Quality ◽  
Job Dissatisfaction ◽  
Job Turnover ◽  
Additional Stress ◽  
Increased Risk

AbstractCompassion fatigue is a concept used to describe how various stressors affect individuals who work in health care and other caregiving professions. The results of compassion fatigue may include decreased work productivity, poor quality of care, safety concerns, job dissatisfaction, and job turnover. The NICU professionals are at an increased risk for experiencing compassion fatigue because of the nature of working with critically ill infants, their families, and the additional stress of the workplace. The purpose of this article is for the NICU professional to understand compassion fatigue, identify the risk factors, recognize the signs and symptoms, and offer strategies to implement within the NICU environment.

scholarly journals The association between training load indices and upper respiratory tract infections (URTIs) in elite soccer players

2021 ◽  
pp. 174795412110204
Author(s):  
Caoimhe Tiernan ◽  
Thomas Comyns ◽  
Mark Lyons ◽  
Alan M Nevill ◽  
Giles Warrington
Keyword(s):  
Respiratory Tract ◽  
Signs And Symptoms ◽  
Training Load ◽  
Soccer Players ◽  
Upper Respiratory Tract ◽  
Increased Risk ◽  
Upper Respiratory ◽  
Tract Infections ◽  
Load Indices ◽  
And Training

This study aimed to investigate the association between training load indices and Upper Respiratory Tract Infection (URTI) across different lag periods in elite soccer players. Internal training load was collected from 15 elite soccer players over one full season (40 weeks). Acute, chronic, Acute:Chronic Workload Ratio (ACWR), Exponentially Weighted Moving Averages (EWMA) ACWR, 2, 3 and 4-week cumulative load, training strain and training monotony were calculated on a rolling weekly basis. Players completed a daily illness log, documenting any signs and symptoms, to help determine an URTI. Multilevel logistic regression was used to analyze the associations between training load indices and URTIs across different lag periods (1 to 7-days). The results found a significant association between 2-week cumulative load and an increased likelihood of a player contracting an URTI 3 days later (Odds Ratio, 95% Confidence Interval: OR = 2.07, 95% CI = 0.026-1.431). Additionally, a significant association was found between 3-week cumulative load and a players’ increased risk of contracting an URTI 4 days later (OR = 1.66, 95% CI = 0.013–1.006). These results indicate that accumulated periods of high training load (2- and 3-week) associated with an increased risk of a player contracting an URTI, which may lead to performance decrements, missed training sessions or even competitions.

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