Effectiveness of Prophylactic Preoperative Antibiotics in Mandible Fracture Repair: A National Database Study

2021 ◽  
pp. 019459982110042
Author(s):  
Elizabeth H. Wick ◽  
Brian Deutsch ◽  
Dorina Kallogjeri ◽  
John J. Chi ◽  
Gregory H. Branham
Keyword(s):  
Relative Risk ◽  
Fracture Repair ◽  
Surgical Revision ◽  
National Database ◽  
Adjusted Relative Risk ◽  
Local Infection ◽  
Database Study ◽  
Mandible Fracture ◽  
Preoperative Antibiotics ◽  
First Time

Objective This is the first database study to assess the effectiveness of prophylactic preoperative antibiotics (PPAs) in mandible fracture repair. Study Design Retrospective cohort. Setting Database study using US inpatient and outpatient insurance claims submitted from July 2006 to March 2015. Methods The IBM MarketScan Commercial Database was queried for adults aged 18 to 64 years who had undergone first-time mandible fracture repair according to Current Procedural Terminology codes for open and closed repair. Primary outcomes included surgical revision, local infection, and osteomyelitis. Rates were compared between cohorts based on whether or not patients had filled antibiotic prescriptions during the preoperative period alone. The effects of drug abuse and type of mandible repair (open vs closed) were explored. Multivariate Poisson regression models were used to calculate adjusted relative risk estimates, and 95% CIs were used to determine statistically significant differences. Results A total of 2676 patients were included, with 847 (31.7%) filling PPAs and 1829 (68.3%) filling no antibiotics. Rates were 38.9% for revision, 5.8% for local infection, and 2.1% for osteomyelitis. After multivariate analysis, exposure to PPAs was not associated with surgical revision (adjusted relative risk, 1.04; 95% CI, 0.94-1.15), local infection (1.16; 0.82-1.64), or osteomyelitis (1.21; 0.68-2.14). Patients were more likely to fill PPAs if they underwent open repair (35.3%) versus closed (26.6%) (proportion difference, 8.7%; 95% CI, 5.2%-12.2%), but exposure to antibiotics did not predict outcomes on subgroup analysis. Conclusion PPAs do not improve mandible repair outcomes, regardless of repair type.

scholarly journals Association of Structural Social Capital and Self-Reported Well-Being among Japanese Community-Dwelling Adults: A Longitudinal Study

2021 ◽  
Vol 18 (16) ◽  
pp. 8284
Author(s):  
Kazuya Nogi ◽  
Haruhiko Imamura ◽  
Keiko Asakura ◽  
Yuji Nishiwaki
Keyword(s):  
Social Capital ◽  
Depressive Symptoms ◽  
Longitudinal Study ◽  
Relative Risk ◽  
Local Community ◽  
Well Being ◽  
Adjusted Relative Risk ◽  
Community Activities ◽  
Self Rated Health ◽  
Structural Social Capital

Previous studies have shown both positive and non-positive associations between social capital and health. However, longitudinal evidence examining its comprehensive effects on well-being is still limited. This study examined whether structural social capital in the local community was related to the later well-being of Japanese people aged 40 or above. A 3.6-year longitudinal study was conducted in a rural Japanese town. “Well-being” was measured using three indicators (happiness, self-rated health, and depressive symptoms), and those who were high in well-being in the baseline 2015 survey and responded to the follow-up 2018 survey were analyzed (n = 1032 for happiness, 938 for self-rated health, and 471 for depressive symptoms). Multilevel Poisson regression analysis adjusted for covariates showed that having contact with fewer neighbors was associated with a decline in happiness at both the community level (adjusted relative risk = 1.64, 95% confidence interval = 1.20–1.63) and the individual level (adjusted relative risk = 1.51, 95% confidence interval = 1.05–2.17), but participation in local community activities was not. The results suggest that dense personal networks might be more important in areas with thriving local community activities, not only for individuals but also for all community members.

scholarly journals Lung Cancer Inequalities in Stage of Diagnosis in Ontario, Canada

2021 ◽  
Vol 28 (3) ◽  
pp. 1946-1956
Author(s):  
Aisha K. Lofters ◽  
Evgenia Gatov ◽  
Hong Lu ◽  
Nancy N. Baxter ◽  
Sara J. T. Guilcher ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Relative Risk ◽  
Late Stage ◽  
Early Stage ◽  
Small Cell ◽  
Cancer Type ◽  
Adjusted Relative Risk ◽  
Late Stage Diagnosis ◽  
Adjusted Model

Lung cancer is the most common cancer and cause of cancer death in Canada, with approximately 50% of cases diagnosed at stage IV. Sociodemographic inequalities in lung cancer diagnosis have been documented, but it is not known if inequalities exist with respect to immigration status. We used multiple linked health-administrative databases to create a cohort of Ontarians 40–105 years of age who were diagnosed with an incident lung cancer between 1 April 2012 and 31 March 2017. We used modified Poisson regression with robust standard errors to examine the risk of diagnosis at late vs. early stage among immigrants compared to long-term residents. The fully adjusted model included age, sex, neighborhood-area income quintile, number of Aggregated Diagnosis Group (ADG) comorbidities, cancer type, number of prior primary care visits, and continuity of care. Approximately 62% of 38,788 people with an incident lung cancer from 2012 to 2017 were diagnosed at a late stage. Immigrants to the province were no more likely to have a late-stage diagnosis than long-term residents (63.5% vs. 62.0%, relative risk (RR): 1.01 (95% confidence interval (CI): 0.99–1.04), adjusted relative risk (ARR): 1.02 (95% CI: 0.99–1.05)). However, in fully adjusted models, people with more comorbidities were less likely to have a late-stage diagnosis (adjusted relative risk (ARR): 0.82 (95% CI: 0.80–0.84) for those with 10+ vs. 0–5 ADGs). Compared to adenocarcinoma, small cell carcinoma was more likely to be diagnosed at a late stage (ARR: 1.29; 95% CI: 1.27–1.31), and squamous cell (ARR: 0.89; 95% CI: 0.87–0.91) and other lung cancers (ARR: 0.93; 95% CI: 0.91–0.94) were more likely to be diagnosed at an early stage. Men were also slightly more likely to have late-stage diagnosis in the fully adjusted model (ARR: 1.08; 95% CI: 1.05–1.08). Lung cancer in Ontario is a high-fatality cancer that is frequently diagnosed at a late stage. Having fewer comorbidities and being diagnosed with small cell carcinoma was associated with a late-stage diagnosis. The former group may have less health system contact, and the latter group has the lung cancer type most closely associated with smoking. As lung cancer screening programs start to be implemented across Canada, targeted outreach to men and to smokers, increasing awareness about screening, and connecting every Canadian with primary care should be system priorities.

scholarly journals Maternal Body Mass Index and Use of Labor Neuraxial Analgesia

2018 ◽  
Vol 129 (3) ◽  
pp. 448-458 ◽  
Author(s):  
Alexander J. Butwick ◽  
Cynthia A. Wong ◽  
Nan Guo
Keyword(s):  
Body Mass Index ◽  
Relative Risk ◽  
Body Mass ◽  
Normal Body Mass Index ◽  
Adjusted Relative Risk ◽  
Obese Women ◽  
Obesity Class ◽  
Normal Body ◽  
Neuraxial Analgesia ◽  
Obese Class

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Neuraxial labor analgesia may benefit obese women by optimizing cardiorespiratory function and mitigating complications related to emergency general anesthesia. We hypothesized that obese women have a higher rate of neuraxial analgesia compared with nonobese parturients. Methods Using U.S. natality data, our cohort comprised 17,220,680 deliveries, which accounts for 61.5% of 28 million births in the United States between 2009 and 2015. We examined the relationships between body mass index class and neuraxial labor analgesia, adjusting for sociodemographic, antenatal, pregnancy, and peripartum factors. Results The study cohort comprised 17,220,680 women; 0.1% were underweight, 12.7% were normal body mass index, 37% were overweight, and 28.3%, 13.5%, and 8.4% were obesity class I, II, and III, respectively. Rates of neuraxial analgesia by body mass index class were as follows: underweight, 59.7% (9,030/15,128); normal body mass index, 68.1% (1,487,117/2,182,797); overweight, 70.3% (4,476,685/6,368,656); obesity class I, 71.8% (3,503,321/4,881,938); obesity class II, 73.4% (1,710,099/2,330,028); and obesity class III, 75.6% (1,089,668/1,442,133). Compared to women with normal body mass index, the likelihood of receiving neuraxial analgesia was slightly increased for overweight women (adjusted relative risk, 1.02; 95% CI, 1.02 to 1.02), obese class I (adjusted relative risk, 1.04; 95% CI, 1.04 to 1.04), obese class II (adjusted relative risk, 1.05; 95% CI, 1.05 to 1.05), and obese class III (adjusted relative risk, 1.06; 95% CI, 1.06 to 1.06). Conclusions Our findings suggest that the likelihood of receiving neuraxial analgesia is only marginally increased for morbidly obese women compared to women with normal body mass index.

Factor affecting length of stay in late preterm infants: an US national database study

2014 ◽  
Vol 28 (5) ◽  
pp. 598-604 ◽  
Author(s):  
Hany Aly ◽  
Heather Hoffman ◽  
Mohamed El-Dib ◽  
Lujain Said ◽  
Mohamed Mohamed
Keyword(s):  
Length Of Stay ◽  
Preterm Infants ◽  
Late Preterm ◽  
National Database ◽  
Database Study ◽  
Late Preterm Infants

Racial and Ethnic Disparities in Adverse Perinatal Outcomes at Term

2021 ◽  
Author(s):  
Jacqueline G. Parchem ◽  
Madeline Murguia Rice ◽  
William A. Grobman ◽  
Jennifer L. Bailit ◽  
Ronald J. Wapner ◽  
...  
Keyword(s):  
Relative Risk ◽  
Primary Outcome ◽  
Perinatal Death ◽  
Ethnic Disparities ◽  
Perinatal Outcomes ◽  
Adjusted Relative Risk ◽  
Racial And Ethnic Disparities ◽  
Risk Pregnancy ◽  
Black Patients ◽  
Adverse Perinatal Outcomes

Objective This study aimed to evaluate whether racial and ethnic disparities in adverse perinatal outcomes exist at term. Study Design We performed a secondary analysis of a multicenter observational study of 115,502 pregnant patients and their neonates (2008–2011). Singleton, nonanomalous pregnancies delivered from 37 to 41 weeks were included. Race and ethnicity were abstracted from the medical record and categorized as non-Hispanic White (White; referent), non-Hispanic Black (Black), non-Hispanic Asian (Asian), or Hispanic. The primary outcome was an adverse perinatal composite defined as perinatal death, Apgar score < 4 at 5 minutes, ventilator support, hypoxic–ischemic encephalopathy, subgaleal hemorrhage, skeletal fracture, infant stay greater than maternal stay (by ≥ 3 days), brachial plexus palsy, or facial nerve palsy. Results Of the 72,117 patients included, 48% were White, 20% Black, 5% Asian, and 26% Hispanic. The unadjusted risk of the primary outcome was highest for neonates of Black patients (3.1%, unadjusted relative risk [uRR] = 1.16, 95% confidence interval [CI]: 1.04–1.30), lowest for neonates of Hispanic patients (2.1%, uRR = 0.80, 95% CI: 0.71–0.89), and no different for neonates of Asian (2.6%), compared with those of White patients (2.7%). In the adjusted model including age, body mass index (BMI), smoking, obstetric history, and high-risk pregnancy, differences in risk for the primary outcome were no longer observed for neonates of Black (adjusted relative risk [aRR] = 1.06, 95% CI: 0.94–1.19) and Hispanic (aRR = 0.92, 95% CI: 0.81–1.04) patients. Adding insurance to the model lowered the risk for both groups (aRR = 0.85, 95% CI: 0.75–0.96 for Black; aRR = 0.68, 95% CI: 0.59–0.78 for Hispanic). Conclusion Although neonates of Black patients have the highest frequency of adverse perinatal outcomes at term, after adjustment for sociodemographic factors, this higher risk is no longer observed, suggesting the importance of developing strategies that address social determinants of health to lessen extant health disparities. Key Points

Mental disorders and their impact on school performance and high school completion by gender in Australia: A matched population-based cohort study

2021 ◽  
pp. 000486742110616
Author(s):  
Rebecca J Mitchell ◽  
Anne McMaugh ◽  
Carolyn Schniering ◽  
Cate M Cameron ◽  
Reidar P Lystad ◽  
...  
Keyword(s):  
High School ◽  
Relative Risk ◽  
Young People ◽  
Confidence Interval ◽  
Mental Disorder ◽  
School Performance ◽  
Adjusted Relative Risk ◽  
Minimum Standard ◽  
Young Males ◽  
Increased Risk

Background: Young people with a mental disorder often perform poorly at school and can fail to complete high school. This study aims to compare scholastic performance and high school completion of young people hospitalised with a mental disorder compared to young people not hospitalised for a mental disorder health condition by gender. Method: A population-based matched case-comparison cohort study of young people aged ⩽18 years hospitalised for a mental disorder during 2005–2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard and generalised linear regression examined risk of not completing high school for young people with a mental disorder compared to matched peers. Results: Young males with a mental disorder had over a 1.7 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.71; 95% confidence interval: [1.35, 2.15]) and reading (adjusted relative risk: 1.99; 95% confidence interval: [1.80, 2.20]) compared to matched peers. Young females with a mental disorder had around 1.5 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.50; 95% confidence interval: [1.14, 1.96]) compared to matched peers. Both young males and females with a disorder had around a three times higher risk of not completing high school compared to peers. Young males with multiple disorders had up to a sixfold increased risk and young females with multiple disorders had up to an eightfold increased risk of not completing high school compared to peers. Conclusion: Early recognition and support could improve school performance and educational outcomes for young people who were hospitalised with a mental disorder. This support should be provided in conjunction with access to mental health services and school involvement and assistance.

scholarly journals Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007−2014: a population-based cohort study from the North Denmark Region

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e014508 ◽  
Author(s):  
Erika Frischknecht Christensen ◽  
Mette Dahl Bendtsen ◽  
Thomas Mulvad Larsen ◽  
Flemming Bøgh Jensen ◽  
Tim Alex Lindskou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Relative Risk ◽  
Population Based ◽  
Ambulance Service ◽  
Annual Number ◽  
Adjusted Relative Risk ◽  
Risk Of Death ◽  
The North ◽  
Emergency Ambulance ◽  
Age And Sex

ObjectiveDemand for ambulances is growing. Nevertheless, knowledge is limited regarding diagnoses and outcomes in patients receiving emergency ambulances. This study aims to examine time trends in diagnoses and mortality among patients transported with emergency ambulance to hospital.DesignPopulation-based cohort study with linkage of Danish national registries.SettingThe North Denmark Region in 2007–2014.ParticipantsCohort of 148 757 patients transported to hospital by ambulance after calling emergency services.Main outcome measuresThe number of emergency ambulance service patients, distribution of their age, sex, hospital diagnoses, comorbidity, and 1-day and 30-day mortality were assessed by calendar year. Poisson regression with robust variance estimation was used to estimate both age-and sex-adjusted relative risk of death and prevalence ratios for Charlson Comorbidity Index (CCI) to allow comparison by year, with 2007 as reference year.ResultsThe annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48.6%, respectively. The proportion of injuries gradually declined, non-specific diagnoses increased, especially the last year. Proportion of patients with high comorbidity (CCI≥3) increased from 6.4% in 2007 to 9.4% in 2014, corresponding to an age- and sex-adjusted prevalence ratio of 1.27 (95% CI 1.16 to 1.39). The 1-day and 30 day mortality decreased from 2.40% to 1.21% and from 5.01% to 4.36%, respectively, from 2007 to 2014, corresponding to age-adjusted and sex-adjusted relative risk of 0.43 (95% CI 0.37 to 0.50) and 0.72 (95% CI 0.66 to 0.79), respectively.ConclusionDuring the 8-year period, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased.

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