scholarly journals Perinatal Asphyxia: Factors Associated with Noncompliance in the specialized Outpatient Treatment

2019 ◽  
Vol 21 (2) ◽  
pp. 175
Author(s):  
Záira Moura da Paixão Freitas ◽  
Carlos Umberto Pereira ◽  
Débora Moura da Paixão Oliveira ◽  
Clarissa Melo Menezes ◽  
Edênya Santos da Silva Félix ◽  
...  
Keyword(s):  
Outpatient Treatment ◽  
Perinatal Asphyxia ◽  
Health Planning ◽  
Birth Asphyxia ◽  
Outpatient Services ◽  
Care Clinic ◽  
Factors Associated ◽  
Increased Risk ◽  
Study Results

Abstract Perinatal asphyxia is a leading cause of preventable brain injury. Between four and nine million newborns develop birth asphyxia. It is estimated that 1.2 million evolve to death and at least the same number develops important disabling neurological sequels. These children need to be accompanied by experts, especially in the first year of life. The continuity of care after hospital discharge should be guaranteed so that there is follow-up care to those who are at increased risk of morbidity and mortality. To identify factors associated with dropout of outpatient specialized treatment of children diagnosed with perinatal asphyxia. The study was conducted in neonatal care clinic specializing in a reference hospital for high-risk births in the state of Sergipe. 98 children with perinatal asphyxia discharged from the Neonatal Intensive Care Unit of this hospital participated in the study. Results: the children who were followed up were  between two months to two years old, and predominantly male 69. Ten children were discharged at age 24 months and had important neurological sequels. Thirty-one children  were discharged aged  10 to 20 months without deficit and 35  remained in regular monitoring. There was a record of 22 cases of noncompliance, before the sixth medical consultation. Among the reasons for the doctor following the abandonment of the follow-up service, there were more reasons regarding the absence of symptoms (and distance from home). The absence of symptoms and distance from the capital were associated with the abandonment of outpatient treatment of anoxic children. Outpatient services should be organized to minimize the follow-up abandon situations. Keywords: Ambulatory Care. Asphyxia Neonatorum. Health Planning. ResumoAsfixia perinatal é uma das principais causas de lesão cerebral evitável. Cerca de quatro a nove milhões de recém-nascidos desenvolvem asfixia ao nascer. Estima-se que 1,2 milhão evoluem para óbito e desenvolvem sequelas neurológicas incapacitantes. Essas crianças precisam ser acompanhadas por especialistas, principalmente no primeiro ano de vida. A continuidade da assistência após a alta hospitalar deve ser garantida para que haja seguimento do cuidado aos que apresentam maior risco de morbimortalidade. Identificar fatores associados ao abandono do tratamento ambulatorial especializado de crianças diagnosticadas com asfixia perinatal. Estudo desenvolvido no ambulatório de assistência neonatal de uma maternidade referência para partos de alto risco no estado de Sergipe. Participaram do estudo 98 crianças anoxiadas egressas da Unidade de Terapia Intensiva Neonatal dessa maternidade. As crianças acompanhadas tinham entre dois meses a dois anos, predominantemente do sexo masculino 69. Dez crianças receberam alta por idade aos 24 meses, apresentando sequelas neurológicas importantes. Trinta e uma crianças receberam alta entre 10 a 20 meses sem déficit e 35 mantiveram-se em acompanhamento regular. Houve o registro de 22 casos de abandono do tratamento, antes da sexta consulta médica. Entre os motivos para o abandono do seguimento no serviço de follow-up, predominaram a ausência de sintomas e a distância do domicílio. A ausência de sintomas e a distância da capital estiveram associadas ao abandono de tratamento ambulatorial de crianças anoxiadas. Os serviços ambulatoriais devem estar organizados para minimizar situações de abandono do seguimento. Palavras-chave: Assistência Ambulatorial. Asfixia Neonatal. Planejamento em Saúde.

Factors Associated with Attrition of Adult Participants in a Longitudinal Database: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study

2019 ◽  
Vol 41 (2) ◽  
pp. 270-279 ◽  
Author(s):  
Alyssa M Bamer ◽  
Kara McMullen ◽  
Nicole Gibran ◽  
Radha Holavanahalli ◽  
Jeffrey C Schneider ◽  
...  
Keyword(s):  
Independent Living ◽  
Model System ◽  
Stepwise Logistic Regression ◽  
Research Projects ◽  
Related Factors ◽  
Time Points ◽  
Factors Associated ◽  
Increased Risk ◽  
Study Results

Abstract Participant attrition in longitudinal studies can lead to substantial bias in study results, especially when attrition is nonrandom. A previous study of the Burn Model System (BMS) database prior to 2002 identified participant and study-related factors related to attrition. The purpose of the current study was to examine changes in attrition rates in the BMS longitudinal database since 2002 and to revisit factors associated with attrition. Individuals 18 years and older enrolled in the BMS database between 2002 and 2018 were included in this study. Stepwise logistic regression models identified factors significantly associated with attrition at 6, 12, and 24 months postburn injury. The percentage of individuals lost to follow-up was 26% at 6 months, 33% at 12 months, and 42% at 24 months. Factors associated with increased risk of loss to follow-up across two or more time points include male sex, lower TBSA burn size, being unemployed at the time of burn, shorter duration of acute hospital stay, younger age, not having private health insurance or workers’ compensation, and a history of drug abuse. Retention levels in the BMS have improved by at least 10% at all time points since 2002. The BMS and other longitudinal burn research projects can use these results to identify individuals at high risk for attrition who may require additional retention efforts. Results also indicate potential sources of bias in research projects utilizing the BMS database.

scholarly journals Factors associated with being lost to follow-up before completing tuberculosis treatment: analysis of surveillance data

2012 ◽  
Vol 141 (6) ◽  
pp. 1223-1231 ◽  
Author(s):  
E. R. C. MILLETT ◽  
D. NOEL ◽  
P. MANGTANI ◽  
I. ABUBAKAR ◽  
M. E. KRUIJSHAAR
Keyword(s):  
Surveillance Data ◽  
Sputum Smear ◽  
Tuberculosis Patients ◽  
Factors Associated ◽  
Increased Risk ◽  
Patients At Risk ◽  
Treatment Analysis ◽  
The Uk ◽  
Lost To Follow Up

SUMMARYCompletion of treatment is key to tuberculosis control. Using national surveillance data we assessed factors associated with tuberculosis patients being lost to follow-up before completing treatment (‘lost’). Patients reported in England, Wales and Northern Ireland between 2001 and 2007 who were lost 12 months after beginning treatment were compared to those who completed, or were still on treatment, using univariable and multivariable logistic regression. Of 41 120 patients, men [adjusted odds ratio (aOR) 1·29; 95% confidence interval (CI) 1·23–1·35], 15- to 44-year-olds (P<0·001), and patients with pulmonary sputum smear-positive disease (aOR 1·25, 95% CI 1·12–1·45) were at higher risk of being lost. Those recently arrived in the UK were also at increased risk, particularly those of the White ethnic group (aOR 6·39, 95% CI 4·46–9·14). Finally, lost patients had a higher risk of drug resistance (aOR 1·41, 95% CI 1·17–1·69). Patients at risk of being lost require enhanced case management and novel case retention methods are needed to prevent this group contributing towards onward transmission.

scholarly journals RISK FACTORS ASSOCIATED WITH NEONATAL HYPOGLYCEMIA

2006 ◽  
Vol 13 (04) ◽  
pp. 687-690
Author(s):  
MUNIR AKMAL LODHI ◽  
GHULAM SHABBIR ◽  
NASIR ALI SHAH
Keyword(s):  
Risk Factors ◽  
Low Birthweight ◽  
Birth Asphyxia ◽  
Neonatal Hypoglycemia ◽  
Factors Associated ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Associated Risk Factors ◽  
Glucose Estimation

Objectives: Recurrent episodes of neonatal hypoglycemia are strongly associated with long termphysical and neuro-developmental deficits. (1) Moreover in neonates hypoglycemia can be overlooked as it may havenonspecific symptoms only. (2) This study was therefore carried out to analyse the risk factors associated with neonatalhypoglycemia and to evaluate the risk factors which have predictive value in its diagnosis. .Design: Based case controlstudy. Period: Six months from January 2005 to June 2005. Setting CMH Pano Aqil. Material and Methods: 385newborns were studied. Newborns of both civilians as well as military personnel were included in the study. 11newborns were excluded. Out of remaining 347 patients 101 were found to be hypoglycemia. Five risk factors (low birthweight, Birth Asphyxia, Neonatal sepsis, Meconeum aspiration syndrome delayed feeding ) strongly and independentlypredicated the risk of hypoglycemia. Results: The most common associated risk factor was low birth weight (47.47%)followed by delayed feeding (46.29%). Blood sampling for glucose estimation was done at birth / admission at 6 hours,12 hours, 24 hours and 48 hours. Test was initially performed by glucometer, the reading which were confirmed bylaboratory testing in border line case. Conclusions: In neonates with associated risk factors it is cost affective to carryout blood glucose levels at the time of birth and follow up readings taken as indicated by clinical progress later on.

scholarly journals Impact of Mobile Health Devices for the Detection of Atrial Fibrillation: Systematic Review

10.2196/26161 ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. e26161
Author(s):  
Tom E Biersteker ◽  
Martin J Schalij ◽  
Roderick W Treskes
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Mobile Health ◽  
Standard Care ◽  
Detection Rate ◽  
Increased Risk ◽  
Study Results ◽  
Statistical Heterogeneity ◽  
Study Participants

Background Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is increasing. Early diagnosis is important to reduce the risk of stroke. Mobile health (mHealth) devices, such as single-lead electrocardiogram (ECG) devices, have been introduced to the worldwide consumer market over the past decade. Recent studies have assessed the usability of these devices for detection of AF, but it remains unclear if the use of mHealth devices leads to a higher AF detection rate. Objective The goal of the research was to conduct a systematic review of the diagnostic detection rate of AF by mHealth devices compared with traditional outpatient follow-up. Study participants were aged 16 years or older and had an increased risk for an arrhythmia and an indication for ECG follow-up—for instance, after catheter ablation or presentation to the emergency department with palpitations or (near) syncope. The intervention was the use of an mHealth device, defined as a novel device for the diagnosis of rhythm disturbances, either a handheld electronic device or a patch-like device worn on the patient’s chest. Control was standard (traditional) outpatient care, defined as follow-up via general practitioner or regular outpatient clinic visits with a standard 12-lead ECG or Holter monitoring. The main outcome measures were the odds ratio (OR) of AF detection rates. Methods Two reviewers screened the search results, extracted data, and performed a risk of bias assessment. A heterogeneity analysis was performed, forest plot made to summarize the results of the individual studies, and albatross plot made to allow the P values to be interpreted in the context of the study sample size. Results A total of 3384 articles were identified after a database search, and 14 studies with a 4617 study participants were selected. All studies but one showed a higher AF detection rate in the mHealth group compared with the control group (OR 1.00-35.71), with all RCTs showing statistically significant increases of AF detection (OR 1.54-19.16). Statistical heterogeneity between studies was considerable, with a Q of 34.1 and an I2 of 61.9, and therefore it was decided to not pool the results into a meta-analysis. Conclusions Although the results of 13 of 14 studies support the effectiveness of mHealth interventions compared with standard care, study results could not be pooled due to considerable clinical and statistical heterogeneity. However, smartphone-connectable ECG devices provide patients with the ability to document a rhythm disturbance more easily than with standard care, which may increase empowerment and engagement with regard to their illness. Clinicians must beware of overdiagnosis of AF, as it is not yet clear when an mHealth-detected episode of AF must be deemed significant.

Neurodevelopmental Outcomes after Neonatal Mechanical Ventilation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Eman Ahmed Zaky ◽  
Hebatallah AM Shaaban ◽  
Mohamed OA Dawoud ◽  
Kareem SEF Madbouly ◽  
Shaymaa M Deifalla
Keyword(s):  
Mechanical Ventilation ◽  
Rating Scale ◽  
Neurodevelopmental Outcomes ◽  
Neurodevelopmental Delay ◽  
Increased Risk ◽  
Study Results ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Significant Difference

Abstract Background A majority of extremely preterm infants are treated with mechanical ventilation, which is associated with an increased risk for future development of chronic lung disease, neonatal brain damage, and neurodevelopmental impairments. Objectives The aim of the current study was to evaluate the current and follow up neurodevelopmental status of an Egyptian sample of newly and previously discharged mechanically ventilated infants following them up for a period of 6 months for the earlier group and a year for the latter. Patients and Methods The current study was designed to be a descriptive study with retrospective (50 infants) and prospective (50 infants) domains. It was carried out on 100 neonates who were recruited from the Pediatric Neonatology Clinic, Children's Hospital and Neonatal Intensive Care Unit, Ain Shams University using clinical evaluation, Bayley Scales of Infant Development, and Childhood Autism Rating Scale (CARS).. Results There was statistically significant negative correlation between CARS score and Bayley Scale by using Composite Score (Cognitive, Language and Motor) on first assessment and follow up in the Prospective group while no correlation was found in the retrospective group. The study results showed that there was no statistical significant difference between two groups as regards gestational age, gender, residency, consanguinity, maternal disease, maturity, mode of delivery, respiratory distress, duration of stay in NICU, duration on mechanical ventilation, weight on admission, audiometry and fundus examination (P &gt; 0.05). Conclusion Using a mechanical ventilator in the neonatal period for a prolonged duration increased the risk for ASD and neurodevelopmental delay. Future studies on large samples are recommended from multicenters to confirm the validity of such findings, Bayley scale is a predicative for neurodevelopmental delay in neonates with long duration stay at NICU especially preterms with low birth weight.

Mortality and Morbidity in Infants Less Than 1,001 Grams Birth Weight

PEDIATRICS ◽  
1982 ◽  
Vol 69 (1) ◽  
pp. 21-26
Author(s):  
John M. Driscoll ◽  
Yvonne T. Driscoll ◽  
Mary E. Steir ◽  
Raymond I. Stark ◽  
Barbara C. Dangman ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Perinatal Asphyxia ◽  
Birth Asphyxia ◽  
Retrolental Fibroplasia ◽  
Mortality And Morbidity ◽  
Intellectual Deficit ◽  
Static Encephalopathy ◽  
A Prospective Study ◽  
Lost To Follow Up

A prospective study of 54 infants with birth weights of 1,000 gm or less was conducted over a period of two years. Of the 26 infants who survived, 24 weighed between 750 and 1,000 gm; two infants died after discharge and one was lost to follow-up, leaving 23 in whom serial observations were made over 18 months to 3 years of age. The incidence of neurologic deficit in these infants was 17% and of intellectual deficit, 13%. Of the four who were abnormal neurologically, two had spastic quadriparesis, one static encephalopathy, and one hydrocephalus secondary to intraventricular hemorrhage. The three with intellectual deficit had a developmental quotient &lt;85. Of the perinatal factors examined, only birth asphyxia correlated significantly with both neonatal mortality and subsequent morbidity. Six (26%) of the surviving infants had mild, nonblinding retrolental fibroplasia; only one of them had a significant refractive error that required corrective lenses for vision. Sepsis was a significant contributor to neonatal mortality in ten of 28 infants who died, but was detected in only one survivor. Although the prognosis for the infant weighing 1,000 gm or less at delivery has improved significantly, there is promise for still further improvement by reducing perinatal asphyxia.

scholarly journals 717. Cumulative Incidence of Asthma/Wheezing Among Neonates/Infants/Toddlers Clinically Diagnosed with Respiratory Syncytial Virus Infection in the United States: A Retrospective Database Analysis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S257-S258
Author(s):  
Veronique Wyffels ◽  
Maartje Smulders ◽  
Sandra Gavart ◽  
Debasish Mazumder ◽  
Rohit Tyagi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Respiratory Syncytial Virus ◽  
Cumulative Incidence ◽  
The United States ◽  
Term Infants ◽  
Increased Risk ◽  
Study Results ◽  
Syncytial Virus ◽  
Time Required

Abstract Background The role of respiratory syncytial virus (RSV) in the development of asthma/wheezing (AW) has been evaluated in several studies, mostly among pre-term infants or among infants after developing severe RSV-related disease. We describe the cumulative incidence (CI) of AW among hospitalized/ambulatory neonates/infants/toddlers after RSV/bronchiolitis infection diagnosis, in a large clinical database. Methods Using deidentified Optum Integrated commercial claims and electronic medical records, we identified patients (0–&lt;3 years old) with a first clinical diagnosis of RSV/bronchiolitis infection from 01 January 2008–31 March 2016. Patients with a diagnosis of asthma/wheezing ≤30 days after first RSV/bronchiolitis diagnosis were excluded. Three cohorts were created with 1/3/5 years of follow-up time required, respectively. Patients were grouped by specific high-risk factors (HRF+/−), including pre-term births and predefined pre-existing disease. Descriptive statistics are reported, with comparisons made by logistic regression analyses. Results 9,811/4,524/1,788 patients with RSV/bronchiolitis infection and HRF− were included in the 1/3/5-years follow-up cohorts. 14.9%/28.2%/36.3% had AW events by the end of follow-up in the three cohorts. 6.5%/6.9%/5.8% were hospitalized for RSV/bronchiolitis. 3,030/1,378/552 patients with RSV/bronchiolitis infection and HRF+ were included in the 1/3/5-years follow-up cohorts. 18.1%/32.9%/37.9% had AW events by the end of follow-up in the three cohorts. 11.4%/11.1%/11.6% were hospitalized for RSV/bronchiolitis. The CI rates of AW in the 1/3/5-year HRF+/− cohorts, stratified by hospitalized for RSV/bronchiolitis Y/N, are shown in Figure 1. Logistic regression confirmed that hospitalization for RSV/bronchiolitis was associated with an increased (P &lt; 0.05) likelihood of AW, for HRF+ and HRF− patients at each follow-up year. Conclusion Thirty-eight percent of RSV/bronchiolitis infants/neonates/toddlers HRF+, and 36% among infants/neonates/toddlers HRF−, developed AW in the 5 years after first RSV/bronchiolitis diagnosis. RSV/bronchiolitis hospitalization was associated with a significantly increased risk of AW development in 1/3/5 years of follow-up; confirming previous observational study results. Disclosures V. Wyffels, Janssen: Employee, Salary. M. Smulders, SmaertAnalyst: Consultant, Consulting fee. S. Gavart, Janssen: Employee, Salary. D. Mazumder, SmartAnalyst: Consultant, Consulting fee. R. Tyagi, SmartAnalyst: Consultant, Consulting fee. N. Gupta, SmartAnalyst: Consultant, Consulting fee. R. Fleischhackl, Janssen: Employee, Salary.

P5341Predictive factors of atherosclerotic cardiovascular diseases events in HIV-HVC co-infected patients: results from hepavih ANRS co13 cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Boccara ◽  
B K Tan ◽  
M Chalouni ◽  
D Salmon Ceron ◽  
A Cinaud ◽  
...  
Keyword(s):  
Viral Load ◽  
Sustained Viral Response ◽  
Biological Data ◽  
Personal History ◽  
Hiv Viral Load ◽  
Factors Associated ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
History Of

Abstract Introduction Several studies highlighted an increased risk of cardiovascular disease (CVD) in HIV-HCV co-infected patients without clearly identifying specific virologic factors associated with atherosclerotic CVD (ASCVD) events. Purpose Hence, we analyzed data collection from the French nationwide ANRS CO13 HEPAVIH cohort to determine the incidence of ASCVD events in HIV-HCV co-infected patients and the predictive factors associated with its occurrence. Methods The French multicenter nationwide ANRS CO13 HEPAVIH clinic-based cohort collected prospective clinical and biological data from HIV-HCV co-infected patients followed-up in 28 different university hospitals between December 2005 to November 2016. Participants with at least one year of follow-up were included. Primary outcome was the occurrence of major ASCVD events (cardiovascular death, acute coronary syndrome, coronary revascularization and stroke). Secondary outcomes were total ASCVD events including major ASCVD events and minor ASCVD events (peripheral arterial disease [PAD]). Incidence rates were estimated using Aalen-Johansen method and factors associated with ASCVD identified with Cox proportional hazards models. Results A total of 1213 patients were included: median age 45.4 years [42.1–49.0], 70.3% men, current smoking 70.2%, overweight 19.5%, liver cirrhosis 18.9%, chronic alcohol consumption 7.8%, diabetes mellitus (5.9%), personal history of CVD 2.7%, and statins use 4.1%. After a median follow-up of 5.1 years [3.9–7.0], 44 participants experienced at least one ASCVD event (26 major ASCVD event, and 20 a minor event). Incidences for total, major and minor ASCVD events were of 6.98 [5.19; 9.38], 4.01 [2.78; 6.00], and 3.17 [2.05; 4.92] per 1000 person-years, respectively. Personal history of CVD (Hazard Ratio (HR)=13.94 [4.25–45.66]), high total cholesterol (HR=1.63 [1.24–2.15]), low HDL cholesterol (HR=0.08 [0.02–0.34]) and undetectable HIV viral load (HR=0.41 [0.18–0.96]) were identified as independent factors associated with major ASCVD events while cirrhosis status, liver fibrosis and HCV sustained viral response were not. Cumulative incidence of CV events Conclusion HIV-HCV co-infected patients experience a high incidence of ASCVD events both coronary and peripheral artery diseases. Traditional CV risk factors are the main determinants of ASCVD whereas undetectable HIV viral load seems to be protective. Management of cholesterol abnormalities and controlling viral load are essential to modify this high cardiovascular risk. Acknowledgement/Funding Agence Natoinale de Recherche sur le SIDA et les Hépatites virales

A Systematic Literature Review and Meta-Analysis of the Risk of Thromboembolic Events in Patients with Immune Thrombocytopenia (ITP) in Observational Studies.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2187-2187 ◽  
Author(s):  
Wendy Langeberg ◽  
Melissa Eisen ◽  
W. Marieke Schoonen ◽  
Laurence Gamelin ◽  
Scott Stryker
Keyword(s):  
Relative Risk ◽  
Observational Studies ◽  
Immune Thrombocytopenia ◽  
Meta Analysis ◽  
Employment Equity ◽  
Effect Model ◽  
Increased Risk ◽  
Study Results ◽  
Equity Ownership

Abstract Abstract 2187 Introduction: A recent systematic review and meta-analysis of randomized controlled trials of thrombopoietin-receptor agonists (TPOr), romiplostim and eltrombopag, in adult thrombocytopenic patients found a numerically but non-statistically significant increase in the occurrence of thromboembolism (TE) among treated patients compared to those not treated with TPOr.1 To put these results into context and to estimate the baseline risk of TE in ITP patients, this study will summarize results of observational studies that reported the risk of venous thrombembolism (VTE) or arterial thrombembolism (ATE) in patients with ITP relative to comparable populations without ITP. Methods: We searched MEDLINE and EMBASE via Ovid and the Cochrane database for articles that included both terms relating to ITP (i.e., immune thrombocytopenia, idiopathic thrombocytopenia) and TE (i.e., thromboembolism, thrombosis, embolism). Articles were restricted to research on humans, published in English, January 1996 to July 2012. Only observational studies were included. We abstracted measures of relative risk (or rate ratio) comparing the incidence of TE in ITP patients with that in a comparable non-ITP population. The pooled relative risk and 95% confidence intervals (CIs) were calculated by taking a weighted average of individual study results using both fixed and random effects models using the META2 module for STATA 10. Results: Five observational studies met the inclusion criteria: two from Denmark and one each from Sweden, United Kingdom, and United States; all published 2010–2012. All studies completed patient follow-up before the commercial availability of TPOr. Studies varied in the duration of follow-up, choice of comparison group, and specific events reported. Some studies excluded patients with previous events. The relative risk of any VTE among patients with ITP compared to that in a non-ITP population ranged from 1.6 to 2.9 based on 3 studies that reported VTE. The pooled relative risk of any VTE was 1.9 (95%CI 1.4, 2.7) using a fixed-effect model and similar estimates using a random effect model (test for heterogeneity, p = 0.3). The relative risk of any ATE among patients with ITP compared to that in a non-ITP population ranged from 1.3 to 1.6 based on 3 studies that reported ATE. The pooled relative risk of any ATE was 1.5 (95%CI 1.3, 1.8) for both the random and fixed effects models (test for heterogeneity, p = 0.7). Conclusions: Five population-based observational studies have been published recently comparing the risk of thrombembolism among ITP patients to populations without ITP. The results of a meta-analysis showed nearly a 2-fold increased risk of VTE and a 50% increased risk of ATE among the general population of ITP patients not treated with TPOr. These ITP patients were likely to have less severe disease than those in experimental trials where entrance criteria may require significant thrombocytopenia, prior bleeding episodes, or failure of a previous therapy. However, the demonstrated elevated risk of TE among patients with ITP should be considered when evaluating the risk of TE ascribed to ITP treatments. Disclosures: Langeberg: Amgen: Employment, Equity Ownership. Eisen:Amgen: Employment, Equity Ownership. Schoonen:Amgen: Employment, Equity Ownership. Gamelin:Amgen: Employment, Equity Ownership. Stryker:Amgen: Employment, Equity Ownership.

Factors associated with regression of cervical dysplasia in adolescents: A retrospective study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5582-5582
Author(s):  
C. Chen ◽  
F. Campbell ◽  
J. Patruno ◽  
S. Kimmel ◽  
R. Boulay ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Pap Smear ◽  
Demographic Data ◽  
Cervical Dysplasia ◽  
Smoking History ◽  
Pap Smears ◽  
Factors Associated ◽  
Increased Risk ◽  
Chi Square Analysis

5582 Background: Sexually active adolescents have high rates of infection with human papilloma virus (HPV) and abnormal pap smears. They are considered a special population as they are likely to regress to normal cytology. The aim of our study was to identify factors associated with regression of cervical dysplasia in adolescents. Methods: We identified adolescent patients (aged 12–21 years) who had abnormal pap smears at the Center for Women's Medicine at Lehigh Valley Hospital in Allentown, PA, by CPT code from a database between Jan 2004 and Dec 2006. A chart review was performed to capture demographic data, cytology, smoking history, number of sexual partners, parity, race, contraceptive choice, use of barrier contraception. Chi-square analysis with logistic regression and multivariate analysis were used to identify factors associated with regression of cervical dysplasia. Results: Two-hundred two patients were identified. Mean age was 18.84 years (14–22 years). One hundred twenty-two (57.8%) were Hispanic, 71 (33.6%) Caucasian, and 16 (7.6%) Black. Fifty-two (24.6%) were pregnant at the time of diagnosis. Seventy-six (36%) were smokers. There were 125 (61.9%) cases of ASCUS, 33.7% (68 cases) LGSIL and 4.5% (9 cases) HGSIL on initial pap smear. One hundred eighteen (55.9%) patients had colposcopy, and of these, 32 (15.2%) had surgical intervention. Follow-up demonstrated that 72 (57.6%) patients had disease regression, 24 (19.2%) persistence and 29 (23.2%) progression. On multivariate analysis, patients who did not smoke were significantly more likely to show regression of cervical dysplasia on pap smear than women who smoked (OR 2.17, 95% CI 1.03–4.55, p = 0.039). Other factors were not statistically significant in predicting regression of cervical dysplasia. Conclusions: Adolescents who smoke were more likely to have persistent cervical dysplasia than non-smoking adolescents, putting smokers at an increased risk of advanced disease. We suggest that this subset have follow-up at shorter intervals and be enrolled in a smoking cessation program. No significant financial relationships to disclose.

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