scholarly journals Maternal Risk Factors Associated with Poor Postpartum Healthcare Utilization

2020 ◽  
Author(s):  
michael e silverman ◽  
Holly Loudon ◽  
Laudy Burgos
Keyword(s):  
Mount Sinai Hospital ◽  
Population Based ◽  
Postpartum Care ◽  
Related Factors ◽  
Maternal Risk ◽  
Factors Associated ◽  
Ambulatory Practice ◽  
Mount Sinai ◽  
Prenatal Visits

Abstract Objectives: Perceptions regarding the benefits of postpartum care among mothers and clinicians often differ. Clinicians generally perceive postpartum care as preventative, whereas pregnant and postpartum women often lack knowledge about its preventative benefits. As a result many women choose not to return for scheduled postpartum care visits. Methods: To examine if clinically relevant demographic and birth related factors are informative predictors for postpartum healthcare follow-up care, we conducted a population based cohort study of all women who delivered a child in 2012 – 2015 at the New York Mount Sinai Hospital Obstetrics and Gynecology Ambulatory Practice. Data was ascertained from electronic health records.Results: Of the 4,240 unique women who delivered between 2012-2015 at the Mount Sinai Hospital OB/GYN Ambulatory Practice, 1,685 (39.7%) did not return for their postpartum care follow-up appointment. The number of prenatal visits, maternal age, and parity were significantly associated with postpartum care follow-up. Conclusion for Practice: The purpose of this study was to determine identifiable factors associated with reduced postpartum healthcare follow-up utilization. Several clinically relevant variables were associated with the reduced likelihood for attending postpartum care visits. Because pregnant women represent a medically captured population, the results of this study point to the need to increase postpartum healthcare literacy during perinatal appointments especially among younger mothers, women who have had previous deliveries, and those with fewer prenatal visits.

scholarly journals Trends in oral corticosteroids use in severe asthma: a 14-year population-based study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mohsen Sadatsafavi ◽  
Amir Khakban ◽  
Hamid Tavakoli ◽  
Solmaz Ehteshami-Afshar ◽  
Larry D. Lynd ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Poisson Regression ◽  
Population Based ◽  
Population Based Study ◽  
Factors Associated ◽  
Asthma Patients ◽  
Oral Corticosteroids ◽  
Administrative Health Databases ◽  
Time Since Diagnosis

Abstract Background Oral corticosteroids are important components of pharmacotherapy in severe asthma. Our objective was to describe the extent, trends, and factors associated with exposure to oral corticosteroids (OCS) in a severe asthma cohort. Methods We used administrative health databases of British Columbia, Canada (2000–2014) and validated algorithms to retrospectively create a cohort of severe asthma patients. Exposure to OCS within each year of follow-up was measured in two ways: maintenance use as receiving on average ≥ 2.5 mg/day (prednisone-equivalent) OCS, and episodic use as the number of distinct episodes of OCS exposure for up to 14 days. Trends and factors associated with exposure on three time axes (calendar year, age, and time since diagnosis) were evaluated using Poisson regression. Results 21,144 patients (55.4% female; mean entry age 28.7) contributed 40,803 follow-up years, in 8.2% of which OCS was used as maintenance therapy. Maintenance OCS use declined by 3.8%/calendar year (p < 0.001). The average number of episodes of OCS use was 0.89/year, which increased by 1.1%/calendar year (p < 0.001). Trends remained significant for both exposure types in adjusted analyses. Both maintenance and episodic use increased by age and time since diagnosis. Conclusions This population-based study documented a secular downward trend in maintenance OCS use in a period before widespread use of biologics. This might have been responsible for a higher rate of exacerbations that required episodic OCS therapy. Such trends in OCS use might be due to changes in the epidemiology of severe asthma, or changes in patient and provider preferences over time.

scholarly journals Opioid prescriptions in patients with osteoarthritis: a population-based cohort study

Rheumatology ◽  
2020 ◽  
Vol 59 (9) ◽  
pp. 2462-2470 ◽  
Author(s):  
Jacoline J van den Driest ◽  
Dieuwke Schiphof ◽  
Marcel de Wilde ◽  
Patrick J E Bindels ◽  
Johan van der Lei ◽  
...  
Keyword(s):  
Cohort Study ◽  
Patient Characteristics ◽  
Population Based ◽  
Prescription Rate ◽  
Factors Associated ◽  
Prescription Rates ◽  
Care Information ◽  
Information Database

Abstract Objectives To examine the incidence, prevalence and trends for opioid prescriptions in patients with OA. Furthermore, types of opioids prescribed and long-term prescription rates were examined. Finally, the patient characteristics associated with the prescription of opioids were assessed. Methods A population-based cohort study was conducted using the Integrated Primary Care Information database. Incidence and prevalence of opioid prescriptions were calculated for the period 2008–2017. Logistic regression was used to assess which patient characteristics were associated with opioid prescriptions. Results In total, 157 904 OA patients were included. The overall prescription rate remained fairly stable, at around 100 incident and 170 prevalent prescriptions per 1000 person years. However, the incident prescription rate for oxycodone increased from 7.1 to 40.7 per 1000 person years and for fentanyl from 4.2 to 7.4 per 1000 person years. The incident prescription rate for paracetamol/codeine decreased from 63.0 to 13.3 per 1000 person years. Per follow-up year, long-term use was found in 3% of the patients with incident OA. Finally, factors associated with more prescriptions were increasing age, OA in ≥2 joint groups [odds ratio (OR) 1.56; 95% CI: 1.51, 1.65] and the presence of other musculoskeletal disorders (OR 4.91; 95% CI: 4.76, 5.05). Men were less likely to be prescribed opioids (OR 0.78; 95% CI: 0.76, 0.80). Conclusion Prescription rates for opioids remained stable, but types of opioids prescribed changed. Oxycodone and fentanyl were increasingly prescribed, while prescriptions of paracetamol/codeine decreased. Since the benefit of opioids for OA pain is questionable and side effects are common, opioids should be prescribed with caution.

Adverse events (AE) following diagnosis (Dx) in older metastatic colorectal cancer (mCRC) patients (Pts).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14068-e14068
Author(s):  
Veena Shankaran ◽  
David G Mummy ◽  
David K Blough ◽  
Lisel Koepl ◽  
Yeun Mi Yim ◽  
...  
Keyword(s):  
Cox Model ◽  
Population Based ◽  
Incidence Rates ◽  
Clinical Settings ◽  
Factors Associated ◽  
Tissue Integrity ◽  
Relative Safety ◽  
Increased Risk ◽  
Use Factors

e14068 Background: The relative safety of newer drugs in older pts with mCRC is understudied. The objective of this analysis is to determine factors associated with AEs in a population-based sample of older mCRC pts treated in real-world clinical settings. Methods: Pts ≥ age 65 Dx with mCRC in 2004-2007 were identified from SEER-Medicare, and excluded if they were enrolled in a Medicare HMO or lacked Medicare parts A and B. Pts who received 1st line (1L) chemotherapy (CTx) within 3 mo of Dx were dichotomized as 1L CTx alone and 1L CTx + bevacizumab (BV). Preexisting conditions (PCs) identified from claims in the 12 mo prior to start of 1L CTx were grouped into 5 categories (cardiovascular (CV), cerebrovascular (CNS), gastrointestinal (GI), tissue integrity (TI), and pulmonary (Pulm)). Claims for any of these same conditions between start of 1L CTx and end of follow-up were identified as AEs. Crude AE incidence rates were determined. Logistic regression was used to examine factors associated with BV use. Factors associated with time to 1st AE were identified in a Cox model. Results: 4,514 pts (median age 77) met inclusion, of whom 1,139 (25%) received 1L CTx only and 669 (15%) received 1L CTx + BV. BV use was less likely among pts age ≥ 75 (OR 0.35, p<0.001), non-whites (OR 0.75, p=0.002), and women (OR 0.8, p=0.001). Bev use was as likely in pts with CV, Pulm, or CNS PCs, and more likely in pts with GI (OR 1.67, p <0.001) and TI (OR 2.75, p=0.001) PCs. In a Cox model of time to 1st AE with death as a competing risk, increased risk of AE was associated with age ≥ 75 (HR 1.13, p=0.02), CNS PC (HR 1.35, p=0.02), and CV PC (HR 1.13, p=0.05). Relative to 1L CTx alone, pts receiving 1L CTx + BV did not have a higher AE risk (HR 0.89, 95% CI 0.80-0.99). AE incidence was higher in pts receiving 1L CTx alone (without subsequent biologic) (185 events / 100,000 person-days (P-D) compared with pts receiving 1L CTx + BV (139 events / 100,000 P-D). Conclusions: In this cohort, pts who received 1L CTx + BV had neither increased AE incidence nor increased risk of 1st AE compared to pts who received 1L CTx alone. PCs were not associated with decreased BV use. These data suggests BV utilization may not increase AE risk among elderly mCRC pts tx in the community.

Risk of arterial (ATE) and venous thromboembolism (VTE) in a population-based cohort of bevacizumab-treated metastatic colorectal cancer (mCRC) patients.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 545-545 ◽  
Author(s):  
Irene S. Yu ◽  
Winson Y. Cheung
Keyword(s):  
Clinical Trials ◽  
Population Based ◽  
Related Effect ◽  
Related Factors ◽  
Increased Risk ◽  
Venous Thromboembolic ◽  
Lost To Follow Up ◽  
Study Setting ◽  
Trial Setting

545 Background: Bevacizumab is associated with both arterial (ATE) and venous thromboembolic (VTE) events, estimated to be </=15% from clinical trials. Our objectives were to 1) characterize the incidence of ATE or VTE among mCRC patients receiving bevacizumab in a non-clinical trial setting; 2) determine patient and treatment-related factors that predispose to an increased risk of ATE or VTE; and 3) explore how thromboembolism is managed and whether bevacizumab is discontinued and/or resumed after an event. Methods: A random sample of mCRC patients diagnosed between 2008 and 2009, referred to 1 of 5 regional cancer centers in British Columbia, and who were offered bevacizumab was reviewed. Summary statistics were used to describe and compare clinical factors between those who experienced an ATE or VTE and those who did not. Results: Of the 200 mCRC patients offered bevacizumab, 10 never received the drug and 12 were lost to follow up. Among the 178 remaining patients, median age was 61 years, 103 (58%) were male, and 121 (85%) had ECOG 0 to 1. A total of 39 patients (28%) experienced at least 1 documented thromboembolic event. Compared to patients who developed a clot, those who did not had similar median age (62 vs 61), gender distribution (23% men and 20% women), ECOG 0 to 1 (84% vs 85%) and body mass index (26.4 vs 25.3). However, the mean number of bevacizumab doses was higher in the group with thromboembolism (12.6 vs 9.0), suggesting a potential dose-related effect. There were a total of 43 VTE and 5 ATE events documented, with 7 of the 39 patients (18%) experiencing more than 1 event. Bevacizumab was held or discontinued in 60% of cases, but it was continued in 25% of the cases; 4% of the events were fatal, and 10% of the VTE/ATE occurred after bevacizumab was stopped. Conclusions: The incidence of ATE and VTE in a non-study setting appears to be higher than that reported in clinical trials. There may be a dose-related effect. Bevacizumab was not consistently held or discontinued in the setting of a VTE or ATE. Development of guidelines for the management of thromboembolism with bevacizumab may be warranted.

Abstract WMP53: Sex Differences n Long-term Mortality and Disability After Stroke: The International Stroke Outcomes Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hoang T Phan ◽  
Mathew J Reeves ◽  
Leigh Blizzard ◽  
Amanda Thrift ◽  
Dominique Cadilhac ◽  
...  
Keyword(s):  
Sex Differences ◽  
Population Based ◽  
Stroke Severity ◽  
Related Factors ◽  
Post Stroke ◽  
Modifiable Factors ◽  
Mortality Rate Ratio ◽  
The Impact

Introduction: It is uncertain why women suffer worse long-term outcomes after stroke than men. We examined sex differences in mortality and disability 1 and 5 years after stroke and identified factors contributing to these differences. Methods: Individual patient data pooling study of incident strokes (ischemic and hemorrhagic) from 1987-2013 obtained from 12 population-based cohorts from Australasia, Europe, South America and the Caribbean. Data on socio-demographics, stroke-related factors and pre-stroke health were obtained for each patient and harmonized between studies. Poisson modelling estimated the mortality rate ratio (MRR) for women compared to men at 1 year (12 studies) and 5 years (7 studies) post-stroke. Log binomial regression estimated the relative risk (RR) of poor outcome (modified Rankin scale>2 or Barthel Index <20) for women compared to men at 1 year (9 studies) and 5 years (6 studies) after stroke. Multivariable models were adjusted for potential confounders including age, pre-stroke dependency, stroke severity and comorbidities. Results: A total of 16557 first-ever-stroke patients with follow-up data to 1 year and 12,839 with follow-up to 5 years were included. The pooled crude mortality was greater in women than men at 1-year (MRR 1.37 95% CI 1.27-1.48) and 5 years (MRR 1.25 95% CI 1.13-1.39). However, these sex differences were reversed after adjustment for confounders at both 1 year (MRR 0.94 95% CI 0.82-1.06) and 5-years post stroke (MRR 0.74 95% CI 0.66-0.84). Similarly, the pooled crude RR for disability after stroke was greater in women than men at 1-year (RR 1.28 95% CI 1.17-1.39 and 5-year (RR 1.32 95% CI 1.18-1.47), but these sex differences disappeared after adjustment at both 1 year (RR 1.08 95%CI 0.98-1.18) and 5-years post stroke (RR 1.08 95% CI 0.97-1.20). The key contributors to worse outcomes in women were greater age, pre-stroke dependency, severe strokes and atrial fibrillation (AF, mortality only) compared with men. Conclusion: Worse outcomes in women were mostly due to age and potentially modifiable factors of stroke severity and AF providing potential targets to reduce the impact of stroke in women.

Care-Related Distress: A Nationwide Study of Parents Who Lost Their Child to Cancer

2005 ◽  
Vol 23 (36) ◽  
pp. 9162-9171 ◽  
Author(s):  
Ulrika Kreicbergs ◽  
Unnur Valdimarsdóttir ◽  
Erik Onelöv ◽  
Olle Björk ◽  
Gunnar Steineck ◽  
...  
Keyword(s):  
Population Based ◽  
Postal Questionnaire ◽  
Physical Pain ◽  
Related Factors ◽  
Nationwide Study ◽  
Pediatric Hematology ◽  
The Moment ◽  
Oncology Center

Purpose Palliative care is an important part of cancer treatment. However, little is known about how care-related factors affect bereaved intimates in a long-term perspective. We conducted a population-based, nationwide study addressing this issue, focusing on potential care-related stressors in parents losing a child to cancer. Methods In 2001, we attempted to contact all parents in Sweden who had lost a child to cancer in 1992 to 1997. The parents were asked, through an anonymous postal questionnaire, about their experience of the care given and to what extent these experiences still affect them today. Results Information was supplied by 449 (80%) of 561 eligible parents. Among 196 parents of children whose pain could not be relieved, 111 (57%) were still affected by it 4 to 9 years after bereavement. Among 138 parents reporting that the child had a difficult moment of death, 78 (57%) were still affected by it at follow-up. The probability of parents reporting that their child had a difficult moment of death was increased (relative risk = 1.4; 95% CI, 1.0 to 1.8) if staff were not present at the moment of death. Ten percent of the parents (25 of 251 parents) were not satisfied with the care given during the last month at a pediatric hematology/oncology center; the corresponding figure for care at other hospitals was 20% (33 of 168 parents; P = .0163). Conclusion Physical pain and the moment of death are two important issues to address in end-of-life care of children with cancer in trying to reduce long-term distress in bereaved parents.

scholarly journals Factors Associated with Remission of Eczema in Children: A Population-based Follow-up Study

2014 ◽  
Vol 94 (2) ◽  
pp. 179-184 ◽  
Author(s):  
L Kobyletzki ◽  
C Bornehag ◽  
E Breeze ◽  
M Larsson ◽  
C Lindström ◽  
...  
Keyword(s):  
Population Based ◽  
Factors Associated ◽  
Follow Up Study

scholarly journals Prevalence, injury-, and non-injury-related factors associated with anxiety and depression in polytrauma patients – A retrospective 20 year follow-up study

PLoS ONE ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. e0232678
Author(s):  
Sascha Halvachizadeh ◽  
Henrik Teuber ◽  
Till Berk ◽  
Florin Allemann ◽  
Roland von Känel ◽  
...  
Keyword(s):  
Anxiety And Depression ◽  
Related Factors ◽  
Factors Associated ◽  
Follow Up Study ◽  
Polytrauma Patients

scholarly journals Maternal Risk Factors Associated with Inadequate Testing and Loss to Follow-up in Infants with Perinatal Hepatitis C Virus Exposure

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S42-S42
Author(s):  
Amrita Bhardwaj ◽  
Maroun Mhanna ◽  
Nazha Abughali
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Methadone Maintenance ◽  
Maternal Risk Factors ◽  
Maternal Risk ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
History Of ◽  
Hcv Testing

Abstract Background Lack of adequate testing and follow-up in infants born to hepatitis C virus (HCV) infected mothers continue to be a major challenge. There are multiple risk factors associated with this low rate of testing and follow-up including maternal, healthcare-related, and social factors. We sought to identify maternal risk factors that are associated with low HCV testing and follow-up in perinatally exposed infants. Methods In a retrospective cohort study, all HCV-infected pregnant women and their infants were reviewed. The study period expanded from June 1993 to May 2016. Medical records were reviewed for maternal characteristics and risk factors that could be associated with inadequate testing and loss to follow-up in infants with perinatal HCV exposure. Results During the study period, medical records of 407 mothers and their infants were reviewed. Only 26.5% (108/407) of all infants had adequate testing and follow-up for HCV. Among all infants, history of maternal intravenous drug use (IVDU) was significantly higher in infants with inadequate HCV testing than infants who were adequately tested [88% (193/218) vs. 76% (70/92) respectively; P = 0.005]. Infants who were adequately tested for HCV had a higher percentage of mothers on methadone maintenance therapy during pregnancy than infants who were not adequately tested [53% (35/66) vs. 34% (65/186) respectively; P = 0.010]. Also, infants with mothers who had HCV care were more likely to be adequately tested than infants whose mothers did not have HCV care [54% (56/102) vs. 41% (106/255), respectively; P = 0.022]. HCV transmission rate among infants with adequate testing was 11.1% (12/108). Conclusion Infants born to HCV infected mothers continue to have suboptimal testing. Maternal history of IVDU is associated with inadequate testing and loss to follow-up among infants exposed perinatally to HCV. Whereas, maternal methadone maintenance therapy during pregnancy, and maternal HCV medical care are associated with better follow-up. Screening pregnant women with HCV infection for history of IVDU and linking them to drug treatment centers as well as to HCV medical care may improve testing and follow-up in infants with perinatal HCV exposure. Disclosures All authors: No reported disclosures.

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