scholarly journals Incidence and mortality of patients transported by ambulance during the first surge of the COVID-19 pandemic in Osaka Prefecture, Japan

2021 ◽  
Author(s):  
Yusuke Katayama ◽  
Kenta Tanaka ◽  
Tetsuhisa Kitamura ◽  
Taro Takeuchi ◽  
Shota Nakao ◽  
...  
Keyword(s):  
Medical Service ◽  
Incidence Rate Ratio ◽  
Population Based ◽  
Poisson Regression Model ◽  
Emergency Patients ◽  
Number Of Patients ◽  
Incidence And Mortality ◽  
Osaka Prefecture ◽  
Population Based Registry ◽  
The Impact

Abstract Background; Novel corona virus (COVID-19) outbreaks have spread worldwide. Although the COVID-19 pandemic affects the emergency medical service (EMS) system, which is one factor of primary care, little is known about its impact. This study aimed to reveal the impact of the COVID-19 pandemic on the EMS system and outcome of patients transported by ambulance.Methods; This was a retrospective study with a study period from 1 January 2020 to 31 May 2020. We included patients transported by ambulance who were registered in a population-based registry of patients transported by ambulance. The endpoints of this study were the incident number of patients transported by ambulance each month and the number of deaths among these patients admitted to hospital each month. We calculated the incidence rate ratio (IRR) and 95% confidence interval (CI) using a Poisson regression model with year 2019 as the reference.Results; From January to May 2019, 205,195 patients were transported, whereas from January to May 2020, 180,362 patients were transported, indicating a significant decrease in the number of emergency patients transported by ambulance (IRR: 0.88, 95% CI: 0.87–0.88). The number of deaths among emergency patients admitted to hospital was 5237 in January-May 2019 and remained unchanged at 5172 in January-May 2020 (IRR: 0.99, 95% CI: 0.95–1.03).Conclusion; The first surge of the COVID-19 pandemic had no adverse effect on the EMS system in Osaka Prefecture, Japan.

scholarly journals Incidence and Mortality of Emergency Patients Transported by Emergency Medical Service Personnel during the Novel Corona Virus Pandemic in Osaka Prefecture, Japan: A Population-Based Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5662
Author(s):  
Yusuke Katayama ◽  
Kenta Tanaka ◽  
Tetsuhisa Kitamura ◽  
Taro Takeuchi ◽  
Shota Nakao ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Population Based ◽  
Emergency Medical Service Personnel ◽  
Emergency Patients ◽  
Emergency Medical ◽  
Number Of Patients ◽  
Incidence And Mortality ◽  
Osaka Prefecture ◽  
The Impact

Although the COVID-19 pandemic affects the emergency medical service (EMS) system, little is known about the impact of the COVID-19 pandemic on the prognosis of emergency patients. This study aimed to reveal the impact of the COVID-19 pandemic on the EMS system and patient outcomes. We included patients transported by ambulance who were registered in a population-based registry of patients transported by ambulance. The endpoints of this study were the incident number of patients transported by ambulance each month and the number of deaths among these patients admitted to hospital each month. The incidence rate ratio (IRR) and 95% confidence interval (CI) using a Poisson regression model with the year 2019 as the reference were calculated. A total of 500,194 patients were transported in 2019, whereas 443,321 patients were transported in 2020, indicating a significant decrease in the number of emergency patients transported by ambulance (IRR: 0.89, 95% CI: 0.88–0.89). The number of deaths of emergency patients admitted to hospital was 11,931 in 2019 and remained unchanged at 11,963 in 2020 (IRR: 1.00, 95% CI: 0.98–1.03). The incidence of emergency patients transported by ambulance decreased during the COVID-19 pandemic in 2020, but the mortality of emergency patients admitted to hospital did not change in this study.

scholarly journals Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study

Gut ◽  
2020 ◽  
Vol 69 (12) ◽  
pp. 2223-2231 ◽  
Author(s):  
Sharon J Hutchinson ◽  
Heather Valerio ◽  
Scott A McDonald ◽  
Alan Yeung ◽  
Kevin Pollock ◽  
...  
Keyword(s):  
Antiviral Treatment ◽  
Scale Up ◽  
Sustained Viral Response ◽  
Population Based ◽  
Decompensated Cirrhosis ◽  
Direct Acting Antiviral ◽  
Clinical Databases ◽  
Number Of Patients ◽  
Direct Acting ◽  
The Impact

ObjectivePopulation-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland.DesignThrough analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs.ResultsApproximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015–18.ConclusionsNational scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same.

Using adjuvant radiotherapy to improve cancer-specific survival in patients with highly aggressive prostate cancer: Examining recently released criteria.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 30-30
Author(s):  
Firas Abdollah ◽  
Giorgio Gandaglia ◽  
Alberto Briganti ◽  
Quoc-Dien Trinh ◽  
Paul Linh Nguyen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Score ◽  
Adjuvant Radiotherapy ◽  
Survival Rates ◽  
Population Based ◽  
Number Needed To Treat ◽  
Cancer Specific Survival ◽  
Pathological Characteristics ◽  
Number Of Patients ◽  
The Impact

30 Background: Although adjuvant radiotherapy (aRT) after radical prostatectomy (RP) improves biochemical recurrence (BCR)-free survival rates, its effect on cancer-specific mortality (CSM) in patients with prostate cancer (PCa) is still controversial. The aim of our study was to test the effect of aRT on CSM according to a risk score based on the number and nature of adverse pathological characteristics (Gleason score 8-10; pT3b/4, lymph node invasion [LNI]). Methods: Overall, 7,616 patients with pT3/4 N0/1 PCa treated with RP between 1995 and 2009 within the Surveillance Epidemiology and End Results Medicare-linked database were included in the study. Patients were stratified according to the risk score (less than 2 vs. 2 or more adverse characteristics), and the impact of aRT on CSM was examined in each sub-group. Additionally, to evaluate the effectiveness of aRT, we calculated the number needed to treat (NNT), defined as the average number of patients who must be treated to prevent one detrimental outcome. Subsequently, competing-risks regression models were used to test the effect of aRT on CSM rates in the overall population and after stratifying patients according to their risk score (less than 2 vs. 2 or more). Results: The risk score was associated with increasing 10-year CSM rates (P<0.001). When focusing on patients with a risk score 2 or more, 10-year CSM rates were significantly lower for individuals undergoing aRT compared to their counterpart not receiving aRT (6.9 vs. 16.2%, respectively; P=0.002). The corresponding NNT to prevent one death from PCa was 10. Adjuvant RT was not associated with lower CSM rates overall and in patients with a risk score less than 2. This was confirmed in multivariable analyses, where aRT decreased the risk of CSM only in patients with a risk score 2 or more (P≤0.02). Conclusions: Our findings confirm the validity of the previously reported risk score in selecting the most optimal candidates for aRT after surgery in a large contemporary population-based cohort of patients with pT3/4 N0/1 PCa. Patients with two or more adverse pathological characteristics at RP might benefit the most from aRT in terms of reduced CSM.

The impact of birth weight on prostate cancer incidence and mortality in a population-based study of men born in 1913 and followed up from 50 to 85 years of age

The Prostate ◽  
2007 ◽  
Vol 67 (11) ◽  
pp. 1247-1254 ◽  
Author(s):  
Margaretha Eriksson ◽  
Hans Wedel ◽  
Mari-Ann Wallander ◽  
Ingvar Krakau ◽  
Jonas Hugosson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Birth Weight ◽  
Cancer Incidence ◽  
Population Based ◽  
Population Based Study ◽  
Prostate Cancer Incidence ◽  
Incidence And Mortality ◽  
The Impact

scholarly journals Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry

2021 ◽  
Vol 23 (3) ◽  
pp. 401-410
Author(s):  
Salvatore Rudilosso ◽  
José Ríos ◽  
Alejandro Rodríguez ◽  
Meritxell Gomis ◽  
Víctor Vera ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Functional Outcome ◽  
Population Based ◽  
Vessel Occlusion ◽  
Inverse Probability ◽  
The Poor ◽  
Good Functional Outcome ◽  
Stroke Disability ◽  
Population Based Registry ◽  
The Impact

Background and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score <6, proximal vertebrobasilar occlusion, supratherapeutic international normalized ratio >3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria). Results Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3).Conclusions Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.

scholarly journals Sex differences in incidence and mortality of bloodstream infections. Results from the population-based HUNT study in Norway

2021 ◽  
Author(s):  
Randi Marie Mohus ◽  
Lise T. Gustad ◽  
Anne Sofie Furberg ◽  
Martine Kjølberg Moen ◽  
Kristin Vardheim Liyanarachi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Large Population ◽  
Bloodstream Infections ◽  
Hdl Cholesterol ◽  
Health Behaviours ◽  
Population Based ◽  
Incidence And Mortality ◽  
The Impact ◽  
First Time

AbstractObjectiveTo examine the effect of sex on risk of bloodstream infections (BSI) and BSI mortality and to assess to what extent known risk factors for BSI mediate this association in the general population.ParticipantsThe prospective, population-based HUNT2 Survey (1995-97) in Norway invited 93,898 inhabitants ≥20 years in the Nord-Trøndelag region, whereof 65,237 (69.5%) participated. 46.8% of the participants were men.ExposuresSex and potential mediators between sex and BSI; health behaviours (smoking, alcohol consumption), education attainment, cardiovascular risk factors (systolic blood pressure, non-HDL cholesterol, body mass index) and previous or current comorbidities.Main outcome measuresSex differences in risk of first-time BSI, BSI mortality (death within first 30 days after a BSI), BSI caused by the most frequent bacteria, and the impact of known BSI risk factors as mediators.ResultsWe documented a first-time BSI for 1,840 (2.9%) participants (51.3% men) during a median follow-up of 14.8 years. Of these, 396 (0.6%) died (56.6% men). Men had 41% higher risk of any first-time BSI (95% confidence interval (CI), 28 to 54%) than women. An estimated 34% of the excess risk of BSI in men was mediated by known BSI risk factors. The hazard ratio (HR) with 95% CI for BSI due to S. aureus was 2.09 (1.28 to 2.54), S. pneumoniae 1.36 (1.05 to 1.76), and E. coli 0.97 (0.84 to 1.13) in men vs women. BSI related mortality was higher in men compared to women with HR 1.87 (1.53 to 2.28).ConclusionsThis large population-based study show that men have higher risk of BSI than women. One-third of this effect was mediated by known risk factors for BSI. This raises important questions regarding sex specific approaches to reduce the burden of BSI.

scholarly journals Early High Efficacy Treatment in Multiple Sclerosis Is the Best Predictor of Future Disease Activity Over 1 and 2 Years in a Norwegian Population-Based Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Cecilia Smith Simonsen ◽  
Heidi Øyen Flemmen ◽  
Line Broch ◽  
Cathrine Brunborg ◽  
Pål Berg-Hansen ◽  
...  
Keyword(s):  
Disease Activity ◽  
Treatment Guidelines ◽  
Population Based ◽  
World Population ◽  
High Efficacy ◽  
Disease Modifying Therapies ◽  
First Choice ◽  
Disease Modifying ◽  
Population Based Registry ◽  
The Impact

Background: Moderate and high efficacy disease modifying therapies (DMTs) have a profound effect on disease activity. The current treatment guidelines only recommend high efficacy DMTs for patients with highly active MS. The objective was to examine the impact of initial treatment choice in achieving no evidence of disease activity (NEDA) at year 1 and 2.Methods: Using a real-world population-based registry with limited selection bias from the southeast of Norway, we determined how many patients achieved NEDA on moderate and high efficacy DMTs.Results: 68.0% of patients who started a high efficacy DMT as the first drug achieved NEDA at year 1 and 52.4% at year 2 as compared to 36.0 and 19.4% of patients who started a moderate efficacy DMT as a first drug. The odds ratio (OR) of achieving NEDA on high efficacy drugs compared to moderate efficacy drugs as a first drug at year 1 was 3.9 (95% CI 2.4–6.1, p &lt; 0.001). The OR for high efficacy DMT as the second drug was 2.5 (95% CI 1.7–3.9, p &lt; 0.001), and was not significant for the third drug. Patients with a medium or high risk of disease activity were significantly more likely to achieve NEDA on a high efficacy therapy as a first drug compared to moderate efficacy therapy as a first drug.Conclusions: Achieving NEDA at year 1 and 2 is significantly more likely in patients on high-efficacy disease modifying therapies than on moderate efficacy therapies, and the first choice of treatment is the most important. The immunomodulatory treatment guidelines should be updated to ensure early, high efficacy therapy for the majority of patients diagnosed with MS.

Survival among colorectal cancer patients with a history of previous cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16146-e16146
Author(s):  
Sandi Pruitt ◽  
David E. Gerber ◽  
Hong Zhu ◽  
Daniel Heitjan ◽  
Bhumika Maddineni ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Cox Regression ◽  
Population Based ◽  
Competing Risk ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

e16146 Background: A growing number of patients with colorectal cancer (CRC) have survived a previous cancer. Although little is known about their prognosis, this population is frequently excluded from clinical trials. We examined the impact of previous cancer on overall and cancer-specific survival in a population-based cohort of patients diagnosed with incident CRC. Methods: We identified patients aged ≥66 years and diagnosed with CRC between 2005-2015 in linked SEER-Medicare data. For patients with and without previous cancer, we estimated overall survival using Cox regression and cause-specific survival using competing risk regression, separately by CRC stage, while adjusting for numerous covariates and competing risk of death from previous cancer, other causes, or the incident CRC. Results: Of 112,769 CRC patients diagnosed with incident CRC, 15,935 (14.1%) had a previous cancer – most commonly prostate (32.9%) or breast (19.4%) cancer, with many 7505 (47.1%) diagnosed ≤5 years of CRC. For all CRC stages except IV in which there was no significant difference in survival, patients with previous cancer had modestly worse overall survival (hazard ratios from fully adjusted models range from 1.11-1.28 across stages; see Table). This survival disadvantage was driven by deaths due to previous cancer and other causes. Notably, most patients with previous cancer had improved CRC-specific survival. Conclusions: CRC patients who have survived a previous cancer have generally worse overall survival but superior CRC-specific survival. This evidence should be considered concurrently with concerns about trial generalizability, low accrual, and heterogeneity of participants when determining exclusion criteria. [Table: see text]

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