Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study

Aim: To report on prevalence of cerebral palsy (CP), severity rates, and types of brain lesions in children born preterm 2004 to 2010 by gestational age groups.Methods: Data from 12 population-based registries of the Surveillance of Cerebral Palsy in Europe network were used. Children with CP were eligible if they were born preterm (<37 weeks of gestational age) between 2004 and 2010, and were at least 4 years at time of registration. Severity was assessed using the impairment index. The findings of postnatal brain imaging were classified according to the predominant pathogenic pattern. Prevalences were estimated per 1,000 live births with exact 95% confidence intervals within each stratum of gestational age: ≤27, 28–31, 32–36 weeks. Time trends of both overall prevalence and prevalence of severe CP were investigated using multilevel negative binomial regression models.Results: The sample comprised 2,273 children. 25.8% were born from multiple pregnancies. About 2-thirds had a bilateral spastic CP. 43.5% of children born ≤27 weeks had a high impairment index compared to 37.0 and 38.5% in the two other groups. Overall prevalence significantly decreased (incidence rate ratio per year: 0.96 [0.92–1.00[) in children born 32–36 weeks. We showed a decrease until 2009 for children born 28–31 weeks but an increase in 2010 again, and a steady prevalence (incidence rate ratio per year = 0.97 [0.92–1.02] for those born ≤27 weeks. The prevalence of the most severely affected children with CP revealed a similar but not significant trend to the overall prevalence in the corresponding GA groups. Predominant white matter injuries were more frequent in children born <32 weeks: 81.5% (≤27 weeks) and 86.4% (28–31 weeks), compared to 63.6% for children born 32–36 weeks.Conclusion: Prevalence of CP in preterm born children continues to decrease in Europe excepting the extremely immature children, with the most severely affected children showing a similar trend.

Download Full-text

Diet quality and mental health in subsequent years among Canadian youth

Public Health Nutrition ◽

10.1017/s1368980012000535 ◽

2012 ◽

Vol 15 (12) ◽

pp. 2253-2258 ◽

Cited By ~ 35

Author(s):

Seanna E McMartin ◽

Stefan Kuhle ◽

Ian Colman ◽

Sara FL Kirk ◽

Paul J Veugelers

Keyword(s):

Mental Health ◽

Incidence Rate ◽

Diet Quality ◽

Rate Ratio ◽

Adolescent Depression ◽

Negative Binomial ◽

Incidence Rate Ratio ◽

Negative Binomial Regression ◽

Canadian Youth ◽

Internalizing Disorder

AbstractObjectiveTo examine the association between diet quality and the diagnosis of an internalizing disorder in children and adolescents.DesignA prospective study examining the relationship between diet quality and mental health. FFQ responses of 3757 children were used to calculate a composite score for diet quality and its four components: variety, adequacy, moderation and balance. Physicians’ diagnoses on internalizing disorders were obtained by linking the children's dietary information to administrative health data. Negative binomial regression models were used to examine the association between diet quality and diagnosis of an internalizing disorder.SettingThe Canadian province of Nova Scotia.SubjectsA provincially representative sample of grade 5 students (age 10–11 years).ResultsDiet quality was not found to be associated with internalizing disorder in a statistically significant manner (incidence rate ratio = 1·09; 95 % CI 0·73, 1·63). However, relative to children with little variety in their diets, children with greater variety in their diet had statistically significant lower rates of internalizing disorder in subsequent years (incidence rate ratio = 0·45; 95 % CI 0·25, 0·82).ConclusionsThese findings suggest the importance of variety in children's diet and opportunities in the prevention of adolescent depression and anxiety.

Download Full-text

Evaluation of community coalition training effects on youth hospital-admitted injury incidence in Victoria, Australia: 2001–2017

Injury Prevention ◽

10.1136/injuryprev-2019-043386 ◽

2019 ◽

Vol 26 (5) ◽

pp. 463-470 ◽

Cited By ~ 1

Author(s):

Janneke Berecki-Gisolf ◽

Bosco Rowland ◽

Nicola Reavley ◽

Barbara Minuzzo ◽

John Toumbourou

Keyword(s):

Risk Factors ◽

Injury Risk ◽

Negative Binomial ◽

Hospital Admissions ◽

Intervention Strategy ◽

Age Groups ◽

Negative Binomial Regression ◽

Population Based ◽

Injury Incidence ◽

The Impact

BackgroundInjuries are one of the three leading causes of morbidity and mortality for young people internationally. Although community risk factors are modifiable causes of youth injury, there has been limited evaluation of community interventions. Communities That Care (CTC) offers a coalition training process to increase evidence-based practices that reduce youth injury risk factors.MethodUsing a non-experimental design, this study made use of population-based hospital admissions data to evaluate the impact on injuries for 15 communities that implemented CTC between 2001 and 2017 in Victoria, Australia. Negative binomial regression models evaluated trends in injury admissions (all, unintentional and transport), comparing CTC and non-CTC communities across different age groups.ResultsStatistically significant relative reductions in all hospital injury admissions in 0–4 year olds were associated with communities completing the CTC process and in 0–19 year olds when communities began their second cycle of CTC. When analysed by subgroup, a similar pattern was observed with unintentional injuries but not with transport injuries.ConclusionThe findings support CTC coalition training as an intervention strategy for preventing youth hospital injury admissions. However, future studies should consider stronger research designs, confirm findings in different community contexts, use other data sources and evaluate intervention mechanisms.

Download Full-text

Young Women Had More Strokes Than Young Men in a Large, United States Claims Sample

Stroke ◽

10.1161/strokeaha.120.030803 ◽

2020 ◽

Vol 51 (11) ◽

pp. 3352-3355 ◽

Cited By ~ 1

Author(s):

Michelle H. Leppert ◽

P. Michael Ho ◽

James Burke ◽

Tracy E. Madsen ◽

Dawn Kleindorfer ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Incidence Rate ◽

Young Women ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Age Groups ◽

Stroke Rate ◽

Index Stroke ◽

Time Varying Covariates

Background and Purpose: Cardiovascular risk factors, which are overall more prevalent in men, are considered the major risk factors for strokes among young adults. However, recent European data found the incidence of strokes to be higher in young women. Using a large US claims sample, we examined sex differences in the index stroke rate of young adults. Methods: We performed a retrospective cohort study of enrollees in a 10% random sample of PharMetrics, a nationally representative claims database of insured Americans from 2001 to 2014. Outcomes were index ischemic stroke events, based on inpatient admissions using International Classification of Diseases-Ninth Revision codes. The index stroke rate was estimated from Poisson rate models with time varying covariates for 2-year periods, stratified by sex and age groups. Results: We identified 20 554 index strokes (50.4% women; mean age 63) including 5198 in young adults ages 15 to 54. There was no difference by sex in the index stroke rate in the extremes of age groups 15 to 24 and ≥75 years old. However, in the 25 to 34 and 35 to 44 year age groups, more women had strokes than men (incidence rate ratio: men:women, 0.70 [95% CI, 0.57–0.86]; 0.87 [95% CI, 0.78–0.98], respectively). In contrast, in the 45 to 54, 55 to 64, and 65 to 74 year age groups, more men had strokes (incidence rate ratio, 1.25 [95% CI, 1.16–1.33]; 1.41 [95% CI, 1.18–1.34]; 1.18 [95% CI, 1.12–125], respectively). Conclusions: More young women than men have strokes, suggesting possible importance of sex-mediated etiologies of stroke. Understanding these drivers is critical to stroke treatment and prevention efforts in young adults.

Download Full-text

Getting Beyond Interruptive Alerts: Reducing Unintentional Duplicate Orders using a Visual Aid

10.1101/640318 ◽

2019 ◽

Author(s):

Steven Horng ◽

Joshua W Joseph ◽

Shelley Calder ◽

Jennifer P Stevens ◽

Ashley L O’Donoghue ◽

...

Keyword(s):

Emergency Department ◽

Time Series ◽

Incidence Rate ◽

Rate Ratio ◽

Negative Binomial ◽

Incidence Rate Ratio ◽

Interrupted Time Series ◽

Alert Fatigue ◽

Visual Aid ◽

Electronic Health

ABSTRACTImportanceElectronic health records (EHRs) allow teams of clinicians to simultaneously care for patients but an unintended consequence could result in duplicate ordering of tests and medications.ObjectiveWe asked if a simple visual aid would reduce duplicate ordering of tests and medications for busy teams of clinicians in our emergency department by placing a red highlight around the checkbox of a computer-based order if previously ordered.DesignWe performed an interrupted time series to analyze all patient visits 1 year before and 1 year after the intervention. Significance testing was performed using a negative binomial regression with Newey-West standard errors, correcting for patient level variables and environmental variables that might be associated with duplicate orders.SettingThe emergency department of an academic hospital in Boston, MA with 55,000 visits annually.Participants184,722 consecutive emergency department patients.ExposureIf an order had previously been placed during that ED visit, we cue the user by showing a red highlight around the checkbox of that order.Main OutcomeNumber of unintentional duplicate orders.ResultsAfter deployment of the non-interrupting nudge, the rate of unintentional duplicates for laboratory orders decreased 49% (incidence rate ratio 0.51, 95% CI 0.45-0.59) and for radiology orders decreased with an incidence rate ratio of 0.60 (0.44-0.82). There was no change in unintentional medication duplicate orders. We estimated that the nudge eliminated 17,936 clicks in our EHR.Conclusions and RelevancePassive visual queues that provide just-in-time decision support are effective, not disruptive of workflow, and may decrease alert fatigue in busy clinical environments.Key PointsQuestionCan a simple visual aid reduce duplicate ordering in an electronic health record?FindingsIn this interrupted time series, the rate of unintentional duplicates for laboratory orders decreased 49% and for radiology orders decreased 40%. There was no change in unintentional medication duplicate orders. We estimated that the nudge eliminated 17,936 clicks in our EHR.MeaningQuality improvement often relies on changing clinician behavior. We believe guiding clinicians to a right action is better than telling the clinician they have already made an error. Our approach will help reduce alert fatigue and lessen clinician complaints about EHRs.

Download Full-text

Intradialytic Hypotension and Cardiac Arrhythmias in Patients Undergoing Maintenance Hemodialysis

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.06810619 ◽

2020 ◽

Vol 15 (6) ◽

pp. 805-812 ◽

Cited By ~ 1

Author(s):

Finnian R. Mc Causland ◽

Jim A. Tumlin ◽

Prabir Roy-Chaudhury ◽

Bruce A. Koplan ◽

Alexandru I. Costea ◽

...

Keyword(s):

United States ◽

Confidence Interval ◽

Incidence Rate ◽

Rate Ratio ◽

Negative Binomial ◽

Incidence Rate Ratio ◽

The United States ◽

Maintenance Hemodialysis ◽

Intradialytic Hypotension ◽

Clinically Significant

Background and objectivesPatients receiving maintenance hemodialysis (HD) have a high incidence of cardiac events, including arrhythmia and sudden death. Intradialytic hypotension (IDH) is a common complication of HD and is associated with development of reduced myocardial perfusion, a potential risk factor for arrhythmia.Design, setting, participants, & measurementsWe analyzed data from the Monitoring in Dialysis study, which used implantable loop recorders to detect and continuously monitor electrocardiographic data from patients on maintenance HD (n=66 from the United States and India) over a 6-month period (n=4720 sessions). Negative binomial mixed effects regression was used to test the association of IDH20 (decline in systolic BP >20 mm Hg from predialysis systolic BP) and IDH0–20 (decline in systolic BP 0–20 mm Hg from predialysis systolic BP) with clinically significant arrhythmia (bradycardia≤40 bpm for ≥6 seconds, asystole≥3 seconds, ventricular tachycardia ≥130 bpm for ≥30 seconds, or patient-marked events) during HD.ResultsThe median age of participants was 58 (25th–75th percentile, 49–66) years; 70% were male; and 65% were from the United States. IDH occurred in 2251 (48%) of the 4720 HD sessions analyzed, whereas IDH0–20 occurred during 1773 sessions (38%). The number of sessions complicated by least one intradialytic clinically significant arrhythmia was 27 (1.2%) where IDH20 occurred and 15 (0.8%) where IDH0–20 occurred. Participants who experienced IDH20 (versus not) had a nine-fold greater rate of developing an intradialytic clinically significant arrhythmia (incidence rate ratio, 9.4; 95% confidence interval, 3.0 to 29.4), whereas IDH0–20 was associated with a seven-fold higher rate (incidence rate ratio, 7.2; 95% confidence interval, 2.1 to 25.4).ConclusionsIDH is common in patients on maintenance HD and is associated with a greater risk of developing intradialytic clinically significant arrhythmia.

Download Full-text

Trends in incident acute myocardial infarction in Norway: An updated analysis to 2014 using national data from the CVDNOR project

European Journal of Preventive Cardiology ◽

10.1177/2047487318780033 ◽

2018 ◽

Vol 25 (10) ◽

pp. 1031-1039 ◽

Cited By ~ 15

Author(s):

Gerhard Sulo ◽

Jannicke Igland ◽

Stein Emil Vollset ◽

Marta Ebbing ◽

Grace M Egeland ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Confidence Interval ◽

Incidence Rate ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Age Groups ◽

Incidence Rates ◽

Myocardial Infarctions ◽

Men And Women

Background We updated the information on trends of incident acute myocardial infarction in Norway, focusing on whether the observed trends during 2001–2009 continued throughout 2014. Methods All incident (first) acute myocardial infarctions in Norwegian residents age 25 years and older were identified in the Cardiovascular Disease in Norway 1994–2014 project. We analysed overall and age group-specific (25–64 years, 65–84 years and 85 + years) trends by gender using Poisson regression analyses and report the average annual changes in rates with their 95% confidence intervals. Results During 2001–2014, 221,684 incident acute myocardial infarctions (59.4% men) were identified. Hospitalised cases accounted for 79.9% of all incident acute myocardial infarctions. Overall, incident acute myocardial infarction rates declined on average 2.6% per year (incidence rate ratio 0.974, 95% confidence interval 0.972–0.977) in men and 2.8% per year (incidence rate ratio 0.972, 95% confidence interval 0.971–0.974) in women, contributed by declining rates of hospitalisations (1.8% and 1.9% per year in men and women, respectively) and deaths (6.0% and 5.8% per year in men and women, respectively). Declining rates were observed in all three age groups. The overall acute myocardial infarction incidence rates continued to decline from 2009 onwards, with a steeper decline compared to 2001–2009. During 2009–2014, gender-adjusted acute myocardial infarction incidence among adults age 25–44 years declined 5.3% per year, contributed mostly by declines in hospitalisation rates (5.1% per year). Conclusion Acute myocardial infarction incidence rates continued to decline after 2009 in Norway in both men and women. The decline started to involve individuals aged 25–44 years, marking a turning point in the previously reported stagnation of rates during 2001–2009.

Download Full-text

COVID-19 vaccine effectiveness against hospitalizations and ICU admissions in the Netherlands, April- August 2021

10.1101/2021.09.15.21263613 ◽

2021 ◽

Author(s):

Brechje de Gier ◽

Marjolein Kooijman ◽

Jeanet Kemmeren ◽

Nicolette de Keizer ◽

Dave Dongelmans ◽

...

Keyword(s):

Negative Binomial ◽

Incidence Rate Ratio ◽

Age Groups ◽

Negative Binomial Regression ◽

Incidence Rates ◽

Vaccine Effectiveness ◽

Negative Binomial Regression Model ◽

Age Group ◽

Icu Admission ◽

Binomial Regression

The objective of this study was to estimate vaccine effectiveness (VE) against COVID-19 hospitalization and ICU admission, per period according to dominating SARS-CoV-2 variant (Alpha and Delta), per vaccine, and per time since vaccination. To this end, data from the national COVID-19 vaccination register was added to the national register of COVID-19 hospitalizations. For the study period 4 April- 29 August 2021, 15,571 hospitalized people with COVID-19 were included in the analysis, of whom 887 (5.7%) were fully vaccinated. Incidence rates of hospitalizations and ICU admissions per age group and vaccination status were calculated, and VE was estimated as 1-incidence rate ratio, adjusted for calendar date and age group in a negative binomial regression model. VE against hospitalization for full vaccination was 94% (95%CI 93-95%) in the Alpha period and 95% (95%CI 94-95%) in the Delta period. The VE for full vaccination against ICU admission was 93% (95%CI 87-96%) in the Alpha period and 97% (95%CI 97-98%) in the Delta period. VE was high in all age groups and did not show waning with time since vaccination up to 20 weeks after full vaccination.

Download Full-text

Firearm laws and the network of firearm movement among US states

BMC Public Health ◽

10.1186/s12889-021-11772-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sae Takada ◽

Kristen R. Choi ◽

Shaw Natsui ◽

Altaf Saadi ◽

Liza Buchbinder ◽

...

Keyword(s):

Standard Deviation ◽

Rate Ratio ◽

Negative Binomial ◽

Incidence Rate Ratio ◽

State Level ◽

Negative Binomial Regression ◽

Similar Model ◽

Us States ◽

Binomial Regression ◽

The Relationship

Abstract Background The movement of firearm across state lines may decrease the effectiveness of state-level firearm laws. Yet, how state-level firearm policies affect cross-state movement have not yet been widely explored. This study aims to characterize the interstate movement of firearms and its relationship with state-level firearm policies. Methods We analyzed the network of interstate firearm movement using Bureau of Alcohol, Tobacco, Firearms, and Explosives firearm trace data (2010–2017). We constructed the network of firearm movement between 50 states. We used zero-inflated negative binomial regression to estimate the relationship between the number of a state’s firearm laws and number of states for which it was the source of 100 or more firearms, adjusting for state characteristics. We used a similar model to examine the relationship between firearm laws and the number of states for which a given state was the destination of 100 or more firearms. Results Over the 8-year period, states had an average of 26 (Standard Deviation [SD] 25.2) firearm laws. On average, a state was the source of 100 or more crime-related firearms for 2.2 (SD 2.7) states and was the destination of 100 or more crime-related firearms for 2.2 (SD 3.4) states. Greater number of firearm laws was associated with states being the source of 100 or more firearms to fewer states (Incidence Rate Ratio [IRR] 0.58 per SD, p < 0.001) and being the destination of 100 or more firearms from more states (IRR1.73 per SD, p < 0.001). Conclusions Restrictive state-level firearm policies are associated with less movement of firearms to other states, but with more movement of firearms from outside states. The effectiveness of state-level firearm-restricting laws is complicated by a network of interstate firearm movement.

Download Full-text

The campylobacteriosis conundrum – examining the incidence of infection with Campylobacter sp. in Australia, 1998–2013

Epidemiology and Infection ◽

10.1017/s0950268816002909 ◽

2016 ◽

Vol 145 (4) ◽

pp. 839-847 ◽

Cited By ~ 11

Author(s):

C. R. M. MOFFATT ◽

K. GLASS ◽

R. STAFFORD ◽

C. D'ESTE ◽

M. D. KIRK

Keyword(s):

Incidence Rate ◽

Negative Binomial ◽

Age Groups ◽

Negative Binomial Regression ◽

Incidence Rates ◽

Age Group ◽

Disease Notification ◽

Significant Public Health ◽

Rate Ratios ◽

Over Time

SUMMARYCampylobacter sp. are a globally significant cause of gastroenteritis. Although rates of infection in Australia are among the highest in the industrialized world, studies describing campylobacteriosis incidence in Australia are lacking. Using national disease notification data between 1998 and 2013 we examined Campylobacter infections by gender, age group, season and state and territory. Negative binomial regression was used to estimate incidence rate ratios (IRRs), including trends by age group over time, with post-estimation commands used to obtain adjusted incidence rates. The incidence rate for males was significantly higher than for females [IRR 1·20, 95% confidence interval (CI) 1·18–1·21], while a distinct seasonality was demonstrated with higher rates in both spring (IRR 1·18, 95% CI 1·16–1·20) and summer (IRR 1·17, 95% CI 1·16–1·19). Examination of trends in age-specific incidence over time showed declines in incidence in those aged <40 years combined with contemporaneous increases in older age groups, notably those aged 70–79 years (IRR 1998–2013: 1·75, 95% CI 1·63–1·88). While crude rates continue to be highest in children, our findings suggest the age structure for campylobacteriosis in Australia is changing, carrying significant public health implications for older Australians.

Download Full-text

Hospital Presentations in Long-Term Survivors of Stroke

Stroke ◽

10.1161/strokeaha.120.030656 ◽

2020 ◽

Vol 51 (12) ◽

pp. 3673-3680

Author(s):

Nadine E. Andrew ◽

Monique F. Kilkenny ◽

Vijaya Sundararajan ◽

Joosup Kim ◽

Steven G. Faux ◽

...

Keyword(s):

Emergency Department ◽

Incidence Rate ◽

Rate Ratio ◽

Associated Factors ◽

Negative Binomial ◽

Incidence Rate Ratio ◽

Study Cohort ◽

Quality Of Life Scale ◽

Long Term Survivors

Background and Purpose: A comprehensive understanding of the long-term impact of stroke assists in health care planning. We aimed to determine changes in rates, causes, and associated factors for hospital presentations among long-term survivors of stroke. Methods: Person-level data from the AuSCR (Australian Stroke Clinical Registry) during 2009 to 2013 were linked with state-based health department emergency department and hospital admission data. The study cohort included adults with first-ever stroke who survived the first 6 months after discharge from hospital. Annualized rates of hospital presentations (nonadmitted emergency department or admission)/person/year were calculated for 1 to 12 months prior, and 7 to 12 months (inclusive) after hospitalization. Multilevel, negative binomial regression was used to identify associated factors after adjustment for prestroke hospital presentations and stratification for perceived impairment status. Perceived impairments to health were defined according to the subscales and visual analog health status scores on the 5-Dimension European Quality of Life Scale. Results: There were 7183 adults with acute stroke, 7-month survivors (median age 72 years; 56% male; 81% ischemic, and 42% with impairment at 90–180 days) from 39 hospitals included in this landmark analysis. Annualized presentations/person increased from 0.88 (95% CI, 0.86–0.91) to 1.25 (95% CI, 1.22–1.29) between the prestroke and poststroke periods, with greater rate increases in those with than without perceived impairment (55% versus 26%). Higher presentation rates were most strongly associated with older age (≥85 versus 65 years, incidence rate ratio, 1.52 [95% CI, 1.27–1.82]) and greater comorbidity score (incidence rate ratio, 1.06 [95% CI, 1.02–1.10]), whereas reduced rates were associated with greater social advantage (incidence rate ratio, 0.71 [95% CI, 0.60–0.84]). Poststroke hospital presentations (7–12 months) were most frequently related to recurrent cardiovascular and cerebrovascular events and sequelae of stroke. Conclusions: A large increase in annualized hospital presentation rates after stroke indicates the potential for improved community management and support for this vulnerable patient group.

Download Full-text