scholarly journals Association between Moving to a High-Volume Hospital in the Capital Area and the Mortality among Patients with Cancer: A Large Population-Based Cohort Study

2021 ◽  
Vol 18 (7) ◽  
pp. 3812
Author(s):  
Jung-kyu Choi ◽  
Se-Hyung Kim ◽  
Myung-Bae Park
Keyword(s):  
Low Income ◽  
Large Population ◽  
High Volume ◽  
Healthcare Services ◽  
Population Based ◽  
Patients With Cancer ◽  
Final Sample ◽  
High Volume Hospital ◽  
Study Population ◽  
Low Income Families

This study aimed to identify the association between moving to a high-volume hospital and the mortality of patients with cancer living in the district. The study population comprised participants diagnosed with cancer within the past nine years (2004–2012). The final sample included 8197 patients with cancer, 3939 were males (48.1%), and 4258 were females (51.9%). A Cox proportional hazard model was used to estimate the hazard ratio (HR) for death. Confounding variables including sex, age, type of social security, income level, disability, and utilization volume were incorporated into the model. Among patients with cancer living in the district, 2874 (35.1%) used healthcare services in Seoul. About 10% (n = 834) of patients died during the follow-up period. The HR for death in females (HR: 0.68, 95% CI: 0.58–0.81) was lower than that in males. Additionally, the HR for the death of patients using healthcare services in Seoul (HR: 1.30, 95% CI: 1.11–1.53) was higher than those patients who did not use healthcare services in Seoul. Among patients utilizing services in the province, wealthier patients’ survival probability was significantly higher than that of others. The cause of income differences should be identified, and accessibility to medical use of low-income families should be enhanced to prevent mortality of patients from cancer disparities.

scholarly journals Incidence, comorbidity and mortality in patients with necrotising soft-tissue infections, 2005–2018: a Danish nationwide register-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e041302
Author(s):  
Morten Hedetoft ◽  
Martin Bruun Madsen ◽  
Lærke Bruun Madsen ◽  
Ole Hyldegaard
Keyword(s):  
Soft Tissue ◽  
High Volume ◽  
Population Based ◽  
Treatment Modalities ◽  
Soft Tissue Infections ◽  
Registration System ◽  
Female Sex ◽  
High Volume Hospital ◽  
Comorbidity Index ◽  
Necrotising Soft Tissue Infections

ObjectiveTo assess the incidence, comorbidities, treatment modalities and mortality in patients with necrotising soft-tissue infections (NSTIs) in Denmark.DesignNationwide population-based registry study.SettingDenmark.ParticipantsDanish residents with NSTI between 1 January 2005 and 31 August 2018.Main outcome measureIncidence of disease per 100 000 person/year and all-cause mortality at day 90 obtained from Danish National Patient Registry and the Danish Civil Registration System.Results1527 patients with NSTI were identified, yielding an incidence of 1.99 per 100 000 person/year. All-cause 30-day, 90-day and 1-year mortality were 19.4% (95% CI 17.4% to 21.5%), 25.2% (95% CI 23.1% to 27.5%) and 30.4% (95% CI 28.0% to 32.8%), respectively. Amputation occurred in 7% of the individuals. Diabetes was the most predominant comorbidity affecting 43% of the cohort, while 26% had no comorbidities. Higher age, female sex and increasing comorbidity index were found to be independent risk factors of mortality. Admission to high-volume hospitals was associated with improved survival (OR 0.59, 95% CI 0.45 to 0.77). Thirty-six per cent received hyperbaric oxygen therapy (HBOT) as an adjunctive therapy. No change in overall mortality was found over the studied time period.ConclusionThe present study found that in Denmark, the incidence of NSTI increased; mortality rates remained high and largely unaltered. Diabetes was the most common comorbidity, while higher age, female sex and increasing comorbidity index were associated to increased mortality. Survival was improved in those admitted to hospitals with more expertise in treating NSTI. In high-volume hospital, HBOT was associated with decreased odds for mortality.

Social capital and related socio-demographic variation in women of reproductive age: A population-based study

2016 ◽  
Vol 61 (2) ◽  
pp. 247-259 ◽  
Author(s):  
Azam Baheiraei ◽  
Fatemeh Bakouei ◽  
Eesa Mohammadi ◽  
Reza Majdzadeh ◽  
Seyed Mostafa Hosseni
Keyword(s):  
Social Capital ◽  
Low Income ◽  
Family Income ◽  
Population Based ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Cross Sectional ◽  
The Social ◽  
Low Income Families

In this population-based cross-sectional study of women of reproductive age in Tehran, Iran, the social capital integrated questionnaire and socio-demographic questionnaire were used. The highest mean scores were related to social cohesion and inclusion dimension (55.72 ± 11.94) and the lowest mean scores to groups and networks dimension (31.78 ± 19.43). Stepwise multiple linear regressions showed the significant association between dimensions of social capital and certain socio-demographic variables, particularly family income. Policy makers should help low-income families by designing effective interventions for improving the status of social capital in this group, because it is considered one of the social determinants of health.

scholarly journals The Pattern of Medication Use amongst a Migrant Population Residing in Southern Iran: A Population-Based Study

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Marziyeh Zare ◽  
Saba Afifi ◽  
Iman Karimzadeh ◽  
Mohammad Salehi-Marzijarani ◽  
Leila Zarei ◽  
...  
Keyword(s):  
Large Population ◽  
Medication Use ◽  
Healthcare Services ◽  
Population Based ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Southern Iran ◽  
Present Cross Sectional Study ◽  
City Population ◽  
First Time

Background: Iran has welcomed a large population of immigrants and refugees, which has led to new demands and priorities in many aspects of life, such as healthcare services. Objectives: For the first time in Southern Iran, in Shiraz City, population-based research was conducted on the patterns of medication use in native non-Iranian residents. Methods: The present cross-sectional study was conducted amongst Shiraz citizens from 2017 to 2018. The population consisted of 43 migrants. Data were collected using a multipart data form. All statistical analyses were performed using SPSS. Results: A total of 43 Afghan migrants were included in the study. Most of them were female (72.1%), aged under 40 years (67.4%), and homemaker (62.8%) with an education level of non-completed high school diploma (97.7%). The majority of the subjects did not have insurance or family physician coverage (93%), and 85.7% got medications without prescription. The three most common medications used by the subjects were iron supplements, acetaminophen, and cold medicines. Conclusions: Iran is now hosting Afghan nationals as one of the largest population of refugees in the world. The health conditions of the Afghan population need more attention in order to improve the health status of their community in Iran.

Risk-Adjusted Mortality Rates as a Quality Proxy Outperform Volume in Surgical Oncology—A New Perspective on Hospital Centralization Using National Population-Based Data

2022 ◽  
Author(s):  
Philip Baum ◽  
Jacopo Lenzi ◽  
Johannes Diers ◽  
Christoph Rust ◽  
Martin E. Eichhorn ◽  
...  
Keyword(s):  
High Volume ◽  
Surgical Oncology ◽  
Population Based ◽  
Travel Times ◽  
Oncologic Surgery ◽  
Surgical Quality ◽  
High Volume Hospital ◽  
Cancer Types ◽  
Validation Set ◽  
New Perspective

PURPOSE Despite a long-known association between annual hospital volume and outcome, little progress has been made in shifting high-risk surgery to safer hospitals. This study investigates whether the risk-standardized mortality rate (RSMR) could serve as a stronger proxy for surgical quality than volume. METHODS We included all patients who underwent complex oncologic surgeries in Germany between 2010 and 2018 for any of five major cancer types, splitting the data into training (2010-2015) and validation sets (2016-2018). For each surgical group, we calculated annual volume and RSMR quintiles in the training set and applied these thresholds to the validation set. We studied the overlap between the two systems, modeled a market exit of low-performing hospitals, and compared effectiveness and efficiency of volume- and RSMR-based rankings. We compared travel distance or time that would be required to reallocate patients to the nearest hospital with low-mortality ranking for the specific procedure. RESULTS Between 2016 and 2018, 158,079 patients were treated in 974 hospitals. At least 50% of high-volume hospitals were not ranked in the low-mortality group according to RSMR grouping. In an RSMR centralization model, an average of 32 patients undergoing complex oncologic surgery would need to relocate to a low-mortality hospital to save one life, whereas 47 would need to relocate to a high-volume hospital. Mean difference in travel times between the nearest hospital to the hospital that performed surgery ranged from 10 minutes for colorectal cancer to 24 minutes for pancreatic cancer. Centralization on the basis of RSMR compared with volume would ensure lower median travel times for all cancer types, and these times would be lower than those observed. CONCLUSION RSMR is a promising proxy for measuring surgical quality. It outperforms volume in effectiveness, efficiency, and hospital availability for patients.

Validation Study for the Brief Measure of Quality of Life and Quality of Care: A Questionnaire for the National Random Sampling Hospital Survey

2017 ◽  
Vol 34 (7) ◽  
pp. 622-631 ◽  
Author(s):  
Megumi Shimizu ◽  
Daisuke Fujisawa ◽  
Miho Kurihara ◽  
Kazuki Sato ◽  
Tatsuya Morita ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Quality Of Care ◽  
Large Population ◽  
Population Based ◽  
Physical Symptoms ◽  
Care Staff ◽  
Health Care Staff ◽  
Validity And Reliability ◽  
Patients With Cancer

Background: To monitor quality of life (QOL) for patients with cancer in a large population-based survey, we developed a short QOL and quality-of-care (QOC) questionnaire. To determine the validity and reliability of this new questionnaire for evaluating QOL in patients with cancer. Methods: Outpatients and inpatients at National Cancer Center Hospital East were administered a questionnaire, including the following items—the short QOL and QOC questionnaire (physical distress, pain, emotional distress, walk burden, and need for help with self-care; perceived general health status; and satisfaction with medical care and treatment by doctor, communication with doctor, support by health-care staff other than doctor, care for physical symptoms such as pain, and psychological care), the Functional Assessment of Cancer Therapy—General (FACT-G), the Cancer Care Evaluation Scale (CCES) for patients, and demographic and medical data. We then readministered the short QOL and QOC questionnaire. Results: In total, 329 outpatients and 239 inpatients completed the survey (response rates: 80% and 90%, respectively). Total Cronbach α for the short QOL and QOC questionnaire was 0.83 for outpatients and 0.82 for inpatients. Items of the questionnaire correlated with cancer-specific measurements, FACT-G, and CCES. Intraclass correlation coefficients for all items of the questionnaire were 0.79 and 0.89 in each setting. Items of QOL and QOC did not correlate with each other. Conclusion: The validity and reliability of the short QOL and QOC questionnaire appear sufficient. This questionnaire enables continuous monitoring of patient QOL in large population-based surveys.

Evaluating Implementation Fidelity of a School-Based Parenting Program for Low-Income Families

2018 ◽  
Vol 35 (5) ◽  
pp. 325-336 ◽  
Author(s):  
Amie F. Bettencourt ◽  
Deborah Gross ◽  
Susan Breitenstein
Keyword(s):  
Young Children ◽  
Low Income ◽  
Large Population ◽  
Implementation Fidelity ◽  
Parent Satisfaction ◽  
Group Leaders ◽  
Behavioral Skills ◽  
School Based ◽  
School Based Interventions ◽  
Low Income Families

Young children first develop the social–behavioral skills needed to succeed in school from parents. However, most school-based interventions designed to bolster children’s social–behavioral skills have focused on strengthening teachers’ skills. This study examined the extent to which a 12-session group-based program for strengthening parenting skills, the Chicago Parent Program (CPP), could be implemented with fidelity in 12 urban schools serving a large population of young children (>95% African American or Latino) living in poverty. Parents of 380 prekindergarten students enrolled in the CPP. Data were collected on child behavior problems; parent satisfaction, attendance, and weekly practice completion; and implementation adherence and competence. Results indicated that CPP group leaders were highly adherent and competent; parents rated groups highly and attended an average of 8 sessions indicating CPP was implemented with high fidelity. Barriers and supports to implementation are reviewed, and implications for long-term sustainability of school-based interventions like CPP are discussed.

scholarly journals Breastfeeding and feeding patterns in three birth cohorts in Southern Brazil: trends and differentials

2008 ◽  
Vol 24 (suppl 3) ◽  
pp. s409-s416 ◽  
Author(s):  
Cesar G. Victora ◽  
Alicia Matijasevich ◽  
Iná S. Santos ◽  
Aluisio J. D. Barros ◽  
Bernardo L. Horta ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Low Income ◽  
Population Based ◽  
Southern Brazil ◽  
Birth Cohorts ◽  
Low Birth Weight Babies ◽  
Low Income Families ◽  
Duration Of Breastfeeding ◽  
The City

Breastfeeding is fundamental for child health. Changes in the duration of breastfeeding are compared for three population-based cohorts of children born in 1982, 1993 and 2004 in the city of Pelotas, Southern Brazil. Samples of the 1982 and 1993 children and all of the children from the 2004 cohort study were sought at home when they were aged around 12 months. Both the duration of breastfeeding and the stage at which different kind of foods were regularly introduced were investigated. The median duration of breastfeeding increased from 3.1 to 6.8 months in this period. Exclusive breastfeeding at three months was practically non-existent in 1982 and had reached one third of infants by 2004. The increase was faster after 1993, suggesting an important impact made by promotion activities. Up to about 6-9 months, breastfeeding was more prevalent in high-income families, but after this age it became more common among the poor. Low birth weight babies were breastfeed for shorter durations. The duration of breastfeeding is still far short of international recommendations, justifying further campaigns. Special attention should be given to low birth weight babies and those from low-income families.

scholarly journals Clinical and Economic Outcomes of Thyroid and Parathyroid Surgery in Children

2008 ◽  
Vol 93 (8) ◽  
pp. 3058-3065 ◽  
Author(s):  
Julie Ann Sosa ◽  
Charles T. Tuggle ◽  
Tracy S. Wang ◽  
Daniel C. Thomas ◽  
Leon Boudourakis ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Low Income ◽  
Hospital Costs ◽  
High Volume ◽  
Income Group ◽  
Economic Outcomes ◽  
Complication Rates ◽  
Cross Sectional ◽  
Specific Complication ◽  
Low Income Families

Abstract Context: Clinical and economic outcomes after thyroidectomy/parathyroidectomy in adults have demonstrated disparities based on patient age and race/ethnicity; there is a paucity of literature on pediatric endocrine outcomes. Objective: The objective was to examine the clinical and demographic predictors of outcomes after pediatric thyroidectomy/parathyroidectomy. Design: This study is a cross-sectional analysis of Healthcare Cost and Utilization Project–National Inpatient Sample hospital discharge information from 1999–2005. All patients who underwent thyroidectomy/parathyroidectomy were included. Bivariate and multivariate analyses were performed to identify independent predictors of patient outcomes. Subjects: Subjects included 1199 patients 17 yr old or younger undergoing thyroidectomy/parathyroidectomy. Main Outcome Measures: Outcome measures included in-hospital patient complications, length of stay (LOS), and inpatient hospital costs. Results: The majority of patients were female (76%), aged 13–17 yr (71%), and White (69%). Whites were more often in the highest income group (80% vs. 8% for Hispanic and 6% for Black; P < 0.01) and had private/HMO insurance (76% vs. 10% for Hispanic and 5% for Black; P < 0.001) rather than Medicaid (13% vs. 32% for Hispanic and 41% for Black; P < 0.001). Ninety-one percent of procedures were thyroidectomies and 9% parathyroidectomies. Children aged 0–6 yr had higher complication rates (22% vs. 15% for 7–12 yr and 11% for 13–17 yr; P < 0.01), LOS (3.3 d vs. 2.3 for 7–12 yr and 1.8 for 13–17 yr; P < 0.01), and higher costs. Compared with children from higher-income families, those from lower-income families had higher complication rates (11.5 vs. 7.7%; P < 0.05), longer LOS (2.7 vs. 1.7 d; P < 0.01), and higher costs. Children had higher endocrine-specific complication rates than adults after parathyroidectomy (15.2 vs. 6.2%; P < 0.01) and thyroidectomy (9.1 vs. 6.3%; P < 0.01). Conclusions: Children undergoing thyroidectomy/parathyroidectomy have higher complication rates than adult patients. Outcomes were optimized when surgeries were performed by high-volume surgeons. There appears to be disparity in access to high-volume surgeons for children from low-income families, Blacks, and Hispanics.

High prevalence of pain in patients with cancer in a large population-based study in The Netherlands

Pain ◽  
2007 ◽  
Vol 132 (3) ◽  
pp. 312-320 ◽  
Author(s):  
Marieke H.J. van den Beuken-van Everdingen ◽  
Janneke M. de Rijke ◽  
Alfons G. Kessels ◽  
Harry C. Schouten ◽  
Maarten van Kleef ◽  
...  
Keyword(s):  
The Netherlands ◽  
Large Population ◽  
Population Based ◽  
Population Based Study ◽  
Patients With Cancer ◽  
High Prevalence ◽  
Prevalence Of Pain

scholarly journals Helicopter emergency medical services missions to islands and the mainland during a 3-year period in Denmark: a population-based study on patient and sociodemographic characteristics, comorbidity, and use of healthcare services

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Thea Palsgaard Møller ◽  
Annette Kjær Ersbøll ◽  
Thora Majlund Kjærulff ◽  
Kristine Bihrmann ◽  
Karen Alstrup ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Low Income ◽  
Health Care Services ◽  
Healthcare Services ◽  
Population Based ◽  
Medical Services ◽  
Sociodemographic Characteristics ◽  
Helicopter Emergency Medical Services ◽  
Patient Transport ◽  
Emergency Medical

Abstract Background The Danish Helicopter Emergency Medical Services (HEMS) is part of the Danish Emergency Medical Services System serving 5.7 million citizens with 1% living on islands not connected to the mainland by road. HEMS is dispatched based on pre-defined criteria including severity and urgency, and moreover to islands for less urgent cases, when rapid transport to further care is needed. The study aim was to characterize patient and sociodemographic factors, comorbidity and use of healthcare services for patients with HEMS missions to islands versus mainland. Methods Descriptive study of data from the HEMS database in a three-year period from 1 October 2014 to 30 September 2017. All missions in which a patient was either treated on scene or transported by HEMS were included. Results Of 5776 included HEMS missions, 1023 (17.7%) were island missions. In total, 90.2% of island missions resulted in patient transport by HEMS compared with 62.1% of missions to the mainland. Disease severity was serious or life-threatening in 34.7% of missions to islands compared with 65.1% of missions to mainland and less interventions were performed by HEMS on island missions. The disease pattern differed with more “Other diseases” registered on islands compared with the mainland where cardiovascular diseases and trauma were the leading causes of contact. Patients from islands were older than patients from the mainland. Sociodemographic characteristics varied between inhabiting island patients and mainland patients: more island patients lived alone, less were employed, more were retired, and more had low income. In addition, residing island patients had to a higher extend severe comorbidity and more contacts to general practitioners and hospitals compared with the mainland patients. Conclusions HEMS missions to islands count for 17.7% of HEMS missions and 90.2% of island missions result in patient transport. The island patients encountered by HEMS are less severely diseased or injured and interventions are less frequently performed. Residing island patients are older than mainland patients and have lower socioeconomic position, more comorbidities and a higher use of health care services. Whether these socio-economic differences result in longer hospital stay or higher mortality is still to be investigated.

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