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Jürgens, Verena, Silvia Ess, Thomas Cerny y Penelope Vounatsou. "A Bayesian generalized age-period-cohort power model for cancer projections". Statistics in Medicine 33, n.º 26 (3 de julio de 2014): 4627–36. http://dx.doi.org/10.1002/sim.6248.
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Jiang, Bei y Keumhee C. Carriere. "Age-period-cohort models using smoothing splines: a generalized additive model approach". Statistics in Medicine 33, n.º 4 (9 de septiembre de 2013): 595–606. http://dx.doi.org/10.1002/sim.5970.
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Hall, M. y N. Friel. "Mortality Projections using Generalized Additive Models with applications to annuity values for the Irish population". Annals of Actuarial Science 5, n.º 1 (12 de noviembre de 2010): 19–32. http://dx.doi.org/10.1017/s1748499510000011.
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AbstractGeneralized Additive Models (GAMs) with age, period and cohort as possible covariates are used to predict future mortality improvements for the Irish population. The GAMs considered are the 1-dimensional age + period and age + cohort models and the 2-dimensional age-period and age-cohort models. In each case thin plate regression splines are used as the smoothing functions. The generalized additive models are compared with the P-Spline (Currie et al., 2004) and Lee-Carter (Lee & Carter, 1992) models included in version 1.0 of the Continuous Mortality Investigation (CMI) library of mortality projections. Using the Root Mean Square Error to assess the accuracy of future predictions, the GAMs outperform the P-Spline and Lee-Carter models over intervals of 25 and 35 years in the age range 60 to 90. The GAMs allow intuitively simple models of mortality to be specified whilst also providing the flexibility to model complex relationships between the covariates. The majority of morality improvements derived from the projections of future Irish mortality yield annuity values at ages 60, 65, 70 and 80 in 2007 in the range of annuity values calculated, assuming a 2 to 4 percent annual compound improvement in mortality rates for both males and females.
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Chernyavskiy, Pavel, Mark P. Little y Philip S. Rosenberg. "Spatially varying age–period–cohort analysis with application to US mortality, 2002–2016". Biostatistics 21, n.º 4 (28 de abril de 2019): 845–59. http://dx.doi.org/10.1093/biostatistics/kxz009.
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Summary Many public health databases index disease counts by age groups and calendar periods within geographic regions (e.g., states, districts, or counties). Issues around relative risk estimation in small areas are well-studied; however, estimating trend parameters that vary across geographic regions has received less attention. Additionally, small counts (e.g., $<10$) in most publicly accessible databases are censored, further complicating age–period–cohort (APC) analysis in small areas. Here, we present a novel APC model with left-censoring and spatially varying intercept and trends, estimated with correlations among contiguous geographic regions. Like traditional models, our model captures population-scale trends, but it can also be used to characterize geographic disparities in relative risk and age-adjusted trends over time. To specify the joint distribution of our three spatially varying parameters, we adapt the generalized multivariate conditional autoregressive prior, previously used for multivariate disease mapping. Specified in this manner, region-specific parameters are correlated spatially, and also to one another. Estimation is performed using the No-U-Turn Hamiltonian Monte Carlo sampler in Stan. We conduct a simulation study to assess the performance of the proposed model relative to the standard model, and conclude with an application to US state-level opioid overdose mortality in men and women aged 15–64 years.
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GAO, Xuede y Haoyun MA. "Changing trends of Chinese people's generalized trust: A dynamic analysis of the age-period-cohort effect". Acta Psychologica Sinica 57, n.º 3 (2025): 463. https://doi.org/10.3724/sp.j.1041.2025.0463.
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Yang, Yang, Wenjiang J. Fu y Kenneth C. Land. "2. A Methodological Comparison of Age-Period-Cohort Models: The Intrinsic Estimator and Conventional Generalized Linear Models". Sociological Methodology 34, n.º 1 (diciembre de 2004): 75–110. http://dx.doi.org/10.1111/j.0081-1750.2004.00148.x.
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Grasso, Maria Teresa, Stephen Farrall, Emily Gray, Colin Hay y Will Jennings. "Thatcher’s Children, Blair’s Babies, Political Socialization and Trickle-down Value Change: An Age, Period and Cohort Analysis". British Journal of Political Science 49, n.º 1 (26 de enero de 2017): 17–36. http://dx.doi.org/10.1017/s0007123416000375.
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To what extent are new generations ‘Thatcherite’? Using British Social Attitudes data for 1985–2012 and applying age-period-cohort analysis and generalized additive models, this article investigates whether Thatcher’s Children hold more right-authoritarian political values compared to other political generations. The study further examines the extent to which the generation that came of age under New Labour – Blair’s Babies – shares these values. The findings for generation effects indicate that the later political generation is even more right-authoritarian, including with respect to attitudes to redistribution, welfare and crime. This view is supported by evidence of cohort effects. These results show that the legacy of Thatcherism for left-right and libertarian-authoritarian values is its long-term shaping of public opinion through political socialization.
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Mousavi-Jarrrahi, Seyed Houssein, Amir Kasaeian, Kamyar Mansori, Mehdi Ranjbaran, Mahmoud Khodadost y Alireza Mosavi-Jarrahi. "Addressing the Younger Age at Onset in Breast Cancer Patients in Asia: An Age-Period-Cohort Analysis of Fifty Years of Quality Data from the International Agency for Research on Cancer". ISRN Oncology 2013 (2 de septiembre de 2013): 1–8. http://dx.doi.org/10.1155/2013/429862.
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Introduction. There is an established fact that Asian breast cancer patients are, on average, younger than their European counterparts. This study aimed to utilize the data from the Cancer Incidence in Five Continents I through XIII (published by the International Agency for Research on Cancer) to examine what contributes to the younger age at onset in the Asian population. Material and Methods. Data (number of breast cancer cases and corresponding population figures) for 29 registries in Europe and 9 registries in Asia for the period of 1953–2002 was accessioned and pooled to form two distinct populations, Asia and Europe. The age specific rates were defined and analyzed cross-sectionally (period wise) and longitudinally (cohort wise). The magnitude and the pattern of age specific rates were analyzed using the age-period-cohort analysis. The constrained generalized linear model with a priority assumption of cohort effect as contributing factor to changing rates was used to analyze the data. Result. During the last 50 years, the rate of breast cancer increased for both populations with an estimated annual percent change of 1.03% (with 95% CI of 1.029, 1.031) for Asia and 1.016% (95% CI of 1.015, 1.017) for Europe. There were stronger cohort effects in the magnitude of rates among the Asian population compared to the European population. The cohort effects, expressed as the rate ratio with cohort born in 1970 as reference, ranged from 0.06 (95% CI 0.05, 0.08) to 0.94 (95% CI 0.93, 0.96) for Asians and 0.35 (95% CI 0.33, 0.36) to 1.03 (95% CI 1.02, 1.04) for Europeans. The estimated longitudinal age specific rates (adjusted for cohort and period effects) showed similar patterns between the two populations. Conclusion. It was concluded that a strong cohort effect contributes to the younger age at onset among Asian breast cancer patients.
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Ranjbaran, Mehdi, Mahmood Khodadost, Kamyar Mansori, Seyed Houssien Mousavi Jarrahi, Erfan Ayubi, Milad Nazarzadeh y Alireza Mosavi Jarrahi. "Mobile Phone Use and Brain Tumor: An Age-Period-Cohort Analysis of Brain Tumor Rates in the Nordic Population". Asian Pacific Journal of Cancer Biology 1, n.º 1 (25 de abril de 2016): 19–29. http://dx.doi.org/10.31557/apjcb.2016.1.1.19-29.
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Background: The association of the mobile phone use and risk of brain tumor remains controversial among radiation epidemiologists. Methods: We hypothesized if an association between brain tumor and mobile phone use exists, this association will be manifested as a cohort effect (as a proxy of association between mobile phone use and brain tumor) in the incidence rates of brain tumor during the period of 1990 to 2009. We used age-period-cohort methodology (generalized log-linear model) and compared the distribution of cohort effects in the observed rates of brain tumor from 1990 to 2009 to the cohort effects from rates driven based on epidemiological study results that reported a positive association between brain tumor and mobile phone use in the Nordic population. Three latency period of 1-4 years with odds ratio (OR) of 1.2, latency period of 5-9 years with OR of 1.3, and latency period of more than 10 years with OR of 2.7 were used to estimate expected rates. Results: The distribution of cohort effects between observed and expected rates were more similar among the males compared with females. A shorter latency was more con¬sistent to observed rates. Conclusion: Our study supports a possible a weak association between mobile phone use and brain tumor; further fueling the controversies in association.
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Marsh, Herbert W. "Age and Gender Effects in Physical Self-Concepts for Adolescent Elite Athletes and Nonathletes: A Multicohort-Multioccasion Design". Journal of Sport and Exercise Psychology 20, n.º 3 (septiembre de 1998): 237–59. http://dx.doi.org/10.1123/jsep.20.3.237.
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Age and gender effects in 10 physical self-concept scales for elite athletes and nonathletes were based on responses from 4 age cohorts (grades 7-10 in high school) who completed the same instrument 4 times during a 2-year period. A multicohort-multioccasion design provides a stronger basis for assessing development differences than a cross-sectional comparison collected on a single occasion or a longitudinal comparison based on responses by a single age cohort collected on multiple occasions. Across all 10 physical self-concepts there were substantial differences due to group (athletes greater than nonathletes), gender (males greater than females), and gender x group interactions (athletes less than nonathletes in gender differences). There were no significant effects of age cohort and only very small effects of occasions. Thus longitudinal and cross-sectional comparisons both showed that mean levels of physical self-concept were stable over this potentially volatile adolescent period and that this stability generalized over gender, age, and athlete groups.
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Hu, Anning. "A loosening tray of sand? Age, period, and cohort effects on generalized trust in Reform-Era China, 1990–2007". Social Science Research 51 (mayo de 2015): 233–46. http://dx.doi.org/10.1016/j.ssresearch.2014.09.008.
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Thompson, Eric M., Susan E. Wozniak, Colin M. Roberts, Amy Kao, Valerie C. Anderson y Nathan R. Selden. "Vagus nerve stimulation for partial and generalized epilepsy from infancy to adolescence". Journal of Neurosurgery: Pediatrics 10, n.º 3 (septiembre de 2012): 200–205. http://dx.doi.org/10.3171/2012.5.peds11489.
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Object Vagus nerve stimulation (VNS) is approved by the FDA for the treatment of partial epilepsy in patients older than 12 years. Authors of the current study performed a large retrospective analysis and comparison of VNS outcomes in children with an age ≥ and < 12 years, including those with partial and generalized epilepsy. Methods A retrospective review of the records of pediatric patients (age < 18 years) who had undergone primary VNS system implantation between 2001 and 2010 by a single pediatric neurosurgeon was undertaken. Considered data included demographics, epilepsy type (partial vs generalized), seizure frequency, seizure duration, postictal period duration, and antiepileptic medication use. Results One hundred forty-six patients (49% female) were followed up for a mean of 41 months after VNS implantation. Thirty-two percent of patients had partial epilepsy and 68% had generalized epilepsy. After VNS system implantation, seizure frequency was reduced in 91% of patients, seizure duration in 50%, postictal period in 49%, and antiepileptic medication use in 75%. There was no significant difference in age, sex, or duration of follow-up according to epilepsy type. Neither was there any significant difference in seizure frequency reduction, seizure duration, postictal period, medication use, overall clinical improvement, or improvement in quality of life based on an age ≥ or < 12 years or epilepsy type. Conclusions Vagus nerve stimulation reduced both seizure frequency and antiepileptic medication use in the majority of pediatric patients regardless of sex, age cohort, or epilepsy type. Vagus nerve stimulation also reduced seizure duration and postictal period in approximately half of the pediatric patients. Contrary to expectation, children with partial epilepsy do not benefit from VNS at higher rates than those with generalized epilepsy.
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Xie, Jinchen, Peng Nie, Mengzi Sun, Xinguang Chen, Tingling Xu, Zumin Shi, Chuntian Lu y Youfa Wang. "One hundred‐year secular trends of overweight and obesity in China: effects of age, period, and cohort". Obesity 32, n.º 11 (noviembre de 2024): 2186–97. http://dx.doi.org/10.1002/oby.24134.
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AbstractObjectiveObesity has become a major public health problem worldwide and particularly in China. This study examined the secular trend of overweight and obesity in China over the past 100 years.MethodsNationwide data from the China Health and Nutrition Survey and the Chinese General Social Survey were used. A generalized binary mixed‐effects model and a weighted quantile sum model were applied.ResultsFrom 1909 to 2021, the prevalence of overweight and obesity remained stable from 1909 to 1944, experienced a smooth increase from 1945 to 1959 followed by a decline between 1960 and 1974, continued to rise after 1975, and peaked in 2003. The prevalence of overweight (obesity) among Chinese adults increased by 2.68 (6.21) times, from 20.65% (3.10%) in 1993 to 55.33% (19.26%) in 2021, and cohorts born during the Chinese Cultural Revolution (1960–1974) exhibited the lowest risk of overweight and obesity, associated with low protein intake and high physical activity. Cohorts born during the Reform and Opening‐Up period (1975–2003) showed a high risk of overweight and obesity related to favorable socioeconomic status and rapid urbanization. Persistent differences by sex and emerging differences by socioeconomic status in overweight and obesity prevalence were captured.ConclusionsOverweight and obesity trends in China have shown a distinctive increasing–decreasing–increasing pattern over the past 100 years. These patterns exhibit unique characteristics and are influenced by discernible social forces.
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DELABRE, R. M., N. SALEZ, N. LAPIDUS, M. LEMAITRE, M. LERUEZ-VILLE, X. de LAMBALLERIE y F. CARRAT. "Immunity against influenza A(H1N1) infections is determined by age at the time of initial strain circulation". Epidemiology and Infection 145, n.º 1 (29 de septiembre de 2016): 141–47. http://dx.doi.org/10.1017/s0950268816002156.
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SUMMARYWe explored age-dependent patterns in haemagglutination inhibition (HI) titre to seasonal [1956 A(H1N1), 1977 A(H1N1), 2007 A(H1N1)] and pandemic [A(H1N1)pdm09] influenza strains using serological data collected from an adult French influenza cohort. Subjects were recruited by their general practitioners from 2008 to 2009 and followed until 2010. We explored age-related differences between strain-specific HI titres using 1053 serological samples collected over the study period from 398 unvaccinated subjects. HI titres against the tested seasonal and pandemic strains were determined using the HI technique. Geometric mean titres (GMTs) were estimated using regression models for interval-censored data. Generalized additive mixed models were fit to log-transformed HI estimates to study the relationship between HI titre and age (age at inclusion and/or age at initial strain circulation). GMT against one strain was consistently highest in the birth cohort exposed to that strain during childhood, with peak titres observed in subjects aged 7–8 years at the time of initial strain circulation. Our results complete previous findings on influenza A(H3N2) strains and identify a strain-dependent relationship between HI titre and age at initial strain circulation.
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Kölbel, Heike, Maximilian Müllers, Olaf Kaiser, Mahmoud Ismail, Marc Swierzy, Jens-Carsten Rueckert, Ulrike Schara y Adela Della Marina. "Outcome after Robotic-Assisted Thymectomy in Children and Adolescents with Acetylcholine Receptor Antibody-Positive Juvenile Myasthenia Gravis". Neuropediatrics 48, n.º 04 (19 de junio de 2017): 315–22. http://dx.doi.org/10.1055/s-0037-1603775.
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AbstractThe aim of our study was to describe the long-term outcomes after robotic-assisted thymectomy in a cohort of acetylcholine receptor (AChR)-antibody (Ab)–positive, generalized juvenile myasthenia gravis (JMG). We retrospectively analyzed a cohort of 18 patients (15 females and 3 males) who underwent robotic-assisted thymectomy. At the time of diagnosis, 12/18 patients were prepubertal; the mean age was 9.8 years at the onset of the disease. All patients received therapy with pyridostigmine; additional immunotherapy included: corticosteroid therapy in 18/18, azathioprine in 14/18 patients, mycophenolate mofetil in 4/18, and cyclosporine in 1/18 patients. Eight patients received intravenous immunoglobulin and four plasma exchange. The mean age of patients at thymectomy was 11.7 years (range: 4.2–16 years). The mean duration of postoperative stay was 2.9 days. Thymectomy was followed by gradual clinical improvement (39% patients achieved clinical remission) and dose reduction in steroid therapy in all patients during the follow-up period (mean: 27.4 months). In children and adolescents with AChR-Ab–positive JMG, thymectomy has a beneficial effect on the weaning off immunosuppressive therapy in patients with generalized symptoms and should be considered as a part of multimodal therapy. Robotic-assisted thymectomy is a safe procedure with low morbidity and a comparable clinical outcome compared with the open sternal procedure.
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Gorski, A. I., M. A. Maksioutov, S. Yu Chekin, A. M. Korelo, E. V. Kochergina, N. S. Zelenskaya y V. K. Ivanov. "Impact of radiation on the atherosclerosis incidence in men participated in mitigation of the consequences of the accident at the Chernobyl NPP". "Radiation and Risk" Bulletin of the National Radiation and Epidemiological Registry 32, n.º 4 (2023): 14–23. http://dx.doi.org/10.21870/0131-3878-2023-32-4-14-23.
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The statistical relationship between radiation dose to the cohort of workers (liquidators), participated in mitigation of effects of the Chernobyl accident are considered in the paper. The follow-up data collected from 1992 to 2021 and accumulated in the National Radiation and Epidemiological Register (NRER) were used for analysis. The cohort of liquidators consisted of 67,304 males. The average radiation dose in the cohort was 0.13 Gy, and the average age at radiation exposure was 34 years. During the follow-up period 10,790 atherosclerosis cases (ICD-10, code 170) were detected for the first time. To identify statistical relationship between radiation dose and atherosclerosis incidence, general “data mining” approaches were used, that do not use hypotheses about the probabilistic laws of random variable distributions, that determine the relationship between radiation dose and atherosclerosis incidence. A group of liquidators with accumulated during the period of work individual radiation doses below 0.15 Gy was selected as the reference group. The maximum radiation dose in the studied cohort was 1.4 Gy. Statistically significant relationship between radiation doses and atherosclerosis incidence (ICD-10, code 170) were found: relative radiation risk RR=1.05 at 95% lower confidence bound 1.027. The relative risks (RR) for individual diagnoses are: RR=1.22 (95% CI lower bound – 1.20) for ICD-10 – I70.0 (aortic atherosclerosis); RR=1.03 (95% CI lower bound – 1.01); for ICD-10 – I70.2 (limb artery atherosclerosis); RR=1.06 (95% CI lower bound – 1.04) for ICD-10 – I70.9 (generalized and unspecified atherosclerosis). The RR increases with the age at diagnosis. The results obtained can be the basis for the design of radiation-epidemiological studies for the detailed quantitative study of the detected dose-effect relationships.
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Richards, Tara N., Wesley G. Jennings, Elizabeth Tomsich y Angela Gover. "A 10-Year Analysis of Rearrests Among a Cohort of Domestic Violence Offenders". Violence and Victims 29, n.º 6 (2014): 887–906. http://dx.doi.org/10.1891/0886-6708.vv-d-13-00145.
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In this study, survival analysis is used to examine time to rearrest for both domestic violence and nondomestic violence crimes among a cohort of domestic violence offenders (N = 286) over a 10-year period. In addition, risk factors for rearrest such as demographic, offending history, and batterer treatment variables are examined to determine their influence on domestic and nondomestic violence recidivism. Overall, the results suggest that approximately half of domestic violence offenders are rearrested. Furthermore, among those who are rearrested, they are rearrested fairly quickly and for generalized (both domestic and nondomestic violence offenses) versus specialized offending. Risk factors associated with both types of rearrest included age, marriage, and domestic violence offense history. Several additional risk factors were unique to rearrest type. Study limitations are explicitly stated and policy implications are discussed.
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Vos, Rein, Jos Boesten y Marjan van den Akker. "Fifteen-year trajectories of multimorbidity and polypharmacy in Dutch primary care—A longitudinal analysis of age and sex patterns". PLOS ONE 17, n.º 2 (25 de febrero de 2022): e0264343. http://dx.doi.org/10.1371/journal.pone.0264343.
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Objective After stratifying for age, sex and multimorbidity at baseline, our aim is to analyse time trends in incident multimorbidity and polypharmacy in the 15-year clinical trajectories of individual patients in a family medicine setting. Methods This study was carried out using data from the Registration Network Family Medicine in the South of the Netherlands. The clinical trajectories of 10037 subjects during the 15-year period (2000–2014) were analyzed in a repeated measurement of using a generalized estimating equations model as well as a multilevel random intercept model with repeated measurements to determine patterns of incident multimorbidity and polypharmacy. Hierarchical age-period-cohort models were used to generate age and cohort trajectories for comparison with prevalence trends in multimorbidity literature. Results Multimorbidity was more common in females than in males throughout the duration of the 15-year trajectory (females: 39.6%; males: 33.5%). With respective ratios of 11.7 and 5.9 between the end and the beginning of the 15-year period, the youngest female and male groups showed a substantial increase in multimorbidity prevalence. Ratios in the oldest female and male groups were 2.2 and 1.9 respectively. Females had higher levels of multimorbidity than males in the 0-24-year and 25-44-year age groups, but the levels converged to a prevalence of 92.2% in the oldest male and 90.7% in the oldest female group. Similar, albeit, moderate differences were found in polypharmacy patterns. Conclusions We sought to specify the progression of multimorbidity from an early age. As a result, our study adds to the multimorbidity literature by specifying changes in chronic disease accumulation with relation to polypharmacy, and by tracking differences in patient trajectories according to age and sex. Multimorbidity and polypharmacy are common and their prevalence is accelerating, with a relatively rapid increase in younger groups. From the point of view of family medicine, this underlines the need for a longitudinal approach and a life course perspective in patient care.
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Mace Firebaugh, Casey, Simon Moyes, Santosh Jatrana, Anna Rolleston y Ngaire Kerse. "Physical Activity, Function, and Mortality in Advanced Age: A Longitudinal Follow-Up (LiLACS NZ)". Journal of Aging and Physical Activity 26, n.º 4 (1 de octubre de 2018): 583–88. http://dx.doi.org/10.1123/japa.2017-0178.
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The relationship between physical activity, function, and mortality is not established in advanced age. Physical activity, function, and mortality were followed in a cohort of Māori and non-Māori adults living in advanced age for a period of 6 years. Generalized linear regression models were used to analyze the association between physical activity and Nottingham Extended Activities of Daily Living scale, whereas Kaplan–Meier survival analysis and Cox proportional hazard models were used to assess the association between the physical activity and mortality. The hazard ratio for mortality for those in the least active physical activity quartile was 4.1 for Māori and 1.8 for non-Māori compared with the most active physical activity quartile. There was an inverse relationship between physical activity and mortality, with lower hazard ratios for mortality at all levels of physical activity. Higher levels of physical activity were associated with lower mortality and higher functional status in advanced-aged adults.
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Li, Sophia, Zhijie Ding, Jennifer H. Lin, Chris Pericone, Ajay S. Behl y Neal D. Shore. "Assessment of health care resource utilization (HRU) in patients with castration-resistant prostate cancer (CRPC)." Journal of Clinical Oncology 36, n.º 30_suppl (20 de octubre de 2018): 89. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.89.
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89 Background: Although patients with CRPC frequently develop metastasis within 3 years following castration resistance, the impact of metastasis on HRU in these patients is not well understood. Methods: The Optum de-identified electronic health record database (1/1/2007 – 4/30/2016) was used in this single cohort observational study comparing HRU after metastasis with HRU before metastasis. The cohort included only non-metastatic CRPC (nmCRPC) patients who later developed metastasis. The pre-metastasis period spanned from nmCRPC identification to development of metastasis; the post-metastasis period spanned from metastasis until death or end of data availability. Per-patient per-month (PPPM) HRU was estimated during both pre- and post-metastasis periods by a generalized linear mixed model adjusted for log-transformed baseline PSA, age, testosterone levels, and Charlson Comorbidity Index. Results: With a mean time of 11 and 17 months of pre- and post-metastasis periods, respectively, 540 CRPC men were included, with a mean age at nmCRPC identification of 75 years. Higher HRU was seen across all service types during the post-metastasis period. There was a 2.5-fold increase in inpatient admissions and a 6.4-fold increase in inpatient length-of-stay in the post-metastasis period compared to the pre-metastasis period (p < 0.01). For emergency department (ED) visits, there was a 2.0-fold increase from the pre- to post-metastasis periods (p < 0.01). For observation unit visits, a 2.7-fold increase was seen in the post-metastasis period (p < 0.01). Finally, patients were 40% more likely to have an office visit after developing metastasis (p < 0.01). The PPPM use of intensive care unit, hospice or skilled nursing facility were too low for meaningful comparison between the pre- and post-metastasis periods. Conclusions: Shorter time to metastasis was observed in this cohort vs. other nmCRPC studies, likely due to delayed disease identification. CRPC patients incurred substantially higher HRU after developing metastasis, attributable to inpatient, ED, observation unit as well as office visits, suggesting that delaying metastasis may reduce or delay the increased HRU in patients with nmCRPC.
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Kristiansen, Anne Lene, Mona Bjelland, Anne Lise Brantsæter, Margaretha Haugen, Helle Margrete Meltzer, Wenche Nystad y Lene Frost Andersen. "Tracking of body size from birth to 7 years of age and factors associated with maintenance of a high body size from birth to 7 years of age – the Norwegian Mother and Child Cohort study (MoBa)". Public Health Nutrition 18, n.º 10 (10 de noviembre de 2014): 1746–55. http://dx.doi.org/10.1017/s1368980014002419.
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AbstractObjectiveTo examine tracking of body size among children participating in the Norwegian Mother and Child Cohort Study (MoBa) from birth to 7 years of age and additionally to explore child and parental characteristics associated with maintenance of a high body size in this period of life.DesignAnthropometric data at birth and at 1, 3 and 7 years of age were collected by questionnaires addressed to the mother.SettingParticipants were recruited from all over Norway during the period 1999–2008.SubjectsA total of 3771 children had complete anthropometric data at birth and at 1, 3 and 7 years of age; the sample includes children born between 2002 and 2004.ResultsCohen’s weighted kappa pointed to fair (0·36) to moderate (0·43) tracking of body size from birth to 7 years of age. Generalized estimating equations further indicated that children in the highest tertile of ponderal index at birth had nearly one unit higher BMI (kg/m2) at the age of 7 years compared with children in other tertiles of ponderal index at birth. Having parents with high BMI (≥25·0 kg/m2) increased the odds of having a stable high body size from birth to 7 years of age; moreover, girls had significantly higher odds compared with boys.ConclusionsThe study indicates fair to moderate tracking of body size from birth to 7 years of age. From a public health perspective, early prevention of childhood overweight and obesity seems to be especially important among children of parents having a high BMI.
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Stanley, Bryden J., Joe G. Hauptman, Michele C. Fritz, Diana S.Rosenstein y Jennifer Kinns. "ESOPHAGEAL DYSFUNCTION IN DOGS WITH IDIOPATHIC LARYNGEAL PARALYSIS: A CONTROLLED COHORT STUDY". Journal of the American Animal Hospital Association 46, n.º 1 (1 de enero de 2010): 86. http://dx.doi.org/10.5326/0460086.
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Objectives: To compare esophageal function in dogs with idiopathic laryngeal paralysis (ILP) to age- and breed-matched controls; to determine if dysfunction is associated with aspiration pneumonia over one year; and to compare clinical neurologic examination of dogs with ILP at enrollment and one year. Study Design: Prospective controlled cohort study Animals or Sample Population: 32 dogs with ILP, and 34 age- and breed-matched healthy dogs. Methods: Three-phase esophagrams were performed on all dogs. Blinded analyses of the esophagrams were performed, and the mean esophageal score determined in each phase. Following unilateral crico-arytenoid laryngoplasty, dogs with ILP were re-examined including thoracic radiography at 1, 3, 6 and 12 months. Neurologic status was recorded at enrollment, 6 and 12 months. Results: Esophagram scores in dogs with ILP were significantly higher in each phase compared to the controls, most notably with liquid (P<.0001). Dysfunction was more pronounced in the cervical and cranial thoracic esophagus. The 5 dogs that experienced aspiration pneumonia during the study period had significantly higher esophagram scores than the dogs that did not develop aspiration pneumonia (P<0.02). Ten of the 32 (31%) dogs with ILP had generalized neurologic signs upon enrollment and all (100%) dogs developed neurologic signs over one year (P<.0001). Conclusions: Dogs with ILP also have esophageal dysfunction. Post-operative aspiration pneumonia is more likely in dogs with higher esophagram scores. Dogs with ILP will most likely develop generalized neuropathy over the course of a year. Clinical Relevance: Esophagrams and neurologic examinations should be performed on all dogs with ILP.
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Pisa, Federica Edith, Giancarlo Logroscino, Anica Casetta, Laura Cecotti, Lorenzo Verriello, Alessio Bratina, Arianna Sartori, Lucio Lazzarino de Lorenzo, Roberto Eleopra y Fabio Barbone. "The Use of Antidepressant Medication before and after the Diagnosis of Amyotrophic Lateral Sclerosis: A Population-Based Cohort Study". Neuroepidemiology 44, n.º 2 (2015): 91–98. http://dx.doi.org/10.1159/000374119.
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Background: The prevalent use of antidepressants (ATDs) in patients with Amyotrophic Lateral Sclerosis (ALS) varies across cross-sectional and clinic-based published studies. This population-based cohort study assesses the real-world prevalence of the use of ATDs, its trajectory and the association of incident use with clinical characteristics. Methods: All patients with incident ALS in the Friuli Venezia Giulia region, Italy, from 2002 to 2009, were identified through multiple sources including health databases. Diagnosis was validated through clinical documentation review. ATDs prescriptions from 2000 to 2011 were obtained from regional database. The trajectory was estimated through generalized estimating equations for repeated measures logistic regression and the Hazard ratio (HR) of initiating ATDs through multivariate proportional hazard Cox regression. Results: In this cohort of 261 ALS cases, age-, sex-adjusted prevalence of the use of ATDs was 37.3%, higher than in general population. The trajectory increased by 16% in 1-year period across diagnosis. Age ≤67 years at diagnosis (HR 1.28, 95% CI 0.84-1.95) and bulbar onset (1.43, 95% CI 0.90-2.26) were positively associated with initiating ATDs after diagnosis. Conclusions: More than one-third of patients used ATDs. Depression may occur more frequently than previously reported. Depression may precede motor alterations and be related to both ALS diagnosis and progression.
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Bröde, Peter, Maren Claus, Patrick D. Gajewski, Stephan Getzmann, Edmund Wascher y Carsten Watzl. "From Immunosenescence to Aging Types—Establishing Reference Intervals for Immune Age Biomarkers by Centile Estimation". International Journal of Molecular Sciences 24, n.º 17 (24 de agosto de 2023): 13186. http://dx.doi.org/10.3390/ijms241713186.
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Immunological aging type definition requires establishing reference intervals from the distribution of immunosenescence biomarkers conditional on age. For 1605 individuals (18–97 years), we determined the comprehensive immune age index IMMAX from flow-cytometry-based blood cell sub-populations and identified age-specific centiles by fitting generalized additive models for location, scale, and shape. The centiles were uncorrelated with age and facilitated the categorization of individuals as immunologically slow or fast aging types. Using its 50th percentile as a reference, we rescaled the IMMAX to equivalent years of life (EYOL) and computed the immunological age gap as the difference between EYOL and chronological age. Applied to preliminary baseline and follow-up measurements from 53 participants of the Dortmund Vital Study (Clinical-Trials.gov Identifier: NCT05155397), the averaged changes in the IMMAX and EYOL conformed to the 5-year follow-up period, whereas no significant changes occurred concerning IMMAX centiles and age gap. This suggested that the participants immunologically adapted to aging and kept their relative positions within the cohort. Sex was non-significant. Methodical comparisons indicated that future confirmatory analyses with the completed follow-up examinations could rely on percentile curves estimated by simple linear quantile regression, while the selection of the immunosenescence biomarker will greatly influence the outcome, with IMMAX representing the preferable choice.
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Odetola, Folafoluwa O., Paul Lin, Wen Ye, Kevin J. Dombkowski y Ariel Linden. "Health Care Resource Use and Costs After Hospitalization With Multiple Organ Dysfunction in Children". JAMA Network Open 8, n.º 1 (29 de enero de 2025): e2456246. https://doi.org/10.1001/jamanetworkopen.2024.56246.
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ImportanceMultiple organ dysfunction (MOD) is a leading cause of in-hospital child mortality. For survivors, posthospitalization health care resource use and costs are unknown.ObjectiveTo evaluate longitudinal health care resource use and costs after hospitalization with MOD in infants (aged &lt;1 year) and children (aged 1-18 years).Design, Setting, and ParticipantsThis retrospective cohort study used nationwide data from 2004 to 2019 from Optum’s deidentified Clinformatics Data Mart Database, an insurance claims database. Infants and children from birth to age 18 years with an index hospitalization between January 1, 2005, and December 31, 2018, were included. Infants (age &lt;1 year) and children (age 1-18 years) with MOD (MOD cohort) or without MOD (non-MOD cohort) were separately identified, and cohorts were propensity score weighted to balance demographics and pre–index hospitalization characteristics, including health care use and comorbidities. The data were analyzed between January 7, 2022, and September 8, 2023.Main Outcomes and MeasuresWeighted generalized estimating equations were used to evaluate differences between cohorts in rehospitalizations, emergency department visits, and health care costs up to 5 years after the index hospitalization.ResultsDuring the study period, 9671 children in the MOD cohort were compared with 1 691 793 children in the non-MOD cohort in the weighted sample. Infants comprised 67.4% of the MOD cohort (mean [SD] age at index hospitalization, 0.1 [0.8] years; 51.2% male) and 87% of the non-MOD cohort (mean [SD] age at index hospitalization, 0.1 [0.8] years; 50.8% male), and children comprised 32.5% of the MOD cohort (mean [SD] age at index hospitalization, 11.6 [5.7] years; 50.7% female) and 13.0% of the non-MOD cohort (mean [SD] age at index hospitalization, 11.5 [5.5] years; 51.3% female). The infant MOD cohort had more emergency department visits, with an adjusted incidence rate ratio of 1.76 (95% CI, 1.56-1.97) at 30 days; this difference persisted for years 1 through 5. Children had a similar pattern except at 30 days among those who acquired new organ-supportive technology during the index hospitalization. Among infants, the MOD cohort had more rehospitalizations, with an adjusted incidence rate ratio of 12.45 (95% CI, 11.40-13.59) at 30 days; this difference persisted for years 1 through 5. A similar pattern was observed among children. Annual health care costs were higher for the MOD cohort in year 1 (infants: mean [SD], $80 133 [$6543] vs $5183 [$19] [P &lt; .001]; children: mean [SD], $54 113 [$17 544] vs $10 935 [$95] [P &lt; .001]) and in all years through year 5.Conclusions and RelevanceIn this cohort study of nearly 1.7 million children, survivors of MOD accrued substantial ongoing health care resource use and cost burden after the index hospitalization. These findings suggest that follow-up care of survivors of MOD should include economic well-being alongside measures of clinical health.
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González-Carrasco, Mònica, Marc Sáez y Ferran Casas. "Subjective Well-Being in Early Adolescence: Observations from a Five-Year Longitudinal Study". International Journal of Environmental Research and Public Health 17, n.º 21 (8 de noviembre de 2020): 8249. http://dx.doi.org/10.3390/ijerph17218249.
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This article aims to redress the lack of longitudinal studies on adolescents’ subjective well-being (SWB) and highlight the relevance of knowledge deriving from such research in designing public policies for improving their health and wellbeing in accordance with the stage of development they are in. To achieve this, the evolution of SWB during early adolescence (in adolescents aged between 10 and 14 in the first data collection) was explored over a five year period, considering boys and girls together and separately. This involved comparing different SWB scales and contrasting results when considering the year of data collection versus the cohort (year of birth) participants belonged to. The methodology comprised a generalized linear mixed model using the INLA (Integrated Nested Laplace Approximation) estimation within a Bayesian framework. Results support the existence of a decreasing-with-age trend, which has been previously intuited in cross-sectional studies and observed in only a few longitudinal studies and contrasts with the increasing-with-age tendency observed in late adolescence. This decrease is also found to be more pronounced for girls, with relevant differences found between instruments. The decreasing-with-age trend observed when the year of data collection is taken into account is also observed when considering the cohort, but the latter provides additional information. The results obtained suggest that there is a need to continue studying the evolution of SWB in early adolescence with samples from other cultures; this, in turn, will make it possible to establish the extent to which the observed decreasing-with-age trend among early adolescents is influenced by cultural factors.
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Olson, Daniel, Molly Lamb, Amy Connery, Desiree Bauer, Alejandra Paniagua-Avila, Kathryn L. Colborn, Muktha Natrajan et al. "757. Association between cumulative febrile, respiratory and diarrheal illness in the first year of life and neurodevelopmental and growth outcomes among a cohort of children in rural Guatemala". Open Forum Infectious Diseases 7, Supplement_1 (1 de octubre de 2020): S425—S426. http://dx.doi.org/10.1093/ofid/ofaa439.947.
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Abstract Background Recurrent infections are associated with neurodevelopmental (ND) delay in infants, but the primary drivers are poorly understood. Leveraging an infant cohort from rural Guatemala designed to evaluate the effects of post-natal Zika virus on ND (DMID 16-0057), we evaluated the association between cumulative illness and ND delay and stunting. Methods Infants enrolled at 0-3 months of age underwent weekly at-home surveillance for caregiver-reported syndromic illness, including cough, fever and vomiting/diarrhea for a 12-month period. Anthropometric assessments and ND testing by Guatemalan psychologists using the Mullen Scales of Early Learning (MSEL) were perforrmed at 12-15 months of age. Multivariable generalized linear regression models were used to test associations between syndromic illness in infancy, 12-15-month MSEL Early Learning Composite (ELC) Score, and stunting (height-for-age < -2 SD) at 12-15 months. Results The cohort (n=425) had a mean enrollment age of 1.3 months; 202 (48%) were female, 387 (91%) self-reported a literate mother, and 301 (71%) were breastfeeding at study completion. Infants had reported illness for a median of 16 weeks during the surveillance period; cough was reported most frequently (median=11 weeks, range=0-37 weeks). Lower maternal education (p=0.007) and literacy (p=0.002) as well as infant age (p=0.007) and male gender (p=0.004) were associated with MSEL ELC Score <85 (-1 SD). After adjusting for gender, breastfeeding, age, and maternal literacy, the cumulative number of weeks with reported cough (p=0.0009), fever (p=0.0001), or any syndromic illness (p=0.0007) were associated with decreased 12-month MSEL ECL Score; there was no association with diarrhea/vomiting (p=0.36). There was no association between caregiver-reported syndromic illnesses (any type) and stunting at final study visit. Conclusion In a cohort of Guatemalan infants, cumulative fever and cough episodes were significantly associated with lower MSEL ELC Score, whereas there was no association with diarrhea/vomiting. In this low-resource community, these findings highlight the potential negative ND consequences of febrile illness and persistent cough in the first year of life. NIAID Contract HHSN272201300015I Task Order HHSN27200013 (Co-PIs: FMM and EJA). Disclosures Molly Lamb, PhD, BioFire (Grant/Research Support) Evan J. Anderson, MD, Sanofi Pasteur (Scientific Research Study Investigator)
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Kassabian, Vahan, Scott Flanders, Samuel Wilson, Bruce A. Brown, Yan Song, Hongbo Yang, Stanislav Lechpammer y Neil M. Schultz. "Health care resource utilization and costs in metastatic castration-resistant prostate cancer patients treated with enzalutamide or abiraterone acetate." Journal of Clinical Oncology 36, n.º 6_suppl (20 de febrero de 2018): 232. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.232.
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232 Background: Cost of care is an important component of valuation of novel treatments in oncology. Enzalutamide (ENZA) and abiraterone acetate (ABI) are approved hormonal agents for the treatment of metastatic castration-resistant prostate cancer (mCRPC). This study compared healthcare resource utilization (HRU) and costs for patients treated with ENZA or ABI in the U.S. Methods: Adult mCRPC patients initiating ENZA or ABI before and or after cytotoxic chemotherapy were identified from the Truven MarketScan claims database (2012–2015). The first claim of ENZA or ABI was defined as the index date; continuous enrollment ≥6 months before and ≥3 months after the index date was required. HRU and costs were estimated during the post-index period for both cohorts. Generalized linear models compared HRU and costs between the cohorts and were adjusted for baseline demographic and clinical covariates. Analyses were separately conducted for chemo-naïve and chemo-experienced patients. Results: The study included 3230 chemo-naive patients (ENZA 920; ABI 2310) and 692 chemo-experienced patients (ENZA 262; ABI 430). Among chemo-naive patients, ENZA cohort was older (mean age: 74.5 vs 73.5; p=0.013), with a higher proportion of baseline comorbidities vs ABI cohort. During the post-index period, ENZA cohort had fewer all-cause inpatient admissions (IPA) [adjusted incidence rate ratio (IRR) 0.87; p=0.033], all-cause outpatient visits (OPV) [adjusted IRR 0.94; p=0.004], and PC-related OPV (adjusted IRR 0.92; p<0.001) vs the ABI cohort. Within 3 months of the index date, ENZA cohort was less likely to have an all-cause IPA (adjusted odds ratio [OR] 0.75; p=0.029). In addition, ENZA cohort had lower PC-related IPA and emergency department (ED) costs vs ABI cohort. The differences of HRU and medical costs between the 2 cohorts were not statistically significant for chemo-experienced patients. Conclusions: Despite a higher comorbidity burden at baseline, chemo-naive mCRPC patients treated with ENZA incurred less HRU and lower PC-related IPA and ED costs vs ABI cohort. Differences between the 2 cohorts were not statistically significant for chemo-experienced patients.
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Zhang, Tingting, Helen Tremlett, Feng Zhu, Elaine Kingwell, John D. Fisk, Virender Bhan, Trudy Campbell et al. "Effects of physical comorbidities on disability progression in multiple sclerosis". Neurology 90, n.º 5 (3 de enero de 2018): e419-e427. http://dx.doi.org/10.1212/wnl.0000000000004885.
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ObjectiveTo examine the association between physical comorbidities and disability progression in multiple sclerosis (MS).MethodsWe conducted a retrospective cohort study using linked health administrative and clinical databases in 2 Canadian provinces. Participants included adults with incident MS between 1990 and 2010 who entered the cohort at their MS symptom onset date. Comorbidity status was identified with validated algorithms for health administrative data and was measured during the 1 year before study entry and throughout the study period. The outcome was the Expanded Disability Status Scale (EDSS) score as recorded at each clinic visit. We used generalized estimating equations to examine the association between physical comorbidities and EDSS scores over time, adjusting for sex, age, cohort entry year, use of disease-modifying drugs, disease course, and socioeconomic status. Meta-analyses were used to estimate overall effects across the 2 provinces.ResultsWe identified 3,166 individuals with incident MS. Physical comorbidity was associated with disability; with each additional comorbidity, there was a mean increase in the EDSS score of 0.18 (95% confidence interval [CI] 0.09–0.28). Among specific comorbidities, the presence of ischemic heart disease (IHD) or epilepsy was associated with higher EDSS scores (IHD 0.31, 95% CI 0.01–0.61; epilepsy 0.68, 95% CI 0.11–1.26).ConclusionsPhysical comorbidities are associated with an apparent increase in MS disability progression. Appropriate management of comorbidities needs to be determined to optimize outcomes.
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Asadova, U. A. y Sh I. Magalov. "Gender aspects of localization-related and generalized epilepsy". Clinical Medicine (Russian Journal) 99, n.º 2 (3 de julio de 2021): 115–20. http://dx.doi.org/10.30629/0023-2149-2021-99-2-115-120.
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Aim. To study gender and age aspects of epilepsy in patients with localization-related and generalized forms of epilepsy in the village of Mashtaga, Baku city.Material and methods. The gender structure of epilepsy in the village study was conducted simultaneously with a cohort pro- and retrospective research of its epidemiology at the United City Hospital (OGB) No. 7 in the village of Mashtaga and at the Department of Neurology of the Educational and Therapeutic Corps of AMU during the period from 2016 till 2019. Psychoemotional state (Ziqmond scale), severity of seizures (NHS3 scale), quality of life (QOLIE-10 questionnaire) were studied. For statistical processing, Fisher LSD and Pearson’s rank correlation coefficient were used at the level of significant results — p < 0.05.Results and discussion. Among 197 patients with epilepsy, 121 (61.4%) men and 76 (38.6%) women were examined. Most of them were accounted for localization-related epilepsy — 129 people (65.4%). 68 patients (33.5%) suffered from generalized epilepsy. The indigenous (37,505 people) and nonindigenous (8295 people) population were represented mainly by Azerbaijanis. The number of male patients with SPE exceeded the number of females (χ2 = 8.515; p = 0.004), (p < 0.05). There were more male patients with HE (41 (60.3%)) than females (27 (39.7%)). The severity of seizures, evaluated with the use of the NHS3 scale, was higher in male patients than in females. The psychoemotional state according to the Ziqmond scale in female patients from non-indigenous inhabitants was lower (9.05 ± 0.30; m = 6, M = 13) than in those of indigenous (8.83 ± 0.21; m = 5, M = 12), (p = 0.046). Assessment of the quality of life of patients with epilepsy according to QOLIE-10, did not reveal any gender diff erence.Conclusions. A gender-specific approach to the condition of patients with epilepsy will contribute to the improvement of both, clinical and psychoemotional parameters, thereby having a positive effect on the quality of life.
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Dachew, B., J. Scott, G. Ayano y R. Alati. "Maternal perinatal depressive symptoms and oppositional-defiant disorder in children and adolescents". European Psychiatry 64, S1 (abril de 2021): S222. http://dx.doi.org/10.1192/j.eurpsy.2021.592.
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IntroductionThere is evidence that maternal perinatal depression is associated with adverse neurodevelopmental and mental health outcomes in children. No study has yet examined the association between maternal depressive symptoms during pregnancy and the postpartum period and the risk of oppositional-defiant disorder (ODD) in children and adolescents.ObjectivesThis study aimed to investigate whether there is an association between perinatal depressive symptoms and the risk of ODD in offspring from age 7 to 15 years.MethodsWe used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based prospective birth cohort study in the UK. Offspring ODD at the age of 7, 10, 13 and 15 years were assessed by using parental reports the Development and Well-Being Assessment (DAWBA). We applied Generalized Estimating Equation (GEE) modelling to examine associations across the four time points.ResultsMaternal postnatal depressive symptoms were associated with more a two-fold increased risk of ODD overall. Third trimester depressive symptoms (measured at 32 weeks of gestation) increased risk of ODD by 72%. Offspring of mothers who had depressive symptoms both during pregnancy and in the first year of postpartum period have a four-fold increased risk of ODD over time (adjusted OR = 3.59 (1.98-6.52).Conclusions Offspring of mothers with perinatal depressive symptoms are at an increased risk of developing behavioural disorders.
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Semnani-Azad, Zhila, Luke W. Johnston, Christine Lee, Ravi Retnakaran, Philip W. Connelly, Stewart B. Harris, Bernard Zinman y Anthony J. Hanley. "Determinants of longitudinal change in insulin clearance: the Prospective Metabolism and Islet Cell Evaluation cohort". BMJ Open Diabetes Research & Care 7, n.º 1 (noviembre de 2019): e000825. http://dx.doi.org/10.1136/bmjdrc-2019-000825.
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ObjectiveTo evaluate multiple determinants of the longitudinal change in insulin clearance (IC) in subjects at high risk for type 2 diabetes (T2D).Research design and methodsAdults (n=492) at risk for T2D in the Prospective Metabolism and Islet Cell Evaluation cohort, a longitudinal observational cohort, had four visits over 9 years. Values from oral glucose tolerance tests collected at each assessment were used to calculate the ratios of both fasting C peptide-to-insulin (ICFASTING) and areas under the curve of C peptide-to-insulin (ICAUC). Generalized estimating equations (GEE) evaluated multiple determinants of longitudinal changes in IC.ResultsIC declined by 20% over the 9-year follow-up period (p<0.05). Primary GEE results indicated that non-European ethnicity, as well as increases in baseline measures of waist circumference, white cell count, and alanine aminotransferase, was associated with declines in ICFASTING and ICAUC over time (all p<0.05). There were no significant associations of IC with sex, age, physical activity, smoking, or family history of T2D. Both baseline and longitudinal IC were associated with incident dysglycemia.ConclusionsOur findings suggest that non-European ethnicity and components of the metabolic syndrome, including central obesity, non-alcoholic fatty liver disease, and subclinical inflammation, may be related to longitudinal declines in IC.
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Murthy, Jagarlapudi MK, Shyam K. Jaiswal y Keshava Anand Gaade. "Posterior Reversible Encephalopathy Syndrome Is the Common Cause of New-Onset Seizures in the Peripartum Period: A Tertiary Hospital-Based Study in South India". Journal of Epilepsy Research 11, n.º 1 (30 de junio de 2021): 49–55. http://dx.doi.org/10.14581/jer.21007.
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Background and Purpose: To study the aetiolgic spectrum of new-onset seizures in the peripartum period in south India.Methods: This is a retrospective analysis of case records of women with new-onset seizures in the peripartum period admitted between 2005 and 2018 (13 years).Results: Of the 41 women (mean age, 26.20 years; range, 19-35 years) admitted, 20 patients (48.7%) had hypertensive disorders of pregnancy (HDP). Generalized tonic-clonic seizure (88%) was the common seizure type. The aetiologies of new-onset seizures were: 1) pregnancy-related aetiologies in 33 (80.5%) and 2) non-pregnancy-related aetiologies in eight (19.5%). Of the pregnancy-related aetiologies, posterior reversible encephalopathy syndrome (PRES) was the commonest cause in 24 patients (58.5%). Seizure cluster presentation was common in patients with PRES (<i>p</i>=0.0087). Of the eight women with non-pregnancy-related aetiologies, endemic central nervous system (CNS) infections accounted for three (7.3%; brain tuberculoma in one and neurocystocercosis in two) of the aetiology. All the women had Glasgow outcome scale-5 outcome.Conclusions: PRES was the common cause of new-onset seizures in peripartum period in this cohort. Endemic infections of CNS accounted for 7.3% of the total aetiological spectrum. This study suggests that the possibility of PRES should be considerd in woman with HDP and seizure cluster in peripartum period.
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Nalmpatian, Asmik, Christian Heumann y Stefan Pilz. "Forecasting Mortality Trends: Advanced Techniques and the Impact of COVID-19". Stats 7, n.º 4 (16 de octubre de 2024): 1172–88. http://dx.doi.org/10.3390/stats7040069.
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The objective of this research is to evaluate four distinct models for multi-population mortality projection in order to ascertain the most effective approach for forecasting the impact of the COVID-19 pandemic on mortality. Utilizing data from the Human Mortality Database for five countries—Finland, Germany, Italy, the Netherlands, and the United States—the study identifies the generalized additive model (GAM) within the age–period–cohort (APC) analytical framework as the most promising for precise mortality forecasts. Consequently, this model serves as the basis for projecting the impact of the COVID-19 pandemic on future mortality rates. By examining various pandemic scenarios, ranging from mild to severe, the study concludes that projections assuming a diminishing impact of the pandemic over time are most consistent, especially for middle-aged and elderly populations. Projections derived from the superior GAM-APC model offer guidance for strategic planning and decision-making within sectors facing the challenges posed by extreme historical mortality events and uncertain future mortality trajectories.
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Nawa, Nobutoshi, Angela C. B. Trude, Maureen M. Black, Lorenzo Richiardi y Pamela J. Surkan. "Associations between Paternal Anxiety and Infant Weight Gain". Children 8, n.º 11 (28 de octubre de 2021): 977. http://dx.doi.org/10.3390/children8110977.
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The aim of this study was to examine the relationship between parental anxiety (father-only, mother-only, or both) and infant weight change. We performed a secondary data analysis among 551 children in the Avon Longitudinal Study of Parents and Children, a birth cohort with weight measurements collected prospectively at 4, 8, and 12 months of age. Paternal and maternal anxiety symptoms were based on the eight-item anxiety subscale of the Crown-Crisp Experiential Index. Scores in the top 15% at 8 weeks postpartum were classified as high anxiety. Generalized Estimating Equations were employed to estimate the joint association between parental anxiety and change in child weight-for-age z-score. Children who had fathers, but not mothers, with anxiety showed a 0.15 (95% CI: 0.01, 0.29) greater increase in weight-for-age z-score than children with neither parent anxious. This result suggests that paternal anxiety, not maternal anxiety, was associated with increases in child weight gain in the first year of life. Public health practitioners and clinicians should consider the use of robust measures of both maternal and paternal anxiety in the postpartum period, in addition to the suggested screening for postpartum depression. Given the limitations of the study, this study should be considered preliminary and hypothesis generating.
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Tess, Beatriz Helena, Veruska Magalhães Scabim, Marco Aurélio Santo y Júlio César R. Pereira. "Obese patients lose weight independently of nutritional follow-up after bariatric surgery". Revista da Associação Médica Brasileira 61, n.º 2 (abril de 2015): 139–43. http://dx.doi.org/10.1590/1806-9282.61.02.139.
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Summary Objective: to examine the association between preoperative body weight, adherence to postsurgical nutritional follow-up, length of postoperative period, and weight loss during the first 18 months among adults who have undergone bariatric surgery. Methods: a retrospective cohort study was conducted on 241 consecutive patients who underwent open Roux-en-Y gastric bypass (RYGBP) from January 2006 to December 2008, in a teaching hospital in São Paulo (Brazil). Data were collected through hospital records review and the variables analyzed included sex, age, immediate preoperative weight, adherence to postsurgical nutritional visits and length of postoperative period. Proportional body weight reductions during the 18-month follow-up period were examined using generalized estimating equations. Results: 81% (n=195) of participants were female, with overall mean age of 44.4 ± 11.6 years, mean preoperative weight of 123.1± 21.2 kg and mean preoperative body mass index of 47.2± 6.2 kg/m2. The overall adherence to postoperative follow- up schedule was 51% (95%CI: 44.5-57.5%). Preoperative body weight and adherence were not associated with proportional weight reduction (Wald’s test p > 0.18). Weight loss leveled off at the end of the 18-month follow-up period for both compliant and non-compliant patients (Wald’s test p = 0.00). Conclusions: our study showed that weight loss occurred steadily over the first 18 months after RYGBP, leveling off at around 40% weight reduction. It was associated with neither presurgical weight, nor nutritional follow-up and it may be primarily dependent on the surgical body alterations themselves. This finding may have implications for intervention strategies aimed at motivating patients to comply with early postsurgical and life-long follow-up.
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Hobbs, Joseph, David L. Kriegel, Ashley Saucier, Denise M. Hodo y Stephen W. Looney. "Student Race and Gender and Patient Encounters in a Family Medicine Clerkship". Family Medicine 51, n.º 1 (7 de enero de 2019): 14–21. http://dx.doi.org/10.22454/fammed.2019.487510.
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Background and Objectives: The purpose of this study was to determine the association of students’ race and gender with the race, gender, age, patient numbers, and problems encountered during a third-year family medicine clerkship across a geographically distributed clinical teaching network. Methods: Student patient experience logbook data from two separate but adjacent 3-year periods were analyzed. Mixed-effects regression models and generalized linear mixed models were used to determine the relationship between student race and gender on number and demographics of patients encountered and odds of encountering required conditions and gender-specific conditions at least once during the clerkship. Results: A total of 458 students documented 66,752 encounters during academic years 2008 through 2010, and 498 students documented 70,213 encounters during academic years 2011 through 2013. The first cohort averaged 145.8 (SD 24.0) encounters per student and the second cohort averaged 141.1 (SD 19.5) encounters per student. Females had more encounters during the first period, but no difference in the second. There was no difference in average encounters between white and nonwhite students during the first period, but during the second, nonwhite students had more encounters. A few differences were found in odds of encountering required conditions or gender-specific conditions, but none were consistent across time. Conclusions: Family medicine clerkship students in this geographically distributed network did not experience significant differences in patient demographics, conditions, or gender-specific diseases, based on their gender or race. The teaching sites in the study were monitored continuously to ensure consistent clinical experiences in volume and scope.
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Passanisi, Stefano, Giuseppina Salzano, Albino Gasbarro, Valentina Urzì Brancati, Matilde Mondio, Giovanni Battista Pajno, Angela Alibrandi y Fortunato Lombardo. "Influence of Age on Partial Clinical Remission among Children with Newly Diagnosed Type 1 Diabetes". International Journal of Environmental Research and Public Health 17, n.º 13 (3 de julio de 2020): 4801. http://dx.doi.org/10.3390/ijerph17134801.
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Partial clinical remission (PCR) is a transitory period characterized by the residual endogenous insulin secretion following type 1 diabetes (T1D) diagnosis and introducing the insulin therapy. Scientific interest in PCR has been recently increasing, as this phase could be crucial to preserve functional beta cells after T1D onset, also taking advantage of new therapeutic opportunities. The aim of this study was to assess the frequency, duration and associated factors of PCR in children newly diagnosed with T1D. Our cohort study included 167 pediatric patients aged 13.8 ± 4.1 years. The association of clinical and laboratory factors with the occurrence and duration of PCR was evaluated via logistic regression and multivariable generalized linear model, respectively. PCR occurred in 63.5% of the examined patients. Patients who achieved the remission phase were significantly older, and they had lower daily insulin requirement compared with non-remitters. PCR was positively associated to body mass index (OR = 1.11; p = 0.032), pH value (OR 49.02; p = 0.003) and c-peptide levels (OR 12.8; p = 0.002). The average duration of PCR was 13.4 months, and older age at diagnosis was the only predictor factor. Two years after diagnosis remitter patients had lower HbA1c and daily insulin requirement.
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Wu, Xialing, Xiao Gao, Tingting Sha, Guangyu Zeng, Shiping Liu, Ling Li, Cheng Chen y Yan Yan. "Modifiable Individual Factors Associated with Breastfeeding: A Cohort Study in China". International Journal of Environmental Research and Public Health 16, n.º 5 (6 de marzo de 2019): 820. http://dx.doi.org/10.3390/ijerph16050820.
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Breast milk is an ideal first food for infants in the initial months of life. This study aimed to identify modifiable individual factors in breastfeeding during the first six months of life in Hunan. This birth cohort study was conducted in three communities in Changsha, Hunan province. Data were collected through maternal health manuals and self-administered questionnaires during the follow-up period. To find risk factors and calculate odds ratios, generalized estimating equation models were applied. The final study included 951 mother-infant pairs. The prevalence of exclusive breastfeeding and any breastfeeding in this study was below the World Health Organization’s breastfeeding goals. Infant age, passive smoking after delivery, minor postnatal depression, and feeding-bottles were shown to act negatively on both exclusive breastfeeding and any breastfeeding. In addition, cesarean delivery and delayed breastfeeding initiation had adverse effects on exclusive breastfeeding. Multiparas were less likely to continue any breastfeeding during the first few months. This study highlights the importance of screening probable maternal depression during primary care service and reducing secondhand smoke and feeding-bottle use. The results also suggest that healthcare professionals should provide more assistance and education to multiparas and mothers with cesarean delivery or delayed breastfeeding initiation.
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Prakash, K. C. y Subas Neupane. "SS43-02 CHANGES IN SELF-RATED HEALTH DURING THE TRANSITION TO RETIREMENT: A MULTI-COHORT ASSESSMENT". Occupational Medicine 74, Supplement_1 (1 de julio de 2024): 0. http://dx.doi.org/10.1093/occmed/kqae023.0260.
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Abstract Introduction Changes in self-rated health during retirement transition are poorly understood, and previous findings have been inconsistent. This study aimed to examine changes in self-rated health during retirement transition and additionally examine whether those changes differ by gender, marital status, occupational status, and educational attainment using longitudinal studies from Finland and France. Methods Aging public sector employees (n=5813, mean age at baseline 50.4 years, standard deviation 3.6, 56% women) from Finland and occupational cohort from France (n=11363, age 51.9 years, standard deviation 2.5, 22% women), were included in the study. For the analyses, we used an original rating of self-rated health. The mean and mean change estimates and their 95% CI were calculated by using the linear regression models with generalized estimating equations, adjusted for age, sex, marital status, occupational status, educational attainment, smoking status, body mass index and leisure time physical activity levels. Results We observed significant positive changes in self-rated health among the entire study population during the retirement transition, which remained stable or improved thereafter. The improvement was significantly greater among women (vs. men), among those in low occupational class (vs. high), and among those who were single or unmarried (vs. married). Conclusions Self-rated health improves during the retirement transition period as people may have positive perceptions of their health status due to easiness in life because of no work-related stress. The stability in improvement after retirement was seen especially among women, and those who were single or unmarried.
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Polupanov, A. G., A. U. Mamatov, M. T. Duishenalieva, A. T. Аrykova, F. T. Rysmatova, I. Kh Bebezov, S. M. Akhunbaev, I. S. Sabirov y A. S. Dzhumagulova. "Age and gender aspects of the association of generalized obesity with development of fatal and nonfatal cardiovascular events (results of the prospective cohort study “Interepepid”)". Acta Biomedica Scientifica 6, n.º 5 (23 de noviembre de 2021): 245–52. http://dx.doi.org/10.29413/abs.2021-6.5.24.
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Background. Currently, obesity has become one of the most important medical and social problems in the world due to its high prevalence. Numerous literature data indicate that high BMI is associated with increased mortality from cardiovascular diseases.The aim: to study the relationship between overweight and generalized obesity with the development of fatal and non-fatal cardiovascular events among residents of the Chui region of the Kyrgyz Republic, taking into account gender and age.Material and methods. This study was carried out as part of the international crosssectional epidemiological study “Interepid”. The total follow-up period was 7 years. Life status at the end of the follow-up period was monitored in 1096 respondents out of 1341 initial cohorts (response – 82.1 %). The endpoints were cases of fatal and non-fatal cardiovascular events. The frequency of events was assessed using methods of analysis of survival (Cox proportional hazard regression model, parametric survival models, survival by the Kaplan – Meier method).Results. A total of 181 cases of fatal and non-fatal cardiovascular events (16.44 %) were recorded during the follow-up. In persons with normal body weight, the incidence of cardiovascular complications was 10 %. In overweight individuals, the value of this indicator increased and reached 17.99 % (p˂ 0.001), and in individuals with obesity – 24.5 % (p˂ 0.0001). The increase in the frequency of events with the increase in body mass index did not depend on the gender of the respondents but was typical only for people under 60 years of age. For elderly patients, there was no relationship between BMI and the development of cardiovascular complications. In contrast, the relative risk had an insignificant tendency to decrease by 2.6 % for every 1 kg/m2 increase in body mass index (RR – 0.974; 95% CI: 0.924–1.025).Conclusion. The increase of body mass index above 25 kg/m2 is an independent risk factor for the development of fatal and non-fatal cardiovascular events in the analyzed cohort of the Chui region residents, regardless of gender, but only in persons under 60 years of age.
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Zhou, Jifang, Gregory Sampang Calip y Edith A. Nutescu. "A Risk Assessment Model for the Identification of Sickle Cell Disease Patients at Risk for Venous Thromboembolism". Blood 132, Supplement 1 (29 de noviembre de 2018): 3568. http://dx.doi.org/10.1182/blood-2018-99-119286.
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Abstract Background: Venous thromboembolism (VTE) is associated with significant morbidity, functional disability and mortality which leads to annual direct medical costs of 6 to 8 billion U.S. dollars. The incidence of VTE among patients with sickle cell disease (SCD) is significantly higher than in those without SCD, with lifetime risk of up to 25%. The highly variable clinical phenotypes of SCD, in addition to complex pathogenesis of thrombosis in SCD, are challenges to the early identification of high-risk patients and timely initiation of anticoagulant prophylaxis. Objective: To develop a population-based risk assessment model (Predictive AlgoRithm of VTE in SCD, PARViS) for the identification of SCD patients at high-risk of VTE using least absolute shrinkage and selection operator (LASSO) methodology and compare its validity to the Caprini VTE risk assessment model. Method: We conducted a retrospective cohort study using the 2009-2014 Truven Health MarketScan® databases to identify commercially-insured health plan enrollees with VTE and SCD based on International Classification of Diseases (ICD) codes for inpatient and outpatient encounters. Baseline characteristics were assessed over the 6 months period following cohort entry and a risk window for any VTE events starting from day 181 after cohort entry and onwards. The clinical outcomes were defined as occurrence of VTE over the 30-, 90- and 180-day period. The population-based cohort was divided into derivation and validation sets in a 2:1 ratio. The risk score was calculated using LASSO generalized linear regression models and divided into three risk categories for predicting 180-day VTE risk. Kaplan-Meier survivor functions were estimated for VTE rates by estimated risk score and censored for end of continuous enrollment, and end of observation period. The C-statistic was used to assess the prediction performance of the 7-factor risk score, which was compared with the Caprini VTE risk prediction model. Results: Among 11,774 subjects with SCD in the derivation cohort, the mean (SD) age at enrollment was 32.1 (19.8) years and 62.2% were female. From the validation cohort, 5949 SCD subjects were analyzed, participants' mean (SD) age at enrollment was 32.2 (19.7) years, and 62.6% were female. The 30-, 90- and 180-day VTE rates of the overall cohort were 0.6%, 1.3% and 2.0%, respectively. The risk model included age, recent central vein catheter use (<30 day), active cancer, history of VTE, iron overload, osteomyelitis and pulmonary hypertension. Patients with SCD in the validation cohort were stratified into high-, intermediate- and low-risk in 2:3:5 ratio by VTE risk scores. Demographics and distribution of VTE risk factors are listed in Table 1. The rates of VTE at 180-days were 0.47% (95%CI 0.35%-0.64%), 1.38% (95%CI 1.10%-1.73%),6.71% (95%CI 5.94%-7.57%). [Figure 1] In the derivation cohort, C statistics were 0.845 (95%CI 0.818-0.872) for 7-factor RAM in predicting 180-day VTE, 0.883 (95%CI 0.853-0.914) for 90-day VTE, and 0.917 (95%CI 0.875-0.959) for 30-day VTE. In the validation cohort, C statistics were 0.833 (95%CI 0.791-0.875) for 7-factor VTE risk assessment model in predicting 180-day VTE, 0.877 (95%CI 0.831-0.923) for 90-day VTE, and 0.942 (95%CI 0.911-0.972) for 30-day VTE. Using the Caprini VTE risk prediction model, we found statistically significant differences (p<0.0001) with C-statistics for 180-, 90- and 30-day VTE prediction of 0.721 (95%CI 0.672-0.770), 0.775 (95%CI 0.719-0.830), and 0.826 (95%CI 0.759-0.892). [Figure 2] Conclusion: We developed and validated a 7-factor VTE risk assessment model specific to patients with SCD (PARViS). With its straightforward calculation and demonstrated accurate prediction of 6-month VTE rates in patients with SCD, the PARViS model can prove to be a useful prediction tool for clinical practitioners. Disclosures No relevant conflicts of interest to declare.
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Chen, Clara, Eros Papademetriou, Zephirin Kiendrebeogo y Ravi Potluri. "Economic Burden of Hospitalizations for Patients with Newly Diagnosed Acute Myeloid Leukemia in Remission in the United States: Retrospective Analysis of an Administrative Claims Database". Blood 138, Supplement 1 (5 de noviembre de 2021): 4976. http://dx.doi.org/10.1182/blood-2021-147909.
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Abstract INTRODUCTION : Managing patients with acute myeloid leukemia (AML) requires extensive healthcare resource utilization and costs; hospitalization is the largest component of medical costs for AML. In the phase 3 QUAZAR AML-001 trial, oral azacitidine (Oral-AZA [CC-486]) was associated with significant improvements in overall survival and relapse-free survival (RFS) vs. placebo (Wei, 2020). Prolonged RFS with Oral-AZA may translate into substantial economic benefits, with lower hospitalization-related costs due to reduced rates of hospitalization and days in hospital (Oliva, ASH 2020). Real-world economic benefits of prolonged remission remain insufficiently studied. OBJECTIVE: This study aimed to examine the economic burden of hospitalizations among patients with newly diagnosed AML in remission from a retrospective analysis of real-world data from a US claims database. METHODS: Using a retrospective cohort design, adult patients were selected from the IBM MarketScan TM Commercial and Medicare Supplemental Databases, with ≥2 outpatient claims or 1 inpatient claim with a primary International Classification of Disease 9th/10th Revision (ICD-9/ICD-10) code for AML between July 1, 2012, and September 30, 2019. Patients were required to have 1) at least 6 months of continuous enrollment, with pharmacy benefits, prior to diagnosis, 2) received systemic induction therapy as first-line (1L) therapy for AML on or after the index diagnosis date, and 3) attained remission from 1L systemic therapy. Patients were followed from remission after systemic induction therapy, with or without consolidation, until the end of the follow-up period. Eligible patients were organized into cohorts based on their duration of remission (DOR): Cohort A included patients with < median DOR and Cohort B had patients with ≥ median DOR. Hospitalization incidence and duration during the follow-up period were calculated using a per-patient per-year (PPPY) metric. Hospitalization-related costs were compared using a generalized linear model (GLM) with gamma distribution and log-link function. Generalized estimating equations (GEE) clustered on the patient were used to compare incidence and duration of hospitalizations. All costs were adjusted for inflation and reported in 2019 US dollars (USD). RESULTS: In all, 693 patients met all selection criteria and were assessed for DOR. The median DOR for all patients was 167 days; cohorts A and B included 346 and 347 patients, respectively, with median times from remission to end of follow-up of 106.5 and 460 days. Baseline characteristics were comparable between cohorts; mean [SD] age was 55.1 [14.4] years, 49.4% of patients were male, and mean [SD] Charlson comorbidity index [CCI] was 0.8 [1.2]. The PPPY number of hospitalizations was higher in Cohort A than in Cohort B (4.56 vs 2.09, respectively), as was the PPPY total length of hospital stay (51.1 vs 19.7 days). The PPPY hospitalization-related costs were $345,728 in Cohort A and $125,018 in Cohort B; the cumulative hospitalization cost per patient was $148,430 higher in Cohort A at 12 months and $177,500 higher at 18 months (Figure). Multivariate GEE and GLM models with adjustment for patient characteristic covariates (eg, age, sex, CCI) identified prolonged remission was significantly associated with reduced number, duration, and cost of hospitalization (P < 0.001, all comparisons). CONCLUSIONS: In a real-world setting, prolonged AML remission was associated with significantly lower rates and durations of hospitalization, which were estimated to result in substantial cumulative cost savings. These data underscore the importance of active maintenance therapies that delay relapse for patients with AML. While the costs of long-term therapy face increasing scrutiny, these costs should be weighed relative to the potential economic benefit of prolonged remission and reduced burden of healthcare resource utilization. Figure 1 Figure 1. Disclosures Chen: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Papademetriou: SmartAnalyst Inc.: Current Employment. Potluri: Bristol Myers Squibb: Consultancy.
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Xiao, Jin, Naemah Alkhers, Dorota T. Kopycka-Kedzierawski, Ronald J. Billings, Tong Tong Wu, Daniel A. Castillo, Linda Rasubala, Hans Malmstrom, Yanfang Ren y Eli Eliav. "Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis". Caries Research 53, n.º 4 (2019): 411–21. http://dx.doi.org/10.1159/000495187.
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Despite the advancement of early childhood caries (ECC) prediction and treatment, ECC remains a significant public health burden in need of more effective preventive strategies. Pregnancy is an ideal period to promote ECC prevention given the profound influence of maternal oral health and behaviors on children’s oral health. However, studies have shown debatable results with respect to the effectiveness of ECC prevention by means of prenatal intervention. Therefore, this study systematically reviewed the scientific evidence relating to the association between prenatal oral health care, ECC incidence, and Streptococcus mutans carriage in children. Five studies (3 randomized control trials, 1 prospective cohort study, and 1 nested case-control study) were included for qualitative assessment. Tested prenatal oral health care included providing fluoride supplements, oral examinations/cleanings, oral health education, dental treatment referrals, and xylitol gum chewing. Four studies that assessed ECC incidence reduction were included in meta-analysis using an unconditional generalized linear mixed effects model with random study effects and age as a covariate. The estimated odds ratio and 95% confidence intervals suggested a protective effect of prenatal oral health care against ECC onset before 4 years of age: 0.12 (0.02, 0.77) at 1 year of age, 0.18 (0.05, 0.63) at 2 years of age, 0.25 (0.09, 0.64) at 3 years of age, and 0.35 (0.12, 1.00) at 4 years of age. Children’s S. mutans carriage was also significantly reduced in the intervention group. Future studies should consider testing strategies that restore an expectant mother’s oral health to a disease-free state during pregnancy.
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Dai, Yiming, Jiming Zhang, Xiaojuan Qi, Zheng Wang, Minglan Zheng, Ping Liu, Shuai Jiang, Jianqiu Guo, Chunhua Wu y Zhijun Zhou. "Cord Blood Manganese Concentrations in Relation to Birth Outcomes and Childhood Physical Growth: A Prospective Birth Cohort Study". Nutrients 13, n.º 12 (28 de noviembre de 2021): 4304. http://dx.doi.org/10.3390/nu13124304.
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Gestational exposure to manganese (Mn), an essential trace element, is associated with fetal and childhood physical growth. However, it is unclear which period of growth is more significantly affected by prenatal Mn exposure. The current study was conducted to assess the associations of umbilical cord-blood Mn levels with birth outcomes and childhood continuous physical development. The umbilical cord-blood Mn concentrations of 1179 mother–infant pairs in the Sheyang mini birth cohort were measured by graphite furnace atomic absorption spectrometry (GFAAS). The association of cord-blood Mn concentrations with birth outcomes, and the BMI z-score at 1, 2, 3, 6, 7 and 8 years old, were estimated separately using generalized linear models. The relationship between prenatal Mn exposure and BMI z-score trajectory was assessed with generalized estimating equation models. The median of cord-blood Mn concentration was 29.25 μg/L. Significantly positive associations were observed between Mn exposure and ponderal index (β, regression coefficient = 0.065, 95% CI, confidence interval: 0.021, 0.109; p = 0.004). Mn exposure was negatively associated with the BMI z-score of children aged 1, 2, and 3 years (β = −0.383 to −0.249, p < 0.05), while no significant relationships were found between Mn exposure and the BMI z-score of children at the age of 6, 7, and 8 years. Prenatal Mn exposure was related to the childhood BMI z-score trajectory (β = −0.218, 95% CI: −0.416, −0.021; p = 0.030). These results indicated that prenatal Mn exposure was positively related to the ponderal index (PI), and negatively related to physical growth in childhood, which seemed most significant at an early stage.
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Chen, Wan-Chin y Hsiao-Yu Yang. "P-108 ASSOCIATION BETWEEN LONG WORKING HOURS AND ESTIMATED GLOMERULAR FILTRATION RATE AMONG HEALTHCARE WORKERS: A RETROSPECTIVE COHORT STUDY". Occupational Medicine 74, Supplement_1 (1 de julio de 2024): 0. http://dx.doi.org/10.1093/occmed/kqae023.0615.
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Abstract Introduction The impact of long working hours on early chronic kidney disease (CKD) remains uncertain. This study aimed to investigate the association between long working hours and estimated glomerular filtration rate (eGFR) in healthcare workers. Methods A retrospective cohort study was conducted among healthcare workers at a tertiary medical center in Taiwan from 2002 to 2021. Eligible participants included all hospital employees aged 20 to 65 with complete working hour records and a yearly blood test of eGFR. Those with eGFR <60 ml/min/1.73 m² at enrollment were excluded. Total working hours and night working hours were recorded for each year. The relationship between total working hours, night working hours and eGFR was assessed using the generalized linear mixed model (GLMM), adjusting for demographic and laboratory profiles. Results A total of 10,358 participants with a mean age of 26.7 years (standard deviation 7.1) were included, with 88.9% being females. The median follow-up period was 4 years. Each 10-hour increase in weekly working hours was associated with a decrease in eGFR by -2.07 (-2.99, -1.14). Factors such as age, diastolic blood pressure, glucose, uric acid, and male sex were also linked to lower eGFR. The effect of a 10-hour increase in weekly working hours on eGFR was nearly 1.2 times that of each year increase in age. Discussion and conclusion This study reveals a significant association between long working hours and lower eGFR among healthcare workers. These findings suggest that regulating working hours may be a potential strategy to impede the progression of early chronic kidney disease.
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Ide, Kazuki, Hiroshi Yonekura, Yohei Kawasaki y Koji Kawakami. "Influence of Institution-Based Factors on Preoperative Blood Testing Prior to Low-Risk Surgery: A Bayesian Generalized Linear Mixed Approach". Computational and Mathematical Methods in Medicine 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/3624075.
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To optimize delivery of health care services in clinical practice, the use of unnecessary interventions should be reduced. Although recommendations for this reduction have been accepted worldwide, recent studies have revealed that the use of such procedures continues to increase. We conducted a retrospective cohort study using a nationwide claim-based database to evaluate factors influencing preoperative blood testing prior to low-risk surgery, via a Bayesian generalized linear mixed approach. The study period was set from April 1, 2012, to March 31, 2016, and 69,252 surgeries performed at 9,922 institutions were included in the analysis. Mean patient age was 44.3 ± 11.3 years (57% female). Preoperative blood tests were performed for 59.0% of procedures. Among institutional factors, the number of beds was strongly associated with preoperative blood testing (odds ratio [95% highest posterior density interval (HPD interval)], 2.64 [2.53 to 2.75]). The difference (95% credible interval) in the rate of preoperative blood testing between institutions with <100 beds and ≥100 beds was 0.315 [0.309 to 0.322], and the Bayesian indexθwas 1.00. This indicated that preoperative blood tests are strongly influenced by institutional factors, suggesting that specific guidelines should be developed to avoid excessive preoperative testing for low-risk surgery.
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DeYoreo, Maria, Carolyn M. Rutter y Sarita D. Lee. "Two-Stage Modeling to Identify How Colorectal Cancer Risk Changes With Period and Cohort". American Journal of Epidemiology, 12 de octubre de 2022. http://dx.doi.org/10.1093/aje/kwac177.
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Abstract Colorectal cancer (CRC) incidence rates have decreased among adults aged 50 and older while increasing in adults under age 50. Understanding these trends is challenging due to the multiple related time scales of age, period of diagnosis, and birth cohort. We analyzed rectal, distal colon, and proximal colon cancer incidence rates for individuals aged 20 and older from the Surveillance, Epidemiology, and End Results program for diagnosis years 1978-2017. We used a two-stage generalized linear model to describe age, period, and cohort effects for incidence. We first estimated birth cohort effects among people under 45. We used these results to specify prior distributions for cohort effects in a Bayesian model to estimate period effects among people 45 and older. There was no evidence of period effects for people under age 45. Risk for rectal and distal colon cancer increased for later birth cohorts. Compared to the 1943-1952 birth cohort, the 1983-1992 birth cohort had 2.1 times the risk of rectal cancer, 1.8 times the risk of distal colon cancer and 1.3 times the risk of proximal colon cancer. For people over 45, period effects show declines in CRC risk that are attributable to screening.
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Weigert, Maximilian, Alexander Bauer, Johanna Gernert, Marion Karl, Asmik Nalmpatian, Helmut Küchenhoff y Jürgen Schmude. "Semiparametric APC analysis of destination choice patterns: Using generalized additive models to quantify the impact of age, period, and cohort on travel distances". Tourism Economics, 15 de enero de 2021, 135481662098719. http://dx.doi.org/10.1177/1354816620987198.
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This study investigates how age, period, and birth cohorts are related to altering travel distances. We analyze a repeated cross-sectional survey of German pleasure travels for the period 1971–2018 using a holistic age–period–cohort (APC) analysis framework. Changes in travel distances are attributed to the life cycle (age effect), macro-level developments (period effect), and generational membership (cohort effect). We introduce ridgeline matrices and partial APC plots as innovative visualization techniques facilitating the intuitive interpretation of complex temporal structures. Generalized additive models are used to circumvent the identification problem by fitting a bivariate tensor product spline between age and period. The results indicate that participation in short-haul trips is mainly associated with age, while participation in long-distance travel predominantly changed over the period. Generational membership shows less association with destination choice concerning travel distance. The presented APC approach is promising to address further questions of interest in tourism research.
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Schramm, Stine, Thorkild I. A. Sørensen, Michael Davidsen y Janne S. Tolstrup. "Changes in adult obesity prevalence in Denmark, 1987–2021: age–period–cohort analysis of nationally representative data". European Journal of Public Health, 25 de febrero de 2023. http://dx.doi.org/10.1093/eurpub/ckad024.
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Abstract Background During the last decades, the prevalence of obesity [body mass index (BMI): weight/height2), ≥30.00 kg/m2] among adults has increased considerably. We examined whether this increase in a high-income, welfare state, like Denmark was driven by age, period or cohort effects, which would inform preventive strategies aiming at reducing the prevalence. Methods We used data from the National Representative Health and Morbidity Studies, which are representative surveys of the Danish adult population (age 16 years and above), conducted in 1987, 1994, 2000, 2005, 2010, 2013, 2017 and 2021 (N = 91 684). Participants reported height and weight, from which BMI was calculated after correction for systematic bias in self-reported data and non-response. Age, survey year and birth cohorts were mutually adjusted and adjusted for sex in generalized linear models. Results The obesity prevalence increased from 6.1% in 1987 to 18.4% in 2021, similarly in men (18.8%) and women (18.0%) and in all age groups. Age had an inverted u-shaped effect on the prevalence. Compared with individuals aged 16–24 years, the highest rate of obesity was seen for the age group 55–64 years [rate ratio 3.27, 95% confidence interval (CI): 2.58; 4.14]. The increasing rate for each recent survey year over time was compatible with a period effect without any birth cohort effects. The rate for obesity in 2021 was 4.16 in 1987 vs. 1987 (95% CI: 3.10; 5.59). Conclusions Obesity prevalence in Denmark increased steadily during the period 1987 through 2021, primarily driven by secular changes over time across all ages and birth cohorts.