Surveillance, Epidemiology, and End Results Database update for pediatric thyroid carcinomas incidence and survival trends 2000-2016
Objective: Review the trends in pediatric thyroid carcinomas using the Surveillance, Epidemiology, and End Results (SEER) Database.
Methods: Institutional review board approval was obtained from Mercy-Bon Secours. The National Cancer Institute's SEER database was used for all cases of pediatric thyroid cancer between the years 2000 and 2016 for patients aged 0-19. Patients were grouped by carcinoma histological subtype, disease specific survival based on treatment modality, and demographic data. Treatment methods were compared using Fifteen-Year Disease Specific Survival Curves.
Results: 1175 pediatric patients were identified. The average age-adjusted rate of malignancy was 0.3 per 100,000 patients. Incidence of pediatric thyroid cancer was approximately 1:3.6, male to female. The papillary follicular variant histological subtype was the most common (n = 689, 58.6%), followed by papillary (n = 223, 18.9%), follicular (n = 153, 13.1%), and medullary (n = 110, 9.4%). Overall incidence of thyroid carcinomas increased with age, highest in patients aged 15-19 (69.8%). Incidence of medullary thyroid carcinomas was highest in patients aged 0-9. Patients aged 10-19 treated with surgery alone had the highest disease specific survival fifteen-years past initial diagnoses and treatment in all histologic subtypes (p < 0.05). Patients with metastatic medullary thyroid carcinoma at initial diagnosis who underwent surgery alone showed significantly poorer fifteen-year disease specific survival when compared to other histologic subtypes (p < 0.05).
Conclusion: There was improved prognosis in pediatric thyroid carcinomas if diagnosed and treated early. All four major histological subtypes exhibit an increase in overall survival rates, (excluding medullary carcinomas).
Ananya Tawde
Anita Jeyakumar
Int J Pediatr Otorhinolaryngol
. 2022 Feb;153:111038. doi: 10.1016/j.ijporl.2021.111038. Epub 2022 Jan 4.
2022
English
Incidence of sudden cardiac arrest and death in young athletes and military members: a systematic review and meta-analysis.
MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19–7/29/19.
The goals of this review are to evaluate the quality of the evidence on the incidence of sudden cardiac arrest and death (SCA/D) in athletes and military members; and to estimate annual incidence of SCA/D.
Lear A; Patel N; Mullen C; Simonson M; Leone V; Koshiaris C; Nunan D
Journal Of Athletic Training
2021
2021-05-26
Journal Article
<table width="91" style="border-collapse:collapse;width:68pt;"><colgroup><col width="91" style="width:68pt;" /></colgroup><tbody><tr style="height:15pt;"><td width="91" height="20" class="xl18" style="width:68pt;height:15pt;"><a href="http://doi.org/10.4085/1062-6050-0748.20">http://doi.org/10.4085/1062-6050-0748.20</a></td>
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Incidence of sudden cardiac arrest and death in young athletes and military members: a systematic review and meta-analysis.
incidence; sudden cardiac death; military; athletes; sudden cardiac arrest
OBJECTIVES: The goals of this review are to evaluate the quality of the evidence on the incidence of sudden cardiac arrest and death (SCA/D) in athletes and military members; and to estimate annual incidence of SCA/D. DATA SOURCES: MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19-7/29/19. STUDY SELECTION: Studies which reported incidence of SCA/D or both in athletes, or military members under age 40 were eligible for inclusion. 40 studies were identified for inclusion Data Extraction: Risk of bias was assessed using a validated, customized tool for prevalence studies in all included studies. 12 were found to be low ROB, with the remaining 28 moderate or high ROB. Data was extracted for narrative review, and meta-analysis. DATA SYNTHESIS: Random-effects meta-analysis was performed in studies judged to be low risk of bias in two separate categories: 5 studies on regional or national level data including athletes at all levels, and both sexes included 130 events of SCD, with a total of 11,272,560 athlete years showing a cumulative incidence rate of 0.98 [95%CI: 0.62, 1.53] per 100,000 athlete years, with high heterogeneity with I2 of 78%; 3 Studies on competitive athletes aged 14 to 25 were combined, and included 183 events, and 17,798758 athlete years showing an incidence rate of 1.91[95%CI: 0.71; 5.14] per 100,000 athlete years with high heterogeneity with I2 of 97%. The remaining low risk of bias studies were in military members, and were not synthesized. CONCLUSION: The worldwide incidence of SCD is a rare event. Low risk of bias studies indicate incidence to be below 2 per 100,000 athlete years. Overall, the quality of the evidence available is low, but there are high quality individual studies to inform the question of incidence levels. PROSPERO Registration: CRD42019125560.
Lear A; Patel N; Mullen C; Simonson M; Leone V; Koshiaris C; Nunan D
Journal Of Athletic Training
2021
2021-05-26
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.4085/1062-6050-0748.20" target="_blank" rel="noreferrer noopener">10.4085/1062-6050-0748.20</a>
Mechanical Thrombectomy for Patients with In-Hospital Ischemic Stroke: A Case-Control Study.
Aged; Humans; Male; Female; Middle Aged; Treatment Outcome; Time Factors; Feasibility Studies; Incidence; Retrospective Studies; thrombectomy; Inpatients; Thrombectomy/adverse effects; Acute ischemic stroke; Brain Ischemia/diagnostic imaging/epidemiology/physiopathology/therapy; in-hospital stroke; Intracranial Thrombosis/diagnostic imaging/epidemiology/physiopathology/therapy; large vessel occlusion; Stroke/diagnostic imaging/epidemiology/physiopathology/therapy
BACKGROUND AND AIM: Patients with in-hospital acute ischemic stroke (AIS) have, in general, worse outcomes compared to those presenting from the community, partly attributed to the numerous contraindications to intravenous thrombolysis. We aimed to identify and analyze a group of patients with in-hospital AIS who remain suitable candidates for acute endovascular therapies. METHODS: A retrospective 6-year data analysis was conducted in patients evaluated through the in-hospital stroke alert protocol in a single tertiary care university hospital to identify those with in-hospital AIS due to acute intracranial large vessel occlusion (ILVO). Feasibility and safety of mechanical thrombectomy for in-hospital AIS was assessed in a case-control study comparing inpatients to those presenting from the community. RESULTS: From 1460 in-hospital stroke alert activations, 11% had a final diagnosis of AIS (n = 167). One hundred and two patients with in-hospital AIS had emergent intracranial vessel imaging and were included in our cohort. Acute ILVO was identified in 27 patients within this cohort. Patients were younger in the ILVO group and had more severe neurologic deficit on presentation. Compared to a matched (1:2) control group of patients presenting from the community, inpatients who underwent mechanical thrombectomy achieved equivalent technical success, safety, and clinical outcomes. CONCLUSIONS: The incidence of acute ILVO in patients with in-hospital AIS who underwent emergent vessel imaging is similar to the reported incidence of ILVO in patients presenting with community-onset AIS. Among patients with in-hospital AIS secondary to ILVO, mechanical thrombectomy is a feasible and safe therapy associated with favorable outcomes.
Bulwa Z; Del Brutto VJ; Loggini A; Ammar FE; Martinez RC; Christoforidis G; Brorson JR; Ardelt AA; Goldenberg FD
Journal of Stroke and Cerebrovascular Diseases
2020
2020-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104692" target="_blank" rel="noreferrer noopener">10.1016/j.jstrokecerebrovasdis.2020.104692</a>
Effect of influenza on outcomes in patients with heart failure.
Female; Humans; Male; Aged; Retrospective Studies; Risk Factors; United States/epidemiology; Incidence; Follow-Up Studies; heart failure; hospitalization; Hospitalization/trends; vaccination; influenza; Survival Rate/trends; Risk Assessment/methods; Inpatients; Morbidity/trends; Hospital Mortality/trends; Propensity Score; Heart Failure/complications/epidemiology; Influenza Human/complications/epidemiology/prevention & control; Vaccination/methods
OBJECTIVES: This study sought to determine whether influenza infection increases morbidity and mortality in patients hospitalized with heart failure (HF). BACKGROUND: Patients with HF may be at increased risk of morbidity and mortality from influenza infection. However, there are limited data for the associated hazards of influenza infection in patients with HF. METHODS: We queried the 2013 to 2014 National Inpatient Sample database for all adult patients (18 years of age or older) admitted with HF with and without concomitant influenza infection. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Outcomes included in-hospital mortality, in-hospital complications, length of stay, and average hospital costs. RESULTS: Of 8,189,119 all-cause hospitalizations in patients with HF, 54,590 (0.67%) had concomitant influenza infection. Patients with concomitant influenza had higher incidence of in-hospital mortality (6.2% vs. 5.4%, respectively; odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.03 to 1.30]; p = 0.02), acute respiratory failure (36.9% vs. 23.1%, respectively; OR: 1.95 [95% CI: 1.83 to 2.07]; p < 0.001), acute respiratory failure requiring mechanical ventilation (18.2% vs. 11.3%, respectively; OR: 1.75 [95% CI: 1.62 to 1.89]; p < 0.001), acute kidney injury (AKI) (30.3% vs. 28.7%, respectively; OR: 1.08 [95% CI: 1.02 to 1.15]; p = 0.01), and AKI requiring dialysis (2.4% vs. 1.8%, respectively; OR: 1.37 [95% CI: 1.14 to 1.65]; p = 0.001). Patients with influenza had longer mean lengths of stay (5.9 days vs. 5.2 days, respectively; p <0.001) but similar average hospital costs ($12,137 vs. $12,003, respectively; p = 0.40). CONCLUSIONS: Influenza infection is associated with increased in-hospital morbidity and mortality in patients with HF. Our results emphasize the need for efforts to mitigate the incidence of influenza, specifically in this high-risk patient cohort.
Panhwar MS; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Ginwalla M
Journal of the American College of Cardiology. Heart failure
2019
2019-02
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.jchf.2018.10.011" target="_blank" rel="noreferrer noopener">10.1016/j.jchf.2018.10.011</a>
PMID: 30611718
Relation of concomitant heart failure to outcomes in patients hospitalized with influenza.
Female; Humans; Male; Aged; Middle Aged; Retrospective Studies; United States/epidemiology; Incidence; Comorbidity; Follow-Up Studies; Survival Rate/trends; Hospitalization/statistics & numerical data; Inpatients; Length of Stay/trends; Heart Failure/epidemiology; Hospital Mortality/trends; Influenza Human/epidemiology
Influenza is a major public health challenge. Patients hospitalized with influenza who also have heart failure (HF) may be at risk for worse outcomes compared with patients without HF. There is a lack of large studies examining this issue. We queried the 2013 to 2014 National Inpatient Sample for all adult patients (aged ≥ 18 years) admitted with influenza with and without concomitant HF. Using propensity score matching, patients were matched across demographics, discharge weights, and comorbidities. Outcomes included in-hospital mortality, complications, length of stay, and average hospital costs. Of 218,540 influenza hospitalizations, 45,460 (20.8%) had concomitant HF. Patients with HF had higher in-hospital mortality (6.1% vs 3.8%, adjusted odds ratio [aOR] 1.66 [95% confidence interval [CI] 1.44 to 1.91]; p <0.001), acute kidney injury (29.5% vs 22.2%, aOR 1.47 [95% CI 1.37 to 1.57]; p <0.001), acute kidney injury requiring dialysis (2.0% vs 1.0%, aOR 2.08 [1.62 to 2.67], acute respiratory failure (36.2% vs 23.5%, aOR 1.85 [1.73 to 1.97]; p <0.001), and acute respiratory failure requiring mechanical ventilation (17.1% vs 9.3%, OR 2.01 [1.84 to 2.21]; p <0.001), longer length of stay (5.70 ± 0.02 days vs 4.60 ± 0.01 days, p <0.001) and higher average hospital costs ($11,609 ± $52 vs $9,003 ± $38, p <0.001). In conclusion, in patients hospitalized with influenza, HF is associated with increased risk of in-hospital mortality and complications. Our results highlight a need for early recognition and aggressive treatment of HF in these patients to try to improve outcomes.
Panhwar MS; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Ginwalla M
The American journal of cardiology
2019
2019-05-01
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.amjcard.2019.01.046" target="_blank" rel="noreferrer noopener">10.1016/j.amjcard.2019.01.046</a>
PMID: 30819433
Contributions of symptomatic osteoarthritis and physical function to incident cardiovascular disease.
Female; Humans; Male; Middle Aged; Cardiovascular disease; Function; *Osteoarthritis; Aged; Incidence; Cohort Studies; Risk Factors; Exercise/*physiology; Cardiovascular Diseases/diagnosis/*epidemiology/physiopathology; Health Surveys/methods/trends; Independent Living/trends; North Carolina/epidemiology; Walk Test/methods/trends; Knee/diagnosis/*epidemiology/physiopathology
BACKGROUND: Osteoarthritis (OA) is associated with worsening physical function and a high prevalence of comorbid health conditions. In particular, cardiovascular disease (CVD) risk is higher in individuals with OA than the general population. Limitations in physical function may be one pathway to the development of CVD among individuals with OA. This study evaluated associations of symptomatic knee OA (sxKOA), baseline physical function and worsening of function over time with self-reported incident CVD in a community-based cohort. METHODS: Our sample consisted of individuals from the Johnston County Osteoarthritis Project who did not report having CVD at baseline. Variables used to evaluate physical function were the Health Assessment Questionnaire (HAQ), time to complete 5 chair stands, and the 8-ft walk. Worsening function for these variables was defined based on previous literature and cutoffs from our sample. Logistic regression analyses examined associations of sxKOA, baseline function and worsening of function over time with self-reported incident CVD, unadjusted and adjusted for relevant demographic and clinical characteristics. RESULTS: Among 1709 participants included in these analyses, the mean age was 59.5 +/- 9.5 years, 63.6% were women, 15% had sxKOA, and the follow up time was 5.9 +/- 1.2 years. About a third of participants reported worsening HAQ score, about two-fifths had worsened chair stand time, half had worsened walking speed during the 8-ft walk, and 16% self-reported incident CVD. In unadjusted analyses, sxKOA, baseline function, and worsening function were all associated with self-reported incident CVD. In multivariable models including all of these variables, sxKOA was not associated with incident CVD, but worsening function was significantly associated with increased CVD risk, for all three functional measures: HAQ odds ratio (OR) = 2.49 (95% confidence interval (CI) 1.90-3.25), chair stands OR = 1.58 (95% CI 1.20-2.08), 8-ft walk OR = 1.53 (95%CI 1.15-2.04). These associations for worsening function remained in models additionally adjusted for demographic and clinical characteristics related to CVD risk. CONCLUSIONS: The association between symptomatic knee osteoarthritis and cardiovascular disease risk was explained by measures of physical function. This highlights the importance of physical activity and other strategies to prevent functional loss among individuals with symptomatic knee osteoarthritis.
Corsi Michela; Alvarez Carolina; Callahan Leigh F; Cleveland Rebecca J; Golightly Yvonne M; Jordan Joanne M; Nelson Amanda E; Renner Jordan; Tsai Allen; Allen Kelli D
BMC musculoskeletal disorders
2018
2018-11
<a href="http://doi.org/10.1186/s12891-018-2311-4" target="_blank" rel="noreferrer noopener">10.1186/s12891-018-2311-4</a>
The Incidence of Complex Regional Pain Syndrome in Simultaneous Surgical Treatment of Carpal Tunnel Syndrome and Dupuytren Contracture.
Humans; Incidence; Postoperative Complications/*etiology; *carpal tunnel; *CRPS; *Dupuytren contracture; Carpal Tunnel Syndrome/complications/*surgery; Complex Regional Pain Syndromes/*etiology; Dupuytren Contracture/complications/*surgery; Fasciotomy
BACKGROUND: To determine the incidence of complex regional pain syndrome (CRPS) in the concurrent surgical treatment of Dupuytren contracture (DC) and carpal tunnel syndrome (CTS) through a thorough review of evidence available in the literature. METHODS: The indices of 260 hand surgery books and PubMed were searched for concomitant references to DC and CTS. Studies were eligible for inclusion if they evaluated the outcome of patients treated with simultaneous fasciectomy or fasciotomy for DC and carpal tunnel release using CRPS as a complication of treatment. Of the literature reviewed, only 4 studies met the defined criteria for use in the study. Data from the 4 studies were pooled, and the incidence of recurrence and complications, specifically CRPS, was noted. RESULTS: The rate of CRPS was found to be 10.4% in the simultaneous treatment group versus 4.1% in the fasciectomy-only group. This rate is nearly half the 8.3% rate of CRPS found in a randomized trial of patients undergoing carpal tunnel release. CONCLUSIONS: Our analysis demonstrates a marginal increase in the occurrence of CRPS by adding the carpal tunnel release to patients in need of fasciectomy, contradicting the original reports demonstrating a much higher rate of CRPS. This indicates that no clear clinical risk is associated with simultaneous surgical treatment of DC and CTS. In some patients, simultaneous surgical management of DC and CTS can be accomplished safely with minimal increased risk of CRPS type 1.
Buller Mitchell; Schulz Steven; Kasdan Morton; Wilhelmi Bradon J
Hand (New York, N.Y.)
2018
2018-07
<a href="http://doi.org/10.1177/1558944717718345" target="_blank" rel="noreferrer noopener">10.1177/1558944717718345</a>
Wii have a problem: a review of self-reported Wii related injuries.
Incidence; Self Report; Sports; Video Games; Virtual Reality; Wounds and Injuries – Etiology
PURPOSE: The increasing popularity of the Wii video game console has been associated with a number of gameplay related traumas. We sought to investigate if there were any identifiable injury patterns associated with Wii use. METHODS: Utilising a database of self-reported Wii related injuries, the data was categorised by type of injury and game title being played at the time of injury. FINDINGS: We found that of 39 reported Wii related injuries over a two-year span, 46% occurred while playing the Wii Sports Tennis software. Further, we identified 14 distinct injury patterns sustained during gameplay. Of these injuries, hand lacerations were the most common, accounting for 44% of the total number of reported cases. CONCLUSIONS: Injury associated with video game play is not unique to the Wii, nor is it a new phenomenon. However, the Wii console appears to have a higher rate of associated injuries than traditional game consoles because of its unique user interface. We review the literature and discuss some of the medical complications associated with the Wii and other video game consoles.
Sparks D; Chase D; Coughlin L
Informatics in Primary Care
2009
2009-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.14236/jhi.v17i1.715" target="_blank" rel="noreferrer noopener">10.14236/jhi.v17i1.715</a>
Aeroallergen sensitization in healthy children: racial and socioeconomic correlates.
Female; Male; Socioeconomic Factors; Incidence; Child; Risk Factors; Sensitivity and Specificity; Odds Ratio; Health Status; Probability; Confidence Intervals; Human; Adolescence; Logistic Regression; Case Control Studies; Immunization; Preschool; Population; Air Pollutants – Immunology; Allergens – Immunology; Hypersensitivity – Diagnosis; Hypersensitivity – Epidemiology; Hypersensitivity – Immunology; Respiratory Hypersensitivity – Diagnosis; Respiratory Hypersensitivity – Ethnology; Respiratory Hypersensitivity – Immunology; Skin Tests – Methods
Objective: Allergic sensitization is very prevalent and often precedes the development of allergic disease. This study examined the association of race with allergic sensitization among healthy children with no family history of atopy.Study Design: Two hundred seventy-five children, predominantly from lower socioeconomic strata, from Cincinnati, Ohio, ages 2 to 18 years without a family or personal history of allergic diseases, underwent skin prick testing to 11 allergen panels. The Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) was used to examine the impact of sensitization on quality of life.Results: Thirty-nine percent of healthy children were sensitized to 1 or more allergen panels. Multivariate logistic regression showed increased risk among African-American children for any sensitization (OR, 2.17; [95% CI: 1.23, 3.84]) and sensitization to any outdoor allergen (OR, 2.96 [95% CI: 1.52, 5.74]). Eighty-six percent of children had PADQLQ scores of 1 or less (0 to 6 scale).Conclusions: Allergic sensitization is prevalent even among children who do not have a personal or family history of asthma, allergic rhinitis, or atopic dermatitis and who have no evidence of current, even subtle effects from this sensitization on allergic disease-related quality of life. African-American children are at greater risk for presence of sensitization, especially to outdoor allergens.
Stevenson MD; Sellins S; Grube E; Schroer K; Gupta J; Wang N; Khurana Hershey GK; Stevenson Michelle D; Sellins Stacey; Grube Emilie; Schroer Kathy; Gupta Jayanta; Wang Ning; Khurana Hershey Gurjit K
Journal of Pediatrics
2007
2007-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jpeds.2007.03.001" target="_blank" rel="noreferrer noopener">10.1016/j.jpeds.2007.03.001</a>
Hospital outcomes and disposition of trauma patients who are intubated because of combativeness.
Adult; Female; Male; Ohio; Incidence; Intubation; Human; Chi Square Test; Case Control Studies; Retrospective Design; Violence; Physical; Restraint; Intratracheal; Treatment Outcomes; Nonparametric Statistics; Trauma Severity Indices; Length of Stay – Statistics and Numerical Data; Wounds and Injuries – Complications; Hypnotics and Sedatives – Therapeutic Use; Lorazepam – Therapeutic Use; Patient Discharge – Statistics and Numerical Data; Pneumonia – Epidemiology
BACKGROUND:: The purpose of this study was to determine whether trauma patients who are intubated because of combativeness, and not because of medical necessity, have more complications resulting in longer lengths of stay. METHODS:: Data were retrospectively collected from 2001 through 2004 on trauma patients who were intubated because of combative behavior before hospital admission (group 1, N = 34). Cases were matched 1:2 by age, sex, injury severity score (ISS), and injury to controls each who were not intubated (group 2, N = 68). Additionally, there were 187 patients identified who were intubated because of medical necessity before hospital admission; these represented unmatched intubated controls and were divided based on ISS \textless15 (group 3, N = 58) and ISS \textgreater15 (group 4, N = 129). RESULTS:: There were no significant differences between groups 1, 2, and 3 with regard to age, sex, or ISS. There was no significant difference between the groups 1 and 2 in frequency of head injuries as demonstrated by positive computed tomography (50 vs. 37%, p = 0.28); however, there was a significant difference in frequency of neurologic deficit at discharge (33 vs. 6%, p = 0.006). There was a significant difference in the frequency of head injuries between groups 1 and 3 (50 vs. 22%, p = 0.006); however, there was no significant difference in neurologic deficit at discharge (33 vs. 22%, p = 0.24). There was a significant difference in hospital length of stay between groups 1 and 2 (7.4 +/- 5.9 vs. 4.3 +/- 4.5 days, p = 0.0009). The incidence of pneumonia was significantly greater in group 1 than in group 2 (29 vs. 0%, p \textless 0.0001). The amount of lorazepam in average mg per day was also significantly greater in group 1 versus group 2 (4.4 +/- 11.5 vs. 0.4 +/- 1.6, p \textless 0.0001). There was also a difference in the discharge status, with significantly fewer group 1 cases being discharged home compared with group 2 (56 vs. 91%, p \textless 0.0001). There was no significant difference between groups 1 and 3 with regard to length of stay, ventilator days, pneumonia, or discharge status. There was a significant difference between groups 1 and 3 in the amount of lorazepam per day (4.4 +/- 11.5 vs. 0.4 +/- 1.6, p = 0.002). CONCLUSION:: The results from this study indicate that trauma patients who are intubated because of combativeness, and not because of medical necessity, have longer lengths of stay, increased incidence of pneumonia, and poorer discharge status when compared with matched controls. The outcomes of this group are similar to that of patients who are intubated because of medical necessity.
Muakkassa FF; Marley RA; Workman MC; Salvator AE
Journal of Trauma
2010
2010-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/TA.0b013e3181dcd137" target="_blank" rel="noreferrer noopener">10.1097/TA.0b013e3181dcd137</a>
Importance of Culture for Group A Strep Pharyngitis after a Negative Rapid Test.
Adult; Incidence; Sensitivity and Specificity; Medical Records; Multicenter Studies; Adolescence; Retrospective Design; Washington; Diagnosis; Differential; Microbial Culture and Sensitivity Tests; Patient Care – Standards; Pharyngitis – Etiology; Streptococcal Infections – Complications; Streptococcal Infections – Diagnosis
Watkins Richard R
Infectious Disease Alert
2014
2014-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Encephalitis from Chikungunya Virus: An Increasingly Recognized Syndrome.
Aged; Incidence; Infant; Age Factors; France; Chikungunya Virus; Chikungunya Fever – Complications; Encephalitis – Epidemiology – France; Encephalitis – Etiology; Encephalitis – Risk Factors
The article focuses on the retrospective cohort study of the outbreak of the chikungunya virus (CHIKV) which causes the encephalitis and the central nervous system (CNS) involvement after a large CHIKV outbreak that occurred on Reunion Island between September 2005 and June 2006. It mentions that CHIKV infection shows the neurological symptoms such as lumbar puncture with a positive cerebral spinal fluid (CSF) and the CHIKV can cause severe neurological disease.
Watkins Richard R
Infectious Disease Alert
2016
2016-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The Zoster Vaccine Rapidly Loses Effectiveness in Adults Over 60.
Adult; Aged; Incidence; Age Factors; Human; Middle Age; Immunization; Quality-Adjusted Life Years; Nonexperimental Studies; Cost Benefit Analysis; Herpes Zoster Vaccine; Neuralgia; Herpes Zoster – Prevention and Control; Herpes Zoster Vaccine – In Old Age; Postherpetic
The article reports that the Herpes Zoster (HZ) vaccine has decreased its effectiveness in adults that are above 60 years of age. Topics discussed include decline in beneficial effect of the HZ vaccine; determination of an optimal re-dosing strategy to make the vaccine more effective; and decline in the effectiveness of the vaccine in preventing PHN.
Watkins Richard R
Infectious Disease Alert
2016
2016-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Infective Endocarditis Trends and Outcomes.
Incidence; New York; California; Endocarditis; Methicillin-Resistant Staphylococcus Aureus; Staphylococcus Aureus; Bacterial – Epidemiology; Bacterial – Mortality; Bacterial – Diagnosis; Bacterial – Etiology; Bacterial – Trends
Watkins Richard R
Hospital Medicine Alert
2017
2017-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Infectious complications in diabetic patients.
Female; Humans; Male; Incidence; Antifungal Agents/therapeutic use; Anti-Bacterial Agents/therapeutic use; Morbidity; *Diabetes Complications; Bacterial Infections/complications/*drug therapy/epidemiology; Candidiasis/complications/*drug therapy/epidemiology; Cholecystitis/complications/epidemiology/therapy; Respiratory Tract Infections/complications/*drug therapy/epidemiology; Urinary Tract Infections/complications/*drug therapy/epidemiology; Infectious/complications/*drug therapy/epidemiology; Skin Diseases
File T M Jr; Tan J S
Current therapy in endocrinology and metabolism
1994
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Caffeine Awareness in Children: Insights from a Pilot Study.
Female; Humans; Male; Adolescent; Pilot Projects; Incidence; Child; Cross-Sectional Studies; United States; Surveys and Questionnaires; Age Factors; Sex Factors; Risk Assessment; adolescents; Awareness; Beverages/*adverse effects/statistics & numerical data; caffeine; Caffeine/administration & dosage/*adverse effects; Needs Assessment; sleep; Sleep Wake Disorders/*chemically induced/epidemiology; Students/statistics & numerical data; Practice; *Health Knowledge; Attitudes
STUDY OBJECTIVES: Caffeine, a commonly consumed psychoactive substance, can have significant effects on sleep. Caffeine intake among children is increasing, mainly in the form of sodas. However, adolescent caffeine consumers may lack knowledge about the caffeine content in common beverages. If true, this very fact may hamper the assessment of the effects of caffeine consumption on sleep in children if such assessments are a priori dependent on responders being able to reliably distinguish between caffeinated and noncaffeinated beverages. This preliminary study investigated adolescents' caffeine knowledge and intake at a Cleveland-area public middle school. METHODS: Seventh- and eighth-grade students were surveyed using: (1) the Caffeine Literacy and Sleep Study (CLASS), a
Thakre Tushar P; Deoras Ketan; Griffin Catherine; Vemana Aarthi; Podmore Petra; Krishna Jyoti
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
2015
2015-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.5664/jcsm.4848" target="_blank" rel="noreferrer noopener">10.5664/jcsm.4848</a>
Adherence to Endotracheal Tube Depth Guidelines and Incidence of Malposition in Infants and Children.
Female; Humans; pediatrics; Male; Ohio; Random Allocation; Incidence; Chi-Square Distribution; Child; Guideline Adherence/*statistics & numerical data; Infant; intubation; Medical Errors/*statistics & numerical data; NRP; PALS; Radiography/*statistics & numerical data; Trachea/diagnostic imaging; tracheal tube malposition; United States; Odds Ratio; Intensive Care Units; Hospitals; Guideline Adherence; Radiography; Intubation; ROC Curve; Confidence Intervals; Inpatients; Human; Chi Square Test; Descriptive Statistics; P-Value; Data Analysis Software; Practice Guidelines; Retrospective Design; Preschool; Thoracic; Intratracheal/adverse effects/standards/*statistics & numerical data; Intratracheal – Standards – United States; Pediatric – Ohio
BACKGROUND: Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT malpositioning, we evaluated initial postintubation chest radiographs and hypothesized that many ETTs in multiple intubation settings would be malpositioned despite adherence to Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines. METHODS: In a random subset (randomization table) of 2,000 initial chest radiographs obtained from January 1, 2009, to May 5, 2012, we recorded height, weight, age, sex, ETT inner diameter, and cm marking at the lip from the electronic health record. Chest radiographs of poor quality and with spinal or skeletal deformities were excluded. We defined adherence to Pediatric Advanced Life Support or Neonatal Resuscitation Program guidelines as the difference between predicted and actual ETT markings at the lip as +/- 0.25, +/- 0.50, or +/- 1.0 cm for ETTs of 2.5-4, 4.5-6.0, or \textgreater6.5 mm inner diameter, respectively. We defined the proper position as the ETT tip being below the thoracic inlet (superior border of the clavicular heads) and \textgreater/=1 cm above the carina. Descriptive statistics reported demographics, guideline adherence, and malposition incidence. The chi-square test was used to assess relationships among intubation setting, malposition, and depth guideline adherence (P \textless .05, significant). RESULTS: We reviewed 507 records, 477 of which met inclusion criteria and had sufficient data for analysis. Fifty-six percent of the subjects were male, with median (interquartile range) age 15.2 (3.4-59.4) months, and 330 ETTs (69%) were malpositioned: 39 above the thoracic inlet, and 291 \textless 1 cm above the carina. Of 79 ETTS (17%) that adhered to depth guidelines, 56 (74%) were malpositioned. Three-hundred seventy-three ETTs (83%) did not meet guidelines. Two-hundred sixty-four (68%) were malpositioned. The intubation setting did not influence malposition or guideline adherence (P = .54). CONCLUSIONS: In infants and children, a high proportion of ETTs were malpositioned on the first postintubation chest radiograph, with little influence of guideline adherence.
Volsko Teresa A; McNinch Neil L; Prough Donald S; Bigham Michael T
Respiratory Care
2018
2018-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4187/respcare.06024" target="_blank" rel="noreferrer noopener">10.4187/respcare.06024</a>
Burden of community-acquired pneumonia in North American adults.
Adult; Humans; Incidence; Risk Factors; Cost of Illness; Length of Stay/statistics & numerical data; North America/epidemiology; Health Care Costs; Health Status Indicators; North America; Human; Community-Acquired Infections/economics/epidemiology/microbiology/prevention & control; Hospitalization/economics/statistics & numerical data; Pneumococcal Vaccines; Streptococcus pneumoniae; Pneumonia; Bacterial/economics/*epidemiology/microbiology/prevention & control; Pneumococcal/economics/epidemiology/mortality/prevention & control; Economic Aspects of Illness; Streptococcus; Pneumococcal Vaccine; Length of Stay – Statistics and Numerical Data; Bacterial – Epidemiology; Community-Acquired Infections – Epidemiology; Community-Acquired Infections – Microbiology; Bacterial – Economics; Bacterial – Microbiology; Bacterial – Mortality; Bacterial – Prevention and Control; Community-Acquired Infections – Economics; Community-Acquired Infections – Prevention and Control; Hospitalization – Economics; Hospitalization – Statistics and Numerical Data
To determine the burden of community-acquired pneumonia (CAP) affecting adults in North America, a comprehensive literature review was conducted to examine the incidence, morbidity and mortality, etiology, antibiotic resistance, and economic impact of CAP in this population. In the United States, there were approximately 4.2 million ambulatory care visits for pneumonia in 2006. Pneumonia and influenza continue to be a common cause of death in the United States (ranked eighth) and Canada (ranked seventh). In 2005, there were \textgreater60,000 deaths due to pneumonia in persons aged\textgreateror=15 years in the United States alone. The hospitalization rate for all infectious diseases increased from 1525 hospitalizations per 100 000 persons in 1998 to 1667 per 100 000 persons in 2005. Admission to an intensive care unit was required in 10% to 20% of patients hospitalized with pneumonia. The mean length of stay for pneumonia was \textgreateror=5 days and the 30-day rehospitalization rate was as high as 20%. Mortality was highest for CAP patients who were hospitalized; the 30-day mortality rate was as high as 23%. All-cause mortality for CAP patients was as high as 28% within 1 year. Streptococcus pneumoniae continues to be the most frequently identified pathogen associated with CAP, and pneumococcal resistance to antimicrobials may make treatment more difficult. The economic burden associated with CAP remains substantial at \textgreater$17 billion annually in the United States. Despite the availability and widespread adherence to recommended treatment guidelines, CAP continues to present a significant burden in adults. Furthermore, given the aging population in North America, clinicians can expect to encounter an increasing number of adult patients with CAP. Given the significance of the disease burden, the potential benefit of pneumococcal vaccination in adults is substantial.
File Thomas M Jr; Marrie Thomas J
Postgraduate medicine
2010
2010-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3810/pgm.2010.03.2130" target="_blank" rel="noreferrer noopener">10.3810/pgm.2010.03.2130</a>
Effect of Immunosuppressive Therapy on the Occurrence of Atypical Hemolytic Uremic Syndrome in Renal Transplant Recipients.
Adult; Female; Humans; Male; Middle Aged; Adrenal Cortex Hormones/adverse effects; Atypical Hemolytic Uremic Syndrome/*epidemiology/etiology; Immunosuppression/adverse effects; Immunosuppressive Agents/*adverse effects; Incidence; Kidney Transplantation/*adverse effects; Postoperative Complications/*epidemiology/etiology; Retrospective Studies; Sirolimus/adverse effects; Transplant Recipients; Kidney Failure; Chronic/*surgery
BACKGROUND Atypical hemolytic uremic syndrome (aHUS), a rare thrombotic microangiopathy, is characterized by hemolytic anemia, thrombocytopenia, and acute renal failure. Caused by genetic mutations in the alternative complement cascade, aHUS often will culminate in end-stage renal disease and occasionally death. Renal transplantation in aHUS patients has been contraindicated in the past due to the recurrence risk, with certain immunosuppressive regimens being commonly attributed. In this study, we analyzed the association between aHUS and immunosuppressive agents so as to offer evidence for the use of certain immunosuppressive regimens in renal transplant recipients. MATERIAL AND METHODS Our study is a retrospective analysis using data from the United States Renal Data System from 2004 to 2012. A cohort of renal transplantation patients diagnosed with aHUS were identified to include in the study. The primary endpoint was the determination of aHUS incidence in renal transplant recipients due to various immunosuppressive agents. The secondary endpoints were to check the relationship between the drug type as well as the demographic variables that increase the risk for aHUS. RESULTS It was found that there was a higher usage of sirolimus (P=0.015) and corticosteroids (P=0.030) in the aHUS patients compared to patients in other diagnoses group. CONCLUSIONS There was a higher usage of sirolimus and corticosteroids in renal transplantation patients diagnosed with aHUS. Unfortunately, due to the rarity of this disease, the sample size was small (n=14). Despite the small sample size, this data analysis throws light on the relationship between aHUS and immunosuppressive agents in renal transplant recipients, although we still have much to learn.
Raina Rupesh; Chauvin Abigail; Fox Kelli; Kesav Natasha; Ascha Mustafa S; Vachharajani Tushar J; Krishnappa Vinod
Annals of transplantation
2018
2018-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.12659/AOT.909781" target="_blank" rel="noreferrer noopener">10.12659/AOT.909781</a>
Vascular complications associated with transcatheter aortic valve replacement.
*bleeding; *transcatheter aortic valve replacement (TAVR); *vascular complications; Aortic Valve Stenosis/diagnosis/physiopathology/*surgery; Aortic Valve/physiopathology/*surgery; Heart Valve Prosthesis; Humans; Incidence; Prosthesis Design; Risk Factors; Severity of Illness Index; Transcatheter Aortic Valve Replacement/*adverse effects/instrumentation; Treatment Outcome; vascular access; Vascular Diseases/diagnostic imaging/*epidemiology/therapy
Transcatheter aortic valve replacement (TAVR) is now an accepted pathway for aortic valve replacement for patients who are at prohibitive, severe and intermediate risk for traditional aortic valve surgery. However, with this rising uptrend and adaptation of this new technology, vascular complications and their management remain an Achilles heel for percutaneous aortic valve replacement. The vascular complications are an independent predictor of mortality for patients undergoing TAVR. Early recognition of these complications and appropriate management is paramount. In this article, we review the most commonly encountered vascular complications associated with currently approved TAVR devices and their optimal percutaneous management techniques.
Sardar M Rizwan; Goldsweig Andrew M; Abbott J Dawn; Sharaf Barry L; Gordon Paul C; Ehsan Afshin; Aronow Herbert D
Vascular medicine (London, England)
2017
2017-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1358863X17697832" target="_blank" rel="noreferrer noopener">10.1177/1358863X17697832</a>
Predictors of mortality for nursing home-acquired pneumonia: a systematic review.
80 and over; Aged; Bacterial/*diagnosis/*mortality/therapy; Biological Markers – Therapeutic Use; CINAHL Database; Cross Infection/*diagnosis/*mortality/therapy; Embase; Female; Homes for the Aged/statistics & numerical data; Human; Humans; Incidence; Male; Medline; Meta Analysis; Mortality – Risk Factors; Nursing Care/*statistics & numerical data; Nursing Home Patients; Nursing Homes/*statistics & numerical data; Pneumonia; Pneumonia – Risk Factors; Prognosis; Risk Assessment/methods; Severity of Illness Index; Survival Analysis; Systematic Review; Treatment Outcome
BACKGROUND: Current risk stratification tools, primarily used for CAP, are suboptimal in predicting nursing home acquired pneumonia (NHAP) outcome and mortality. We conducted a systematic review to evaluate current evidence on the usefulness of proposed predictors of NHAP mortality. METHODS: PubMed (MEDLINE), EMBASE, and CINAHL databases were searched for articles published in English between January 1978 and January 2014. The literature search elicited a total of 666 references; 580 were excluded and 20 articles met the inclusion criteria for the final analysis. RESULTS: More studies supported the Pneumonia Severity Index (PSI) as a superior predictor of NHAP severity. Fewer studies suggested CURB-65 and SOAR (especially for the need of ICU care) as useful predictors for NHAP mortality. There is weak evidence for biomarkers like C-reactive protein and copeptin as prognostic tools. CONCLUSION: The evidence supports the use of PSI as the best available indicator while CURB-65 may be an alternative prognostic indicator for NHAP mortality. Overall, due to the paucity of information, biomarkers may not be as effective in this role. Larger prospective studies are needed to establish the most effective predictor(s) or combination scheme to help clinicians in decision-making related to NHAP mortality.
Dhawan Naveen; Pandya Naushira; Khalili Michael; Bautista Manuel; Duggal Anurag; Bahl Jaya; Gupta Vineet
BioMed research international
2015
1905-07
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<a href="http://doi.org/10.1155/2015/285983" target="_blank" rel="noreferrer noopener">10.1155/2015/285983</a>
Brain metastasis in bone and soft tissue cancers: a review of incidence, interventions, and outcomes.
Bone Neoplasms – Complications; Brain Neoplasms – Epidemiology; Descriptive Statistics; Human; Incidence; Neoplasm Metastasis – Epidemiology; PubMed; Soft Tissue Neoplasms – Complications; Systematic Review; Therapeutics; Treatment Outcomes
Bone and soft tissue malignancies account for a small portion of brain metastases. In this review, we characterize their incidence, treatments, and prognosis. Most of the data in the literature is based on case reports and small case series. Less than 5% of brain metastases are from bone and soft tissue sarcomas, occurring most commonly in Ewing's sarcoma, malignant fibrous tumors, and osteosarcoma. Mean interval from initial cancer diagnosis to brain metastasis is in the range of 20-30 months, with most being detected before 24 months (osteosarcoma, Ewing sarcoma, chordoma, angiosarcoma, and rhabdomyosarcoma), some at 24-36 months (malignant fibrous tumors, malignant peripheral nerve sheath tumors, and alveolar soft part sarcoma), and a few after 36 months (chondrosarcoma and liposarcoma). Overall mean survival ranges between 7 and 16 months, with the majority surviving \textless 12 months (Ewing's sarcoma, liposarcoma, malignant fibrous tumors, malignant peripheral nerve sheath tumors, angiosarcoma and chordomas). Management is heterogeneous involving surgery, radiosurgery, radiotherapy, and chemotherapy. While a survival advantage may exist for those given aggressive treatment involving surgical resection, such patients tended to have a favorable preoperative performance status and minimal systemic disease.
Shweikeh Faris; Bukavina Laura; Saeed Kashif; Sarkis Reem; Suneja Aarushi; Sweiss Fadi; Drazin Doniel
Sarcoma
2014
1905-07
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<a href="http://doi.org/10.1155/2014/475175" target="_blank" rel="noreferrer noopener">10.1155/2014/475175</a>
Timing and type of surgical treatment of Clostridium difficile-associated disease: a practice management guideline from the Eastern Association for the Surgery of Trauma.
*Clostridium difficile; *Practice Guidelines as Topic; *Societies; *Traumatology; Clostridium Difficile; Clostridium Infections – Epidemiology; Clostridium Infections – Microbiology; Clostridium Infections – Surgery; Clostridium Infections/epidemiology/microbiology/*surgery; Cross Infection – Epidemiology; Cross Infection – Microbiology; Cross Infection – Surgery; Cross Infection/epidemiology/microbiology/*surgery; Human; Humans; Incidence; Medical; Medical Organizations; Meta Analysis; Operative Time; Practice Guidelines; Survival – Trends; Survival Rate/trends; Systematic Review; Time Factors; Traumatology; United States; United States/epidemiology
BACKGROUND: Clostridium difficile infection is the leading cause of nosocomial diarrhea in the United States; however, few patients will develop fulminant C. difficile-associated disease (CDAD), necessitating an urgent operative intervention. Mortality for patients who require operative intervention is very high, up to 80% in some series. Since there is no consensus in the literature regarding the best operative treatment for this disease, we sought to answer the following:PICO [population, intervention, comparison, and outcome] Question 1: In adult patients with CDAD, does early surgery compared with late surgery, as defined by the need for vasopressors, decrease mortality?PICO Question 2: In adult patients with CDAD, does total abdominal colectomy (TAC) compared with other types of surgical intervention decrease mortality? METHODS: A subcommittee of the Practice Management Guideline Committee of the Eastern Association for the Surgery of Trauma conducted a systematic review and meta-analysis for the selected questions. RevMan software was used to generate forest plots. Grading of Recommendations, Assessment, Development and Evaluations methodology was used to rate the quality of the evidence, using GRADEpro software to create evidence tables. RESULTS: Reduction in mortality was significantly associated with early surgery, with a risk ratio (RR) of 0.5 (95% confidence interval [CI], 0.35-0.72). The quality of evidence was rated "moderate." Considering only the first procedure performed, mortality seemed to trend higher for TAC, with an RR of 1.11 (95% CI, 0.69-1.80). Considering only the actual procedure performed, the point estimate switched sides, showing a trend toward decreased mortality with TAC (RR, 0.86; 95% CI, 0.56-1.31). The quality of evidence was rated "very low." CONCLUSION: We strongly recommend that adult patients with CDAD undergo early surgery, before the development of shock and need for vasopressors. We conditionally recommend total or subtotal colectomy (vs. partial colectomy or other surgery) when the diagnosis of The Centers for Disease Control and Prevention is known.
Ferrada Paula; Velopulos Catherine G; Sultan Shahnaz; Haut Elliott R; Johnson Emily; Praba-Egge Anita; Enniss Toby; Dorion Heath; Martin Niels D; Bosarge Patrick; Rushing Amy; Duane Therese M
The journal of trauma and acute care surgery
2014
2014-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/TA.0000000000000232" target="_blank" rel="noreferrer noopener">10.1097/TA.0000000000000232</a>
Characterization of the incidence and risk factors for the development of lumbar radiculopathy.
Adolescent; Adult; Age Distribution; Aged; Female; Humans; Incidence; Lumbar Vertebrae; Male; Middle Aged; Military Personnel/*statistics & numerical data; Radiculopathy/*epidemiology; Risk Assessment; Risk Factors; Sex Distribution; United States/epidemiology; Young Adult
STUDY DESIGN: Epidemiological study of a prospectively collected database. OBJECTIVES: This investigation sought to evaluate the incidence of symptomatic lumbar radiculopathy, and identify risk factors for its development, among individuals serving in the United States military over a 10-year period. SUMMARY OF BACKGROUND DATA: Risk factors for the development of lumbar radiculopathy are poorly understood and the incidence of this disorder has not been characterized earlier for a young, high-demand population. METHODS: The Defense Medical Epidemiology Database was queried for the years 2000 to 2009 using the International Classification of Diseases ninth revision code for lumbar radiculopathy (724.4). Overall incidence was determined and multivariate Poisson regression analysis was carried out to identify the influence of risk factors such as age, sex, race, military rank, and branch of service on the development of this condition. RESULTS: In this population, the overall incidence of lumbar radiculopathy was 4.86 per 1000 person-years. Multivariate Poisson regression analysis showed that female sex, white race, senior positions within the rank structure, and service in the Army, Navy, or Air Force increased the risk of developing lumbar radiculopathy. Servicemembers of 30 years and older were found to have \textgreater3 times the risk of developing lumbar radiculopathy when compared with individuals \textless20. CONCLUSIONS: The incidence of lumbar radiculopathy in this young, racially diverse, and physically active population is higher than many other degenerative conditions. In this study female sex and white race increased the risk of developing lumbar radiculopathy. However, increasing age seems to be one of the most significant independent factors for developing this disorder. LEVEL OF EVIDENCE: Level II, prognostic study.
Schoenfeld Andrew J; Laughlin Matthew; Bader Julia O; Bono Christopher M
Journal of spinal disorders & techniques
2012
2012-05
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<a href="http://doi.org/10.1097/BSD.0b013e3182146e55" target="_blank" rel="noreferrer noopener">10.1097/BSD.0b013e3182146e55</a>
Incidence and epidemiology of cervical radiculopathy in the United States military: 2000 to 2009.
*Military Personnel/statistics & numerical data; Adult; Age Factors; Cohort Studies; Databases; Factual; Female; Humans; Incidence; Male; Prospective Studies; Radiculopathy/diagnosis/*epidemiology; Risk Factors; Sex Factors; United States/epidemiology; Young Adult
STUDY DESIGN: Epidemiological review of a prospectively collected military database. OBJECTIVE: This investigation sought to determine the incidence of cervical radiculopathy and risk factors for its development within the population of the United States military from 2000 to 2009. SUMMARY OF BACKGROUND DATA: Currently, the epidemiology of cervical radiculopathy remains poorly understood and risk factors for its development have not been reliably defined. METHODS: The military's Defense Medical Epidemiological Database was used to identify all servicemembers diagnosed with cervical radiculopathy (International Classification of Diseases code 723.4) between 2000 and 2009. Demographic data was obtained for all identified individuals including age group, sex, race, military rank, and branch of service. Like data was recorded for all servicemembers within the Armed Forces during the time period under study. The incidence of cervical radiculopathy was calculated and unadjusted incidence rate ratios were determined. Risk factors were analyzed by performing multivariate Poisson regression analysis, controlling for all other factors within the model. RESULTS: Between 2000 and 2009, about 24,742 individuals were diagnosed with cervical radiculopathy among a population-at-risk of 13,813,333, for an incidence of 1.79 per 1000 person-years. Statistically significant differences (P\textless0.001) in adjusted incidence rate ratios were identified for each successive age group with mutually exclusive 95% confidence intervals. Those age 40 years and above were found to have the greatest risk of cervical radiculopathy. Female sex (P\textless0.001), White race (P\textless0.001), senior positions within the rank structure (P\textless0.001), and service in the Army (P\textless0.001) or Air Force (P=0.01) were also identified as significant risk factors for cervical radiculopathy. CONCLUSIONS: This study is the first to attempt to define the incidence of cervical radiculopathy and characterize risk factors for its development within an American population. Findings presented here indicate that age is most likely the greatest risk factor for cervical radiculopathy, with female sex, White race, senior military positions, and Army or Air Force service also influencing risk to varying degrees.
Schoenfeld Andrew J; George Alan A; Bader Julia O; Caram Pedro M Jr
Journal of spinal disorders & techniques
2012
2012-02
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<a href="http://doi.org/10.1097/BSD.0b013e31820d77ea" target="_blank" rel="noreferrer noopener">10.1097/BSD.0b013e31820d77ea</a>
Panniculectomy at the time of gynecologic surgery in morbidly obese patients.
*Gynecologic Surgical Procedures; Adult; Aged; Evaluation Studies as Topic; Female; Humans; Hysterectomy; Incidence; Middle Aged; Morbid/*surgery; Obesity; Retrospective Studies; Surgical Wound Dehiscence/epidemiology; Time Factors; Wound Infection/epidemiology
OBJECTIVE: Our goal was to demonstrate that panniculectomy performed at the time of gynecologic surgery aids in reducing the operative time and exposure and does not increase the wound infection rate in morbidly obese patients. STUDY DESIGN: A retrospective survey was performed of massively obese patients who underwent panniculectomy at the time of gynecologic surgery at Northeastern Ohio Universities College of Medicine consortium hospitals from 1990-1999. Data collected during surgery included the patient's weight, operative opening and closing times, blood loss, and weight of the removed panniculus adiposus. Postoperative wound infection rates were monitored, and patients were followed up for 6 months. RESULTS: Seventy-eight patients underwent the following operations: radical hysterectomy (n = 19), extrafascial hysterectomy (n = 18), standard hysterectomy (n = 32), or other gynecologic surgery (n = 9). The average blood loss was 71 mL. Opening and closing times were 27 and 33 minutes, respectively, adding a minimal amount of operative time to the required gynecologic surgery. The average removed panniculus adiposus weighed 4745 g. Efficiency in obtaining exposure to the operative site was noted. A total of 2 wound infections were recorded in the postoperative period. In 1 case debridement was required, and in the other healing occurred by secondary intention. Minimal separation occurred in 4 other cases and required no intervention. CONCLUSION: Massively obese patients can safely undergo panniculectomy simultaneously with a gynecologic procedure. The difficulty with operative exposure is reduced, and these patients are better served intraoperatively. Postoperatively, the wound infection rates quoted for this population were markedly improved from prior studies and involved a larger group of patients.
Hopkins M P; Shriner A M; Parker M G; Scott L
American journal of obstetrics and gynecology
2000
2000-06
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<a href="http://doi.org/10.1067/mob.2000.107333" target="_blank" rel="noreferrer noopener">10.1067/mob.2000.107333</a>
The epidemiology of respiratory tract infections.
80 and over; Adolescent; Adult; Age Factors; Aged; Child; Community-Acquired Infections/epidemiology; Cross Infection/epidemiology; Drug Resistance; Female; Humans; Incidence; Infant; Male; Microbial; Middle Aged; Newborn; Preschool; Respiratory Tract Diseases/*epidemiology/mortality/prevention & control; Risk Factors; United States/epidemiology
Respiratory tract infections (RTIs) are the most common, and potentially most severe, of infections treated by health care practitioners. Lower RTIs along with influenza, are the most common cause of death by infection in the United States. Risk factors for pneumonia and other respiratory tract infections include: extremes of age (very young and elderly), smoking, alcoholism, immunosuppression, and comorbid conditions. The microbial cause of RTIs vary depending on the infection (i.e., pneumonia compared with acute bacterial sinusitis), setting (i.e., community-acquired compared with nosocomial), and other factors. The causative pathogens associated with CAP have changed in prevalence over time. Although Streptococcus pneumoniae remains the most common causative pathogen, a number of newer pathogens, such as Chlamydia pneumoniae and sin nombre virus, have been recognized in recent years. The emerging antimicrobial resistance of respiratory pathogens (most notably S. pneumoniae) has also increased the challenge for appropriate management of RTI. An awareness of the epidemiology and cause of specific respiratory infections should optimize care.
File T M
Seminars in respiratory infections
2000
2000-09
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<a href="http://doi.org/10.1053/srin.2000.18059" target="_blank" rel="noreferrer noopener">10.1053/srin.2000.18059</a>
Incidence and epidemiology of spinal cord injury within a closed American population: the United States military (2000-2009).
*Military Personnel; Adolescent; Adult; Female; Humans; Incidence; International Classification of Diseases; Male; Middle Aged; Retrospective Studies; Risk Factors; Spinal Cord Injuries/*epidemiology; United States/epidemiology; Young Adult
STUDY DESIGN: Cohort study. OBJECTIVES: The objective of this study was to characterize the incidence of spinal cord injury (SCI) within the population of the United States military from 2000-2009. This investigation also sought to define potential risk factors for the development of SCI. SETTING: The population of the United States military from 2000-2009. METHODS: The Defense Medical Epidemiology Database was queried for the years 2000-2009 using the International Classification of Diseases, Ninth Revision, Clinical Modification codes for SCI (806.0, 806.1, 806.2, 806.3, 806.4, 806.5, 806.8, 806.9, 952.0, 952.1, 952.2, 952.8, 952.9). The raw incidence of SCI was calculated and unadjusted incidence rates were generated for the risk factors of age, sex, race, military rank and branch of service. Adjusted incidence rate ratios were subsequently determined via multivariate Poisson regression analysis that controlled for other factors in the model and identified significant independent risk factors for SCI. RESULTS: Between 2000 and 2009, there were 5928 cases of SCI among a population at-risk of 13,813,333. The raw incidence of SCI within the population was 429 per million person-years. Male sex, white race, enlisted personnel and service in the Army, Navy or Marine Corps were found to be significant independent risk factors for SCI. The age groups 20-24, 25-29 and \textgreater40 were also found to be at significantly greater risk of developing the condition. CONCLUSIONS: This study is one of the few investigations to characterize the incidence, epidemiology and risk factors for SCI within the United States. Results presented here may represent the best-available evidence for risk factors of SCI in a large and diverse American cohort.
Schoenfeld A J; McCriskin B; Hsiao M; Burks R
Spinal Cord
2011
2011-08
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<a href="http://doi.org/10.1038/sc.2011.18" target="_blank" rel="noreferrer noopener">10.1038/sc.2011.18</a>
Response error in self-reported current smoking frequency by black and white established smokers.
*African Americans; *European Continental Ancestry Group; Adult; Analysis of Variance; Bias; Cotinine/*analysis; Female; Humans; Incidence; Male; Reproducibility of Results; Smoking/*epidemiology/ethnology; Surveys and Questionnaires
As compared with white smokers, black smokers, although they report using fewer cigarettes per day, are at higher risk for most smoking-related diseases. Among black smokers serum cotinine levels are also higher in proportion to cigarettes per day; this observation has led to suggestions of bias in self-reporting. The purpose of this study was to evaluate and compare the extent of errors in self-reported smoking patterns among black and white established smokers. Ninety-seven white and 66 black smokers participated in structured telephone interviews, filled out two self-administered questionnaires one week apart, and collected all of their cigarette butts for a week. Group differences in the validity of self-reported smoking patterns were assessed by comparison with cigarette butt counts and the measured butt lengths. Both black and white smokers significantly overestimated smoking on our measure of smoking frequency (both P \textless 0.001); the group difference in bias was not significant (P = 0.13). There was no evidence that underreporting was more common among blacks than among whites (P = 0.67). Test-retest reliability was not significantly different in the two groups (P = 0.09). Both groups performed poorly when asked to categorize their smoking frequency according to the cutpoints of the Fagerstrom Test for Nicotine Dependence. Black smokers smoked more of each cigarette and smoked longer cigarettes, but they smoked fewer total millimeters of cigarettes per day (all P \textless 0.001). Contrary to an earlier report, the disproportionately high cotinine levels could not be attributed to reporting error.
Clark P I; Gautam S P; Hlaing W M; Gerson L W
Annals of epidemiology
1996
1996-11
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<a href="http://doi.org/10.1016/s1047-2797(96)00049-x" target="_blank" rel="noreferrer noopener">10.1016/s1047-2797(96)00049-x</a>
Putting chemical and environmental sensitivities in perspective.
Allergens/immunology; Cellular/immunology; Environmental Exposure; Environmental Illness/*diagnosis/immunology/physiopathology/therapy; Food Hypersensitivity/diagnosis; Humans; Hypersensitivity; Hypersensitivity/diagnosis/therapy; Immediate/immunology; Immunity; Incidence; Multiple Chemical Sensitivity/*diagnosis/immunology/physiopathology/therapy; Otorhinolaryngologic Diseases/diagnosis/immunology/therapy; Physical Examination
Chemical sensitivity has been recognized for an extended period. Over the last 30 years or more, there has been a growing number of chemicals to which humans are being exposed. Some people have become sensitive to one or more of these chemicals and present this sensitivity in a wide variety of signs or symptoms. Single or multiple organ systems may become involved. This article is intended to give an overview on the existence and recognition of chemical sensitivities and how they may be diagnosed and treated. The important item is to educate physicians to the existence of chemical sensitivity and to consider this in their differential diagnosis when the patient presents with the signs, symptoms, or clinical pattern that is explained.
Waickman F J; Vojdani A
Otolaryngologic clinics of North America
1998
1998-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0030-6665(05)70029-3" target="_blank" rel="noreferrer noopener">10.1016/s0030-6665(05)70029-3</a>
A computer model for the study of breast cancer.
*Computer Simulation; Breast Neoplasms/epidemiology/mortality/*pathology; Female; Humans; Incidence; Life Expectancy; Lymphatic Metastasis; Neoplasm Metastasis; SEER Program; Software; United States/epidemiology
A computer model was designed as a relational database to assess breast cancer screening in a cohort of women where the growth and development of breast cancer originates with the first malignant cell. The concepts of thresholds for growth, axillary spread, and distant sites are integrated. With tumor diagnosis, staging was performed that includes clinical and sub-clinical states. The model was parameterized to have staging characteristics similar to data published by the Surveillance, Epidemiology, and End-Results (SEER) Program. Validation was accomplished by comparing simulated staging results with non-SEER sources, and simulated survival with independent clinical survival data.
Carter Kimbroe J; Castro Frank; Kessler Edward; Erickson Barbara
Computers in biology and medicine
2003
2003-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0010-4825(03)00003-9" target="_blank" rel="noreferrer noopener">10.1016/s0010-4825(03)00003-9</a>
Epidemiology of cervical spine fractures in the US military.
Adult; Cervical Vertebrae/*injuries; Databases; Factual; Female; Humans; Incidence; Male; Military Personnel/statistics & numerical data; Spinal Cord Injuries/epidemiology/etiology; Spinal Fractures/complications/*epidemiology; United States/epidemiology; Young Adult
BACKGROUND CONTEXT: The epidemiology of cervical spine fractures and associated spinal cord injury (SCI) has not previously been estimated within the American population. PURPOSE: To determine the incidence of cervical spine fractures and associated SCI and identify potential risk factors for these injuries in a large multicultural military population. STUDY DESIGN: Query of a prospectively collected military database. PATIENT SAMPLE: The 13,813,333 military servicemembers serving in the US Armed Forces between 2000 and 2009. OUTCOME MEASURES: The Defense Medical Epidemiology Database (DMED) was queried to identify all servicemembers diagnosed with cervical spine fractures with and without SCI during the time period under investigation. Data were used to determine the incidence of cervical spine fractures and SCI as well as identify risk factors for their development. METHODS: The DMED was queried for the years 2000 to 2009 using the International Classification of Diseases, Ninth Revision, Clinical Modification code for cervical spine fractures with and without SCI (805.0, 805.1, 806.0, and 806.1). The database was also used to determine the total number of servicemembers within the military during the same period. The incidence of cervical spine fractures and fractures associated with SCI was determined, and unadjusted incidence rates were calculated for the demographic characteristics of sex, race, military rank, branch of service, and age. Adjusted incidence rate ratios were then determined using multivariate Poisson regression analysis to control for other factors in the model and identify significant risk factors for cervical spine fractures and cervical injuries associated with SCI. RESULTS: From 2000 to 2009, there were 4,048 cervical spine fractures in a population at risk of 13,813,333 servicemembers. The overall incidence of cervical spine fractures was 0.29 per 1,000 person-years, and the incidence of fracture associated SCI was 70 per 1,000,000. The cohorts at highest risk of cervical spine fracture were males, whites, Enlisted personnel, those serving in the Army, Navy, or Marine Corps, and servicemembers aged 20 to 29. Risk of fracture-associated SCI was significantly increased in males, Enlisted personnel, servicemembers in the Army, Navy, or Marines, and those aged 20 to 29. CONCLUSIONS: This study is the largest population-based investigation to be conducted within the United States regarding the incidence of SCI and the only study addressing incidence and risk factors for cervical spine fractures. Male sex, white race, Enlisted military rank, service in the Army, Navy, or Marine Corps, and ages 20 to 29 were found to significantly increase the risk for cervical fractures and/or fracture associated SCI. Our findings support previously published data but also represent best available evidence based on the size and diversity of the population under study. LEVEL OF EVIDENCE: Prognostic; Level II.
Schoenfeld Andrew J; Sielski Bernadette; Rivera Kenneth P; Bader Julia O; Harris Mitchel B
The spine journal : official journal of the North American Spine Society
2012
2012-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.spinee.2011.01.029" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2011.01.029</a>
Characterization of combat-related spinal injuries sustained by a US Army Brigade Combat Team during Operation Iraqi Freedom.
*Iraq War; 2003-2011; Adolescent; Adult; Female; Humans; Incidence; Male; Middle Aged; Military Personnel/statistics & numerical data; Spinal Injuries/*epidemiology; United States/epidemiology; Young Adult
BACKGROUND CONTEXT: The United States is presently engaged in the largest scale armed conflict since Vietnam. Despite recent investigations into the scope of injuries sustained by soldiers in Iraq and Afghanistan, little information is available regarding the incidence and epidemiology of spine trauma in this population. PURPOSE: Characterize the incidence and epidemiology of spinal injuries sustained during combat by soldiers of a US Army Brigade Combat Team (BCT) that participated in Operation Iraqi Freedom. STUDY DESIGN: Descriptive epidemiologic study. PATIENT SAMPLE: A total of 4,122 soldiers who served in Iraq with an Army BCT during "The Surge" operation. OUTCOME MEASURES: Spine injury epidemiology was calculated for the BCT, including the spine combat casualty rate, and percent medically evacuated (MEDEVAC). METHODS: Unit rosters were obtained, and a comprehensive database identifying all combat-related spine injuries was created by querying each soldiers' electronic medical record and the unit's casualty rosters. Demographic information was recorded including age, sex, rank, injury mechanism, presence of polytrauma, and injury outcome. Injury outcomes were classified as killed in action, died of wounds, MEDEVAC, or returned to duty. The incidence of spine injuries was determined, and epidemiology was characterized using calculations of the spine combat casualty rate and percent MEDEVAC. Comparisons were made to published reports from previous conflicts. RESULTS: A total of 29 soldiers sustained 31 combat-related spine injuries. These accounted for 7.4% (29 out of 390) of all casualties sustained during combat. Blunt trauma to the spine, often resulting from an explosive mechanism, was encountered in 65% of cases. Closed fractures of the spine occurred in 21% of casualties and open injuries occurred in 7%. The spine combat casualty rate was 5.6 out of 1,000 soldier combat-years, and the percent MEDEVAC was 19%. CONCLUSIONS: This investigation is the first of its kind, documenting the nature of spine trauma in a major American conflict. The incidence of spine injuries in this study is the highest ever documented and is indicative of the tactics used by the enemy in the current war. Given this fact, it is likely that the prevalence of combat-related spine trauma will increase in the future. Larger, more extensive, studies of this kind must be conducted in the future.
Schoenfeld Andrew J; Goodman Gens P; Belmont Philip J Jr
The spine journal : official journal of the North American Spine Society
2012
2012-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.spinee.2010.05.004" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2010.05.004</a>
High Body Mass Index in Infancy May Predict Severe Obesity in Early Childhood.
*BMI percentile; *Body Mass Index; *infant growth; *obese; *weight for length; Age Factors; Body Mass Index; Case Control Studies; Case-Control Studies; Child; Comparative Studies; Evaluation Research; Female; Human; Humans; Incidence; Infant; Logistic Models; Logistic Regression; Male; Morbid – Diagnosis; Morbid – Epidemiology; Morbid/*diagnosis/*epidemiology; Multicenter Studies; Newborn; Obesity; Obesity – Diagnosis; Obesity – Epidemiology; Obesity/diagnosis/epidemiology; Predictive Value of Tests; Preschool; Reference Values; Reproducibility of Results; Risk Assessment; Scales; Sex Factors; Validation Studies; Weight Gain
OBJECTIVE: To characterize growth trajectories of children who develop severe obesity by age 6 years and identify clinical thresholds for detection of high-risk children before the onset of obesity. STUDY DESIGN: Two lean (body mass index [BMI] 5th to /=99th percentile) groups were selected from populations treated at pediatric referral and primary care clinics. A population-based cohort was used to validate the utility of identified risk thresholds. Repeated-measures mixed modeling and logistic regression were used for analysis. RESULTS: A total of 783 participants of normal weight and 480 participants with severe obesity were included in the initial study. BMI differed significantly between the severely obese and normal-weight cohorts by age 4 months (P \textless .001), at 1 year before the median age at onset of obesity. A cutoff of the World Health Organization (WHO) 85th percentile for BMI at 6, 12, and 18 months was a strong predictor of severe obesity by age 6 years (sensitivity, 51%-95%; specificity, 95%). This BMI threshold was validated in a second independent cohort (n = 2649), with a sensitivity of 33%-77% and a specificity of 74%-87%. A BMI \textgreater/=85th percentile in infancy increases the risk of severe obesity by age 6 years by 2.5-fold and the risk of clinical obesity by age 6 years by 3-fold. CONCLUSIONS: BMI trajectories in children who develop severe obesity by age 6 years differ from those in children who remain at normal weight by age 4-6 months, before the onset of obesity. Infants with a WHO BMI \textgreater/=85th percentile are at increased risk for developing severe obesity by age 6 years.
Smego Allison; Woo Jessica G; Klein Jillian; Suh Christina; Bansal Danesh; Bliss Sherri; Daniels Stephen R; Bolling Christopher; Crimmins Nancy A
The Journal of pediatrics
2017
2017-04
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<a href="http://doi.org/10.1016/j.jpeds.2016.11.020" target="_blank" rel="noreferrer noopener">10.1016/j.jpeds.2016.11.020</a>
Altered mental status in older emergency department patients.
Aged; Emergency Service; Hospital/*statistics & numerical data; Humans; Incidence; Mental Disorders/diagnosis/*epidemiology; Mental Status Schedule; United States/epidemiology
This article reviews the significance of altered mental status in older emergency department patients. Specific diagnoses are discussed, including delirium, stupor and coma, and dementia, with a focus on delirium. Finally, an approach to all older patients is suggested that should result in increased clinician comfort with older patients, improved ability to communicate with other physicians, increased quality of care, and improved patient and family satisfaction.
Wilber Scott T
Emergency medicine clinics of North America
2006
2006-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.emc.2006.01.011" target="_blank" rel="noreferrer noopener">10.1016/j.emc.2006.01.011</a>
Bacterial Pneumonia in Older Adults.
*Community-acquired; *Decision Making; *Elderly; *Etiology; *Pneumonia; *Risk factors; *Treatment; Aged; Bacterial – Epidemiology; Bacterial/*epidemiology; Community-Acquired Infections – Epidemiology; Community-Acquired Infections/*epidemiology; Decision Making; Global Health; Humans; Incidence; Pneumonia; Risk Factors; World Health
Community-acquired pneumonia is common in the elderly person; its presentation in this population is often confounded by multiple comorbid illnesses, including those that result in confusion. Although severity-of-illness scoring systems might aid decision-making, clinical judgment following a careful assessment is key in deciding on the site of care and appropriate therapy.
Marrie Thomas J; File Thomas M Jr
Clinics in geriatric medicine
2016
2016-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.cger.2016.02.012" target="_blank" rel="noreferrer noopener">10.1016/j.cger.2016.02.012</a>
The associations of 25-hydroxyvitamin D levels, vitamin D binding protein gene polymorphisms, and race with risk of incident fracture-related hospitalization: Twenty-year follow-up in a bi-ethnic cohort (the ARIC Study).
*Polymorphism; African Continental Ancestry Group; Aged; Alleles; Epidemiology; Ethnic Groups; European Continental Ancestry Group; Female; Follow-Up Studies; Fracture; Fracture Healing; Genetic Variation; Genotype; Hip Fractures/blood/*ethnology/*genetics; Hospitalization; Humans; Incidence; Male; Middle Aged; Proportional Hazards Models; Prospective Studies; Race; Risk Factors; Single Nucleotide; Vitamin D; Vitamin D binding protein polymorphisms; Vitamin D-Binding Protein/*genetics; Vitamin D/*analogs & derivatives/blood
BACKGROUND: Deficient levels of 25-hydroxyvitamin D [25(OH)D] have been associated with increased fracture risk. Racial differences in fracture risk may be related to differences in bioavailable vitamin D due to single nucleotide polymorphism (SNP) variations in the vitamin D binding protein (DBP). METHODS: We measured 25(OH)D levels in 12,781 middle-aged White and Black participants [mean age 57 years (SD 5.7), 25% Black] in the ARIC Study who attended the second examination from 1990-1992. Participants were genotyped for two DBP SNPs (rs4588 and rs7041). Incident hospitalized fractures were measured by abstracting hospital records for ICD-9 codes. We used Cox proportional hazards models to evaluate the association between 25(OH)D levels and risk of fracture with adjustment for possible confounders. Interactions were tested by race and DBP genotype. RESULTS: There were 1122 incident fracture-related hospitalizations including 267 hip fractures over a median of 19.6 years of follow-up. Participants with deficient 25(OH)D (\textless20 ng/mL) had a higher risk of any fracture hospitalization [HR=1.21 (95% CI 1.05-1.39)] and hospitalization for hip fracture [HR=1.35 (1.02-1.79)]. No significant racial interaction was noted (p-interaction=0.20 for any fracture; 0.74 for hip fracture). There was no independent association of rs4588 and rs7041 with fracture. However, there was a marginal interaction for 25(OH)D deficiency with rs7041 among Whites (p-interaction=0.065). Whites with both 25(OH)D deficiency and the GG genotype [i.e., with predicted higher levels of DBP and lower bioavailable vitamin D] were at the greatest risk for any fracture [HR=1.48 (1.10-2.00)] compared to Whites with the TT genotype and replete 25(OH)D (reference group). CONCLUSIONS: Deficient 25(OH)D levels are associated with higher incidence of hospitalized fractures. Marginal effects were seen in Whites for the DBP genotype associated with lower bioavailable vitamin D, but result inconclusive. Further investigation is needed to more directly evaluate the association between bioavailable vitamin D and fracture risk.
Takiar Radhika; Lutsey Pamela L; Zhao Di; Guallar Eliseo; Schneider Andrea L C; Grams Morgan E; Appel Lawrence J; Selvin Elizabeth; Michos Erin D
Bone
2015
2015-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.bone.2015.04.029" target="_blank" rel="noreferrer noopener">10.1016/j.bone.2015.04.029</a>
Revision total joint arthroplasty: the epidemiology of 63,140 cases in New York State.
80 and over; 80 and Over; Aged; arthroplasty; Arthroplasty; Databases; Factual; Humans; incidence; Joint Diseases – Epidemiology; Joint Diseases – Surgery; Joint Diseases/*epidemiology/surgery; Joint Prosthesis – Adverse Effects; Joint Prosthesis/adverse effects; Middle Age; Middle Aged; New York; New York/epidemiology; Prosthesis Failure; Reoperation – Statistics and Numerical Data; Reoperation – Trends; Reoperation/statistics & numerical data/trends; Replacement – Adverse Effects; Replacement – Statistics and Numerical Data; Replacement – Trends; Replacement/adverse effects/*statistics & numerical data/trends; Resource Databases; revision; revision burden; SPARCS
Recent evidence suggests a substantial rise in the number of revision total joint arthroplasty (TJA) procedures performed. The New York State SPARCS inpatient database was utilized to identify revision total shoulder, knee, and hip arthroplasty procedures between 1993 and 2010. Yearly incidence and related epidemiology were analyzed. A total of 1,806 revision TSA, 26,080 revision TKA, and 35,254 revision THA cases were identified. The population-based incidence of these procedures increased 288%, 246%, and 44% respectively (P\textless0.001). Revision burden for hip arthroplasty decreased from 16.1% in 2001 to 11.5% in 2010 (P\textless0.001). The rates of revision TSAs and TKAs increased at a substantially faster rate than that of revision THAs. Revision burden for hip arthroplasty steadily has decreased since 2001.
Bansal Ankit; Khatib Omar N; Zuckerman Joseph D
The Journal of arthroplasty
2014
2014-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.arth.2013.04.006" target="_blank" rel="noreferrer noopener">10.1016/j.arth.2013.04.006</a>
Alcohol, drugs, and urban violence in a small city trauma center.
*Psychotropic Drugs; *Street Drugs; Adult; African Americans/statistics & numerical data; Alcoholism/complications/*epidemiology; Cross-Sectional Studies; European Continental Ancestry Group/statistics & numerical data; Female; Humans; Incidence; Male; Multiple Trauma/*epidemiology/prevention & control; Multivariate Analysis; Ohio/epidemiology; Risk Factors; Social Environment; Substance-Related Disorders/complications/*epidemiology; Trauma Centers/statistics & numerical data; Urban Population/*statistics & numerical data; Violence/prevention & control/*statistics & numerical data
Substance abuse and urban trauma go hand in hand. But research focuses on large cities served by major academic medical centers. Do small cities face the same problems? Two hundred thirty-three urban trauma inpatients from a metro area of 250,000 were studied using patient interviews and medical records. As in large cities, one half used alcohol or drugs when attacked. Seventy percent were likely to be young, male, poor African-Americans. Only 3% were gang members, but demographic characteristics failed to explain substance abuse as they have for larger cities. A culture of violence pervades the small city, as it does in large urban ghettos. Two fifths were repeat urban trauma victims. Two fifths witnessed assaults in the past year. One third carried a knife or gun. Fifteen percent used a weapon on another person in the last year. Contextual variables, like being hurt in a bar, were related to drinking and drugs. The best predictor of present substance abuse and urban trauma was medical history of substance abuse. The need for (a) toxicology screens for all trauma victims, (b) referrals to substance abuse programs, (c) targeting at-risk populations for prevention, and (d) eliminating environments fostering violence and substance abuse is supported.
Buss T F; Abdu R; Walker J R
Journal of substance abuse treatment
1995
1995-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0740-5472(94)00086-7" target="_blank" rel="noreferrer noopener">10.1016/0740-5472(94)00086-7</a>