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National Cohort Study (national + cohort_study)
Selected AbstractsDisease-Specific Survival Benefit of Lung Transplantation in Adults: A National Cohort StudyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2009A. Titman The lung transplantation candidate population is heterogeneous and survival benefit has not been established for all patient groups. UK data from a cohort of 1997 adult (aged , 16), first lung transplant candidates (listed July 1995 to July 2006, follow-up to December 2007) were analyzed by diagnosis, to assess mortality relative to continued listing. Donor lungs were primarily allocated according to local criteria. Diagnosis groups studied were cystic fibrosis (430), bronchiectasis (123), pulmonary hypertension (74), diffuse parenchymal lung disease (564), chronic obstructive pulmonary disease (COPD, 647) and other (159). The proportion of patients in each group who died while listed varied significantly (respectively 37%, 48%, 41%, 49%, 19%, 38%). All groups had an increased risk of death at transplant, which fell below waiting list risk of death within 4.3 months. Thereafter, the hazard ratio for death relative to listing ranged from 0.34 for cystic fibrosis to 0.64 for COPD (p < 0.05 all groups except pulmonary hypertension). Mortality reduction was greater after bilateral lung transplantation in pulmonary fibrosis patients (p = 0.049), but not in COPD patients. Transplantation appeared to improve survival for all groups. Differential waiting list and posttransplant mortality by diagnosis suggest further use and development of algorithms to inform lung allocation. [source] Premenopausal Smoking and Bone Density in 2015 Perimenopausal WomenJOURNAL OF BONE AND MINERAL RESEARCH, Issue 4 2000Dr. A. P. Hermann Abstract The importance of cigarette smoking in relation to bone mass remains uncertain, especially in younger women. In a recent meta-analysis including 10 studies in premenopausal women no effect was seen in this age group. We used baseline data from a large national cohort study (Danish Osteoporosis Prevention Study [DOPS]) to study the cumulated effect of pre- and perimenopausal smoking on bone mineral density (BMD) measured shortly after the cessation of cyclic bleedings. Baseline observations on 2015 recently menopausal women were available. Eight hundred thirty-two women were current smokers and 285 were exsmokers. Significant negative associations of cigarette smoking coded as current, ex-, or never smoking were seen on bone mass in the lumbar spine (P = 0.012), femoral neck (P < 0.001), and total body (P < 0.001). Quantitatively, the differences between current smokers and never smokers were limited to 1.6, 2.9, and 1.9%, respectively. A statistical interaction was found between smoking and fat mass, indicating that women in the highest tertile of fat mass were unaffected by cigarette smoking. Serum vitamin D levels and osteocalcin were inversely related to the number of cigarettes smoked per day (r = 0.11 and P < 0.001; r = 0.17 and P = 0.04), respectively. Bone alkaline phosphatase (BALP) and urinary hydroxyproline (U-OHP) were unaffected by current smoking. The average cumulated effect of premenopausal smoking on bone is small but biologically significant. Reduced body mass in smokers explains part of the negative effect on the skeleton and a complex interaction between smoking and fat mass on the skeleton is indicated. Serum levels of 25-hydroxyvitamin D (25-OHD) and osteocalcin are lower in smokers, which may effect rate of bone loss. [source] Impact of radiotherapy on local recurrence of rectal cancer in NorwayBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2007M. H. Hansen Background: The purpose of this study was to analyse the impact of radiotherapy on local recurrence of rectal cancer in Norway after the national implementation of total mesorectal excision (TME). Methods: This was a prospective national cohort study of 4113 patients undergoing major resection of rectal carcinoma between November 1993 and December 2001. Results: The proportion of patients who had radiotherapy before or after operation increased from 4·6 per cent in 1994 to 23·0 per cent in 2001. The cumulative 5-year local recurrence rate decreased from 16·2 to 10·7 per cent. Multivariable analysis showed that preoperative radiotherapy significantly reduced local recurrence (hazard ratio 0·59 (95 per cent confidence interval 0·39 to 0·87)). The use of preoperative radiotherapy in patients from a local hospital offering radiotherapy was 50 per cent higher than that for patients from a hospital without such services (P = 0·003); cumulative 5-year local recurrence rates for these patients were 10·6 and 15·8 per cent respectively (P < 0·001). Conclusion: Following national implementation of TME for rectal cancer, increased use of preoperative radiotherapy appeared to reduce recurrence rates further. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Social adversity predicts ADHD-medication in school children , a national cohort studyACTA PAEDIATRICA, Issue 6 2010A Hjern Abstract Aims:, To test the hypothesis that psychosocial adversity in the family predicts medicated ADHD in school children. Method:, ADHD-medication during 2006 was identified in the Swedish Prescribed Drug Register in national birth cohorts of 1.1 million 6,19 year olds. Logistic regression models adjusted for parental psychiatric disorders were used to test our hypothesis. Results:, There was a clear gradient for ADHD medication with level of maternal education, with an adjusted odds ratio of 2.20 (2.04,2.38) for the lowest compared with the highest level. Lone parenthood and reception of social welfare also implied higher risks of ADHD-medication with adjusted ORs of 1.45 (1.38,1.52) and 2.06 (1.92,2.21) respectively. Low maternal education predicted 33% of cases with medicated ADHD and single parenthood 14%. Conclusions:, Social adversity in the family predicts a considerable proportion of ADHD-medication in school children in Sweden. [source] Teenage childbirth among female international adoptees: a national cohort studyACTA PAEDIATRICA, Issue 6 2009Cecilia Ekéus No abstract is available for this article. [source] A national cohort study of long-course preoperative radiotherapy in primary fixed rectal cancer in DenmarkCOLORECTAL DISEASE, Issue 7Online 2010S. Bülow Abstract Objective, Preoperative radiotherapy has been shown to enable a fixed rectal cancer to become resectable which in turn may result in long-time survival. In this study, we analysed the outcome of long-course preoperative radiotherapy in fixed rectal cancer in a national cohort including all Danish patients registered with primary inoperable rectal cancer and treated in the period May 2001 to December 2005. Method, The study was based on surgical and demographic data from a continuously updated and validated national database. In addition, retrospective data were retrieved from all departments of radiotherapy concerning technique of radiotherapy, dose and fractionation and use of concomitant chemotherapy. Outcome was determined by actuarial analysis of local control, disease-free survival and overall survival. Results, A total of 258 patients with fixed rectal cancer received long-course radiotherapy (> 45 Gy). The median age at diagnosis was 66 years (range: 32,85) and 185 (72%) patients were male. The resectability rate was 80%, and a R0 resection was obtained in 148 patients (57% of all patients and 61% of those operated). The 5-year local recurrence rate for all patients was 5% (95% CI: 3,7%), and the actuarial distant recurrence rate was 41% (95% CI: 35,47%). The cumulative 5-year disease-free survival was 27% (95% CI: 22,32%) and overall 5-year survival was 34% (95% CI: 29,39%). Conclusions, This study is the first population-based report on outcome of preoperative long-course radiotherapy in a large unselected patient group with clinically fixed rectal cancer. Most patients could be resected with the intention of cure and one in three was alive after 5 years. [source] Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patientsCOLORECTAL DISEASE, Issue 1 2005M. T. Eriksen Abstract Objective Mesorectal excision is successfully implemented as the standard surgical technique for rectal cancer resections in Norway. This technique has been associated with higher rates of anastomotic leakage (AL) and the purpose of this study was to examine AL in a large national cohort of patients. Methods This was a prospective national cohort study of 1958 patients undergoing rectal cancer surgery with anterior resection in Norway from November 1993 to December 1999. Results The overall rate of AL was 11.6% (228 of 1958 patients). In a multivariate analysis, the risk of AL was significantly higher in males (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1,2.2), in patients receiving pre-operative radiotherapy (OR 2.2, CI 1.0,4.7) and in low level (4,6 cm) (OR 3.5, CI 1.6,7.7) and ultra-low level (, 3 cm) anastomoses (OR 5.4, CI 2.3,12.9). The presence of a diverting stoma was associated with a 60% reduction in the risk of AL (OR 0.4, CI 0.3,0.7) for anastomoses 6 cm and below. 30-day mortality was significantly higher for the patients with AL (7.0%, CI 3.7,10.3) compared with no AL (2.4%, CI 1.7,3.2) AL had no significant effect on local recurrence rate (log rank P = 0.608). Conclusion Low anastomoses should be defunctioned to avoid AL and the associated high perioperative mortality. No effect of AL on local recurrence was found in this large cohort. [source] | ||||||||||