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Retrospective Population (retrospective + population)
Selected AbstractsCost Convergence between Public and For-Profit Hospitals under Prospective Payment and High Competition in TaiwanHEALTH SERVICES RESEARCH, Issue 6p2 2004Sudha Xirasagar Objective. To test the hypotheses that: (1) average adjusted costs per discharge are higher in high-competition relative to low-competition markets, and (2) increased competition is associated with cost convergence between public and for-profit (FP) hospitals for case payment diagnoses, but not for cost-plus reimbursed diagnoses. Data Sources. Taiwan's National Health Insurance database; 325,851 inpatient claims for cesarean section, vaginal delivery, prostatectomy, and thyroidectomy (all case payment), and bronchial asthma and cholelithiasis (both cost-based payment). Study Design. Retrospective population-based, cross-sectional study. Data Analysis. Diagnosis-wise regression analyses were done to explore associations between cost per discharge and hospital ownership under high and low competition, adjusted for clinical severity and institutional characteristics. Principal Findings. Adjusted costs per discharge are higher for all diagnoses in high-competition markets. For case payment diagnoses, the magnitudes of adjusted cost differences between public and FP hospitals are lower under high competition relative to low competition. This is not so for the cost-based diagnoses. Conclusions. We find that the empirical evidence supports both our hypotheses. [source] Prevalence of neural tube defects in Australia prior to mandatory fortification of bread-making flour with folic acidAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2010Samanthi Abeywardana Abstract Objective: To establish baseline prevalence of neural tube defects (NTDs) prior to mandatory folic acid fortification in Australia. Method: Retrospective population based study. Data from the Australian Congenital Anomalies Monitoring System, for 1998,2005 were used to calculate birth prevalence including live/stillbirths of at least 20 weeks gestation or 400 g birthweight. Total prevalence and trends of NTD including terminations of pregnancy (TOPs) before 20 weeks were established using data from South Australia, Victoria and Western Australia because of the incomplete ascertainment in other states. Results: The birth prevalence of NTDs from 1998,2005, was 5/10,000 births. The total prevalence including TOPs was 13/10,000 births. A 26% declining trend in total prevalence was seen from 1992,2005, but the main decline occurred prior to 1998. Women who were Indigenous, socially disadvantaged, young, living in remote areas and had multiple gestations were more likely to give birth to babies with NTDs. Conclusion: The prevalence of NTD has been stable since 1998. Reporting of the birth prevalence alone underestimates the actual prevalence of NTD. Implications: From a public health perspective, future monitoring of NTD following implementation of fortification of bread-making flour with folic acid should include a mixed methods approach; reporting birth prevalence on national data and total prevalence on tri-state data. [source] Population-Based Study of Cesarean Section After In Vitro Fertilization in AustraliaBIRTH, Issue 3 2010Elizabeth A. Sullivan MBBS, FAFPHM Abstract:, Background:, Decisions about method of birth should be evidence based. In Australia, the rising rate of cesarean section has not been limited to births after spontaneous conception. This study aimed to investigate cesarean section among women giving birth after in vitro fertilization (IVF). Methods:, Retrospective population-based study was conducted using national registry data on IVF treatment. The study included 17,019 women who underwent IVF treatment during 2003 to 2005 and a national comparison population of women who gave birth in Australia. The outcome measure was cesarean section. Results:, Crude rate of cesarean section was 50.1 percent versus 28.9 percent for all other births. Single embryo transfer was associated with the lowest (40.7%) rate of cesarean section. Donor status and twin gestation were associated with significantly higher rates of cesarean section (autologous, 49.0% vs donor, 74.9%; AOR: 2.20, 95% CI: 1.80, 2.69) and (singleton, 45.0% vs twin gestations, 75.7%; AOR: 3.81, 95% CI: 3.46, 4.20). The gestation-specific rate (60.1%) of cesarean section peaked at 38 weeks for singleton term pregnancies. Compared with other women, cesarean section rates for assisted reproductive technology term singletons (27.8% vs 43.8%, OR: 2.02 [95% CI: 1.95,2.10]) and twins (62.0% vs 75.7%, OR: 1.92 [95% CI: 1.74,2.11]) were significantly higher. Conclusions:, Rates for cesarean section appear to be disproportionately high in term singleton births after assisted reproductive technology. Vaginal birth should be supported and the indications for cesarean section evidence based. (BIRTH 37:3 September 2010) [source] Increased mortality and morbidity in mild primary hyperparathyroid patients.CLINICAL ENDOCRINOLOGY, Issue 1 2010Audit Research Study (PEARS), The Parathyroid Epidemiology Summary Objective, To describe mortality and disease-specific morbidities in patients with mild primary hyperparathyroidism (PHPT). Design, Retrospective population-based observational study. Setting, Tayside, Scotland, from 1997 to 2006. Participants, Patients with mild PHPT were selected from a predefined PHPT cohort between 1997 and 2006. Main outcome measures, Standardised mortality ratios (SMRs) were examined for all-cause mortality, as well as cardiovascular and cancer mortality. Standardised morbidity ratios and standardised incidence ratios were also calculated for eleven observed co-morbidities. Results, In total, there were 1683 (69·1% female) patients identified with mild PHPT in Tayside. Patients were found to have an increased risk of all-cause mortality and cardiovascular mortality (SMR-all cause 2·62, 95% CI 2·39,2·86; SMR-cardiovascular 2·68, 95% CI 2·34,3·05). Patients with mild PHPT had a significantly increased risk of developing cardiovascular and cerebrovascular disease, renal dysfunction and fractures compared to the age- and sex-adjusted general population. Conclusions, Mortality and morbidity were increased for patients with mild untreated PHPT, which is similar to more severe PHPT. [source] Shift in the burden of cancer towards older people , a retrospective population-based studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2007S. Ahmad Summary Cancer is age-related. However, oncology and palliative medicine services focus on the needs of younger and middle-aged adults. This study examined trends in cancer deaths across age in Wales over the last 20 years. All Wales death certificates from 1981 to 2001 were examined for total and cancer deaths. Place of death and age were noted. Total deaths decreased from 35 015 in 1981 to 32 966 in 2001 while cancer deaths increased from 7369 (21.1% of all deaths) to 8292 (25.2%). Deaths due to cancer increased in the over 85 years from 9.1% to 13.1%, 75,84 years (17.1,25.2%), 65,74 years (25,35.7%), 45,64 years (33.5,40.4%) and fell from 18.3% to 16.1% in those under 44 years. Cancer deaths over 75 years increased from 33.6% of cancer deaths in 1981 to 50.1% in 2001. Cancer deaths in the community decreased from 2713 in 1981 to 2153 in 2001 and increased in hospital from 4398 to 5185 and care homes from 258 to 954. The increase in hospital cancer deaths is mainly because of 75,84 year olds (1207,1840), and the over 85 years (294,740). Half of all cancer deaths are now in those over 75 years. Cancer deaths have shifted from the community to hospital and care homes mainly because of cancer in older people. Services need to be developed to target this population. [source] Acute intermittent porphyria in women: clinical expression, use and experience of exogenous sex hormones.JOURNAL OF INTERNAL MEDICINE, Issue 2 2003A population-based study in northern Sweden Abstract., Andersson C, Innala E, Bäckström T (University Hospital, Umeå, Sweden). Acute intermittent porphyria in women: clinical expression, use and experience of exogenous sex hormones. A population-based study in northern Sweden. J Intern Med 2003; 254: 176,183. Objective., To describe the clinical expression of acute intermittent porphyria (AIP) in women, their use of exogenous sex hormones, and the effects on AIP. Design., A retrospective population-based study. Subjects., All women aged ,18 years (n = 190) with DNA-diagnosed AIP in northern Sweden. Results., A total of 166 women (87%) participated; 91 (55%) had manifest AIP. Severe attacks were reported by 82%; 39% reported recurrent premenstrual AIP attacks and 22% reported chronic AIP symptoms. Oral hormonal contraceptives had been used by 58% of all these women and by 50 with manifest AIP (57%). Twelve women (24%) associated oral contraceptives as precipitating AIP attacks; in nine cases their first attack. One woman experienced relief from AIP symptoms. On commencing their treatment, 72% of the women with manifest AIP had not yet suffered their first attack. Twenty-two women (25%) aged ,45 years had used hormonal replacement therapy (HRT) at menopause to remedy climacteric symptoms (the percutaneous route was most frequently used); no AIP attack was precipitated. HRT to remedy vaginal dryness was used by 26 women (28%) aged ,45 years without triggering an AIP attack. Miscarriages were more frequent in women with manifest AIP (50%) than in the latent group (30%, P = 0.014). Conclusions., About half of the women with AIP had used oral hormonal contraceptives. As 25% of women with manifest AIP reported attacks associated with such drugs, caution must still be recommended. Menopausal HRT only rarely affected the disorder. Miscarriage was more common amongst women with manifest AIP. [source] IDENTIFICATION OF MOLECULAR MARKERS IN DCIS RECURRENCEPATHOLOGY INTERNATIONAL, Issue 12 2001Provenzano E Background: DCIS represents preinvasive malignant change. With screening mammography DCIS has become a common entity. Its natural history is poorly understood and treatment remains controversial. Using a retrospective population based cohort, we have identified histological and molecular variables predictive of recurrence. Methods: All cases of DCIS reported in Victoria between 1988 and 1992 were entered into the Victorian Cancer Registry. In Situ and Small Cancer Register (ISSIBCR) and followed up annually regarding treatment, the event of recurrence and its nature and location. From this register a cohort of 66 DCIS lesions with subsequent recurrence as in situ or invasive disease were studied histologically, immunohistochemically and with CGH-based genetic analyses comparing them to a nested randomized control group of DCIS without recurrence matched for patient age and year of diagnosis. Recurrences have been analysed by the same techniques to compare them to the primary lesion. Results: 13 histological features were evaluated and lesion size, nuclear pleomorphism, cellular polarity, micropapillary architecture and central necrosis were all significant predictors of recurrence (p < 0.05). Immunohistochemistry showed p21 overexpression, bcl2 negativity and ERBB2 positivity to be markers of recurrence. In the case of ERBB2, positivity was a predictor of recurrence even when its overexpression was focal. Primary and recurrent DCIS lesions had similar morphological appearances, and grade of primary DCIS correlated with grade of subsequent invasive cancer. This morphological similarity was paralleled by similar protein expression and genomic changes in both in situ and invasive recurrences. Conclusion: We have identified histological and immunohistochemical markers of recurrence in DCIS, and shown similarities in morphology, protein expression and genetic changes between primary DCIS and its recurrence. [source] The effect of warfarin use on clinical stage and histological grade of prostate cancerPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 5 2010V. Tagalakis MD Abstract Purpose Prolonged warfarin use may decrease the risk of prostate cancer. We aimed to assess the effect of warfarin on histological grade and clinical stage of prostate cancer at diagnosis. Methods We carried out a retrospective population-based cohort study of men older than 50 years of age diagnosed with prostate cancer between 1985 and 2002 and registered with the Saskatchewan Cancer Registry. We compared a composite score of histological grade and clinical stage of prostate cancer at diagnosis according to warfarin use in the 5 years preceding the diagnosis of prostate cancer. Results Compared with non-users, men with at least 2 years of cumulative warfarin use in the 5 year period preceding the diagnosis of prostate cancer were at a lower risk of a poor prognosis composite score at the time of their prostate cancer diagnosis (OR 0.40, 95%CI (0.19,0.83)), and when intermediate and poor prognosis scores were combined, a similar estimate of association was observed (OR 0.55, 95%CI (0.33,0.91)), adjusted for age at diagnosis and year of diagnosis. However, an increased risk of poor prognosis disease was observed with 4 years of cumulative warfarin use compared to never use (OR 2.2, 95%CI (1.03,4.81)). Conclusions There is a suggestion that at least 2 years of warfarin use is associated with a more favourable prognosis but that extended duration of use beyond 2 years may be associated with poor prognosis disease. Further investigation with a more complete assessment of confounders and that addresses potential detection biases is warranted. Copyright © 2010 John Wiley & Sons, Ltd. [source] Term breech singletons and caesarean section: A population study, Australia 1991,2005AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Elizabeth Anne SULLIVAN Objective: To describe the method of birth of term breech singletons in Australia. Design, setting and participants: A retrospective population-based study of women who gave birth to term breech singletons in Australia between 1 January 1991 and 31 December 2005 using data from the National Perinatal Data Collection. Main outcome measures: Caesarean section, vaginal breech birth. Results:, Method of birth changed for term breech singletons from 1991 (vaginal breech birth 23.1% versus caesarean (no labour 55.6%, labour 21.2%)) to 2005 (vaginal breech birth 3.7% versus caesarean (no labour 76.6%, labour 19.7%)). Overall, the population attributable risk percentage of term breech singletons for all caesarean sections declined from 10.2% in 1991 to 6.9% in 2005. Conclusion:, Planned caesarean section is the standard method of birth for term breech singletons in Australia. Active measures including external cephalic version should be supported to reduce the rate of caesarean section where clinically indicated. Retention of a skilled clinical workforce is essential in the provision of the latter and to assist the minority of women having vaginal breech births. Breech presentation is not a major factor in the overall rise in caesarean section experienced by Australia since 1996. [source] Renal oncocytoma: a clinicopathological analysis of 45 consecutive casesBJU INTERNATIONAL, Issue 9 2005Tomas Gudbjartsson OBJECTIVE To evaluate the clinical behaviour and pathology of renal oncocytoma in a well-defined population over a 30-year period. PATIENTS AND METHODS In a retrospective population-based study we assessed relevant clinical and pathological factors in 45 patients (31 men and 14 women) diagnosed with renal oncocytoma in Iceland between 1971 and 2000. Clinical presentation, pathology, survival and causes of death were evaluated. RESULTS The age-standardized incidence was 0.3 per 100 000 per year for both men and women, the incidence of oncocytomas being 5.5% of renal cell carcinomas (RCCs) diagnosed during the same period in Iceland. Fourteen patients were diagnosed at autopsy for an unrelated disease. Of 31 living patients (mean age 70.5 years), seven were diagnosed incidentally (23%), and the others had presented with haematuria (32%), abdominal pain (29%), and weight loss (10%). All the patients had a radical nephrectomy, except for one with bilateral oncocytoma who had a partial nephrectomy. The mean (range) tumour size was 5.7 (0.9,12) cm. Eighteen patients (58%) were diagnosed at Tumour-Node-Metastasis stage I, 10 at stage II (32%) and three at stage III (10%), all of those at stage III having renal capsular penetration or tumour invasion into perirenal fat tissue (T3aN0M0). No patients were diagnosed with lymph node or distant metastasis. Two cases of coexisting RCC were detected. After a median follow-up of 8.3 years there were no recurrences or deaths from oncocytoma (100% disease-specific survival). The overall 5-year survival was 63%, with most patients dying from cardiovascular diseases or nonrenal cancers. CONCLUSIONS In most cases renal oncocytoma behaves like a benign tumour; the long-term prognosis is excellent. Thus, in the present patients, radical nephrectomy could be regarded as an over-treatment and nephron-sparing surgery as more appropriate, especially in patients with small tumours. However, both coexisting RCC and perirenal fat invasion, a hallmark of malignant behaviour, might indicate that more radical surgery is warranted in some of these patients. [source] Case ascertainment and estimated incidence of drug-induced long-QT syndrome: study in Southwest FranceBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 3 2008Mariam Molokhia WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT , Drug-induced long-QT syndrome (LQTS) is a potentially fatal condition that has led to a number of postmarketing withdrawals in recent years. , However, many cases may not survive long enough to reach hospital, and only a small proportion are reported to pharmacovigilance agencies. , The extent to which genetic determinants of susceptibility to LQTS are specific to particular drugs, or common to several classes of drug, remains to be determined. WHAT THIS STUDY ADDS , We estimated population prevalence of drug-induced LQTS in the Midi-Pyrenees region, southwest France, using five different institutions and assessed feasibility of tracing potential cases (in addition to pharmacovigilance data), using hospital data and rigorous case definition. , These methods can be adapted to a wider region, used to augment pharmacovigilance reporting, and offer researchers the opportunity to study genetic susceptibility to drug-induced LQTS. AIMS The aim of this study was to investigate the incidence and reporting rate of drug-induced long-QT syndrome (LQTS) in France [defined by evidence of torsades de pointes (TdP), QT prolongation and exposure to a relevant drug] and to assess feasibility of case collection for drug-induced LQTS. METHODS A retrospective population-based study was carried out in Southwest France in five institutions: three main hospitals, one private clinic and one cardiac emergency unit, searched from 1 January 1999 to 1 January 2005 (population coverage of 614 000). The study population consisted of 861 cases with International Classification of Diseases-10 diagnostic codes for ventricular tachycardia (I147.2), ventricular fibrillation (I149.0) and sudden cardiac death (I146.1) from hospital discharge summaries, supplemented by cases reported to national or regional pharmacovigilance systems, and voluntary reporting by physicians, validated according to internationally defined criteria for drug-induced LQTS. RESULTS Of 861 patients coded with arrhythmias or sudden cardiac death, there were 40 confirmed surviving acquired cases of drug-induced LQTS. We estimated that the incidence of those who survive to reach hospital drug-induced LQTS is approximately 10.9 per million annually in France (95% confidence interval 7.8, 14.8). CONCLUSIONS Many cases of drug-induced LQTS may not survive before they reach hospital, as the reporting rate for drug-induced LQTS identified through the cardiology records and also reported to pharmacovigilance systems for the Midi-Pyrenees area is 3/40 (7.5%). Using the methods outlined it is possible to assemble cases to study genetic susceptibility to drug-induced LQTS and adapt these methods more widely. [source] Trends in melanoma epidemiology suggest three different types of melanomaBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2007D. Lipsker Summary Background It has been suggested that the incidence of thin melanomas but not of thick tumours is rising in fair-skinned populations, although the reason for this discrepancy is not understood. Objectives To describe temporal trends in melanoma epidemiology in a limited part of France in order to confirm this observation and to provide an explanation. Methods This is a retrospective population- and academic centre-based study in which all melanomas diagnosed in the department of the Bas-Rhin, France between January 1980 and December 2004 were included. Results The study included 2094 melanomas diagnosed in 2020 patients. There was a steady increase in incidence of thin (< 1 mm) melanomas, mainly located on the trunk, and to a lesser extent in the head and neck region, in both sexes, and of intermediate (1,2 mm) melanomas in men. The incidence of intermediate melanomas in women and of thick (> 2 mm) melanomas, as well as mortality related to melanoma, remained stable. There was a steady decline of mean and median Breslow thickness. The 12 months median delay to diagnosis of thick tumours was significantly shorter than the 24 months delay to diagnosis of thin tumours. Conclusions Temporal trends suggest the existence of three unrelated types of melanoma: type I, thick melanomas, with stable incidence; type II, thin melanoma with a steady and important increase in incidence, mainly located on the trunk; and type III, melanoma with a slower increase in incidence, mainly located on the head and neck region. [source] | |||||||||||||||||||