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Posts Tagged ‘CONFIDENCE intervals’

Rheumatoid arthritis prevalence, incidence, and mortality rates: a nationwide population study in taiwan

There are few nationwide population studies on the epidemiology of rheumatoid arthritis (RA). Here, we present the epidemiologic features and mortality rates of RA in Taiwan. The catastrophic illness registry of the Taiwan National Health Insurance Research Database and the National Death Registry of Taiwan were used to estimate the incidence and prevalence of RA and its associated mortality rates. All-cause and cause-specific standardized mortality ratios (SMRs) were calculated and compared to the corresponding ratios of the general population in 2002. The study comprised 15,967 incident RA cases (3,562 men; 12,405 women) occurring from 2002 through 2007. The annual incidence of RA was 15.8 cases (men, 10.1; women, 41.0) per 100,000 population. The period prevalence was 97.5 cases (men, 37.4; women, 159.5) per 100,000 population. During 67,010 person-years of follow-up, 985 deaths (372 men; 613 women) were identified, and this corresponded to a crude mortality rate of 14.7 deaths (men, 25.0; women, 11.8) per 1,000 person-years. Compared to female patients, male patients had a higher risk for mortality (log-rank test, p < 0.001). RA patients had an SMR of 1.25 (95 % confidence interval [CI], 1.18-1.33) for all-cause mortality. Compared to the general population, RA patients of both genders in this cohort had a significantly higher risk of mortality from infection (SMR, 2.49) and gastrointestinal diseases (SMR, 1.76). RA incidence and prevalence were higher in women than in men. Mortality was higher in men than in women. Compared to the general population, RA patients had a higher risk of death, particularly from infection and gastrointestinal diseases. [ABSTRACT FROM AUTHOR]

October 27, 2012 Tags: CONFIDENCE intervals, DISEASE prevalence, MORTALITY -- Statistics, RHEUMATOID arthritis
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Higher complication risk of totally implantable venous access port systems in patients with advanced cancer – a single institution retrospective analysis

The article reports a study which was conducted to assess the risk of totally implantable port system failure in patients with advanced cancer. The results indicate that receiving palliative care immediately after implantation was substantially associated with premature port removal due to infection and/or occlusion. Further research should be conducted to compare outcomes of various central venous access devices in patients with advanced cancer.

October 25, 2012 Tags: BLOOD-vessels, CANCER -- Patients -- Medical care, CANCER -- Treatment, CATHETER-related infections, CATHETERS, CENTRAL venous catheterization, CONFIDENCE intervals, MEDICAL device reliability, MEDICAL device removalRISK factorsSAFETY measures, MEDICAL instruments & apparatus, PROPORTIONAL hazards models, RETROSPECTIVE studies, SPECIALTY hospitals
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Mental health of african americans and caribbean blacks in the united states: results from the national epidemiological survey on alcohol and related conditions

Objectives. Previous epidemiological studies have found lower mood, anxiety, and substance use disorder prevalence in Black Americans, in general, compared with White Americans. We estimated the prevalence and persistence of psychiatric disorders in African Americans, Caribbean Blacks, and non-Hispanic Whites. Methods. We drew data from wave 1 (2001-2002) of the National Epidemiological Survey of Alcohol and Related Conditions, a nationally representative sample of US adults, which included 7529 African Americans, 469 Caribbean Blacks, and 24 502 non-Hispanic Whites. Results. Blacks had equal or lower prevalence than Whites of lifetime (adjusted odds ratio [AOR] = 0.6 for African Americans; 0.3 for Caribbean Blacks) and 12-month (AOR = 0.7 for African Americans; 0.4 for Caribbean Blacks) Axis I psychiatric disorders, but higher prevalence of several personality disorders. Among Blacks, Caribbean Blacks had higher prevalence of 12-month psychotic disorders and lower lifetime prevalence of major depressive disorder, alcohol dependence, and drug abuse than African Americans. There were no differences in persistence of disorders between Caribbean Blacks and African Americans. Conclusions. This study yielded new data on prevalence of mental disorders in these groups, which has important implications for clinical work with US Blacks. [ABSTRACT FROM AUTHOR]

October 24, 2012 Tags: BIRTHPLACES, BLACKS -- United States, COMPARATIVE studies, CONFIDENCE intervals, CORRELATION (Statistics), CROSS-sectional method, DATA analysis, DESCRIPTIVE statistics, DISEASE duration, DISEASE prevalence, EPIDEMIOLOGY, LOGISTIC regression analysis, MENTAL depression, PERSONALITY disorders, PSYCHIATRIC epidemiology, PSYCHOSES, RESEARCH -- Finance, SECONDARY analysis, SUBSTANCE abuse, WHITES
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Congruence between preferred and actual place of care and death among danish cancer patients

The article discusses the agreement between place of care (POC) and place of death (POD) among Danish cancer patients. According to the authors, in palliative care, it is important to meet patient’s preference especially regarding POC and POD. Results of the study showed that terminally ill patients preferred home care and a home death with their partners beside them, and regular discussion with patients and large scaled studies are needed to focus how to meet their preferences.

October 23, 2012 Tags: CANCER -- Patients -- Psychology, CAREGIVERS, CHI-squared test, CONFIDENCE intervals, DATA analysis -- Software, DEATH, DECISION making, HEALTH facilities, HOME environment, INTERVIEWING, LONGITUDINAL method, MEDICAL protocols, PALLIATIVE treatment, PATIENTS, QUESTIONNAIRES, RESEARCH -- Finance, STATISTICS, T-test (Statistics), U-statistics
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Awareness of incurable cancer status and health-related quality of life among advanced cancer patients: a prospective cohort study

The article discusses a cohort study that examines the effect of advanced cancer patients awareness of disease status on the health-related quality of life (HRQOL). It also examines factors associated with awareness of disease status and monitored changes in quality of life (QOL) during palliative chemotherapy. The results reveal that patients aware of their condition showed overall improvement in HRQOL but showed no association between response to chemotherapy and change in HRQOL.

October 23, 2012 Tags: ANALYSIS of covariance, CANCER -- Chemotherapy, CANCER -- Patients -- Psychology, CONFIDENCE intervals, DATA analysis, DATA analysis -- Software, EPIDEMIOLOGY, LONGITUDINAL method, PALLIATIVE treatment, QUALITY of life, QUESTIONNAIRES, REPEATED measures design, SCALES (Weighing instruments), T-test (Statistics), TERMINALLY ill -- Psychology
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Effects of socioeconomic status and health care access on low levels of human papillomavirus vaccination among spanish-speaking hispanics in california

Little is known about the effect of language preference, socioeconomic status, and health care access on human papillomavirus (HPV) vaccination. We examined these factors in Hispanic parents of daughters aged 11 to 17 years in California (n = 1090). Spanish-speaking parents were less likely to have their daughters vaccinated than were English speakers (odds ratio [OR] = 0.55; 95% confidence interval [CI] = 0.31, 0.98). Adding income and access to multivariate analyses made language nonsignificant (OR = 0.68; 95% CI = 0.35, 1.29). This confirms that health care use is associated with language via income and access. Low-income Hispanics, who lack access, need information about free HPV vaccination programs. [ABSTRACT FROM AUTHOR]

October 21, 2012 Tags: ACCESS to information, COMMUNICATION barriers, CONFIDENCE intervals, DATA analysis, DESCRIPTIVE statisticsTHERAPEUTIC use, EPIDEMIOLOGY, HEALTH services accessibility, HISPANIC Americans, MULTIVARIATE analysis, PAPILLOMAVIRUS vaccines, RESEARCH -- Finance, SECONDARY analysis, SOCIOECONOMIC factors, SURVEYS
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Directly observed antidepressant medication treatment and hiv outcomes among homeless and marginally housed hiv-positive adults: a randomized controlled trial

Objectives. We assessed whether directly observed fluoxetine treatment reduced depression symptom severity and improved HIV outcomes among homeless and marginally housed HIV-positive adults in San Francisco, California, from 2002 to 2008. Methods. We conducted a nonblinded, randomized controlled trial of once-weekly fluoxetine, directly observed for 24 weeks, then self-administered for 12 weeks (n = 137 persons with major or minor depressive disorder or dysthymia). Hamilton Depression Rating Scale score was the primary outcome. Response was a 50% reduction from baseline and remission a score below 8. Secondary measures were Beck Depression Inventory-II (BDI-II) score, antiretroviral uptake, antiretroviral adherence (measured by unannounced pill count), and HIV-1 RNA viral suppression (< 50 copies/mL). Results. The intervention reduced depression symptom severity (b = -1.97; 95% confidence interval [CI] = -0.85, -3.08; P < .001) and increased response (adjusted odds ratio [AOR] = 2.40; 95% CI = 1.86, 3.10; P < .001) and remission (AOR = 2.97; 95% CI = 1.29, 3.87; P < .001). BDI-II results were similar. We observed no statistically significant differences in secondary HIV outcomes. Conclusions. Directly observed fluoxetine may be an effective depression treatment strategy for HIV-positive homeless and marginally housed adults, a vulnerable population with multiple barriers to adherence. [ABSTRACT FROM AUTHOR]

October 21, 2012 Tags: ANTIDEPRESSANTS, ANTIRETROVIRAL agents, CHI-squared test, CONFIDENCE intervals, DATA analysis, DESCRIPTIVE statisticsTHERAPEUTIC use, DISEASE remission, DRUGS, EPIDEMIOLOGY, FLUOXETINE, HAMILTON Depression Inventory, HIV-positive persons, HOMELESS persons, MENTAL depression -- Chemotherapy, OBSERVATION (Scientific method), OUTCOME assessment (Medical care), PATIENT compliance, PSYCHOLOGICAL tests, RANDOMIZED controlled trials, RESEARCH -- Finance, SAMPLING (Statistics), SCALES (Weighing instruments), T-test (Statistics), TREATMENT effectiveness
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Patterns of osteoporosis treatment change and treatment discontinuation among commercial and medicare advantage prescription drug members in a national health plan

Rationale, aims and objectives Multiple treatments are available for osteoporosis; however, little is known about treatment change patterns and associated factors. Osteoporosis treatment change patterns, discontinuation and factors associated with treatment change in members of a large national health plan were examined. Methods A retrospective cohort study was conducted in 7315 commercial and 34 146 Medicare Advantage Prescription Drug (MAPD) members newly initiated on an osteoporosis medication between 2006 and 2008. Osteoporosis treatment change, discontinuation and re-initiation patterns were assessed. Multivariate logistic regression was used to examine factors associated with treatment change. Commercial and MAPD members were assessed separately because of differences in demographics and insurance benefits. Results Approximately 12% of members had a change in index therapy within 12 months. Almost 60% of members discontinued the index medication at least once, based on a 90-day refill gap. Over 40% of members discontinued all osteoporosis medications by the end of 12 months post-index. Among MAPD and commercial members, women and those with risedronate, ibandronate or calcitonin at index, index therapy in 2008 and an osteoporosis diagnosis were more likely to have a treatment change while members with health plans other than health maintenance organizations and generic alendronate at index were less likely to have a treatment change. Conclusions Osteoporosis treatment change occurred in approximately 12% of members, while a greater proportion of members discontinued treatment completely within 12 months. Member characteristics may be used to predict therapy change for evaluation and quality initiatives within a health plan. [ABSTRACT FROM AUTHOR]

October 17, 2012 Tags: CHI-squared test, CONFIDENCE intervals, DATA analysis, DESCRIPTIVE statisticsTHERAPEUTIC use, DIPHOSPHONATES, DRUG utilization, EPIDEMIOLOGY, FISHER exact test, LOGISTIC regression analysis, LONGITUDINAL method, MEDICAL care -- Utilization, MEDICARE, MEDICINE -- Formulae, NATIONAL health services, OSTEOPOROSIS, prescriptions, receipts, RESEARCH -- Finance, RETROSPECTIVE studies, STATISTICS, T-test (Statistics)
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Menopost – calcium and vitamin d supplementation in postmenopausal osteoporosis treatment: a descriptive cohort study

Summary: Adequate vitamin D/calcium supplementation during osteoporosis (OP) treatments seems insufficient. This cohort study within a national claims database evaluated calcium/vitamin D co-prescription in postmenopausal women initiating an OP treatment. A high co-prescription rate was observed with three quarters of women supplemented with calcium and/or vitamin D in agreement with current recommendations. Introduction: Adequate calcium/vitamin D supplementation should be taken in combination with antiresorptive drugs in OP treatment. Despite guidelines, supplementation appears to be insufficient. The objective of this study was to describe and estimate co-prescription rates of calcium/vitamin D among postmenopausal women initiating an OP treatment. Methods: All women over 50 years with a first claim for a bisphosphonates, raloxifene, or strontium prescription filled between May and August 2010 were included in a retrospective cohort study. Data source was the health insurance claims database of the Rhône-Alpes area. Results: Among 4,415 women, 77.0 % had co-prescription of calcium or vitamin D with initial OP treatment, of which 2,150 (49.7 %) had both calcium and vitamin D. The proportion of women with calcium and/or vitamin D (81.7 %) was significantly higher when OP treatment was a bisphosphonate compared to strontium (70.9 %) or raloxifene (67.0 %) ( p < 0.05). Among women prescribed both calcium and vitamin D, 7.6 % received a bisphosphonate and vitamin D ± calcium fixed-combination pack. General practitioners prescribed two thirds of initial supplementation treatment (66.9 %). Patients were twice as likely to be prescribed supplementation when the prescriber was a rheumatologist (OR = 2; 95 % CI = 1.57-2.54). Conclusion: Three quarters of women initiating OP treatment were supplemented with calcium and/or vitamin D in agreement with current recommendations. This represents a high co-prescription rate. [ABSTRACT FROM AUTHOR]

October 17, 2012 Tags: ACADEMIC medical centers, CALCIUM, CHI-squared test, CONFIDENCE intervals, DATA analysis, DATA analysis -- Software, DESCRIPTIVE statisticsTHERAPEUTIC use, DIPHOSPHONATES, EPIDEMIOLOGY, LOGISTIC regression analysis, MULTIVARIATE analysis, OSTEOPOROSIS -- Prevention, OUTCOME assessment (Medical care), POSTMENOPAUSE, RETROSPECTIVE studies, TREATMENT effectiveness, VITAMIN D -- Therapeutic use, X-ray densitometry in medicine
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How doctors practice evidence-based medicine

Rationale and aims Evidence-based medicine (EBM) has gained worldwide attention. Many studies have used questionnaires to discuss factors obstructing the practice of EBM. However, no large-scale data analysis has focused on who has practised EBM and when they practised it. This retrospective study aims to fill the research gap by applying nationally representative data to analyse EBM practice after the provision of new evidence regarding the prescription of rosiglitazone which has been shown to increase the risk of myocardial infarction. Methods We used the National Health Insurance Database in Taiwan to analyse the variations in rosiglitazone prescription among physicians. The study period was from the second quarter of 2007 to the fourth quarter of 2008. A total of 2536 physicians who prescribed rosiglitazone at least once were included in this study. We applied multivariate logistic analyses to predict the probability of physicians ceasing to prescribe rosiglitazone. Results We observed a significant improvement in EBM practice among specialists and experienced physicians. Endocrinologists were four times more likely to change rosiglitazone prescription habits than other specialists (odds ratio 4.129, 95% confidence interval 2.484-6.863). Doctors with more than 10 years of specialist experience performed better in EBM practice. Moreover, a prominent time lag with more than 6 months between EBM emergence and EBM practice was noticed. Conclusions Our study suggested that EBM was still not well practised, using rosiglitazone prescription as a study case. Further education and encouragement to strengthen physicians’ EBM practice remain urgently needed within the medical community. [ABSTRACT FROM AUTHOR]

October 16, 2012 Tags: CHI-squared test, CONFIDENCE intervals, DATA analysis, DESCRIPTIVE statisticsTHERAPEUTIC use, DIABETES, DRUGS -- Prescribing, EPIDEMIOLOGY, EVIDENCE-based medicine, LOGISTIC regression analysis, MEDICINE -- Specialties & specialists, MULTIVARIATE analysis, PHYSICIAN practice patterns, PHYSICIANS, RESEARCH -- Finance, RETROSPECTIVE studies, ROSIGLITAZONE
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