Does clinical method mask significant VTE-related mortality and morbidity in malignant disease?
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ABSTRACT:
SUBMITTER: Maraveyas A
PROVIDER: S-EPMC2714244 | biostudies-other | 2009 Jun
REPOSITORIES: biostudies-other
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Project description:For end-stage liver disease (ESLD) patients, care focuses on managing the life-threatening complications of portal hypertension, causing high resource utilization.To describe the end-of-life trajectory of hospitalized ESLD patients in Medicare.Using a 5% random sample of Medicare fee-for-service beneficiaries, we performed a retrospective cohort study, identifying hospitalized ESLD and heart failure (HF) patients (2007-2011). Index hospitalization end points included mortality, discharge to hospice, and length of stay. Postdischarge end points included all-cause mortality, rehospitalization, hospice enrollment, and days alive and out of hospital (DAOH). Follow-up was at one and three years after index hospitalization discharge. A reference cohort of decompensated HF patients was used for baseline comparison.At one year, the ESLD cohort (n = 22,311) had 209 DAOH; decompensated HF (n = 85,397) had 252 DAOH. Among ESLD patients, inpatient mortality was 13.5%; all-cause mortality was 64.9%. For these outcomes, rates were higher in those with ESLD than HF. In the ESLD group, rehospitalization rate was 59.1% (slightly lower than the HF group), hospice enrollment rate was 36.1%, and there were higher than expected cancer rates. For hospice-enrolled patients, the median length of time spent in hospice was nine days. The HF cohort had lower hospice enrollment, but more days enrolled.The results of this study show that morbidity and mortality rates associated with end of life in ESLD are substantial. There is an acute need for alternative approaches to manage the care of ESLD patients.
| S-EPMC5144155 | biostudies-literature
Project description:ICA-treatment following allogeneic bone marrow transplant in mice limited GvHD pathology and GVHD mortality, augmented the integrity of the intestinal mucosal barrier, and limited production of inflammatory cytokines, but did not compromise donor T cell-mediated Graft vs. Leukemia (GvL) responses. Following protracted exposure, ICA treatment also induced donor-strain-specific tolerance of engrafted T cells. We used microarray to assess gene expression changes induced by ICA in the small intestine in animals with GvHD.
2018-03-08 | GSE111512 | GEO
Project description:While polygenic risk scores (PRS) have been shown to predict many diseases and risk factors, the potential of genomic prediction in harm caused by alcohol use has not yet been extensively studied. Here, we built a novel polygenic risk score of 1.1 million variants for alcohol consumption and studied its predictive capacity in 96,499 participants from the FinnGen study and 39,695 participants from prospective cohorts with detailed baseline data and up to 25 years of follow-up time. A 1?SD increase in the PRS was associated with 11.2?g (=0.93 drinks) higher weekly alcohol consumption (CI?=?9.85-12.58?g, p?=?2.3?×?10-58). The PRS was associated with alcohol-related morbidity (4785 incident events) and the risk estimate between the highest and lowest quintiles of the PRS was 1.83 (95% CI?=?1.66-2.01, p?=?1.6?×?10-36). When adjusted for self-reported alcohol consumption, education, marital status, and gamma-glutamyl transferase blood levels in 28,639 participants with comprehensive baseline data from prospective cohorts, the risk estimate between the highest and lowest quintiles of the PRS was 1.58 (CI?=?1.26-1.99, p?=?8.2?×?10-5). The PRS was also associated with all-cause mortality with a risk estimate of 1.33 between the highest and lowest quintiles (CI?=?1.20-1.47, p?=?4.5?×?10-8) in the adjusted model. In conclusion, the PRS for alcohol consumption independently associates for both alcohol-related morbidity and all-cause mortality. Together, these findings underline the importance of heritable factors in alcohol-related health burden while highlighting how measured genetic risk for an important behavioral risk factor can be used to predict related health outcomes.
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Project description:BackgroundHepatitis C virus (HCV) is a leading cause of chronic liver disease, end-stage cirrhosis, and liver cancer, but little is known about the burden of disease caused by the virus. We summarised burden of disease data presently available for Europe, compared the data to current expert estimates, and identified areas in which better data are needed.MethodsLiterature and international health databases were systematically searched for HCV-specific burden of disease data, including incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and liver transplantation. Data were collected for the WHO European region with emphasis on 22 countries. If HCV-specific data were unavailable, these were calculated via HCV-attributable fractions.ResultsHCV-specific burden of disease data for Europe are scarce. Incidence data provided by national surveillance are not fully comparable and need to be standardised. HCV prevalence data are often inconclusive. According to available data, an estimated 7.3-8.8 million people (1.1-1.3%) are infected in our 22 focus countries. HCV-specific mortality, DALY, and transplantation data are unavailable. Estimations via HCV-attributable fractions indicate that HCV caused more than 86000 deaths and 1.2 million DALYs in the WHO European region in 2002. Most of the DALYs (95%) were accumulated by patients in preventable disease stages. About one-quarter of the liver transplants performed in 25 European countries in 2004 were attributable to HCV.ConclusionOur results indicate that hepatitis C is a major health problem and highlight the importance of timely antiviral treatment. However, data on the burden of disease of hepatitis C in Europe are scarce, outdated or inconclusive, which indicates that hepatitis C is still a neglected disease in many countries. What is needed are public awareness, co-ordinated action plans, and better data. European physicians should be aware that many infections are still undetected, provide timely testing and antiviral treatment, and avoid iatrogenic transmission.
| S-EPMC2656539 | biostudies-literature
Project description:Background:The role of splenectomy to diagnose and treat hematologic disease continues to evolve. In this single-center retrospective review, we describe modern morbidity, mortality, and long-term outcomes associated with splenectomy for benign and malignant hematologic disorders. Methods:We analyzed all nontrauma splenectomies performed for benign or malignant hematologic disorders from January 2009 to September 2018. Variables collected included demographics, preexisting comorbidities, laboratory results, intra- and postoperative features, and long-term follow-up. Outcomes of interest included postoperative complications, 30-day mortality, and overall mortality. Results:We identified 161 patients who underwent splenectomy for hematologic disorders. Median age was 54?years (range 19-94), and 83 (52%) were female. Splenectomy was performed for 95 (59%) patients with benign hematologic disorders and for 66 (41%) with malignant conditions. Most splenectomies were laparoscopic (76%), followed by laparoscopic hand assisted (11%), open (8%), and laparoscopic converted to open (6%). Median follow-up was 761?days (interquartile range: 179-2025?days). Major complications occurred in 21 (13%) patients. Three (2%) patients died within 30?days; 16 (9%) died more than 30?days after operation, none from surgical complications, with median time to death of 438?days (interquartile range: 231-1497?days). Among malignant cases, only preoperative thrombocytopenia predicted death (odds ratio?=?5.8, 95% confidence interval?=?1.1-31.8, P?=?.04). For benign cases, increasing age was associated with inferior survival (odds ratio?=?2.3, 95% confidence interval?=?1.0-5.1, P?=?.05). Conclusion:Splenectomy remains an important diagnostic and therapeutic option for patients with benign and malignant hematologic disorders and can be performed with a low complication rate. Despite considerable burden of comorbid disease in these patients, early postoperative mortality was uncommon.
| S-EPMC7479208 | biostudies-literature
Project description:This study applied a text string search algorithm to ascertain suspect farm tractor or agricultural machinery-related injuries in data sources available for 2000-2014 in the state of Arkansas. The occurrences of tractor or other agricultural machinery-related injuries were compared with data available from the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) and the Bureau of Labor Statistics' Census of Fatal Occupational Injuries (CFOI). For death certificates that assigned an external cause of death, the authors first collected all those that were coded as related to agricultural machinery, based on search strings for occupation and industry and a description of how the injury occurred. They then inspected each case individually and removed those that were likely unrelated to agricultural machinery. This approach significantly increased (by 7.8 times) the number of suspect agricultural machinery-related fatalities compared to the number reported to CFOI, but there was only a 17% (not statistically significant) increase compared to NCHS. All hospital records with any discharge diagnosis coded as related to agricultural machinery were selected. Descriptive analysis of the fatalities and hospital records showed a significantly increased risk among men above retirement age, peaks during the summer, and an increased risk in the Mississippi delta region. About one-third of the agricultural machinery-related fatalities were due to overturns. The use of the algorithm can improve ascertainment of fatal agricultural machinery-related injuries in Arkansas. The death records were found to be rich in data on the circumstances of the injuries, which can be used to screen for tractor-related fatalities and, if confirmed, translated into action to improve the safety of Arkansas farmers.
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Project description:16S sequencing data from skin microbiota samples derived from female volunteers
| PRJEB45035 | ENA
Project description:BackgroundClimate change is expected to cause increases in heat-related mortality, especially among the elderly and very young. However, additional studies are needed to clarify the effects of heat on morbidity across all age groups and across a wider range of temperatures.ObjectivesWe aimed to estimate the impact of current and projected future temperatures on morbidity and mortality in Rhode Island.MethodsWe used Poisson regression models to estimate the association between daily maximum temperature and rates of all-cause and heat-related emergency department (ED) admissions and all-cause mortality. We then used downscaled Coupled Model Intercomparison Project Phase 5 (CMIP5; a standardized set of climate change model simulations) projections to estimate the excess morbidity and mortality that would be observed if this population were exposed to the temperatures projected for 2046-2053 and 2092-2099 under two representative concentration pathways (RCP): RCP 8.5 and 4.5.ResultsBetween 2005 and 2012, an increase in maximum daily temperature from 75 to 85°F was associated with 1.3% and 23.9% higher rates of all-cause and heat-related ED visits, respectively. The corresponding effect estimate for all-cause mortality from 1999 through 2011 was 4.0%. The association with all-cause ED admissions was strongest for those < 18 or ≥ 65 years of age, whereas the association with heat-related ED admissions was most pronounced among 18- to 64-year-olds. If this Rhode Island population were exposed to temperatures projected under RCP 8.5 for 2092-2099, we estimate that there would be 1.2% (range, 0.6-1.6%) and 24.4% (range, 6.9-41.8%) more all-cause and heat-related ED admissions, respectively, and 1.6% (range, 0.8-2.1%) more deaths annually between April and October.ConclusionsWith all other factors held constant, our findings suggest that the current population of Rhode Island would experience substantially higher morbidity and mortality if maximum daily temperatures increase further as projected.CitationKingsley SL, Eliot MN, Gold J, Vanderslice RR, Wellenius GA. 2016. Current and projected heat-related morbidity and mortality in Rhode Island. Environ Health Perspect 124:460-467; http://dx.doi.org/10.1289/ehp.1408826.
| S-EPMC4829994 | biostudies-literature
Project description:ObjectivesAlcohol-related morbidity and mortality are significant public health issues. The purpose of this study was to describe the prevalence and trends over time of alcohol consumption and alcohol-related morbidity and mortality; and public attitudes of alcohol use impacts on families and the community in Ottawa, Canada.MethodsPrevalence (2013-2014) and trends (2000-2001 to 2013-2014) of alcohol use were obtained from the Canadian Community Health Survey. Data on paramedic responses (2015), emergency department (ED) visits (2013-2015), hospitalizations (2013-2015) and deaths (2007-2011) were used to quantify the acute and chronic health effects of alcohol in Ottawa. Qualitative data were obtained from the "Have Your Say" alcohol survey, an online survey of public attitudes on alcohol conducted in 2016.ResultsIn 2013-2014, an estimated 595,300 (83%) Ottawa adults 19 years and older drank alcohol, 42% reported binge drinking in the past year. Heavy drinking increased from 15% in 2000-2001 to 20% in 2013-2014. In 2015, the Ottawa Paramedic Service responded to 2,060 calls directly attributable to alcohol. Between 2013 and 2015, there were an average of 6,100 ED visits and 1,270 hospitalizations per year due to alcohol. Annually, alcohol use results in at least 140 deaths in Ottawa. Men have higher rates of alcohol-attributable paramedic responses, ED visits, hospitalizations and deaths than women, and young adults have higher rates of alcohol-attributable paramedic responses. Qualitative data of public attitudes indicate that alcohol misuse has greater repercussions not only on those who drink, but also on the family and community.ConclusionsResults highlight the need for healthy public policy intended to encourage a culture of drinking in moderation in Ottawa to support lower risk alcohol use, particularly among men and young adults.
| S-EPMC5619783 | biostudies-literature
Project description: Not available
| S-EPMC7753771 | biostudies-literature