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1.
Cereb Cortex ; 34(2)2024 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-38265870

RESUMO

In this study, a multiobjective model was devoted to the objectives of minimizing blood supply chain costs and minimizing the waiting time of blood donors for blood transfusion and minimizing blood transfusion schedule and increasing the efficiency of fixed and mobile centers in collecting blood. One of the most important constraints considered in the mathematical model is the capacity constraints of considering fixed and mobile blood facilities and management of the transfer of blood products to centers for collecting and distinguishing healthy and unhealthy blood. A multiobjective model was considered with the objectives of minimizing blood supply chain costs, the waiting time of blood donors for blood transfusion, and blood transfusion timing and increasing the efficiency of fixed and mobile centers in blood collection. The model findings were analyzed in order to validate the model on a larger scale, using the meta-innovative algorithm NSGAII and MOSPO. According to the research findings, we suggest that fuzzy uncertainty and fair distribution problem shouldn't be added to the dimensions of the main problem, and further analysis should be done in this area. It was shown that the NSGAII algorithm's performance was better than the MOPSO meta-heuristic algorithm.


Assuntos
Algoritmos , Modelos Teóricos , Incerteza
2.
J Pak Med Assoc ; 72(6): 1208-1210, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35751338

RESUMO

A retrospective review was conducted In Aga Khan University from January 2013-December 2020 for patients who received Total Skin Electron Beam Therapy (TSEBT) on the management of Mycosis Fungoides (MF). The clinical response rate and disease-free interval (DFI) was evaluated for three patients. All of the patients received a 3600 cGy dose of radiation. Clinical complete remission (cCR) was observed in two out of three patients, while one patient showed clinical partial response. Following the cCR to TSEBT, the DFI of the first patient with stage 1B lasted 30 months, while the second patient with stage IIB remained disease free for five months. TSEBT is an effective treatment for MF disease. It can thus be expected that patients with limited disease in the early stage can acquire a cCR with a longer DFI. The clinical outcomes of our study show concordance with the literature. The patients who had extensive (T3) skin involvement and had refractory diseases showed lower DFI with radiation.


Assuntos
Micose Fungoide , Neoplasias Cutâneas , Elétrons , Humanos , Micose Fungoide/tratamento farmacológico , Micose Fungoide/radioterapia , Estudos Retrospectivos , Neoplasias Cutâneas/radioterapia , Resultado do Tratamento
3.
J Pak Med Assoc ; 72(9): 1865-1867, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36280995

RESUMO

We report a case of a middle age male who presented to our tertiary care university hospital with the complaints of nasal obstruction and decrease hearing. The CT scan of head and neck exhibited a mass in nasopharynx and enlarged bilateral cervical lymph nodes. Biopsy from nasopharynx confirmed the lesion as poorly differentiated non-keratinizing squamous cell carcinoma and staged as cT2N2M0. He received neoadjuvant chemotherapy. Subsequently, he underwent chemo radiation therapy. He represented with left chest wall pain. Imaging confirmed isolated lesion on left sided 6th rib. Rib lesion was resected followed by radiation therapy to surgical bed and systemic treatment. The patient remained disease free for 4.5 years. Later, his disease relapsed, and he died of systemic disease progression. To the best of the author's knowledge, only few cases have been reported with isolated rib metastasis from nasopharyngeal carcinoma and this is the first case in which metastasectomy was considered.


Assuntos
Metastasectomia , Neoplasias Nasofaríngeas , Pessoa de Meia-Idade , Masculino , Humanos , Carcinoma Nasofaríngeo , Pescoço , Neoplasias Nasofaríngeas/diagnóstico por imagem , Neoplasias Nasofaríngeas/terapia , Neoplasias Nasofaríngeas/patologia , Costelas/diagnóstico por imagem , Costelas/patologia
4.
Mo Med ; 114(1): 44-46, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-30233100

RESUMO

Back pain is extraordinarily common, and the current approach to treatment has yielded enormous financial burdens on health care systems and society in general. In addition, primary care providers and patients alike are often unsure where to seek further care, and what, if any, advanced tests or images are needed. As a result, spine surgeons often see a high percentage of non-operative patients when unnecessary, redundant, or incorrect imaging was obtained. At MU Health Care a team of physiatrists, orthopedic surgeons, neurosurgeons sought to address these issues by forming the MU Comprehensive Spine Center that offers a systematic, collaborative approach to spine care.

5.
Birth Defects Res A Clin Mol Teratol ; 106(10): 831-839, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27511615

RESUMO

BACKGROUND: The main objective of the current study is to examine the trend of congenital abnormalities among children born by women with and without diabetes, and to explore the impact of food fortification by folic acid on the rate of birth defects among these two groups of mothers. METHODS: All children born alive in Ontario, Canada, during 1994 to 2009 and their mothers were included in study. Diagnosis of pregestational diabetes among mothers was identified using Diabetes registry, and diagnosis of birth defects among children were identified using hospital records. RESULTS: The prevalence of births among diabetic mothers increased by almost 200% during the study period. Among children born to mothers with diabetes, the prevalence for all anomalies combined was approximately 47% higher and for various cardiac and central nervous system anomalies up to a three- to fivefold higher than those born to nondiabetic mothers. While the rate of birth defects in both groups observed a considerable decline after food fortification in 1999, but the gap between two groups remained unchanged over time. CONCLUSION: While the prevalence of birth defects among diabetic pregnancies is still considerably higher that nondiabetic pregnancies, results of the current study indicate a declining trend in the prevalence of some congenital abnormalities among babies born to both diabetic and nondiabetic mothers after 1999. We need to be more aggressive in implementing preventive measures, including a national diabetes plan or the proposed universal policy of supra-dietary folic acid supplementation for women with diabetes who are of reproductive age. Birth Defects Research (Part A) 106:831-839, 2016. © 2016 Wiley Periodicals, Inc.


Assuntos
Anormalidades Congênitas/epidemiologia , Diabetes Gestacional/epidemiologia , Adulto , Anormalidades Congênitas/prevenção & controle , Diabetes Gestacional/prevenção & controle , Feminino , Seguimentos , Alimentos Fortificados , Humanos , Recém-Nascido , Masculino , Ontário/epidemiologia , Gravidez , Prevalência
6.
Cancer ; 121(24): 4389-97, 2015 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-26406998

RESUMO

BACKGROUND: Survivors of childhood cancer are at considerable risk of experiencing treatment-related adverse health outcomes. To provide survivors with specialized care focused on these risks during adulthood, the government of Ontario funded a provincial network of specialized survivor clinics in 1999. The aim of this study was to determine whether prior attendance at survivor clinics by adult survivors of childhood cancer was associated with rates of emergency department (ED) visits. METHODS: This was a population-based, retrospective cohort study using multiple linked administrative health databases. The cohort consisted of all adult survivors of childhood cancer diagnosed between January 1, 1986 and December 31, 2005 in Ontario, Canada. A recurrent event regression model was used to evaluate the association between prior attendance at survivor clinics and the rate of ED visits; adjustments were made for individual, demographic, treatment, and provider characteristics. RESULTS: The study consisted of 3912 adult survivors of childhood cancer. Individuals who had at least 1 prior visit to a survivor clinic had a 19% decreased rate of ED visits in comparison with individuals who had not visited a survivor clinic (adjusted relative rate, 0.81; 95% confidence interval, 0.78-0.85). Each additional prior visit to a survivor clinic was associated with a 5% decrease in the rate of ED visits (adjusted relative rate, 0.95; 95% confidence interval, 0.93-0.96). These results were independent of whether or not survivors received care from a primary care physician. CONCLUSIONS: Attendance at a specialized survivor clinic was significantly associated with decreased ED visits among adult survivors of childhood cancer.


Assuntos
Assistência Ambulatorial/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Neoplasias/terapia , Sobreviventes/estatística & dados numéricos , Adulto , Assistência Ambulatorial/métodos , Criança , Estudos de Coortes , Feminino , Humanos , Armazenamento e Recuperação da Informação , Masculino , Análise Multivariada , Ontário , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco
7.
Pediatr Blood Cancer ; 60(3): 438-45, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23015413

RESUMO

BACKGROUND: Families of children with cancer are confronted with a broad range of direct costs (out-of-pocket expenses), but the nature of these costs is poorly understood. This study aimed to disaggregate and describe these costs. PROCEDURE: A prospective, mixed method, cost-of-illness design was utilized. Starting in the fourth week following their child's diagnosis, parents recorded resources consumed, and costs incurred for 1 week per month for 3 consecutive months. Any additional costs not captured in this typical 1 week period were added for the remainder of the month. Parents also discussed their costs in an audio-taped interview at the end of the 3 months. Descriptive statistics and qualitative content analyses were performed to disaggregate and describe families' costs. RESULTS: In total, 99 families reported utilizing 16 cost categories and 74 cost items. Nearly three quarters of these costs were attributed to travel (56%) and food (18%). Costly items included acquisition of a car ($CAD35,000), relocation of a family ($CAD6,000), and purchase of a wheelchair ($CAD6,800). Parents described facing significant out-of-pocket expenses to ensure that their children had access to cancer treatment, to cope with the clinical treatment side effects of treatment, and to maintain the family household. CONCLUSION: Families of children with cancer experience a wide range of costs. Our understanding of the nature of their costs and resource use may formulate the basis for future cost assessments and provide insight into practice and policy changes aimed at lessening the economic impact of this burden.


Assuntos
Efeitos Psicossociais da Doença , Família , Gastos em Saúde/estatística & dados numéricos , Neoplasias/economia , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Adulto Jovem
8.
Cureus ; 15(10): e46320, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37916243

RESUMO

The impact of community-acquired bacteremia on the prognosis of children with COVID-19 is an area of ongoing research. Pediatric data on this aspect is limited. Here, we report the case of a four-month-old male infant who presented to King Abdulaziz University Hospital in January 2022 with a co-infection of COVID-19 and Salmonella meningitis, and sepsis complicated by a brain abscess.

9.
Intractable Rare Dis Res ; 12(2): 122-125, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37287656

RESUMO

Myasthenia gravis (MG) is a rare autoimmune disease that affects the neuromuscular junction. It is characterized by the production of heterogeneous autoantibodies that bind to the neuromuscular junction and alter neural transmission. Recently, more attention was given to MG-related antibodies and their clinical influence. In Lebanon, studies about MG are very rare. To date, there is still no research on the different autoantibodies developed by Lebanese MG patients. We conducted a study aimed at detecting the prevalence of different antibodies in a group of seventeen Lebanese patients with MG, and exploring their associations with clinical phenotypes and quality of life (QOL). MG antibody test in Lebanon is restricted only to two antibodies: acetylcholine receptor (anti-AChR) and muscle-specific kinase (anti-MUSK) antibodies. Results showed that 70.6% of patients were anti-AChR positive and all of them were anti-MUSK negative. Association between MG serological profiles, clinical outcomes and QOL was not significant. Together, current findings suggest that anti-MUSK antibody is not common and difference in antibody profile may not change the clinical phenotypes and QOL of MG Lebanese patients. In the future, it is recommended to check also for autoantibodies other than anti-AChR and anti-MUSK, which may reveal new antibody profiles and possible associations with clinical outcomes.

10.
Psychooncology ; 21(10): 1113-23, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21774033

RESUMO

OBJECTIVES: A diagnosis of cancer in childhood places a considerable economic burden on families, although costs are not well described. The objectives of this study were to identify and determine independent predictors of the direct and time costs incurred by such families. METHODS: A prospective, cost-of-illness study was conducted in families of children newly diagnosed with cancer. Parents recorded the resources consumed and costs incurred during 1 week per month for three consecutive months beginning the fourth week following diagnosis and listed any additional costs incurred since then. Descriptive and multiple regression analyses were performed to describe families' costs (expressed in 2007 Canadian dollars) and to determine direct and time cost predictors. RESULTS: In total, 28 fathers and 71 mothers participated. The median total direct and time costs in 3 months were $CAD3503 and $CAD23 130, respectively, per family. The largest component of direct costs was travel and of time costs was time allocated previously for unpaid activities. There were no statistically significant predictors of direct costs. Six per cent of the variance for time costs was explained by language spoken at home. CONCLUSIONS: Families of children with cancer are confronted with a wide range of direct and time costs, the largest being travel and time allocated previously for unpaid activities.


Assuntos
Efeitos Psicossociais da Doença , Família , Gastos em Saúde , Neoplasias/economia , Neoplasias/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Custos e Análise de Custo , Coleta de Dados , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Ontário , Estudos Prospectivos , Análise de Regressão , Fatores de Tempo , Adulto Jovem
11.
Neuromuscul Disord ; 32(8): 682-686, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35715317

RESUMO

Morvan Syndrome (MoS) is an autoimmune disorder characterized by peripheral nerve hyperexcitability, autonomic dysfunction, and encephalopathy. We describe the case of a man with a history of thymoma diagnosed with a paraneoplastic MoS with a severe painful neuropathy refractory to immunoglobulins and steroids who had a dramatic and lasting response following treatment with rituximab. We also reviewed the clinical features, comorbidities, laboratory findings, treatment responses, relapses, and long-term outcomes of all published cases of MoS treated with rituximab. This drug appears promising for the treatment of patients with MoS who failed first line therapy with immunoglobulins and steroids.


Assuntos
Siringomielia , Timoma , Neoplasias do Timo , Autoanticorpos , Humanos , Masculino , Rituximab/uso terapêutico , Esteroides , Siringomielia/terapia
12.
J Clin Oncol ; 40(12): 1281-1290, 2022 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-35226549

RESUMO

PURPOSE: Survivors of childhood, adolescent, and young adult cancer are at risk of late effects, including pulmonary and infectious complications. Whether survivors are at increased risk of COVID-19 infection and severe complications is unknown. METHODS: Population-based registries in Ontario, Canada, identified all 5-year survivors of childhood cancer diagnosed age 0-17 years between 1985 and 2014, and of six common adolescent and young adult cancers diagnosed age 15-21 years between 1992 and 2012. Each survivor alive on January 1, 2020, was randomly matched by birth year, sex, and residence to 10 cancer-free population controls. Individuals were linked to population-based laboratory and health care databases to identify COVID-19 tests, vaccinations, infections, and severe outcomes (emergency department [ED] visits, hospitalizations, intensive care unit admissions, and death within 60 days). Demographic, disease, and treatment-related variables were examined as possible predictors of outcomes. RESULTS: Twelve thousand four hundred ten survivors were matched to 124,100 controls. Survivors were not at increased risk of receiving a positive COVID-19 test (386 [3.1%] v 3,946 [3.2%]; P = .68) and were more likely to be fully vaccinated (hazard ratio, 1.23; 95 CI, 1.20 to 1.37). No increase in risk among survivors was seen in emergency department visits (adjusted odds ratio, 1.2; 95 CI, 0.9 to 1.6; P = .19) or hospitalization (adjusted odds ratio, 1.8; 95 CI, 1.0 to 3.5; P = .07). No survivor experienced intensive care unit admission or died after COVID-19 infection. Pulmonary radiation or chemotherapies associated with pulmonary toxicity were not associated with increased risk. CONCLUSION: Cancer survivors were not at increased risk of COVID-19 infections or severe sequelae. These results can inform risk-counseling of survivors and their caregivers. Further study is warranted to determine risk in older survivors, specific subsets of survivors, and that associated with novel COVID-19 variants.


Assuntos
COVID-19 , Neoplasias , Adolescente , Idoso , COVID-19/complicações , COVID-19/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/terapia , Ontário/epidemiologia , SARS-CoV-2 , Sobreviventes , Adulto Jovem
13.
Birth Defects Res A Clin Mol Teratol ; 91(12): 1011-8, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22002854

RESUMO

BACKGROUND: A twofold increase in the prevalence of congenital heart defects (CHDs) has been reported since the early 1970s with higher rates among children from low socioeconomic status (SES). This increase and the observed SES gap are postulated to be reflective of higher ascertainment, especially increased use of ultrasound and echography. The purpose of this study was to examine if trends over time in the prevalence of CHD were the same for high and low SES groups. METHODS: Using the child's health number as a unique identifier and through record linkage, children born in Ontario between 1994 and 2007 were followed for the diagnosis of CHD. Using postal codes and census information, SES quintiles were assigned to each child. We used adjusted rates and used multivariate models to compare trends in the prevalence rate among children born in different SES groups. RESULTS: Children born in low SES areas (23% of all births) had significantly higher rates of CHDs (rate ratio = 1.20; 95% confidence interval [CI] = 1.15-1.24). While prevalence of nonsevere CHDs declined in all SES groups since 2000, severe CHDs, especially atrial septal defects were on the rise during the study period. DISCUSSION: It is assumed that increased ascertainment is responsible for observed increase in the prevalence of CHD, especially minor defects. While the trend and pattern over time changed for severe and nonsevere CHDs, the SES gap remained consistent during the study period. Our results indicate that even free and universal access to a health care system does not eliminate the SES gap observed in the prevalence of CHD.


Assuntos
Cardiopatias Congênitas/epidemiologia , Vigilância da População , Classe Social , Adulto , Criança , Pré-Escolar , Bases de Dados Factuais , Atenção à Saúde/organização & administração , Feminino , Humanos , Renda/estatística & dados numéricos , Recém-Nascido , Estudos Longitudinais , Masculino , Idade Materna , Ontário/epidemiologia , Prevalência
14.
BMC Emerg Med ; 11: 13, 2011 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-21854606

RESUMO

BACKGROUND: Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. METHODS: Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic. RESULTS: The CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4%) and females (49.6%). The majority (86.2%) were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%), with mid-high household incomes (92.2%) and well-educated, receiving at least a high-school diploma (84.1%). Many participants reported no chronic disease (51.9%), fell into a small number (0-5) of ambulatory diagnostic groups (62.3%), and perceived their health status as good/excellent (88.1%); however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%). These factors were largely stable for CCHS cycle 3.1 respondents. Factors influencing demand for emergency department services varied according to the severity of triage scores at initial presentation. For example, although a non-significant predictor of the odds of emergency department utilization in high severity cases, access to a primary care physician was a statistically significant predictor of the likelihood of emergency department utilization (OR: 0.69; 95% CI OR: 0.63-0.75) and the rate of emergency department utilization (RR: 0.57; 95% CI RR: 0.50-0.66) in low severity cases. CONCLUSION: Using a theoretically appropriate hurdle negative binomial regression model this unique study illustrates that access to a primary care physician is an important predictor of both the odds and rate of emergency department utilization in Ontario. Restructuring primary care services, with aims of increasing access to undersupplied populations may result in decreased emergency department utilization rates by approximately 43% for low severity triage level cases.


Assuntos
Emergências/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Modelos Organizacionais , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Análise de Regressão , Fatores Socioeconômicos , Adulto Jovem
15.
Front Med (Lausanne) ; 8: 718316, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34557503

RESUMO

Childhood cancer survivors are known to be at risk of chronic co-morbidities, although their risk of COVID-19 infection remains uncertain. Understanding the risk of COVID-19 in this population is necessary to counsel survivors and inform potential mitigation strategies. The objective of this study was to determine whether the rates of COVID-19 infection differed between childhood cancer survivors and the general population. Administrative health care data from a population-based registry of children and adolescents diagnosed with cancer in Ontario, Canada, were linked with a universal health insurance registry and a repository of laboratory data. Rates of COVID-19 testing, test positivity and infection between March 1, 2020 and March 31, 2021 among childhood cancer survivors (n = 10 242) were compared to matched controls from the general population (n = 49 068). Compared to the general population, childhood cancer survivors were more likely to have COVID-19 testing (35.9% [95% CI, 34.5-37.4%] vs. 32.0% [95% CI, 31.4-32.6%]), but had a lower likelihood of positive COVID-19 result among those tested (4.3% [95% CI, 3.6-4.9%] vs. 5.5% [95% CI, 5.1-5.8%]) and a similar rate of infection among all subjects at risk (1.5% [95% CI, 1.3-1.8%] vs. 1.7% [95% CI, 1.6-1.9%]). These findings can inform counseling of survivors and clinician recommendations for this population.

16.
Med Care ; 48(2): 175-82, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19927013

RESUMO

OBJECTIVES: The objective of this study was to evaluate an administrative data-based risk adjustment method for predicting physician utilization and the contribution of survey-derived indicators of health status. The results of this study will support the use of administrative data for planning, reimbursement, and assessing equity of physician utilization. METHODS: The Ontario portion of the 2000-2001 Canadian Community Health Survey was linked with administrative physician claims data from 2002-2003 and 2003-2004. Explanatory models of family physician (FP) and specialist physician (SP) utilization were run using demographic information and The Johns Hopkins University Adjusted Clinical Groups (ACG) Case-mix System. Survey-based measures of health status were then added to the models. The coefficient of determination, R, indicated the models' explanatory power. RESULTS: The study sample consisted of 25,558 individuals aged 20 to 79 years representing approximately 7.8 million people. Over the 2 years of study period, 82.5% of the study population had a FP visit with a median of 6 visits and 53.2% had a SP visit with a median of 1 visit. The R values based on administrative data alone were 33% and 21% for the frequency of FP and SP visits and 16% and 35% for having one or more visit to an FPs and SPs, respectively. The addition of the survey-based measures to the administrative data-based models produced less than a 2% increase in explanatory power for any outcome. CONCLUSION: Administrative data-based measures of morbidity burden are valid and useful indicators of future physician utilization. The survey-derived measures used in this study did not contribute significantly to models on the basis of administrative data-based measures. These findings support the future use of administrative data-based data and Adjusted Clinical Groups for planning, reimbursement, and research.


Assuntos
Medicina de Família e Comunidade , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Indicadores Básicos de Saúde , Revisão da Utilização de Seguros/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Risco Ajustado/métodos , Adulto , Idoso , Feminino , Previsões , Alocação de Recursos para a Atenção à Saúde , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Ontário/epidemiologia , Estudos Prospectivos
17.
Ann Fam Med ; 7(5): 396-405, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19752467

RESUMO

PURPOSE: Universal coverage of physician services should serve to reduce socioeconomic disparities in care, but the degree to which a reduction occurs is unclear. We examined equity in use of physician services in Ontario, Canada, after controlling for health status using both self-reported and diagnosis-based measures. METHODS: Ontario respondents to the 2000-2001 Canadian Community Health Survey (CCHS) were linked with physician claim files in 2002-2003 and 2003-2004. Educational attainment and income were based on self-report. The CCHS was used for self-reported health status and Johns Hopkins Adjusted Clinical Groups was used for diagnosis-based health status. RESULTS: After adjustment, higher education was not associated with at least 1 primary care visit (odds ratio [OR] = 1.05; 95% confidence interval [CI], 0.87-1.24), but it was inversely associated with frequent visits (OR = 0.77; 95% CI, 0.65-0.88). Higher education was directly associated with at least 1 specialist visit (OR = 1.20; 95% CI, 1.07-1.34), with frequent specialist visits (OR = 1.21; 95% CI, 1.03-1.39), and with bypassing primary care to reach specialists (OR = 1.23, 95% CI 1.02-1.44). The largest inequities by education were found for dermatology and ophthalmology. Income was not independently associated with inequities in physician contact or frequency of visits. CONCLUSIONS: After adjusting for health status, we found equity in contact with primary care for educational attainment but inequity in specialist contact, frequent visits, and bypassing primary care. In this setting, universal health insurance appears to be successful in achieving income equity in physician visits. This strategy alone does not eliminate education-related gradients in specialist care.


Assuntos
Visita a Consultório Médico/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde , Adulto , Idoso , Escolaridade , Feminino , Acessibilidade aos Serviços de Saúde/economia , Nível de Saúde , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde/economia , Humanos , Revisão da Utilização de Seguros , Masculino , Medicina/estatística & dados numéricos , Pessoa de Meia-Idade , Visita a Consultório Médico/economia , Ontário , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde/economia , Encaminhamento e Consulta/economia , Fatores Socioeconômicos , Especialização , Adulto Jovem
18.
Environ Res ; 109(5): 567-74, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19406394

RESUMO

BACKGROUND: Previous research demonstrates that ambient air pollution exacerbates asthma. Asthma morbidity also varies with socioeconomic position (SEP). Few studies have examined if ambient air pollution has a differential impact on income subgroups of the population. This paper investigates socioeconomic variation in ambulatory physician consultations for asthma and assesses possible effect modification of SEP on the association between physician visits and air pollution for children aged 1-17 and adults aged 18-64 in Toronto, Canada, between 1992 and 2001. METHODS: Generalized additive models and generalized linear models were used to estimate the adjusted risk of asthma physician visits associated with an interquartile range increase in sulfur dioxide (SO2), nitrogen dioxide (NO2), particulate matter (PM2.5), and ozone (O3). RESULTS: A socioeconomic gradient in the number of physician visits was observed among children and adults and both sexes. SO2, NO2, and PM2.5 had positive associations with physician visits. The risk ratios for the low socioeconomic group were significantly greater than those for the high socioeconomic group in several of the models of SO2 and PM2.5. CONCLUSIONS: These findings suggest increased ambulatory physician visits represent another component of the public health impact of urban air pollution. The burden of this impact may be borne disproportionately by those with lower SEP. Clarifying the role of SEP in altering susceptibility to the effects of air pollution is essential not only to inform revisions of ambient air quality standards, but also to design public health interventions to reduce health impacts on sensitive subgroups of the population.


Assuntos
Poluição do Ar , Asma/terapia , Fatores Socioeconômicos , Adolescente , Asma/induzido quimicamente , Asma/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Modelos Teóricos , Ontário/epidemiologia
19.
Global Spine J ; 9(4): 393-397, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31218197

RESUMO

STUDY DESIGN: Prospective, nonrandomized, clinical study. OBJECTIVE: Epidural steroid injections (ESIs) are an important diagnostic and treatment modality for spine pathology. The success of these injections has been attributed to the anatomic location reached by the injectate. This study evaluates injectate dispersal patterns after cervical interlaminar ESI using magnetic resonance imaging (MRI). METHODS: Patients between the ages of 18 and 85 years with cervical radiculopathy were identified. After obtaining consent for study participation, a gadolinium-enhanced cervical ESI was administered via an interlaminar approach under fluoroscopic guidance. Study participants underwent a cervical spine MRI within 15 minutes of administering the injection. Craniocaudal dispersal and the presence or absence of circumferential dispersal was assessed. RESULTS: The injectate dispersed a mean of 8.11 cm in the cranial direction, 6.63 cm in the caudal direction, and 360° circumferentially. No adverse events related to the ESI were reported. CONCLUSIONS: Fluoroscopy-guided cervical interlaminar ESI resulted in nearly uniform circumferential dispersal within the epidural space with multilevel migration in the cranial and caudal directions. MRI is a safe and accurate tool to evaluate spinal injectate dispersal.

20.
J Cancer Res Ther ; 14(5): 1079-1082, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30197352

RESUMO

INTRODUCTION AND OBJECTIVES: Nowadays, noncoding RNAs are of special significance to scientists. Among RNAs, long noncoding RNAs (lncRNAs) have an important role in gene expression regulation. Recent studies show aberrant lncRNAs expression in different types of cancer including blood malignancies. As such, lncRNAs could be a possible way for diagnosis and treatment of certain cancers. In the current study, the level of PCA3 gene expression in patients with chronic myeloid leukemia (CML) was compared with normal individuals to find out whether the level of PCA3 in CML patients is increased according to our hypothesis. MATERIALS AND METHODS: The buffy coat was collected from peripheral blood of thirty untreated CML patients (BCR-ABL positive) and twenty normal volunteers. RNA was extracted from white blood cells and cDNA was synthesized. The level of PCA3 gene expression was measured using quantitative reverse transcription-polymerase chain reaction. RESULTS: The results showed that PCA3 has expression in both normal and leukemic white blood cells. The data also revealed higher expression of PCA3 in leukemic patients, compared to the normal counterpart (P < 0.05). CONCLUSION: The unusual increase in PCA3 gene expression in CML patients suggests the need for more research on mechanisms of molecular pathways related to PCA3 which could help achieve better treatment.


Assuntos
Antígenos de Neoplasias/genética , Biomarcadores Tumorais/genética , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , RNA Longo não Codificante/genética , Adulto , Idoso , Antígenos de Neoplasias/sangue , Biomarcadores Tumorais/sangue , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/sangue , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Masculino , Pessoa de Meia-Idade , RNA Longo não Codificante/sangue
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