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1.
Epidemiol Psychiatr Sci ; 29: e95, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31987063

RESUMO

AIMS: Children with autism spectrum disorder (ASD) tend to suffer from various medical comorbidities. We studied the comorbidity burden and health services' utilisation of children with ASD to highlight potential aetiologies and to better understand the medical needs of these children. METHODS: In this nested case-control study, ASD cases and controls - matched by age, sex and ethnicity in a 1:5 ratio - were sampled from all children born between 2009 and 2016 at a tertiary medical centre. Data were obtained from the hospital's electronic database. Comorbid diagnoses were classified according to pathophysiological aetiology and anatomical/systemic classification of disease. Standard univariate and multivariate statistics were used to demonstrate comorbidities and health services' utilisation patterns that are significantly associated with ASD. RESULTS: ASD children had higher rates of comorbidities according to both pathophysiological and anatomical/systemic classifications (p < 0.001). The most marked significant differences were observed for: hearing impairments (OR = 4.728; 95% CI 2.207-10.127) and other auricular conditions (OR = 5.040; 95% CI 1.759-14.438); neurological (OR = 8.198; 95% CI 5.690-11.813) and ophthalmological (OR = 3.381; 95% CI 1.617-7.068) conditions; and ADD/ADHD (OR = 3.246; 95% CI 1.811-5.818). A subgroup analysis revealed a more profound case-control difference in anaemia rates among girls than in boys (OR = 3.25; 95% CI 1.04-10.19 v. OR = 0.74; 95% CI 0.33-1.64 respectively) and an opposite trend (larger differences in males than in females in cardiovascular diseases (OR = 1.99; 95% CI 1.23-3.23 v. OR = 0.76; 95% CI 0.17-3.45, respectively)). In addition, larger case-control differences were seen among Bedouin children than in Jewish children in a number of medical comorbidities (Breslow-Day test for homogeneity of odds ratio p-value <0.05). Finally, we found that children with ASD tended to be referred to the emergency department and to be admitted to the hospital more frequently than children without ASD, even after adjusting for their comorbidity burden (aOR = 1.28; 95% CI 1.08-1.50 and aOR = 1.28; 95% CI 1.11-1.47 for >1 referrals and admissions per year, respectively). CONCLUSIONS: The findings of this study contribute to the overall understanding of comorbid conditions and health services' utilisation for children with ASD. The higher prevalences of comorbidities and healthcare services' utilisation for children with ASD highlight the additional medical burden associated with this condition.


Assuntos
Transtorno do Espectro Autista/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Estudos de Casos e Controles , Criança , Comorbidade , Feminino , Humanos , Israel/epidemiologia , Masculino , Registros Médicos/estatística & dados numéricos , Prevalência
2.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190010.supl.3, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800849

RESUMO

INTRODUCTION: Brazil presented a high proportion of ill-defined causes of death (IDCD) in 2000, compromising accurate cause-of-death analysis. OBJECTIVE: To analyze specific underlying causes for deaths originally assigned as IDCD in the Mortality Information System (SIM - Sistema de Informação sobre Mortalidade), after investigation activities implemented in country between 2006 and 2017. METHOD: For all IDCD identified in the SIM, municipal health professionals collected information about the final disease obtained from hospital records, autopsies, forms of family health teams, and home investigation. Specific causes among reclassified IDCD after investigation were evaluated according to age groups and four calendar periods. RESULTS: Proportions of IDCD reassigned to other causes after review increased over time, reaching 30.1% in 2017. From a total of 257,367 IDCD reclassified in 2006-2017, neonatal-related conditions, injury, ischemic heart disease and stroke were the leading causes detected in the age groups 0-9 years, 10-29 years, 30-69 years, 70 years and over, respectively. DISCUSSION: The similarity and plausibility of cause-specific proportions derived from the reclassification of IDCD by age group over time indicate the accuracy of the investigation data. CONCLUSION: High proportions of IDCD reassigned to more informative causes after review indicate the success of this approach to correct misclassification in the SIM, an initiative that should be maintained. Training physicians on death certification along with better quality of medical care and access to health services would lead to further improvement.


Assuntos
Causas de Morte , Coleta de Dados/métodos , Sistemas de Informação/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Autopsia/estatística & dados numéricos , Brasil/epidemiologia , Criança , Pré-Escolar , Atestado de Óbito , Feminino , Humanos , Lactente , Entrevistas como Assunto/estatística & dados numéricos , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
3.
Rev. bras. cir. plást ; 34(4): 497-503, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047912

RESUMO

Introdução: A úlcera plantar por hanseníase é uma lesão no pé resultante da falta de sensibilidade plantar. O objetivo é descrever o tratamento realizado em portadores de úlceras plantares por hanseníase. Métodos: Estudo de prontuários de portadores de úlcera plantar atendidos no Hospital Sarah em Brasília, de 2006 a 2016, quanto ao sexo, idade, etiologia, localização e tratamento. Resultados: Foram atendidos 27 pacientes, 17(62,96%) homens e 10 (37,04%) mulheres, procedentes de Goiás e DF, na faixa etária de 41 a 60 anos (40,74%). Todos necessitaram de um ou mais procedimentos cirúrgicos. Conclusão: Observou-se maior frequência no sexo masculino, grau avançado, localizadas no primeiro artelho. Todos necessitaram de procedimentos cirúrgicos e não cirúrgicos, evoluindo com cicatrização completa da ferida, amputação transtibial em um caso e de artelhos em sete casos, e 90% dos casos apresentaram recorrência da úlcera após um ano.


Introduction: Leprosy-induced plantar ulcers result from a lack of plantar sensitivity. Objective: This study aimed to describe the treatment provided to patients with leprosy-induced plantar ulcers. Methods: We retrospectively reviewed the medical records of patients with plantar ulcers treated at Sarah Hospital in Brasilia from 2006 to 2016 and collected information about sex, age, etiology, location, and treatment. Results: A total of 27 patients (17 [62.96%] men, 10 [37.04%] women; 40.74% were aged 41­60 years) were treated from Goiás and the Federal District. All required ≥1 surgical procedure. Conclusion: A higher frequency of advanced grade was observed in men, primarily on the first toe. All needed surgical and non-surgical procedures and achieved complete wound healing. Transtibial amputation was required in 1 case and toe amputation in 7 cases; 90% patients developed ulcer recurrence after 1 year.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Reabilitação , Terapêutica , Tratamento Terciário , Registros Médicos , Úlcera do Pé , Hanseníase , Reabilitação/métodos , Reabilitação/estatística & dados numéricos , Terapêutica/métodos , Terapêutica/estatística & dados numéricos , Tratamento Terciário/métodos , Tratamento Terciário/estatística & dados numéricos , Registros Médicos/normas , Registros Médicos/estatística & dados numéricos , Úlcera do Pé/cirurgia , Úlcera do Pé/complicações , Úlcera do Pé/terapia , Hanseníase/cirurgia , Hanseníase/complicações , Hanseníase/terapia
5.
NeuroRehabilitation ; 45(2): 151-161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498143

RESUMO

The number of adults diagnosed with brain tumors is increasing, as are the survival rates. Neurological impairments from brain tumors can impact activity and participation. Adults with brain tumors benefit from post-acute rehabilitation. However, there is limited evidence from the acute care setting. The purpose of this study was to examine how acute care occupational therapy services were utilized and whether patients made functional gains after receiving occupational therapy services. A retrospective chart review of 153 electronic medical records was completed for patients who received occupational therapy services at a large teaching hospital. Data collected included number of occupational therapy visits, the types of interventions, and patient performance using the Boston University Activity Measure for Post-Acute Care "6 Clicks for Daily Activity" short form (AM-PAC). More than half the patients received one occupational therapy visit (54.2%) with a median length of stay of three days. Most interventions focused on activities of daily living (ADLs). Of those patients who received more than one visit, 67% showed improvements in their AM-PAC scores. Occupational therapy practitioners provided interventions that addressed ADLs, and patients demonstrated gains in functional performance. These findings suggest that patients benefit from occupational therapy services provided in the acute care setting.


Assuntos
Atividades Cotidianas , Neoplasias Encefálicas/reabilitação , Utilização de Instalações e Serviços , Terapia Ocupacional/estatística & dados numéricos , Adulto , Idoso , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade
6.
J Autism Dev Disord ; 49(12): 4919-4928, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31473948

RESUMO

Knowledge about the quality of care delivered to children with autism spectrum disorders (ASD) in relation to that recommended by clinical practice guidelines (CPGs) is limited. ASD care quality indicators were developed from CPGs and validated by experts, then used to assess the quality of care delivered by general practitioners (GPs) and pediatricians in Australia. Data were retrospectively collected from the medical records of 228 children (≤ 15 years) with ASD for 2012-2013. Overall quality of care was high, but with considerable variation among indicators, and between GPs and pediatricians-e.g., GPs were less likely to complete the assessment care bundle (61%; 95% CI 21-92). Findings highlight potential areas for improvement in the need for standardized criteria for diagnosis.


Assuntos
Transtorno do Espectro Autista/terapia , Medicina Geral/normas , Qualidade da Assistência à Saúde , Austrália , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Criança , Pré-Escolar , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Registros Médicos/estatística & dados numéricos
7.
Rev. bras. cir. plást ; 34(3): 310-314, jul.-sep. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047144

RESUMO

Introdução: A demanda por cirurgia plástica tem aumentado progressivamente, dentre os procedimentos mais frequentes estão as cirurgias de mamas (aumento e redução). Métodos: Estudo retrospectivo de prontuários de pacientes que foram submetidas a mamoplastia redutora e de aumento, no período de janeiro de 2015 a junho de 2018, no Hospital PUC-Campinas. Resultados: Foram realizadas 13 mamoplastias de aumento e 275 mamoplastias redutoras. Das 288 cirurgias realizadas duas (n=2) evoluíram com TEP (tromboembolismo pulmonar). Conclusão: Portanto, a incidência de fenômenos tromboembólicos em mamoplastias de aumento e redutoras mostrou-se baixa no presente estudo, assim como na literatura. Já as pacientes acometidas no estudo eram consideradas de baixo risco para complicação tromboembólica, de acordo com protocolos de profilaxia, devendo-se atentar para tais fenômenos no pós-operatório. Ainda são necessários mais estudos para padronização do uso de medidas de profilaxia do tromboembolismo venoso.


Introduction: The demand for plastic surgery has progressively increased, and breast enlargement and reduction surgeries are among the most frequent procedures. Methods: This retrospective study reviewed the medical records of patients who underwent reduction and augmentation mammoplasty between January 2015 and June 2018 at the PUC-Campinas Hospital. Results: Thirteen augmentation mammoplasties and 275 reduction mammoplasties were performed. Of the 288 patients who underwent surgeries, two patients developed postoperative pulmonary thromboembolism. Conclusion: The incidence of thromboembolic phenomena in augmentation and reduction mammoplasty is low. Patients in this study were considered at low risk for thromboembolic complications. According to prophylaxis protocols, this phenomena should be monitored postoperatively. Further studies are needed to standardize the use of venous thromboembolism prophylaxis measures.


Assuntos
Humanos , Feminino , Adulto , História do Século XXI , Pacientes , Embolia Pulmonar , Cirurgia Plástica , Mama , Registros Médicos , Estudos Retrospectivos , Embolia e Trombose , Trombose Venosa , Pacientes/estatística & dados numéricos , Embolia Pulmonar/cirurgia , Embolia Pulmonar/complicações , Cirurgia Plástica/estatística & dados numéricos , Mama/cirurgia , Registros Médicos/estatística & dados numéricos , Embolia e Trombose/cirurgia , Trombose Venosa/cirurgia , Trombose Venosa/complicações
8.
BMC Public Health ; 19(1): 1040, 2019 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-31376829

RESUMO

BACKGROUND: In Cameroon, since the first epidemiological week held in 2015, snakebites have been registered among Potential Epidemic Diseases (PED). In the Centre Region, the most densely populated of the country, weekly reports of snakebites are generated at health districts level for monthly data updates. METHODS: To contribute to the better management of snakebite cases, an observational study was conducted to assess the snakebite reporting rate in the Centre Region of Cameroon. The results of this retro-prospective survey were confronted to those of the weekly epidemiological surveillance system, recorded in the PED regional data base. RESULTS: The incidence of bites was relatively high (36.6 bites per 100,000 inhabitants), as well as the general attack rate (about 49 envenomations per 100 victims). The lethality recorded was 2.5% and the mortality was about 1 death per 100,000 inhabitants a year. The sex ratio was largely female biased (61.6%). The bites occurred mostly during the rainy season (73.0%). Bitten victims were mainly farmers (47.4%), and agriculture was the main risk factor. The comparative analysis of the data suggested a high non-reporting rate of snakebite cases (67.8%). CONCLUSION: Snakebite is an endemic condition in the Centre Region of Cameroon. Because of the high rate of non-reporting of cases, the collection of information from the registers of the health facilities only appears not enough to assess the real importance of envenomation in this Region.


Assuntos
Registros Médicos/estatística & dados numéricos , Mordeduras de Serpentes/epidemiologia , Adulto , Camarões/epidemiologia , Feminino , Humanos , Incidência , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
Int J Med Inform ; 129: 184-188, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445253

RESUMO

BACKGROUND: Nursing triage documentation is the first free-form text data created at the start of an emergency department (ED) visit. These 1-3 unstructured sentences reflect the clinical impression of an experienced nurse and are key in gauging a patient's illness. We aimed to predict final ED disposition using three commonly-employed natural language processing (NLP) techniques of nursing triage notes in isolation from other data. METHODS: We constructed a retrospective cohort of all 260,842 consecutive ED encounters in 2015-16, from three clinically heterogeneous academically-affiliated EDs. After exclusion of 3964 encounters based on completeness of triage, and disposition data, we included 256,878 encounters. We defined the outcome as: 1) admission, transfer, or in-ED death [68,092 encounters] vs. 2) discharge, "left without being seen," and "left against medical advice" [188,786 encounters]. The dataset was divided into training and testing subsets. Neural network regression models were trained using bag-of-words, paragraph vectors, and topic distributions to predict disposition and were evaluated using the testing dataset. RESULTS: Area under the curve for disposition using triage notes as bag-of-words, paragraph vectors, and topic distributions were 0.737 (95% CI: 0.734 - 0.740), 0.785 (95% CI: 0.782 - 0.788), and 0.687 (95% CI: 0.684 - 0.690), respectively. CONCLUSIONS: Nursing triage notes can be used to predict final ED patient disposition, even when used separately from other clinical information. These findings have substantial implications for future studies, suggesting that free text from medical records may be considered as a critical predictor in research of patient outcomes.


Assuntos
Serviço Hospitalar de Emergência , Registros Médicos/estatística & dados numéricos , Processamento de Linguagem Natural , Triagem , Hospitalização , Humanos , Estudos Retrospectivos , Triagem/estatística & dados numéricos
10.
Nat Commun ; 10(1): 3298, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31363098

RESUMO

Gastric acid suppression promotes allergy in mechanistic animal experiments and observational human studies, but whether gastric acid inhibitors increase allergy incidence at a population level remains uncharacterized. Here we aim to assess the use of anti-allergic medication following prescription of gastric acid inhibitors. We analyze data from health insurance records covering 97% of Austrian population between 2009 and 2013 on prescriptions of gastric acid inhibitors, anti-allergic drugs, or other commonly prescribed (lipid-modifying and antihypertensive) drugs as controls. Here we show that rate ratios for anti-allergic following gastric acid-inhibiting drug prescriptions are 1.96 (95%CI:1.95-1.97) and 3.07 (95%-CI:2.89-3.27) in an overall and regional Austrian dataset. These findings are more prominent in women and occur for all assessed gastric acid-inhibiting substances. Rate ratios increase from 1.47 (95%CI:1.45-1.49) in subjects <20 years, to 5.20 (95%-CI:5.15-5.25) in > 60 year olds. We report an epidemiologic relationship between gastric acid-suppression and development of allergic symptoms.


Assuntos
Antiulcerosos/efeitos adversos , Hipersensibilidade/epidemiologia , Inibidores da Bomba de Prótons/efeitos adversos , Adolescente , Adulto , Idoso , Antiulcerosos/uso terapêutico , Áustria/epidemiologia , Feminino , Ácido Gástrico/química , Humanos , Hipersensibilidade/etiologia , Hipersensibilidade/imunologia , Sistema Imunitário/efeitos dos fármacos , Sistema Imunitário/imunologia , Incidência , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Adulto Jovem
11.
Biosci Trends ; 13(3): 276-278, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31327796

RESUMO

As the super-aged society, Japan is facing challenges in health care system. As one of measures to cope with challenges, the Ministry of Health, Labor, and Welfare started to construct an open medical information platform, named PeOPLe, in 2016 for personalized medical care, improvement of medical services, and the redistribution of medical resources. The Ministry plans to build the platform infrastructure by 2020 and put the platform into full-scale operation by 2025. PeOPLe collects only medical records, but it should collect lifelogs as well in order to better improve the health, especially for elderly. A lifelog is a record of a person's activity and it has potential to predict the probability a person will suffer a lifestyle-related disease as a result of the person's lifestyle. This prediction could help to maintain the health of the elderly. In addition, constructing a self-recording platform integrated with the medical platform is the best way to collect lifelogs since collecting a large amount of lifelogs for a long time from various people at public or medical agencies is difficult. A self-recording platform is a place where people can post and manage their lifelogs. In return for posting lifelogs, people will receive personalized health advice, which will attract more people.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Idoso , Humanos , Japão , Registros Médicos/estatística & dados numéricos
12.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(6): 368-375, jun.-jul. 2019. mapas, ilus
Artigo em Espanhol | IBECS | ID: ibc-182853

RESUMO

Introducción: El tratamiento con hormona de crecimiento recombinante (rhGH) ha demostrado mejorar la talla adulta de los pacientes pediátricos con déficit de GH (DGH). Sin embargo, cuando los pacientes son reevaluados al llegar a la talla final, se evidencia que existen pacientes en los que el déficit de GH es permanente (DPGH) y otros en los que el déficit ha sido transitorio (DTGH). El objetivo es evaluar, en una cohorte de pacientes pediátricos con DGH, si existen diferencias en la respuesta al tratamiento con GH en función de que dicho déficit sea permanente o transitorio. Materiales y métodos: Estudio retrospectivo de 89 pacientes con DGH, que fueron seguidos desde el diagnóstico y durante todo el seguimiento hasta la talla adulta. Se obtuvieron parámetros clínicos, auxológicos, radiológicos y analíticos al diagnóstico, así como tras el primer año de tratamiento y en la revisión de la talla final. Resultados: El 28% de los pacientes presentaron un DPGH. Talla inicial de −2,46 ± 0,86 DE en el DPGH y −2,24 ± 0,68 DE en el DTGH. El valor pico de GH al diagnóstico fue de 4,26 ± 2,78 y 6,20 ± 2,01 ng/mL, respectivamente (p < 0,01). Tras el primer año de tratamiento el incremento de la velocidad de crecimiento fue mayor en el grupo de DPGH: 4,33 ± 3,53 DE vs. 2,95 ± 2,54 DE (p = 0,043). Talla final de −0,81 ± 0,87 DE los DPGH y de −0,95 ± 0,83 DE los DTGH (p = 0,47). Conclusiones: Los pacientes con DPGH obtienen un mayor beneficio del tratamiento con rhGH tanto a corto como a largo plazo. Además, muestran niveles más bajos de GH en las pruebas de estímulo al diagnóstico, como ha sido descrito previamente


Introduction: Treatment with recombinant human growth hormone (rhGH) has been shown to improve adult height in pediatric patients with GH deficiency (GHD). However, reassessment of patients after they reach their final height shows some of them have permanent GH deficiency (PGHD), while others had a transient deficiency (TGHD). The study objective was to assess, in a cohort of pediatric patients with GHD, potential differences in response to treatment with rhGH depending on whether deficiency is permanent or transient. Materials and methods: A retrospective study of 89 patients with GHD, who were monitored from diagnosis to adult height. Clinical, auxological, radiographic and laboratory variables were collected at diagnosis, after the first year of treatment, and when they had reached their adult height. Results: PGHD was found in 28% of patients. Initial height was −2.46 ± 0.86 SD and −2.24 ± 0.68 SD in subjects with PGHD and TGHD respectively. Peak GH level at diagnosis was 4.26 ± 2.78 and 6.20 ± 2.01 ng/mL (p < 0.01) in the PGHD and TGHD groups respectively. After the first year of treatment, increase in growth velocity was greater in the PGHD group: 4.33 ± 3.53 SD vs. 2.95 ± 2.54 SD in the PGHD group (p = 0.043). Final height was −0.81 ± 0.87 SD in the PGHD and −0.95 ± 0.83 SD in the TGHD group (p = 0.47). Conclusions: Patients with PGHD had a better short- and long-term response to rhGH. They also showed lower GH levels in stimulation tests at diagnosis, as previously reported


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Peso-Estatura , Hormônio do Crescimento/deficiência , Hormônio do Crescimento/uso terapêutico , Estudos de Coortes , Estudos Retrospectivos , Estudos Transversais , Hormônio do Crescimento/metabolismo , Índice de Massa Corporal , Registros Médicos/estatística & dados numéricos , Imunoensaio/métodos
13.
J Med Econ ; 22(9): 953-959, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31234672

RESUMO

Aims: This retrospective chart review examined the six-month migraine-related healthcare resource use (HRU) among European patients who had ≥4 migraine days per month and previously failed at least two prophylactic migraine treatments. Methods: Neurologists, headache specialists, and pain specialists in France, Germany, Italy, and Spain who treated ≥10 patients with migraine in 2017 were recruited (April-June 2018) to extract anonymized patient-level data. Eligible physicians randomly selected charts of up to five adult patients with clinically-confirmed migraine, ≥4 migraine days in the month prior to the index date, and had previously failed at least two prophylactic migraine treatments. Treatment failure was defined as discontinuation due to lack of efficacy and/or tolerability. Demographic and disease characteristics as of the index date, and migraine-related HRU incurred during the 6-month study period, were recorded. Results: A total of 104 physicians contributed 168 charts for patients (63% female). On average, patients were 38 years old and failed 2.3 prophylactic treatments as of the index date. During the study period, 83% of patients had ≥1 outpatient visit for migraine in the physician's office, and 27% went to the ER/A&E. Approximately 5% of patients were hospitalized for migraine, with an average of one hospitalization and an average length of stay of 3 days. Approximately 39% of patients had ≥1 blood test, 22% had ≥1 magnetic resonance imaging, 17% had ≥1 electroencephalogram, and 13% had ≥1 computerized tomography scan. Visits to other healthcare providers were common. Limitations: This study is subject to the limitations of chart review studies, such as errors in data entry. Conclusions: Across four European countries, the HRU burden of migraine among patients who previously failed at least two prophylactic treatments was high, indicating a need for more effective prophylactic treatments to appropriately manage migraine and reduce the HRU burden attributable to this common disorder.


Assuntos
Recursos em Saúde/estatística & dados numéricos , Registros Médicos/estatística & dados numéricos , Transtornos de Enxaqueca/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Diagnóstico por Imagem , Europa (Continente) , Feminino , Recursos em Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/terapia , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Falha de Tratamento
16.
Injury ; 50(7): 1277-1283, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31109684

RESUMO

OBJECTIVE: To i) quantify the agreement between comorbidities documented within medical records and an orthopaedic trauma dataset; and ii) compare agreement between these sources before and after the introduction of new comorbidity coding rules in Australian hospitals. STUDY DESIGN AND SETTING: A random sample of adult (≥ 16 years) orthopaedic trauma patients (n = 400) were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Diagnoses of obesity, arthritis, diabetes and cardiac conditions documented within patients' medical records were compared to ICD-10-AM comorbidity codes (provided by hospitals) for the same admission. Agreement was calculated (Cohen's kappa) before and after the introduction of new coding rules. RESULTS: All comorbidities had the same or higher prevalence in medical record data compared to coded data. Kappa values ranged from <0.001 (poor agreement) for coronary artery disease to 0.94 (excellent agreement) for type 2 diabetes. There was improvement in agreement between sources for most conditions following the introduction of new coding rules. CONCLUSION: There has been improvement in the coding of certain comorbidities since the introduction of new coding rules, suggesting that, since 2015, administrative data has improved capacity to capture patients' comorbidity profiles. Consideration must be taken when using the ICD-10-AM data due to its limitations.


Assuntos
Codificação Clínica , Comorbidade , Diabetes Mellitus/epidemiologia , Registros Médicos/estatística & dados numéricos , Obesidade/epidemiologia , Osteoporose/epidemiologia , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Feminino , Controle de Formulários e Registros , Pesquisa sobre Serviços de Saúde , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Adulto Jovem
17.
Health Serv Res ; 54(4): 957-963, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31099021

RESUMO

OBJECTIVE: To improve on existing methods to infer race/ethnicity in health care data through an analysis of birth records from Connecticut. DATA SOURCE: A total of 162 467 Connecticut birth records from 2009 to 2013. STUDY DESIGN: We developed a logistic model to predict race/ethnicity using data from US Census and patient-level information. Model performance was tested and compared to previous studies. Five performance measures were used for comparison. PRINCIPAL FINDINGS: Our full model correctly classifies 81 percent of subjects and shows improvement over extant methods. We achieved substantially improved sensitivity in predicting black race. CONCLUSIONS: Predictive models using Census information and patients' demographic characteristics can be used to accurately populate race/ethnicity information in health care databases, enhancing opportunities to investigate and address disparities in access to, utilization of, and outcomes of care.


Assuntos
Declaração de Nascimento , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Registros Médicos/estatística & dados numéricos , Viés , Connecticut , Humanos , Modelos Logísticos , Fatores Socioeconômicos
18.
PLoS One ; 14(4): e0215697, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022236

RESUMO

BACKGROUND: BMI is a feasible and recommended measure for overweight and obesity screening in children and adolescents. The study aimed to determine how often physicians correctly identified obesity/ overweight status in children and adolescents by using BMI percentile charts. METHODS: This retrospective cross-sectional study reviewed the paper medical records of children and adolescents (6-14 years) who visited family medicine and pediatric outpatient clinics (Jan-June 2012) in a medical city in Riyadh. Investigators calculated BMI percentiles (using height, weight, age and gender data retrieved from the records) in order to identify patient weight status. Physician documentation of obesity/overweight diagnoses in patient problem lists were cross checked against their BMI percentile to assess the accuracy of physicians' identification of weight status. The recommended management plan for identified patients was also recorded. RESULTS: A total of 481 charts were reviewed, 213 (44%) children were seen by family medicine physicians and 268 (56%) by pediatricians. The sample was equally distributed by gender. Height was undocumented for 13% (71) of visiting patients. Eighteen percent of patients (86) were classified as overweight (35)/obese (51) according to age and sex adjusted BMI percentile. Physicians' correctly identified and documented weight status in 20% of overweight/obese patients: 17 out of 86 subjects. Weight status identification was higher among pediatricians-25% as compared to family medicine physicians-10% [p = 0.08]. Dietary referral was the most common management plan for the identified children. Physicians were more likely to identify obese children {≥95th} compared to overweight {≥85th - 95th} children. Subjects whose BMI for age classified them into the highest BMI percentile category {≥95th} were more likely to be correctly identified (29%) compared to those classified within {≥85th - 95th} category-6% [p = 0.007]. CONCLUSION: Physician identification of obesity/ overweight status for children and adolescents was low, irrespective of their specialty, and despite the condition being prevalent in the sample. Future research that concentrates on interventions that may improve documentation of obesity/overweight diagnoses and parameters needed for BMI indices would be beneficial.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Obesidade/epidemiologia , Ambulatório Hospitalar/estatística & dados numéricos , Sobrepeso/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Peso Corporal , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento/organização & administração , Registros Médicos/estatística & dados numéricos , Obesidade/diagnóstico , Ambulatório Hospitalar/organização & administração , Sobrepeso/diagnóstico , Padrões de Prática Médica/organização & administração , Prevalência , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Centros de Atenção Terciária
19.
Geriatr Gerontol Int ; 19(7): 577-581, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30950139

RESUMO

AIM: To estimate the 5-year incidence of common comorbidities, including lifestyle-associated diseases, in older Japanese patients with rheumatoid arthritis (RA). METHODS: We enrolled 129 consecutive patients with RA aged ≥65 years in this study. We examined all patients for the presence of hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease, cerebrovascular disease and cancer at baseline (in 2013) and 5 years later (in 2018) using clinical records, self-reported questionnaires, interviews and medication records. RESULTS: At baseline, hypertension was prevalent in 37.2% of the patients, dyslipidemia in 18.6%, diabetes mellitus in 9.3%, cardiovascular disease in 14.7%, cerebrovascular disease in 10.1% and cancer in 10.1%. Furthermore, the change of prevalence after 5 years from baseline of hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease, cerebrovascular disease and cancer was 4.6%, 3.9%, 0.8%, 4.7%, 2.3% and 1.5%, respectively. The factors associated at baseline and/or after 5 years of hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease and cancer included disease duration and body mass index, body mass index and anti-cyclic citrullinated peptide antibody, corticosteroid use, body mass index, and male and disease duration, respectively. CONCLUSIONS: The Japanese population is aging and so is the population of patients with RA. In older patients with RA, hypertension and cardiovascular disease should be particularly considered. Therefore, although the therapeutic agents for RA have improved, a better understanding of the comorbidities in older patients with RA should impact the treatment of RA. Geriatr Gerontol Int 2019; 19: 577-581.


Assuntos
Artrite Reumatoide , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Neoplasias/epidemiologia , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Comorbidade , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Registros Médicos/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
20.
Scand J Trauma Resusc Emerg Med ; 27(1): 39, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961648

RESUMO

BACKGROUND: Cardiovascular disease accounts for nearly half of all deaths in Poland. The aim of this study was to assess both the duration and the delays of prehospital treatment in ST-segment elevation myocardial infarction (STEMI) patients and how it impacts left ventricle ejection fraction (LVEF) measured at the time of discharge and the frequency of in-hospital patient mortality. METHODS: This study retrospectively analyzed medical records from January 2011 to December 2015 (excluding the year 2013) of 573 patients who were transported to a hospital with a diagnosis of STEMI. RESULTS: The mean time of prehospital system delays was 59 min with a maximum time of 152 min and a minimum time of 23 min. The relationship between reduced LVEF (< 55%) and in-hospital patient mortality and the relationship between length of time from first medical contact (FMC) to hospital admission was analysed in 515 respondents. Extending the time of FMC to hospital admission by 1 min increased the chances of lowering LVEF by 2% (95% CI: 1.004-1.041) and increased the chances of death by 2% (95% CI: 1.002-1.04) in STEMI patients. CONCLUSIONS: This study emphasised how vital it is to minimise time spent with STEMI patients at the scene of their cardiovascular event by performing an ECG as quickly as possible and by immediately transporting the patient to the hospital with the targeted treatment. This may lead to the implementation of additional training in the field of ECG interpretation, increase the prevalence of teletransmission systems, and improve communication between Emergency Medical Services (EMS) and catheterization laboratories ultimately reducing patient mortality.


Assuntos
Eletrocardiografia , Serviços Médicos de Emergência/normas , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento , Idoso , Cateterismo Cardíaco , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Polônia/epidemiologia , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Fatores de Tempo , Resultado do Tratamento
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