Differences In Crude Rates Research Articles

Assisted Peritoneal Dialysis Implementation: A Pilot Program From a Large Dialysis Unit in Quebec.

Background:Kidney failure prevalence is increasing in older patients for whom dialysis initiation can be challenging. Assisted peritoneal dialysis (PD), where PD is performed with the help of a healthcare worker, can facilitate PD for frailer patients who may not be candidate otherwise.Objectives:This study aimed to assess the feasibility of implementing the first pilot assisted PD program in Quebec (Canada) and to evaluate the characteristics and outcomes of the PD cohort before and after assisted PD availability.Design:Observational retrospective cohort study.Setting and Population:All adult patients initiating PD between 2015 and 2020 in a single-center dialysis unit were included.Measurements:Incidence, characteristics, and outcomes of patients with PD were compared between (1) the “pre” (2015-2017) and the “post” assisted PD era (2018-2020) and (2) patients with assisted PD and independent PD in the more recent period.Methods:The primary outcome was peritonitis rate over the first year. Secondary outcomes included hospitalization, transfers to in-center hemodialysis (HD) and mortality.Results:Overall, 124 patients initiated PD with an annual incidence of 17 ± 3 patients during the “pre” and 24 ± 8 patients during the “post” assisted PD era (P = .18). First-year peritonitis rate was similar over the 2 eras. Years of PD initiation and use of assisted PD were not associated with risk peritonitis (over total follow-up) after adjustment. Adjusted hazard of transfer to HD or death was higher during the “post” era (hazard ratio [HR]: 2.77; 95% confidence interval [CI]: 1.42-5.58). Seventeen patients received assisted PD including 13 (18%) of the 72 patients initiated between 2018 and 2020. Patients with assisted PD were older than those with independent PD (72 [64-84] vs. 59 [47-67], P = .006) and received assistance for 0.8 (0.4-1.5) years. When comparing assisted and independent cohorts, there were no differences in crude rates of peritonitis or hospitalization.Limitations:Single-center study with small sample size.Conclusion:This study shows the feasibility of implementing an assisted PD program, with favorable overall outcomes including similar rates of peritonitis during the first year after PD initiation.

外国人の市区町村間移動に関する人口学的分析

This paper presents demographic analysis of municipality-level migration of foreign residents in Japan. Using inter-municipal migration data derived from the Basic Resident Registration System, which covers foreign residents from 2013, in- and out-migration rates of foreign residents are compared to those of Japanese residents for each municipality. Preliminary analysis using the crude indicators shows higher rates of both in- and out- migration for foreign residents than Japanese residents in 94 per cent of the municipalities across the country. To adjust for age-sex composition, the indirect standardization method is applied with age-sex specific in- and out-migration rates of Japanese residents as the standard migration rates for each municipality. Comparison of the crude and standardized indicators suggests that, on average, differences in age-sex composition between foreign and Japanese residents account for over 40 per cent of differences in crude rates between the two groups for in- and out- migration in each municipality. At the same time, the results of analysis with the standardized migration ratios confirm that, even after controlling for age-sex composition, foreign residents are more mobile than Japanese residents in terms of municipality-level migration rates. Higher mobility of foreign residents is observed particularly in the three major metropolitan areas (Kanto, Chukyo, and Kinki), where over 90 per cent of the municipalities are characterized by both higher in- and out-migration rates for foreign residents than Japanese residents. Distinctive patterns with a combination of higher in-migration and lower out-migration rates for foreign residents are observed at some of the small and rural municipalities located in non-metropolitan areas, particularly in western regions such as Shikoku and Kyushu. Relatively high in-migration rates for foreign residents in these municipalities, however, can be attributed mainly to inflows of foreign trainees under the Technical Intern Training Program, which is not aimed at facilitating the long-term settlement of foreign trainees. From a long-term and sustainability point of view, thus, the implications of these observations challenge the demographic role of foreign residents in mitigating depopulation and population ageing in these rural areas.

CO2 laser versus cold steel margin analysis following endoscopic excision of glottic cancer

ObjectiveTo compare the suitability of CO2 laser with steel instruments for margin excision in transoral laser microsurgery.MethodsProspective randomized blinded study. Patients with glottic cancer undergoing laser resection were randomized to margin excision by either steel instruments or CO2 laser. Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique.Results45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable. Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24).ConclusionLaser margin excision is associated with a greater degree of artifact than steel instrument excision, but was not associated with higher rate of uninterpretability.

Overcoming the Odds: Access to Care for Immigrant Children in Working Poor Families in California

To explore the extent to which, among working poor families, uninsured immigrant children experience more barriers to care than uninsured nonimmigrants, and compare these differences to those of insured children. We used data from the 2001 California Health Interview Survey, a randomized, population-based telephone survey conducted from November 2000 through September 2001. Financial and nonfinancial access to health care and utilization of health services were examined for 3,978 nonimmigrant and 462 immigrant children and adolescents under the age of 18 years. We compared differences in crude rates across four subgroups (insured immigrants, uninsured immigrants, insured nonimmigrants, uninsured nonimmigrants) and in adjusted models controlling for socioeconomic and immigration characteristics, parental language, health status, and other demographic factors. More immigrant than nonimmigrant children lacked health insurance at the time of the interview (44% vs. 17%, p < 0.0001). Among the uninsured, immigrants had higher odds of perceiving discrimination (11% vs. 5%, p < 0.05) and postponing emergency room (ER) (16% vs. 7%, p < 0.05) and dental care (40% vs. 30%, p < 0.05) after controlling for covariates. Among the insured, immigrants fared worse on almost every access and utilization outcome. Among insured immigrants, child and parent undocumented status and having a non-English-speaking parent contributed to missed physician and ER visits. Disparities in access and use remain for immigrant poor children despite public insurance eligibility expansions. Insurance does not guarantee equitable health care access and use for undocumented children. Financial and nonfinancial barriers to health care for immigrant children must be removed if we are to address disparities among minority children.

Ethnic Differences in Intimate Partner Violence in the U.S. General Population

This article reviews cross-sectional and longitudinal research on ethnic differences related to intimate partner violence (IPV) in the U.S. general population and the role of alcohol use and socioeconomic characteristics. Evidence indicates that significant ethnic differences exist in the prevalence of IPV. Although ethnic minorities report higher rates of IPV, differences in crude rates are reduced after controlling for socioeconomic circumstances and alcohol use. However, Black couples appear to be at greater risk of IPV than their White or Hispanic counterparts even after controlling for such risk factors. Overall, socioeconomic characteristics,demographic characteristics, and alcohol use appear to play important roles in the occurrence of IPV. These findings suggests that IPV continues to be a significant public health problem and represents an area of health disparity for ethnic minorities.

Canadian Study of Health and Aging: Study Description and Patterns of Early Cognitive Decline

The Canadian Study of Health and Aging (CSHA) is a national longitudinal study of the epidemiology of dementia in Canada. The CSHA also described patterns of disability, frailty and healthy aging. The study involved 10,263 people aged 65 or over, sampled representatively from the community and from long-term care institutions, and participants were interviewed and assessed clinically in 1991, 1996 and 2001. Over 200 papers have been published from the study; a brief summary of results is given. The current analyses provide descriptive statistics on patterns and correlates of early cognitive decline in the study cohort. Several salient findings emerged: almost half of this representative sample showed no cognitive decline over a 10-year period. Education showed a strong protective effect against decline, but not after age 80. There was little difference in crude rates of cognitive decline between men and women, but after adjustment for disability and cardiovascular risk factors, men showed a greater risk of decline, up to age 80. Among those who experienced cognitive decline, the extent of decline was predicted mainly by age, rather than by baseline cognitive scores. Among those who developed dementia, baseline tests were better able to predict Alzheimer’s disease than vascular dementia. Further analyses designed to elucidate these complex associations are described.