Differences In Time Trends Research Articles

Outpatient antibiotic use in Dutch infants after 10-valent pneumococcal vaccine introduction: a time-series analysis

ObjectiveThis population-based cohort study assesses the impact of switching from a 7-valent pneumococcal conjugate vaccine (PCV) to a 10-valent PCV on outpatient antibiotic use in Dutch infants, and whether geographical...

Sociodemographic differences in 10-year time trends of emotional and behavioural problems among adolescents attending secondary schools in Amsterdam, The Netherlands

Societal change in western societies may impact emotional and behavioural problems of adolescents. Firm epidemiological evidence of changes in emotional and behavioural problems during the last decade is lacking. Insight into secular changes in emotional and behavioural problems among adolescents from various sociodemographic groups is crucial for adequate and targeted policy making. Therefore, the purpose of this study was to examine 10-year time trends in emotional and behavioural problems among adolescents, and potential differences in time trends between sociodemographic groups. Analyses were based on annually repeated cross-sectional data including 56,159 multi-ethnic students (13–14 years old) in the second year of various levels of secondary education in Amsterdam, The Netherlands, using the internationally validated Strengths and Difficulties Questionnaire. In general, emotional and behavioural problems increased over a 10-year time period (i.e., relative increase of total difficulties by 19%). This increase was mainly due to an increase in hyperactivity/inattention problems, while peer-relationship problems decreased. Time trends differed somewhat by sex: total difficulties and emotional problems increased in girls but remained fairly stable in boys. In Amsterdam, emotional and behavioural problems in adolescents seemingly increased over time, especially hyperactivity/inattention problems. Further research is needed to clarify the underlying causes. We cannot totally exclude potential confounders underlying our findings. Our findings can inform policies to target health programs at sociodemographic groups at increased risk.

Improved access to health care in Massachusetts after 2006 Massachusetts Healthcare Reform Law is associated with a significant decrease in mortality among vascular surgery patients

BackgroundAccess to medical care, by adequate insurance coverage, has a direct impact on outcomes for patients undergoing vascular procedures. We evaluated in-hospital mortality for patients undergoing index vascular procedures before and after the Massachusetts Healthcare Reform Law (MHRL) in 2006, which mandated insurance for all Massachusetts residents, both in Massachusetts and throughout the United States. MethodsThe National Inpatient Sample was queried to identify patients undergoing interventions for peripheral arterial disease, carotid artery stenosis, and abdominal aortic aneurysms based on International Classification of Diseases, Ninth Revision, Clinical Modification procedural and diagnostic codes. The cohort was then divided into patients treated within Massachusetts (MA) and non-Massachusetts (NMA) hospitals. Two time intervals were examined: before (2003-2006, P1) and after the MHRL (2007-2011, P2). The primary outcome of interest included in-hospital mortality. Patients in MA and NMA hospitals were described in terms of demographics and presentation by time interval (P2 vs P1) compared using χ2 and t-tests. Weighted logistic regression with term modeling change in the odds ratio (OR) for P2 was performed to test and to estimate trends in mortality. Time (year of procedure) and region interactions were investigated by inclusion of time-region interactions in our analyses. Subgroup analysis was performed for P2 vs P1 among nonwhite, nonelderly, and low-income patients. ResultsWe identified 306,438 patients who underwent repair of abdominal aortic aneurysm, lower extremity bypass, or carotid endarterectomy in MA and NMA hospitals. MA hospital patients had an increase in both Medicaid and private insurance status after the MHRL (P1 = 2.6% and 21% vs P2 = 3.3% and 21.7%, respectively; P = .034). In-hospital mortality trended down for all groups across the entire study. In comparing P2 vs P1 trends, MA hospital odds of mortality per year was lowered by 26% (OR, 0.74; 95% confidence interval [CI], 0.56-0.99; P = .042) not seen in NMA hospitals (OR, 1.03; 95% CI, 0.97-1.09; P = .405). Time and region interaction terms indicated significant time trend difference in both unadjusted (P = .031) and adjusted (P = .033) analysis in MA hospitals not observed in NMA hospitals. This pattern continued when the samples were stratified by procedure. Patients undergoing vascular procedures in MA hospitals had a significantly lowered OR of mortality, with fewer patients presenting at late disease stages in P2 vs P1. Nonelderly patients in Massachusetts, who benefit from the Medicaid expansion provided by the MHRL, had a profound 92% drop in odds of mortality in P2 vs P1 (OR, 0.08; 95% CI, 0.010-0.641; P = .017) compared with the 14% drop in NMA (OR, 0.86; 95% CI, 0.709-1.032; P = .103). ConclusionsThe 2006 MHRL is associated with a decrease in mortality for patients undergoing index vascular surgery procedures in MA compared with NMA hospitals. This study suggests that governmental policy may play a key role in positively affecting the outcomes for patients.

Abstract TP296: Time Trends in Race-Ethnic Differences in Do-Not-Resuscitate Orders After Stroke

Introduction: Do-not-resuscitate (DNR) orders are common after stroke and have recently received increased attention. However, there has been little study of trends in DNR status. We investigated time trends in DNR use after stroke in a community with a large minority population. Methods: Cases of ischemic stroke (IS) or intracerebral hemorrhage (ICH) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) study from June 2007 through October 2016. Demographics, clinical characteristics, and DNR status were collected from medical charts by trained abstractors. Race-ethnic differences in DNR orders were assessed with logistic regression models and adjusted for potential confounders. Time trends were assessed with a linear term for time (years) and further explored with interaction terms between time and race-ethnicity or time and stroke type. Results: After excluding cases with missing DNR status and recurrent events, 2,860 cases were available. Mean age was 69 (range 45-102), 50% were female, and race-ethnicity was Mexican American (MA, 58%), non-Hispanic White (NHW, 37%), and African American (AA, 5%). Overall, 17% had a DNR order during the hospitalization. Time trends in DNR orders differed for IS and ICH (interaction p=0.04, see Table). However, change in DNR status over time within each stroke type was modest (non-significant increase over time for IS and non-significant decrease for ICH). MAs were less likely than NHWs to have DNR orders (p=0.007) There was no evidence of interaction between time and race-ethnicity (p=0.57), suggesting that the race-ethnic disparity is stable over time. Conclusions: Use of DNR orders after stroke has been largely stable over the past 10 years, with only slight differences in time trends comparing IS to ICH. Mexican Americans remain less likely than NHWs to use DNR orders after stroke with no evidence of change over time.

Ultra-low-dose Naloxone as an Adjuvant to Patient Controlled Analgesia (PCA) With Morphine for Postoperative Pain Relief Following Lumber Discectomy: A Double-blind, Randomized, Placebo-controlled Trial.

Lumbar discectomy is one of the most commonly performed neurosurgical procedures. Many patients experience postoperative pain after lumbar discectomy. This study evaluated the effect of ultra-low-dose naloxone infusion on pain intensity after lumbar discectomy in individuals receiving patient-controlled analgesia (PCA) with morphine. In a double-blind, randomized, controlled trial, a total of 80 patients scheduled for open discectomy was randomly assigned to receive naloxone (group N) or placebo (group P). After surgery, all patients were connected to a morphine PCA pump. Both groups received 500 mL of normal saline using a continuous infusion pump through a separate intravenous line for 24 hours. However, group N received a total dose of 0.25 μg/kg/h naloxone, which was added to the normal saline infusion. All patients were asked to grade the intensity of their pain, severity of nausea, vomiting, and pruritus on a 0 to 10 visual analog scale before being discharged from the postanesthesia care unit and at 1, 6, 12, and 24 hours postoperatively. It was observed that both groups had a statistically significant (P<0.01) time trend difference for pain, nausea, and pruritus scores. A significant difference was found between the 2 groups in terms of intensity of pain, nausea, and pruritus, with the naloxone group experiencing a lower level in comparison with the placebo group. Moreover, the median (interquartile range) of morphine consumption after surgery for patients who received naloxone was 26 (24.25 to 28) mg, which is significantly (P<0.001) lower than for the placebo group, which had a median (interquartile range) of 34 (32 to 36) mg. It is concluded that infusion of ultra-low-dose naloxone (0.25 μg/kg/h) along with morphine PCA can significantly reduce pain intensity, morphine consumption, and opioid-induced nausea and pruritus after lumbar discectomy.

Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel): changes in weighting methodology.

to introduce the methodology used to calculate post-stratification weights of the 2012 Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) and to compare the trends of indicators estimated by cell-by-cell weighting and raking methods. in this panel of cross-sectional studies, the prevalences of smokers, overweight, and intake of fruits and vegetables from 2006 to 2012 were estimated using the cell-by-cell weighting and raking methods. there were no differences in time trends of the indicators estimated by both methods, but the prevalence of smokers estimated by the raking method was lower than the estimated by cell-by-cell weighting, whilst the prevalence of fruit and vegetable intake was higher; for overweight, there was no difference between the methods. raking method presented higher accuracy of the estimates when compared to cell-by-cell weighting method, proving to be most convenient, although it presents register coverage bias.

Sex differences in time trends of blood pressure among Swedish septuagenarians examined three decades apart: a longitudinal population study.

The aim of this study was to analyze the influence of birth cohort, sex and age on the trajectories of SBP and DBP in two birth cohorts of 70-year-olds, examined 3 decades apart and followed up at ages 75 and 79-80 years. Two population samples of 70-year-olds from Gothenburg, Sweden, were examined. The first, born in 1901-1902, was examined in 1971-1972 (n = 973). The second, born in 1930, was examined in 2000 (n = 509). Both samples were re-examined at ages 75 and 79-80 years. We found that SBP and DBP were considerably lower in septuagenarian men and women born 1930 compared with those born 1901-1902, also when adjusting for antihypertensive treatment in different ways. The decline was especially pronounced in women. Blood pressure was higher in women than in men in the 1970s, whereas there were no sex differences in the 2000s. The age-related decline in SBP started earlier and was more accentuated in those born in 1930 than in those born in 1901-1902. Blood pressure decreased, and the age-related decline in SBP started earlier in septuagenarians examined in the 2000s compared with those examined in the 1970s. The decrease was especially pronounced in women and diminished the sex differences. Antihypertensive treatment only partly explained our findings, suggesting that other mostly unknown factors played an important role.

Medical Male Circumcision Is Associated With Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya

BackgroundTwo cohort studies using data from randomized controlled trials in Africa offer the best evidence to date on the effects of voluntary medical male circumcision (VMMC) on male sexual function and satisfaction, suggesting no significant impairments in sexual function or satisfaction and some improvements in sexual function after male circumcision. AimTo assess the effects of VMMC on sexual function and satisfaction in a large population-based cohort of men circumcised as adults and uncircumcised controls in Kenya. MethodsSexual function and satisfaction of young (median age = 20 years) sexually active men (1,509 newly circumcised men and 1,524 age-matched uncircumcised controls after 5% loss to follow-up) were assessed at baseline and 6, 12, 18, and 24 months, with data collected in 2008 to 2012. Self-reported data on lack of sexual interest or pleasure, difficulty getting or maintaining erections, orgasm difficulties, premature ejaculation, pain during intercourse, and satisfaction with sexual intercourse were analyzed with mixed-effect models to detect differences between circumcised and uncircumcised men and changes over time. OutcomesChanges over time in sexual interest, desire and pleasure, erectile and ejaculatory function, and pain during intercourse (dyspareunia) in circumcised and uncircumcised men; group differences in time trends; satisfaction with sexual performance; and enjoyment of sex before and after circumcision. ResultsSexual dysfunctions decreased in the two study groups from 17% to 54% at baseline to 11% to 44% at 24 months (P < .001), except dyspareunia, which decreased only in circumcised men (P < .001). Sexual satisfaction outcomes increased in the two study groups from 34% to 82% at baseline to 66% to 93% at 24 months (P < .001), with greater improvements in circumcised men (P < .001). On average, 97% of circumcised men were satisfied with sexual intercourse and 92% rated sex as more enjoyable or no different after circumcision compared with before circumcision. Clinical TranslationResults are applicable to VMMC programs seeking to increase the acceptability of male circumcision as part of comprehensive HIV prevention. Strengths and LimitationsLarge-scale population-based longitudinal data restricted to sexually active individuals and adjusted for differences in baseline levels of outcomes and potential confounders are used. The questionnaire used, although not a standardized survey instrument, includes all major domains of male sexual function and satisfaction used in the most common standardized tools. ConclusionsResults are consistent with large cohort studies of VMMC using data from randomized controlled trials and indicate that VMMC has no significant detrimental effect or might have beneficial effects on male sexual function and satisfaction for the great majority of men circumcised as adults.Nordstrom MPC, Westercamp N, Jaoko W, et al. Medical Male Circumcision Is Associated With Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya. J Sex Med 2017;14:601–612.

Historical occupational isocyanate exposure levels in two Canadian provinces

ABSTRACTIsocyanates such as toluene 2, 4-diisocyanate (TDI), methylene bisphenyl isocyanate (MDI), and hexamethylene diisocyanate (HDI) are known sensitizers and exposure to these chemicals can result in isocyanate-induced asthma—the leading cause of occupational asthma. A newly created exposure database was available containing occupational isocyanate measurements spanning 1981–1996 from Ontario and British Columbia (BC)—two of the largest provinces in Canada. The aim was to describe the historical measurements relative to exposure thresholds, ascertain differences in the data between provinces, and identify time trends. Descriptive statistics of the observations were summarized and stratified by isocyanate species and province. Chi-square tests and Student's t-test were performed to determine differences between provinces. To investigate time trends in the odds of a measurement exceeding the limit of detection (LOD) and time-weighted average (TWA), mixed effects logistic regression models were constructed. In total, 6,984 isocyanate measurements were analyzed, the majority of which were below the LOD (79%). Overall, 8.3% of samples were in excess of the 2014 TLV-TWA of 0.005 ppm. Comparing the two provinces, the proportion of samples exceeding the LOD and TLV-TWA was greater in BC for all isocyanate species. Differences in time trends were also observed between provinces—the odds of a sample exceeding the TLV-TWA decreased over time in the case of MDI (Ontario only), TDI (both Ontario and BC), and other isocyanates (BC only). Our finding that a majority of the exposure measurements was below the LOD is similar to that reported by others. Differences between provinces may be due the fact that isocyanates are classified as a designated substance in Ontario and must adhere to specific exposure control regulations. Limitations of the database, such as finite number of variables and measurements available until 1996 only, presents challenges for more in-depth analysis and generalization of results. An argument is made that a Canadian occupational exposure database be maintained to facilitate risk assessments as well as for occupational epidemiology research.

The Validity and Precision of the Comparative Interrupted Time-Series Design

We explore the conditions under which short, comparative interrupted time-series (CITS) designs represent valid alternatives to randomized experiments in educational evaluations. To do so, we conduct three within-study comparisons, each of which uses a unique data set to test the validity of the CITS design by comparing its causal estimates to those from a randomized controlled trial (RCT) that shares the same treatment group. The degree of correspondence between RCT and CITS estimates depends on the observed pretest time trend differences and how they are modeled. Where the trend differences are clear and can be easily modeled, no bias results; where the trend differences are more volatile and cannot be easily modeled, the degree of correspondence is more mixed, and the best results come from matching comparison units on both pretest and demographic covariates.

Female labor force participation and child education in India: evidence from the National Rural Employment Guarantee Scheme

We exploit the implementation of India’s National Rural Employment Guarantee Scheme to identify exogenous shifts in mothers’ labor force participation and its impact on their children’s educational outcomes. Using child level panel data, we find that a mother’s participation in the labor force increases her children’s time spent in school and leads to better grade progression. These results account for age cohort trends and for differences in time trends by initial levels of economic development at the district and sub-district levels. We find evidence of greater household decision-making power of working mothers as an explanation of our results. Jel codes: D1, I21, I38, J16

Red Cell Distribution Width (RDW) as a Prognostic Tool in Burn Patients.

Red cell distribution width (RDW) is associated with mortality in patients with certain diseases. However, the relationship between RDW and burn patients remains unknown. The objective of this study was to evaluate the diagnostic and prognostic performance of RDW. Data of 149 patients admitted to the Burn ICU of the Changhai Hospital were retrospectively included in this study. Clinical and laboratory information of all subjects was extracted from medical records. This study demonstrated that: 1) burn patients with higher RDW had increased mortality, third-degree burn, total burn surface area (TBSA), length of hospital stay, infection rate, WBC, temperature, and CRP; 2) TBSA and length of hospital stay were positively correlated with RDW. 3) RDW levels were higher in burn patients with infection than non-infected burn patients. 4) There were differences in time trend of RDW between survivors and non-survivors from burns. RDW can provide useful information about burn severity and outcome. It may be used as a monitoring index for the illness of burn.

Abstract B2-09: A systems biology approach to understanding estrogen responsiveness in breast cancer cells using the MCF7 model

Abstract Estrogen receptor alpha (ER) is expressed in 70% of breast cancers and is critical for breast cancer cell proliferation, differentiation, and apoptosis. ER functions primarily as a nuclear transcription factor that dimerizes upon binding of the natural ligand, 17beta estradiol (E2). ER is a potent regulator of gene expression, altering the transcriptome, and ultimately both the proteome and metabolome. In the clinic, ER+ tumors are often treated with antiestrogens or aromatase inhibitors. However, resistance to these endocrine therapies is common, and there is an urgent need to understand how estrogen signaling contributes to the malignancy of breast cancer cells. The MCF7 ER+ breast cancer cell line is a commonly used cell model to study estrogen responsiveness in ER+ breast cancers. However, the field lacks a clear and detailed description of all the changes that occur in response to E2 by time and dose in MCF7 cells. Additionally, there is a great need to obtain a consistent view of the estrogen-regulated gene set, resolve the disconnections among epigenetics regulation of estrogen signaling and protein phosphoproteomics, and provide reliable metabolomics data sets for MCF7 cells. In this multi-institutional project, we have generated multi-omics data and cell cycle profile for MCF7 cells treated with 1 pM and 1 nM of E2 for 26-time points, 0 to 72 h. MCF7 cell line was obtained from American Type Culture Collection (ATCC), fingerprinted and confirmed for E2 and Tamoxifen sensitivity prior to omics studies. Moreover, ER expression (basal and with E2 stimulation) was determined using Western blotting and qPCR. Omics data generated include: RNA-seq (coding and non-coding), reverse phase protein array (RPPA; proteins and phospho-proteins), methylome analysis, cell cycle analysis and metabolomics (metabolites). Using our data sets, comprehensive responses to physiologically relevant E2 concentrations, including both rapid and long-term E2 responses, can be determined. Our data were processed using current best practices and the time trends for the 1 pM and 1 nM doses of E2 were assessed via linear models separately for the various omics features. Global differences between samples were further assessed via principal components analysis. The features which showed the most significant differences in time trends between the two dose groups were visualized as heatmaps. The objective of this study is to provide our data and discoveries as a common resource for the systems biology centers and the broader research community. A multi-dimensional dataset such as our will enable the development of dynamic network model(s) to interrogate estrogen signaling, from nucleic acids to proteins, with changes in the MCF7 metabolome. Citation Format: Ayesha N. Shajahan-Haq, Lang Li, Yunlong Liu, Lu Jin, David F. Miller, Jay Pilrose, Amrita K. Cheema, Simina M. Boca, Krithika Bhuvaneshwar, Subha Madhavan, Robert Clarke, Kenneth P. Nephew. A systems biology approach to understanding estrogen responsiveness in breast cancer cells using the MCF7 model. [abstract]. In: Proceedings of the AACR Special Conference on Computational and Systems Biology of Cancer; Feb 8-11 2015; San Francisco, CA. Philadelphia (PA): AACR; Cancer Res 2015;75(22 Suppl 2):Abstract nr B2-09.

Global variations and time trends in the prevalence of childhood myopia: a systematic review and meta-analysis

BackgroundEthnic and geographical differences in prevalence of childhood myopia seem to have changed over time. We aimed to quantify the variation in prevalence of childhood myopia over time, accounting for demographic and study design factors. MethodsPopulation-based surveys of myopia prevalence published in English were identified from a combination of text words for myopia (short$sight*/myopi?/myope$/refractive error$/ocular refraction), childhood (child/childhood/children/adolescent/adolescence/teenage), epidemiology (incident/incidence/prevalen*/population$/survey$) combined with the related subject headings in Medline (from Jan 1, 1950, to Feb 16, 2015), Embase (Jan 1, 1980, to Feb 16, 2015), and Web of Science (Jan 1, 1970, to Feb 16, 2015). Bayesian multilevel binomial logistic regression analyses of log-odds of myopia provided mutually adjusted associations for age, ethnicity, sex, urban versus rural setting, survey year, and study design factors. Findings143 articles (374 349 participants aged 6 months to 18 years, 74 847 cases of myopia) reported age-specific prevalence of childhood myopia in 42 countries representing nine ethnic groups between 1958 and 2014. Increase in myopia prevalence with age varied by ethnicity. East Asians showed the highest prevalence at all ages, reaching 69% (95% credible interval [CrI] 61–77) at 15 years of age (86% [79–91] among Singaporean-Chinese). In Africa, blacks had the lowest prevalence (5·5% at 15 years [3·1–9·0]). Whites had the highest prevalence at 15 years (16·7%, 10·6–24·5). Time trends in myopia prevalence were stable in whites, and increased by 23% per decade in East Asians (odds ratio 1·23, 95% CrI 1·00–1·55), with no clear evidence of time trends in other ethnic groups. In all ethnic groups, children from urban environments were more than twice as likely to be myopic as those from rural environments (2·61, 1·79–3·86). In whites and East Asians, sex differences emerged at about 9 years of age; by late adolescence girls were twice as likely as boys to be myopic. InterpretationMarked ethnic differences in age-specific prevalence of myopia exist, with significant increases in prevalence over time in East Asians. An urban environment seems to be universally associated with a high risk of myopia. Findings suggest that environmental factors have an important role in explaining ethnic variations in myopia prevalence and differences in time trends. FundingBUPA foundation.

Disability, Poverty, and Material Hardship since the Passage of the ADA.

The past 25 years have seen an unprecedented expansion in formal civil rights for people with disabilities that, among other things, was predicted to improve their economic well-being. Studies of economic well-being among people with disabilities have traditionally focused on employment and earnings, despite the fact that a minority of people with disabilities are employed. More recent literature has expanded to include measures of income poverty and material hardship, but has not examined trends in these dimensions of economic well-being over time or across different groups of people with disabilities. The current study uses nationally representative data covering the 1993-2010 period to examine trends over time in cross-sectional and dynamic measures of income poverty, and multiple dimensions of material hardship. It also describes differences in time trends by education, sex, race/ethnicity, and employment status among people with disabilities in income poverty and any material hardship. Levels of both material hardship and income poverty are high across the entire period for all groups, but while material hardship remains at the same level between 1993 and 2010, income poverty declines. These findings show that there has been little improvement over the past two decades in the economic well-being of people with disabilities, and additional research is needed to understand the mechanisms that keep even groups that are relatively privileged - college graduates and full-time, full-year workers - at very low levels of economic well-being.

CYP2A6 Longitudinal Effects in Young Smokers.

The present study sought to identify time-dependent within-participant effects of CYP2A6 genotypes on smoking frequency and nicotine dependence in young smokers. Predicted nicotine metabolic rate based on CYP2A6 diplotypes (CYP2A6 diplotype predicted rate [CDPR]) was partitioned into Normal, Intermediate, and Slow categories using a metabolism metric. Growth-curve models characterized baseline and longitudinal CDPR effects with data from eight longitudinal assessments during a 6-year period (from approximately age 16-22) in young smokers of European descent (N = 296, 57% female) who had smoked less than 100 cigarettes lifetime at baseline and more than that amount by Year 6. Phenotypes were number of days smoked during the previous 30 days and a youth version of the Nicotine Dependence Syndrome Scale (NDSS). A zero-inflated Poisson growth-curve model was used to account for the preponderance of zero days smoked. At baseline, Intermediate CDPR was a risk factor relative to both Normal and Slow CDPR for smoking frequency and the NDSS. Slow CDPR was associated with the highest probability of smoking discontinuation at baseline. However, due to CDPR time trend differences, by young adulthood these baseline effects had been reordered such that the greatest risks for smoking frequency and the NDSS were associated with Normal CDPR. Reduced metabolism CYP2A6 genotypes are associated with both risk and protective effects in novice smokers. However, differences in the time-by-CDPR effects result in a reordering of genotype effects such that normal metabolism becomes the risk variant by young adulthood, as has been reliably reported in older smokers.

Decisions, decisions: the importance of condom use decision making among HIV sero-discordant couples in a prospective cohort study in Uganda

ObjectivesWe examined sexual decision making type among couples in HIV sero-discordant partnerships in Uganda, and investigated how sexual decision making type changed over time and its effect on condom use.MethodsData...

National Trends in Second-Generation Antipsychotic Augmentation for Nonpsychotic Depression

This study estimates national trends and patterns in use of second-generation antipsychotics (SGAs) for adjunctive treatment of nonpsychotic adult depression in office-based practice. Twelve consecutive years (1999-2010) of the National Ambulatory Medical Care Survey were analyzed to estimate trends and patterns of adjunctive SGA treatment for adult (≥ 18 years) nonpsychotic depression in office-based visits. Adjunctive SGA use was examined among all office visits in which depression was diagnosed (N = 7,767), excluding visits with diagnoses for alternative SGA indications (schizophrenia, bipolar disorder, pervasive development disorder, psychotic depression, dementia) and those without an active antidepressant prescription. From 1999 to 2010, 8.6% of adult depression visits included an SGA. SGA use rates increased from 4.6% in 1999-2000 to 12.5% in 2009-2010, with an adjusted odds ratio (AOR) for time trend of 2.78 (95% CI, 1.84-4.20). The increase in SGA augmentation was broad-based, with no significant differences in time trends between demographic and clinical subgroups. For the most recent survey years (2005-2010), SGA use rates were higher in visits to psychiatrists than to other physicians (AOR = 5.08; 95% CI, 2.96-8.73), visits covered by public than private insurance (AOR = 3.20; 95% CI, 2.25-4.54), visits with diagnosed major depressive disorder than other depressive disorders (AOR = 1.49; 95% CI, 1.08-2.06), and visits with diabetes, hyperlipidemia, or cardiovascular disease (AOR = 2.13; 95% CI, 1.12-4.03) and lower in visits by patients > 65 years than 18-44 years (AOR = 0.51; 95% CI, 0.32-0.82) and visits that included psychotherapy (AOR = 0.68; 95% CI, 0.47-0.96). Between 1999 and 2010, SGAs were increasingly accepted in the outpatient treatment of adult nonpsychotic depression.

Informing Women on Menopause and Hormone Therapy: Know the Menopause a Multidisciplinary Project Involving Local Healthcare System

BackgroundHormone therapy (HT) in the menopause is still a tricky question among healthcare providers, women and mass media. Informing women about hormone replacement therapy was a Consensus Conference (CC) organized in 2008: the project Know the Menopause has been launched to shift out the results to women and healthcare providers and to assess the impact of the cc’s statement. Methods And Findings: The project, aimed at women aged 45-60 years, was developed in four Italian Regions: Lombardy, Tuscany, Lazio, Sicily, each with one Local Health Unit (LHU) as “intervention” and one as “control”. Activities performed were: survey on the press; training courses for health professionals; educational materials for target populations; survey aimed at women, general practitioners (GPs), and gynaecologists; data analysis on HT drugs’ prescription. Local activities were: training courses; public meetings; dissemination on mass media. About 3,700 health professionals were contacted and 1,800 participated in the project. About 146,500 printed leaflets on menopause were distributed to facilitate the dialogue among women and health care professionals. Training courses and educational cascade-process activities: participation ranged 25- 72% of GPs, 17-71% of gynaecologists, 14-78% of pharmacists, 34-85% of midwives. Survey: 1,281 women interviewed. More than 90% believed menopause was a normal phase in life. More than half did not receive information about menopause and therapies. HT prescription analysis: prevalence fell from 6% to 4% in five years. No differences in time trends before-after the intervention. Major limitations are: organizational difficulties met by LHU, too short time for some local activities.ConclusionsA huge amount of information was spread through health professionals and women. The issue of menopause was also used to discuss women’s wellbeing. This project offered an opportunity to launch a multidisciplinary, multimodal approach to menopause looking not only at pharmacological aspects, but also at quality of life and information.

Introduction of Laser Technology and Procedure Use for Benign Prostatic Hyperplasia: Data from Florida

To examine the association of laser technology adoption in a market with surgery rates for benign prostatic hyperplasia. Using the Florida files from the State Ambulatory and Inpatient Surgery Databases (2001-2009), we identified all patients who underwent transurethral surgery for benign prostatic hyperplasia. We calculated rates of benign prostatic hyperplasia surgery for all markets within the state (defined by Hospital Service Area) over time. Markets were split into 3 categories: (1) Always offering, (2) never offering, or (3) initially not offering but adopting laser prostatectomy after 2001. We used multivariable regression models to estimate surgery rates adjusted for other market characteristics. Interaction terms were included in the models to examine differences in time trends between market categories. After adjusting for market characteristics, time trends differed by market category (P < .001). Surgery rates decreased from 318 to 248 procedures per 100,000 men in markets always offering laser prostatectomy (P < .001). Markets never offering laser surgery had much lower rates that remained stable (180-187 procedures per 100,000 men, P = .805). In markets adopting laser technology, rates increased from 268 to 296 procedures per 100,000 men after adoption (P = .044), such that 4 years after adoption these markets had the highest rates among the 3 categories. Adoption of laser technology is associated with rising rates of surgical intervention for benign prostatic hyperplasia. This trend appears to be induced by the introduction of laser surgery.