National Population Database Research Articles

PRECIOUS study (PREterm Caesarean/vaginal birth and IVH/OUtcomeS): does mode of birth reduce the risk of death or brain injury in very preterm babies? A cohort and emulated target trial protocol

IntroductionVery preterm babies are at risk of poor neurodevelopmental outcomes and death. Intraventricular haemorrhage (IVH) after birth is the most prevalent cause of this. Birth by caesarean section may protect...

Regular HbA1c examination and health outcomes in adult patients with type 2 diabetes in South Korea: A retrospective cohort study.

Concerns have been raised about the effectiveness of using process-centered indicators to assess the quality of diabetes care in Korea. This study aims to examine the factors influencing the performance of regular HbA1c testing and to explore its association with health outcomes, including hospitalization and mortality. We utilized a retrospective cohort design with a 4-year follow-up period, involving 159,452 adult patients newly diagnosed with type 2 diabetes (E11 in International Classification of Diseases, 10th Edition) in 2011. We established a national population database by merging the Korea National Health Insurance (KNHI) claims database and the KNHI Qualification Database of South Korea. The proportion of diabetic patients who underwent regular HbA1c testing at least once a year in the first 3 years was determined to be 33.8%. In comparison, patients who did not receive regular tests during the same period exhibited significantly increased odds of hospitalization (diabetes/CVD/renal, OR, 1.23, 95% CI, 1.12-1.34; diabetes, OR, 1.36, 95% CI, 1.17-1.57). Additionally, this nonpatient group experienced a higher risk of mortality (OR: 1.56, 95% CI: 1.36-1.80). This study supports the positive impact of regular HbA1c testing on health outcomes for individuals with type 2 diabetes. To increase the current 33% rate of regular HbA1c testing, developing patient-customized management policies is essential. Priority should be given to diabetic patients aged 65 or older, living in rural areas, and those belonging to low-income families (medical aid).

Implementasi Kebijakan Pembuatan Kartu Tanda Penduduk Elektronik di Dinas Kependudukan dan Catatan Sipil Kabupaten Malinau

The implementation of the electronic identity card (KTP-el) is part of an effort to accelerate and support the accuracy of the population data base in the district/city, province and national population data base. This research aims to analyze the implementation of the electronic identity card policy at the Population and Civil Registration Office of Malinau Regency and analyze the factors that support and hinder the implementation of the electronic identity card policy program at the Population and Civil Registration Office of Malinau Regency. This research was conducted using descriptive qualitative methods. The results showed that the Implementation of the Electronic Identity Card (KTP-el) Policy at the Population and Civil Registration Office of Malinau Regency has gone well. However, there are still obstacles in the process of recording and printing KTP-el that need to be overcome. There needs to be additional training and technical guidance to improve the knowledge of the apparatus in carrying out the system and policies that have been set.

Obstetric and neonatal outcomes among pregnant patients with cystic fibrosis

ObjectiveThe pregnancy, delivery, and neonatal outcomes of pregnancies complicated by cystic fibrosis (CF) have yet to be evaluated in a prolonged, population-based study. We sought to evaluate the obstetric and neonatal outcomes in pregnant patients with CF using a national population database. Study DesignRetrospective population-based cohort study utilizing the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). All women who delivered or had a maternal death in the US (2004–2014) were included in the study. Pregnancy, delivery, and neonatal outcomes were compared between women with an ICD-9 diagnosis of cystic fibrosis to those without. ResultsOverall, 9 096 159 women met the inclusion criteria. Of these, 629 women (6.9/100000) had CF. Women with CF were more likely to be younger and have pregestational diabetes mellitus compared to those without. CF in pregnancy was associated with an increased risk of developing gestational diabetes mellitus [aOR 3.20 (95 %CI 2.48–4.15), p = 0.0001], placenta previa [aOR 2.74 (95 %CI 1.30–5.79), p = 0.008], preterm delivery [aOR 2.17 (95 %CI 1.71–2.77), p = 0.0001], operative vaginal delivery [aOR 1.59 (95 %CI 1.17–2.16), p = 0.003], and death [aOR 86.41 (95 %CI 30.91–241.58), p = 0.0001], and a decreased likelihood of having a spontaneous vaginal delivery [aOR 0.80 (95 %CI 0.66–0.97), p = 0.02]. Patients with CF were more likely to experience deep venous thrombosis [aOR 7.64 (95 %CI 1.90–30.72), p = 0.004] and disseminated intravascular coagulation [aOR 3.68 (95 %CI 1.37–9.87), p = 0.01] compared to those without. The risk of delivering a fetus with congenital anomalies was similar between groups. ConclusionPregnant patients with CF have an increased risk of developing adverse maternal and delivery outcomes. As such, these patients should receive vigilant surveillance during pregnancy.

Protective effects of statins on the incidence of NAFLD-related decompensated cirrhosis in T2DM.

Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome and poses a significant threat to patients with type 2 diabetes mellitus (T2DM) and metabolic dysregulation. Statins exert anti-inflammatory, antioxidative and antithrombotic effects that target mechanisms underlying NAFLD. However, the protective effects of the different doses, intensities and types of statins on the incidence of NAFLD-related decompensated liver cirrhosis (DLC) in patients with T2DM remain unclear. This study used the data of patients with T2DM who were non-HBV and non-HCV carriers from a national population database to examine the protective effects of statin use on DLC incidence through propensity score matching. The incidence rate (IR) and incidence rate ratios (IRRs) of DLC in patients with T2DM with or without statin use were calculated. A higher cumulative dose and specific types of statins, namely rosuvastatin, pravastatin, atorvastatin, simvastatin and fluvastatin, reduced the risk of DLC in patients with T2DM. Statin use was associated with a significant reduction in the risk of DLC (HR: .65, 95% CI: .61-.70). The optimal daily intensity of statin use with the lowest risk of DLC was .88 defined daily dose (DDD). The results revealed the protective effects of specific types of statins on DLC risk in patients with T2DM and indicated a dose-response relationship. Additional studies are warranted to understand the specific mechanisms of action of different types of statins and their effect on DLC risk in patients with T2DM.

Mortality rate and its determinants among people with dementia receiving home healthcare: a nationwide cohort study.

People with dementia (PwD) who receive home healthcare (HHC) may have distressing symptoms, complex care needs and high mortality rates. However, there are few studies investigating the determinants of mortality in HHC recipients. To identify end-of-life care needs and tailor individualized care goals, we aim to explore the mortality rate and its determinants among PwD receiving HHC. We conducted a retrospective cohort study using a Taiwanese national population database. People with new dementia diagnosis in 2007-2016 who received HHC were included. We calculated the accumulative mortality rate and applied Poisson regression model to estimate the risk of mortality for each variable (adjusted risk ratios, aRR) with a 95% confidence interval (CI). We included 95,831 PwD and 57,036 (59.5%) of them died during the follow-up period (30.5% died in the first-year). Among comorbidities, cirrhosis was associated with the highest mortality risks (aRR 1.65, 95% CI 1.49-1.83). Among HHC-related factors, higher visit frequency of HHC (> 2 versus ≦1 times/month, aRR 3.52, 95% CI 3.39-3.66) and higher level of resource utilization group (RUG, RUG 4 versus 1, aRR = 1.38, 95% CI 1.25-1.51) were risk factor of mortality risk. Meanwhile, HHC provided by physician and nurse was related to reduced mortality risk (aRR 0.79, 95% CI 0.77-0.81) compared to those provided by nurse only. Anticipatory care planning and timely end-of life care should be integrated in light of the high mortality rate among PwD receiving HHC. Determinants associated with increased mortality risk facilitate the identification of high risk group and tailoring the appropriate care goals. Trial registration number: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.

COVID-19 outbreak rates and infection attack rates associated with the workplace: a descriptive epidemiological study

ObjectivesA large number of COVID-19 outbreaks/clusters have been reported in a variety of workplace settings since the start of the pandemic but the rate of outbreak occurrence in the workplace...

O-271 The impacts of intracytoplasmic sperm injection on the neurodevelopmental disorders in offspring with male or female infertility parents: a national population cohort study in Taiwan

Abstract Study question This study aims to evaluate whether ICSI intervention in male or female infertility will increase the risks of neurodevelopmental disorders in offspring or not. Summary answer ICSI increases the risks of autism spectrum disorder and delayed developments in offspring with female infertility but has no impact on male infertility. What is known already Damaged sperm has been proved to change epigenetics and increase the genome instability in early embryogenesis. It might also affect the offspring’s health, such as neurodevelopmental disorders. ICSI is the most common procedure in assisted reproductive technology. It is used not only in male infertility but also in female infertility. Several studies have advocated the potential risks of epigenetic alternation in embryos and neurodevelopmental disorders in the offspring. However, there is no conclusion to determine the risk of ICSI in the offspring’s health. Neurodevelopmental disorders are associated with epigenetic alterations such as ASD, ADHD, DD. Study design, size, duration Patients were collected between January 2008 and December 2016 in the national report of the ART database and the national population database in Taiwan. The inclusion criteria were singleton, infertility parents with fresh embryos transfer, and embryos without invasion procedure except for ICSI. The exclusion criteria were donated eggs or sperms. The follow-up time started from birth to December 2018. Participants/materials, setting, methods In total, 1,580,267 singletons were conducted in this study. They were divided into three groups: female infertility, male infertility, and spontaneous conception. Inverse probability of treatment weighting was used to lower the bias among the study groups. The covariate factors include maternal age, obstetrics risk factors, pregnancy complications, and parental psychiatric disorders. The offspring outcome includes ADHD, ASD, and DD. The result was analyzed with multivariate regression. The value of P < 0.05 is significant. Main results and the role of chance Offspring with male infertility showed to increase risk of ADHD (attention deficit and hyperactivity disorder) compared to spontaneous conception (Hazard ratio 1.76, 95% CI 1.03-3.02, p = 0.0389). There was no increased risks of ADHD, ASD (autism spectrum disorder), and DD (delayed developments) in offspring with female infertility compared to spontaneous conception. We further analyzed the impact of ICSI on offspring’s neurodevelopmental disorders. In singletons with male infertility, the risk of ADHD increased in offspring without ICSI intervention compared to spontaneous conception and male infertility with ICSI intervention (Hazard ratio 3.88, 95% CI 1.56-9.62, p = 0.0252) In newborns with female infertility, the risk of ASD and DD increased in offspring with ICSI intervention compared to spontaneous conception and female infertility without ICSI intervention. (ASD: hazard ratio 2.50, 95% CI 1.33-4.70, p = 0.0157; DD: hazard ratio 1.59, 95% CI 1.13-2.24, p = 0.0142) We also found the risks of neurodevelopmental disorders were higher in boys than girls. Preterm infants had increased risks of neurodevelopmental disorders than full-term infants. Limitations, reasons for caution This study had several limitations, such as the severity of sperm, the quality of embryos, and various laboratory conditions. However, we have tried to lower the potential cofactors such as maternal age, pregnancy complications, risk factors during pregnancy and labor, and psychiatric disorders in parents. Wider implications of the findings ICSI is widely used in female infertility to achieve pregnancy. However, our preliminary data shows that ICSI in female infertility increases the risk of neurodevelopmental disorders in offspring. This finding implies that we should pay attention on when using ICSI in female infertility couples. Trial registration number KMUHIRB-E(II)-20200217

Health services utilization and cost of abusive head trauma in Taiwan: A population-based retrospective matched cohort study

BackgroundAbusive head trauma (AHT) is a serious health problem that results the highest mortality among children who are maltreated. Many AHT survivors suffer from long-term sequelae and require medical treatment. However, the knowledge of AHT-attributable health services utilization and costs at national level are limited. ObjectiveTo estimate health services utilization and costs attributable to AHT among children aged 0–4 years in Taiwan. Participants and settingSixty-three fatal and 664 survival AHT cases were identified using Taiwan national population database between 2003 and 2015. A total of 2656 non-AHT children were exactly 4:1 matched to the survival cases based on their birth year, gender, the calendar year of the index date, insured location, and health insurance premium (social economic status indicator). MethodsHealth services utilization and costs were calculated on an annual basis for 3 years after the index date. AHT-attributable health services utilization and costs during 3-year follow-up period was evaluated by regression models. ResultsAHT diagnosis was positively associated with inpatient admissions, length of stay, emergency room (ER) visits, and outpatient visits. AHT-attributable medical costs were 1.64–17.27 times, 1.25–5.22 times, and 1.77–2.36 times greater for inpatient, ER, and outpatient during 3-year period than matched controls, respectively. Fatal AHT cases had higher inpatient utilization and greater medical costs than AHT survivors. ConclusionsChildren with AHT had greater health services utilization and higher costs for years. Strategies to reduce the burden of AHT on health care system are imperative.

Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.

Both health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and interaction of race and insurance with CC treatment disparities. Retrospective cohort review of a prospective hospital-based database. In this cross-sectional study, patients diagnosed with stage I to III CC in the United States were identified from the National Cancer Database (NCDB; 2006 to 2016). Multivariable regression with generalized estimating equations (GEEs) were performed to evaluate the association of insurance and race/ethnicity with odds of receipt of surgery (stage I to III) and adjuvant chemotherapy (stage III), with an additional 2-way interaction term to evaluate for effect modification. Confounders included sex, age, median income, rurality, comorbidity, and nodes and margin status for the model for chemotherapy. Of 353,998 patients included, 73.8% (n = 261,349) were non-Hispanic White (NHW) and 11.7% (n = 41,511) were non-Hispanic Black (NHB). NHB patients were less likely to undergo resection [odds ratio (OR) 0.66, 95% confidence interval [CI] 0.61 to 0.72, p < 0.001] or to receive adjuvant chemotherapy [OR 0.83, 95% CI 0.78 to 0.87, p < 0.001] compared to NHW patients. NHB patients with private or Medicare insurance were less likely to undergo resection [OR 0.76, 95% CI 0.63 to 0.91, p = 0.004 (private insurance); OR 0.59, 95% CI 0.53 to 0.66, p < 0.001 (Medicare)] and to receive adjuvant chemotherapy [0.77, 95% CI 0.68 to 0.87, p < 0.001 (private insurance); OR 0.86, 95% CI 0.80 to 0.91, p < 0.001 (Medicare)] compared to similarly insured NHW patients. Although Hispanic patients with private and Medicare insurance were also less likely to undergo surgical resection, this was not the case with adjuvant chemotherapy. This study is mainly limited by the retrospective nature and by the variables provided in the dataset; granular details such as continuity or disruption of insurance coverage or specific chemotherapy agents or dosing cannot be assessed within NCDB. This study suggests that racial disparities in receipt of treatment for CC persist even among patients with similar health insurance coverage and that different disparities exist for different racial/ethnic groups. Changes in health policy must therefore recognize that provision of insurance alone may not eliminate cancer treatment racial disparities.

Early unplanned readmissions following same-admission cholecystectomy for acute biliary pancreatitis.

Same-admission cholecystectomy (CCY) is recommended for mild acute biliary pancreatitis (biliary-AP). However, there is a paucity of research investigating reasons for early (30-day) unplanned readmissions in patients who undergo CCY for biliary-AP. Hence, we sought to investigate this gap using a large population database. Using the Nationwide Readmission Database (2010-2014), we identified all adults (age ≥ 18years) with a principal diagnosis of biliary-AP who had undergone CCY during the index hospitalization. Multivariable logistic regression models were obtained to assess independent predictors for 30-day readmission. Principal diagnosis for all readmissions was collected to ascertain the indications for early readmission. During the study period, 118,224 patients underwent same-admission CCY for biliary-AP. Three-fourths of all patients underwent invasive cholangiography during the hospitalization (intraoperative cholangiogram (IOC) = 57,038, ERCP = 31,500). The rate of early (30-day) readmission was 7.25% (n = 8574). Exacerbation of prior medical conditions (42.2%), sequelae of biliary-AP (resolving and recurrent pancreatitis, pseudocysts) (27.6%), surgical site and other postoperative complications (16%), choledocholithiasis and/or bile leak (9.6%), and preventable hospital-acquired conditions (4.6%) accounted for early readmissions. On multivariable analysis, predictors for readmission included male sex (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08-1.28), insurance type (Medicare insurance [OR 1.26, 95% CI 1.13-1.40]; Medicaid [OR 1.22, 95% CI 1.09-1.38]), outside-facility discharge (OR 1.35, 95% CI 1.16-1.57), severe AP (OR 1.35, 95% CI 1.21-1.50), and ≥ 3 Elixhauser comorbidities (OR 1.55, 95% CI 1.41-1.69). Performance of IOC (OR 0.90, 95% CI 0.82-0.97) and ERCP (OR 0.81, 95% CI 0.73-0.89) were associated with decreased risk of early readmission. In this study, using a national population database evaluating patients who underwent same-admission CCY after biliary-AP, we identified potentially modifiable risk factors and causes for early readmission as well as opportunities to improve clinical care.

Psoriasis Is Associated With an Increased Risk of Hospitalization for Systemic Lupus Erythematosus: Analysis of the National Inpatient Sample Database.

Background: There is a scarcity of literature on co-existing psoriasis (Ps) and systemic lupus erythematosus (SLE). We used a large national population database to determine if there is any association between Ps and SLE. The primary objective was to compare the odds of being admitted for SLE in patients with Ps compared to those without Ps. The secondary objective was to compare hospital outcomes of patients admitted for SLE with co-existing Ps to those without Ps.Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Databases. We search for hospitalizations using ICD-10 codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders.Results: There were over 71 million discharges included in the database. A total of 20,630 hospitalizations had SLE as the principal diagnosis. One hundred fifty (0.7%) of these SLE hospitalizations have co-existing Ps. Hospitalizations for SLE with co-existing Ps had similar length of stay (LOS), total hospital charges, need for blood transfusion, odds of having a secondary discharge diagnosis of venous thrombosis or embolism/pulmonary embolus, and acute kidney injury compared to those without Ps. Hospitalizations with a secondary diagnosis of Ps have an adjusted odds ratio (AOR)=2.73 (95% CI 1.86-4.02, P<0.0001) of SLE being the principal reason for hospitalization compared to hospitalizations without Ps.Conclusion: In our study, patients with Ps had almost three times the odds of being admitted for SLE compared to non-Ps patients. However, Ps patients admitted for SLE had similar hospital outcomes compared to non-Ps patients admitted for SLE.

Analisis Antrian pada Loket Pembuatan Elektronik KTP dengan Menggunakan Simulasi Promodel

E-KTP or Electronic KTP is a population document that contains a system of security / control both in terms of administration or information technology based on the National population database. Kelurahan is one of the places visited by residents to make the E-KTP. But the high enthusiasm of the population to renew their KTPs, problems arose. The problem that occurs is a long queue occurs in several regions. Lack of information dissemination between officers and residents and systematic scheduling to the community resulting in services being less effective. The results of the data and analysis studies that have been carried out using Student Version 6.0 can be found that the pattern of population arrivals is Poisson distribution while the service time is exponentially distributed. The simulation output of utility level models from service facilities with the average percentage of teller utilities is 62.55% and the average waiting time of 12.71 minutes per person. Therefore it can be concluded that the queuing system that is long enough and the utility is low in the Kelurahan makes the services obtained by the population not optimal. Supposedly by increasing the queue window, systematic scheduling, and supporting facilities such as counseling the latest services can help overcome the duration of the population queuing. So that the proposal for the improvement of the system is very intended for Kebon Pala Village, in order to improve the quality of services that are more adequate so that residents feel satisfied with the service facilities provided and can minimize the time in line.

Study protocol: optimising newborn nutrition during and after neonatal therapeutic hypothermia in the United Kingdom: observational study of routinely collected data using propensity matching

IntroductionTherapeutic hypothermia is standard of care for infants born ≥36 weeks gestation with hypoxic ischaemic encephalopathy (HIE); consensus on optimum nutrition during therapeutic hypothermia is lacking. This results in variation...

Effectivity Of Single Identity Number (SIN) In Implementation Of KTP Electronic

One of the problems that are now emerging and intractable associated with the development of information systems in various institutions / agencies in Indonesia is the heterogeneity of the network , hardware , OS , programming language , developers , database , and the number of unique identity number used . Project -based e-ktp card valid SIN who are expected to be nationally significant improvement steps. Development of information system of e-ktp card equipped with occupancy database that stores the database associated with the identity of every citizen over the age of 17 years and / or married. Various attempts have been made , among others, introduced the concept of a Single Identity Number ( SIN ) . SIN is a unique number that is integrated in the identity card of a citizen . SIN and identity cards will form a national population database that can be the only reference to a variety of public service applications . ( http://news.viva.co.id/ ) This study wants to assess the effectiveness of the application of komprehansif about single identity number ( SIN ) in the implementation of e -ktp card to realize good governance The target of this study is to examine the effectiveness of the application of single identity number ( SI ) , and examines how the implementation of e-ktp model using kosep single identity number is implemented . In this study the authors used a qualitative approach . As for the data collection was done with a quick survey , indept interview and observation . Results: policy and regulatory support required to realize the national population database as a prerequisite for good governance . In the future , the presence of SIN and national identity cards population , will facilitate the implementation of biometric data . Biometric data guarantee uniqueness of one's identity card ownership .

Abstract P1-15-04: Outcome of small (≤1 cm), node-negative breast cancer

Abstract Background: Screening mammogram has resulted in increased diagnosis of very small breast cancers, especially less than 1 cm node negative. These small tumors have excellent prognosis with cancer-specific survival rates as high as 90% to 95%. This study evaluates outcome in different subtypes of very early breast cancer in a national population database. Method: Patients with stage I breast cancer, tumor ≤ 1cm with negative nodes (T1aN0 (&amp;lt;0.5cm), T1bN0 (≥ 0.5cm to ≤ 1cm) diagnosed between 2006 and 2011 were identified in the SEER database. We excluded patients with missing biomarker information. Treatment outcome and prognostic factors for disease-specific survival (DSS) and overall survival (OS) were evaluated. Results: We identified 70,543 cases and included 54,796 patients with stage T1aN0M0 and T1bN0M0 in the final analysis. The mean age was 62.09 yrs. (CI 95% 62.2-61.99), 84% are white, 7% black and 7% others.89% had ER positive tumor, 11% ER negative and 3% had Her 2 positive tumors.71% of patients had T1b (≤ 1cm). The 5-year disease specific survival (DSS) and overall survival (OS) for patients with stage T1aN0, T1bN0 was 98.7% and 93.7%, respectively. Estrogen receptor (ER) positive tumors were associated with improved 5-yr DSS 99% vs. 96% in ER negative (p&amp;lt;0.0001) and OS in ER positive 94% vs. 92%( p&amp;lt;0.0001). Among white patients 5-yr DSS was 98.8% and OS was 93.7% while 5yr-DSS was 94%, OS 91.5% among black vs. 5-yr DSS 99% and OS 96.3% in others (Asian or Pacific Islanders, AI), (p&amp;lt;0.0001). Tumor subtype was not associated with significant difference in outcome but T1a tumor was associated with OS 94.5% vs. 93.4% with T1b tumors (p&amp;lt;0.0001) On cox model analysis factors which correlated with prolonged DSS and OS are race (p&amp;lt;0.0001), older age (p&amp;lt;0.0001), ER positivity (p&amp;lt;0.0001) and tumor less than 5mm (p=0.0006). Conclusions: Very early breast cancer is associated with excellent outcome but has some heterogeneity. Nonwhite/Non Black race was associated with better survival compared to white and black patients. ER positive tumors, and older age were also associated with better outcome. This data while reassuring also brings into question the overtreatment of this disease subset. One of the limitations of this dataset is lack of details of systemic therapy administered. Conventional prognostic factors are not sufficient to risk stratify very early breast cancer and molecular profiling may help identify patients who will need adjuvant treatment. Citation Format: Muzaffar M, Namireddy P, Naqash R, Wong J, Vohra N. Outcome of small (≤1 cm), node-negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-15-04.

Reoperation Rates After Surgery for Degenerative Cervical Spine Disease According to Different Surgical Procedures: National Population-based Cohort Study.

National population-based cohort study. To evaluate reoperation rates of cervical spine surgery for cervical degenerative conditions utilizing a national population database. There is an inherently low incidence of reoperation after surgery for cervical degenerative disease. Therefore, it is difficult to sufficiently power studies to detect differences between reoperation rates of different cervical surgical procedures. National population-based databases provide large, longitudinally followed cohorts that may help overcome this challenge. We used the Korean Health Insurance Review and Assessment Service national database to select our study population. We included patients with diagnosis of cervical spondylotic radiculopathy or myelopathy who underwent cervical surgeries from January 2009 to June 2014. We separated patients into three groups based on surgical procedures: discectomy or corpectomy with anterior fusion, laminoplasty, or laminectomy with posterior fusion. Age, sex, presence of diabetes, osteoporosis, associated comorbidities, number of operated cervical disc levels, and hospital types were considered potential confounding factors. Reoperation rates were analyzed over early and late periods. The reoperation rate over the entire follow-up period was 3.31%. Overall, the reoperation rate was significantly higher after laminectomy with posterior fusion or laminoplasty than after discectomy or corpectomy with anterior fusion. A similar pattern was seen during the late period. In the early period, rates were higher only after laminectomy with posterior fusion than after discectomy or corpectomy with anterior fusion. Sex, presence of diabetes, associated comorbidities, and hospital types were noted to be risk factors for reoperation. The reoperation rate was higher after laminectomy with posterior fusion or laminoplasty. Given clinical scenarios in which either anterior or posterior approaches can be utilized, risk of reoperation can be another variable to consider in surgical planning and patient education. 3.

Epidemiology of adult-onset hydrocephalus: institutional experience with 2001 patients.

OBJECTIVE Adult-onset hydrocephalus is not commonly discussed in the literature, especially regarding its demographic distribution. In contrast to pediatric hydrocephalus, which is related to a primary CSF pathway defect, its development in adults is often secondary to other pathologies. In this study, the authors investigated the epidemiology of adult-onset hydrocephalus as it pertains to different etiologies and in reference to age, sex, and race distributions. METHODS The authors retrospectively reviewed the clinical notes of 2001 patients with adult-onset hydrocephalus who presented to Louisiana State University Health Sciences Center within a 25-year span. Significant differences between the groups were analyzed by a chi-square test; p < 0.05 was considered significant. RESULTS The overall mean (± SEM) incidence of adult hydrocephalus in this population was 77 ± 30 per year, with a significant increase in incidence in the past decade (55 ± 3 [1990-2003] vs 102 ± 6 [2004-2015]; p < 0.0001). Hydrocephalus in a majority of the patients had a vascular etiology (45.5%) or was a result of a tumor (30.2%). The incidence of hydrocephalus in different age groups varied according to various pathologies. The incidence was significantly higher in males with normal-pressure hydrocephalus (p = 0.03) or head injury (p = 0.01) and higher in females with pseudotumor cerebri (p < 0.0001). In addition, the overall incidence of hydrocephalus was significantly higher in Caucasian patients (p = 0.0002) than in those of any other race. CONCLUSIONS Knowledge of the demographic variations in adult-onset hydrocephalus is helpful in achieving better risk stratification and better managing the disease in patients. For general applicability, these results should be validated in a large-scale meta-analysis based on a national population database.

Evaluating the Primary Prevention of Ischemic Stroke of Oral Antithrombotic Therapy in Head and Neck Cancer Patients with Radiation Therapy.

Although previous studies demonstrated the risk of ischemic stroke (IS) in patients with head and neck cancer (HNC), the impact of oral antithrombotic therapy (OAT) on this risk has not yet been assessed. We aimed to evaluate the effectiveness and safety of OAT in patients with HNC treated with RT. This retrospective cohort study was performed using the National Health Insurance Research Database of Taiwan. A total of 37,638 patients diagnosed with HNC included in the study were classified as users and nonusers of OAT. Primary outcome was IS or transient ischemic attack (TIA), and secondary outcomes were death and major bleeding. The Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). There was no significant difference in the risk of IS or TIA between patients on continuous OAT and nonusers (adjusted HR, 0.812; 95% CI, 0.199–3.309). The risk of major bleeding was not significantly different between the groups. From a national population database, we did not find an association between OAT and decreasing risk of ischemic stroke/TIA or increasing hazard of major bleeding.

Danish retinoblastoma patients 1943–2013 – genetic testing and clinical implications

Background: In heritable retinoblastoma there is a 50% risk of transmitting the RB1 mutation, and offspring carriers have more than 90% risk of developing retinoblastoma. Today, all newly diagnosed retinoblastoma patients in Denmark are screened for mutations in RB1, as opposed to only a minority of patients diagnosed before DNA testing was offered. Knowledge of heredity increases the chance of early diagnosis in offspring, leading to improved prognosis. We present data from the Danish retinoblastoma patients that emphasize the need for genetic counseling and RB1 screening in all untested retinoblastoma survivors.Material and methods: Data are extracted from The Danish Ocular Oncology Group Database, a national population database containing data on all Danish retinoblastoma patients since 1943.Results: In total 323 retinoblastoma patients have been diagnosed between 1943 and 2013. Since 1963, the rate has been stable around 1 per 14 000 live births with 95% of the patients surviving their retinoblastoma. Stratifying data on the time of diagnosis and status of genetic testing, the number of screened patients gradually increased from 5% in the beginning of the period to 96% in the last five-year period. A cohort of 181 retinoblastoma survivors with sporadic disease (15% heritable) did not receive genetic testing. Since the introduction of routine testing, one of 14 sporadic unilateral patients tested (7%) has been identified with a germline mutation. Before routine testing, five additional sporadic unilateral patients have been identified as heritable.Conclusion: Only a minority of Danish retinoblastoma patients diagnosed before routine genetic testing was offered have been RB1 screened. To counsel the remaining untested patients and their families sufficiently regarding the risk to offspring and elevated risk of second primary cancers, we recommend information and access to genetic counseling and RB1 screening. This has ethical, psychological and possible economic consequences, and should be handled with caution.