Population-based Perspective Research Articles

The impact of diagnosis on health-related quality of life in people with coeliac disease: a UK population-based longitudinal perspective

BackgroundBefore diagnosis, people with coeliac disease suffer reduced quality of life, which improves substantially after the disease has been diagnosed. Delayed diagnosis is common. The aim of this study was to assess changes over time in prevalence of coeliac disease symptoms/associated medical conditions, time to diagnosis, quality of life and its determinants before and after diagnosis in the United Kingdom.MethodsA postal questionnaire was designed in 2015 and sent to 4000 individuals with diagnosed coeliac disease, requesting information on respondents’ socio-demographic and clinical characteristics, and their quality of life pre- and post-diagnosis using the EQ-5D instrument. Data were analysed and compared with results from a survey conducted in 2006 using descriptive analyses, univariate and multivariable regression methods.ResultsThe survey response rate was 40%. Sixty-five percent of respondents reported at least 4 symptoms pre-diagnosis, a significant reduction by 13 percentage points (95% CI: -16.9, − 9.4; p-value: < 0.001) compared to 2006. Pre-diagnosis mean duration of symptoms was 12.8 years (SD: 15.3), a non-significant reduction of 0.6 years (95% CI: -2, 0.8; p-value: 0.426) compared to 2006. There was a significant improvement of 0.20 (95% CI: 0.18, 0.22; p-value: < 0.001) in quality of life from pre- (0.65) to post-diagnosis (0.85). Pre-diagnosis values were significantly higher by 0.09 (95% CI: 0.06, 0.12; p-value: < 0.001) than in 2006. Number of symptoms and low income were associated with decreased quality of life.ConclusionsUndiagnosed coeliac disease is associated with a substantial decrement in quality of life. Time to diagnosis has not significantly shortened over the decade 2006–2015, but symptoms are less severe when diagnosis occurs. Harmonising clinical guidelines for intensified active case finding will help improve quality of life of people with coeliac disease.

Psychiatric Disorders in Mothers of Children with Attention-Deficit/Hyperactivity Disorder: A Population-Based Perspective

The purpose of this study was to conduct a long-term, population-based, epidemiologic study of psychiatric disorders in mothers of children with attention-deficit/hyperactivity disorder (ADHD). Subjects included mothers of 306 childhood incident cases of ADHD and mothers of 617 age/gender matched controls from a 1976–1982 birth cohort. Compared to mothers of controls, mothers of children with ADHD were significantly more likely to be diagnosed prior to the child’s birth with a depressive disorder (adjusted odds ratio (aOR), 3.1; 95% confidence interval (CI), 1.3–7.7), an adjustment disorder (aOR, 8.1; 95% CI, 1.7–39.5), or any psychiatric disorder (aOR, 2.5; 95% CI, 1.61–4.7) and were likewise significantly more likely to be diagnosed with a de novo (i.e., first diagnosed after the child’s birth) depressive disorder (adjusted hazard ratio (aHR), 1.7; 95% CI, 1.2–2.4), de novo adjustment disorder (aHR, 2.0; 95% CI, 1.4–2.7), or any de novo psychiatric disorder (aHR, 1.7; 95% CI, 1.4–2.2) during the 21 years after the child’s birth. This study provides an opportunity to study the natural occurrence of psychiatric disorders in mothers of children with ADHD and suggests that the likelihood of having a child with ADHD is associated with maternal psychopathology both before and after the birth. This adds to existing knowledge of maternal psychopathology for children with ADHD and has implications for screening and monitoring. Future research is needed to clarify the role that both genetic and environmental risk factors play in the increased rates of psychopathology in mothers of children with ADHD.

248. Screening For Chlamydia And Gonorrhea And High Risk Sexual Behaviors In Utah’s Juvenile Justice Population July 1, 2015-June 3,0 2018

Purpose Youth in the correctional system are a high-risk population with many unmet physical and mental-health needs1. According to the CDC, “Prevalence rates for chlamydia (CT)and gonorrhea (GC) in the correctional setting are consistently among the highest observed in any venue”2. Admission to a correctional facility offers a prime opportunity to screen for medical concerns, including the largely asymptomatic CT/GC infections. CT is the most commonly reported notifiable sexually transmitted infection (STI) in the United States3. In Utah, over 60% of reported CT cases are among persons 15–24 years of age4. GC, though much less common, is also of particular concern due to its rising prevalence in the state, the severity of its sequelae, and its increasing drug resistance5. Additionally, sex trafficking and sexual violence are serious public health problems. Justice-involved youth are at high risk for sex trafficking6. One study in Ohio found that 21% of domestic minor sex trafficking (DMST) victims had spent time in juvenile detention7. Furthermore, JJS youth experience sexual violence at a higher rate than their peers in the community at large1. Both DMST and sexual violence can lead to a host of physical, psychological, and social problems, including engaging in other high-risk behaviors such as drug use and criminal behavior8. Before this project, no data on the CT/GC rates or on high risk sexual behaviors of youth within Utah’s Juvenile Justice System (JJS) had been gathered in a systematic manner that provided a population-based perspective. July 1, 2015 – Jun 30 2018 nurses and staff in all 18 Utah Juvenile Justice facilities verbally screened all youth admitted to their facilities for risk factors for STIs. If the youth met CDC-established, JJS-specific criteria, urine screening for CT/GC was performed. We have conducted 5,412 verbal screenings. Of these who answered the high risk questions and reported sexual activity, 8.14% reported experiencing “forced sex”, 3.23% reported DMST, 27.64% reported having sex with someone not well known, and 27.57% reported never using a condom. We have collected 4,351 urine samples, 9.72% of which screened positive for CT/GC/both. Among females, however, 17.24% were positive. Approximately, 85% of those who screened positive were treated. The remaining 15% are considered treatment pending or were lost to follow up. Given that youth in corrections are more likely than the general population to have inadequate and inconsistent health care1, screening for and treating STIs and addressing other high risk sexual behaviors must be a priority of the medical staff within JJS facilities. Screening on intake for CT and GC offers an opportunity to identify infections, prevent complications, and reduce transmission to the broader community. Furthermore, this screening provides a time for data collection on high-risk behaviors that can be addressed through intervention and education.

Better Guidelines Needed for Cancer Survivorship Management.

Better Guidelines Needed for Cancer Survivorship Management.

Relative impact characteristic curve: a graphical tool to visualize and quantify the clinical utility and population-level consequences of implementing markers

PurposeReceiver operating characteristic (ROC) curve analysis is a popular method for evaluating the performance of (bio)markers. However, the standard ROC curve does not directly connect marker performance to patient-related outcomes. Our aim was to fill this gap by proposing a conceptually similar graphical tool that carries information about the clinical uitility of markers. MethodsWe propose a novel graphical tool, the relative impact characteristic (RIC) curve, that depicts the trade-off between the population-level impact of treatment as a function of the size of the treated population for a given marker positivity rule (e.g., a threshold). We establish analogies between the ROC and the RIC curves around the interpretations of shape, slopes, and area under the curve and discuss parametric inference on RIC. ResultsAs a case study, we used data from a clinical trial on preventive therapy for exacerbations of chronic obstructive pulmonary disease. We illustrate how the RIC curve can be constructed for a predication score and be interpreted in terms of a marker's ability toward concentrating treatment benefit in the population. We discuss hoe the RIC curve can be used to identify a threshold on the risk score based on the maximal acceptable number-needed-to-treat. ConclusionsThe RIC curve enables evaluation of markers in terms of their treatment-related clinical utility. Its analogies with the standard ROC analysis can facilitate its interpretation, bringing a population-based perspective to the activities of diverse marker development and evaluation teams.

Twenty-Five-Year (1986-2011) Trends in the Incidence and Death Rates of Stroke Complicating Acute Myocardial Infarction

BackgroundThe occurrence of a stroke after an acute myocardial infarction is associated with increased morbidity and mortality rates. However, limited data are available, particularly from a population-based perspective, about recent trends in the incidence and mortality rates associated with stroke complicating an acute myocardial infarction.The purpose of this study was to examine 25-year trends (1986-2011) in the incidence and in-hospital mortality rates of initial episodes of stroke complicating acute myocardial infarction. MethodsThe study population consisted of 11,436 adults hospitalized with acute myocardial infarction at all 11 medical centers in central Massachusetts on a biennial basis between 1986 and 2011. ResultsIn this study cohort, 159 patients (1.4%) experienced an acute first-ever stroke during hospitalization for acute myocardial infarction. The proportion of patients with acute myocardial infarction who developed a stroke increased through the 1990s but decreased slightly thereafter. Compared with patients who did not experience a stroke, those who experienced a stroke were significantly older, were more likely to be female, had a previous acute myocardial infarction, had a significant burden of comorbidities, and were more likely to have died (32.1% vs 10.8%) during their index hospitalization. Patients who developed a first stroke in the most recent study years (2003-2011) were more likely to have died during hospitalization than those hospitalized during earlier study years. ConclusionsAlthough the incidence rates of acute stroke complicating acute myocardial infarction remained relatively stable during the years under study, the in-hospital mortality rates of those experiencing a stroke have not decreased.

Abstract TP38: Drip and Ship versus Direct Transfer to Comprehensive Stroke Center: A Modelling Based Analysis

Introduction: The success of thrombectomy trials for acute ischemic stroke create 2 options for prehospital decision-making-(1) transport the patient to the nearest endovascular capable center (ECC) even though this may mean bypassing a closer non-ECC (mothership model): or (2) transport to nECC for intravenous thrombolysis and then transfer the patient to the nearest ECC for endovascular therapy (drip and ship model). Methods: A decision- analytical modelling study was constructed to simulate a 50-year old man with acute stroke. Input probabilities were derived from recent literature with thrombectomy data and outcomes from the HERMES. We include extensive subgroup analysis by varying each possible time interval and evaluate the two strategies under different circumstances. Multiple sensitivity analysis were performed to give the threshold values. Results: In the base case calculation , we found Mothership to be the better strategy. The results shows when time to nECC is 30 min, Mothership is the better strategy until the time to ECC exceeds 93 min, or when it takes less than 126 min to transfer patients from nECC to ECC. When the time to nECC is 90 min, Drip and Ship becomes the better strategy regardless of the additional time to ECC and the transfer time. Subsequently we assigned the time to perform IA in transferred patients as 1.5 longer than patients who are directly sent to ECC and performed further sensitivity analyses. When nECC is within 30 min away, Drip and Ship is the better strategy when it takes more than 78 min to get to ECC, regardless of the transfer time. Conclusion: We have used decision analysis, modelling based technique to address the problem of acute stroke triage from a population-based perspective. By feeding in the time to the nearest ECC and nECC, the EMS and stroke team can make the most appropriate decision on where to transfer the patient for the best outcomes based on the currently available data.

Infant Vocal Cord Paralysis: A Population-Based Perspective

Infant Vocal Cord Paralysis: A Population-Based Perspective

Modeling antimicrobial cycling and mixing: Differences arising from an individual-based versus a population-based perspective

In order to manage bacterial infections in hospitals in the face of antibiotic resistance, the two treatment protocols “mixing” and “cycling” have received considerable attention both from modelers and clinicians. However, the terms are not used in exactly the same way by both groups. This comes because the standard modeling approach disregards the perspective of individual patients. In this article, we investigate a model that comes closer to clinical practice and compare the predictions to the standard model. We set up two deterministic models, implemented as a set of differential equations, for the spread of bacterial infections in a hospital. Following the traditional approach, the first model takes a population-based perspective. The second model, in contrast, takes the drug use of individual patients into account. The alternative model can indeed lead to different predictions than the standard model. We provide examples for which in the new model, the opposite strategy maximizes the number of uninfected patients or minimizes the rate of spread of double resistance. While the traditional models provide valuable insight, care is hence needed in the interpretation of results.

Changes in cigarette smoking initiation, cessation, and relapse among U.S. adults: a comparison of two longitudinal samples

BackgroundThe tobacco epidemic in the U.S. has matured in the past decade. However, due to rapidly changing social policy and commercial environments, tailored prevention and interventions are needed to support further reduction in smoking.MethodsUsing Tobacco Use Supplement to the Current Population Survey (TUS-CPS) 2002–2003 and 2010–2011 longitudinal cohorts, five smoking states are defined including daily-heavy, daily-light, non-daily, former and non-smoker. We quantified the changes between smoking states for the two longitudinal cohorts, and used a series of multivariable logistic regression models to examine the association of socio-demographic attributes and initial smoking states on smoking initiation, cessation, and relapse between waves within each cohort.ResultsThe prevalence of adult heavy smoking decreased from 9.9% (95% CI: 9.6%, 10.2%) in 2002 to 7.1% (95% CI: 6.9%, 7.4%) in 2010. Non-daily smokers were less likely to quit in the 2010–2011 cohort than the 2002–2003 cohort (37.0% vs. 44.9%). Gender, age group, smoker type, race and marital status exhibit similar patterns in terms of their association to the odds of initiation, cessation and relapse between the two cohorts, while education groups showed some inconsistent results between the two cohorts regarding the odds of cessation.ConclusionsTransitions between smoking states are complex and increasingly unstable, requiring a holistic, population-based perspective to understand the stocks and flows that ultimately dictate the public health impact of cigarette smoking behavior. This knowledge helps to identify groups in need of increased tobacco control prevention and intervention efforts.

The Projected Epidemic of Chronic Obstructive Pulmonary Disease Hospitalizations over the Next 15 Years. A Population-based Perspective.

COPD is currently one of the leading causes of hospitalizations in industrialized countries. The future burden of COPD is uncertain as the trends in the prevalence of the main risk factors for COPD, namely cigarette smoking and population aging, are moving in opposite directions in many jurisdictions. Here, we used data from British Columbia (BC), a Canadian Province of 4.7 million people, as an exemplary jurisdiction to illustrate the projected growth of COPD hospitalizations over the next 15 years in developed countries. We combined forecasts of population growth and aging with an Autoregressive Integrated Moving Average (ARIMA) model applied to BC’s population-based administrative health databases (2001 to 2010) to project the trends in the incidence, prevalence, deaths, and total length of inpatient stays to 2030. Based on this model, we predict that the absolute number of COPD cases will increase by more than 150% from 2010 to 2030 with the greatest growth in the older age group (75 years of age and ...

Decade-Long Trends (2001 to 2011) in the Use of Evidence-Based Medical Therapies at the Time of Hospital Discharge for Patients Surviving Acute Myocardial Infarction

Optimization of medical therapy during discharge planning is vital for improving patient outcomes after hospitalization for acute myocardial infarction (AMI). However, limited information is available about recent trends in the prescribing of evidence-based medical therapies in these patients, especially from a population-based perspective. We describe decade-long trends in the discharge prescribing of aspirin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β blockers, and statins in hospital survivors of AMI. The study population consisted of 5,253 patients who were discharged from all 11hospitals in central Massachusetts after AMI in 6 biennial periods from 2001 to 2011. Combination medical therapy (CMT) was defined as the prescription of all 4 cardiac medications at hospital discharge. The average age of this patient population was 69.2years and 57.7% were men. Significant increases were observed in the use of CMT, from 25.6% in 2001 to 48.7% in 2011, with increases noted for each of the individual cardiac medications examined. Subgroup analysis also showed improvement in discharge prescriptions for P2Y12 inhibitors in patients who underwent a percutaneous coronary intervention. Presence of a do-not-resuscitate order, before co-morbidities, hospitalization for non-ST-segment elevation myocardial infarction, admission to a nonteaching hospital, and failure to undergo cardiac catheterization or a percutaneous coronary intervention were associated with underuse of CMT. In conclusion, our study demonstrates encouraging trends in the prescribing of evidence-based medications at hospital discharge for AMI. However, certain patient subgroups continue to be at risk for underuse of CMT, suggesting the need for strategies to enhance compliance with current practice guidelines.

Updated competencies for the dental public health specialist: using the past and present to frame the future.

A new set of competencies for entry-level specialists in dental public health (DPH) developed in 2016 updates the 1998 version. Our objective is to provide some context and perspective on this update. We discuss the evolution of this dental specialty, how it differs from other dental specialties, and its importance for the public's oral health. Some societal trends that provide the rationale for this update are summarized. The ways in which this set of competencies differs from the last version are described. The first set of behavioral objectives was established in 1974 and updated at workshops in 1988 and 1997. Advanced population-based knowledge and public health perspectives beyond that obtained in predoctoral dental education continue to be essential for the nation's oral health. Since 1998, the impact of the digital age, advances in science and technology, changes in population demographics, health status and increasing inequalities, treatment needs, prevention and treatment modalities, healthcare delivery systems, financing, personnel, legislation, and regulations have all influenced DPH practice. The updated competencies include guiding principles for the specialty, a new focus on social determinants of health, and more flexibility to address the increasing complexity and interdisciplinary nature of public health problems and the expanding knowledge and skills needed to address them. The rapid expansion of public health education might serve as an important pipeline for future DPH specialists. The updated competencies can guide the educational preparation of DPH specialists and are aligned with the rapidly changing environment.

Mismatch repair gene mutation spectrum in the Swedish Lynch syndrome population.

Lynch syndrome caused by constitutional mismatch‑repair defects is one of the most common hereditary cancer syndromes with a high risk for colorectal, endometrial, ovarian and urothelial cancer. Lynch syndrome is caused by mutations in the mismatch repair(MMR) genes i.e., MLH1, MSH2, MSH6 and PMS2. After 20years of genetic counseling and genetic testing for Lynch syndrome, we have compiled the mutation spectrum in Sweden with the aim to provide a population-based perspective on the contribution from the different MMR genes, the various types of mutations and the influence from founder mutations. Mutation data were collected on a national basis from all laboratories involved in genetic testing. Mutation analyses were performed using mainly Sanger sequencing and multiplex ligation-dependent probe amplification. A total of 201unique disease-predisposing MMR gene mutations were identified in 369Lynch syndrome families. These mutations affected MLH1 in 40%, MSH2 in 36%, MSH6 in 18% and PMS2 in 6% of the families. A large variety of mutations were identified with splice site mutations being the most common mutation type in MLH1 and frameshift mutations predominating in MSH2 and MSH6. Large deletions of one or several exons accounted for 21% of the mutations in MLH1 and MSH2 and 22% in PMS2, but were rare (4%) in MSH6. In 66% of the Lynch syndrome families the variants identified were private and the effect from founder mutations was limited and predominantly related to a Finnish founder mutation that accounted for 15% of the families with mutations in MLH1. In conclusion, the Swedish Lynch syndrome mutation spectrum is diverse with private MMR gene mutations in two-thirds of the families, has a significant contribution from internationally recognized mutations and a limited effect from founder mutations.

Epidemiology of community-acquired severe sepsis. A population-based study

Background and objectiveMost studies aimed at getting to know the incidence of severe sepsis have methodological limitations which condition results that are difficult to compare and are inapplicable when it comes to estimating the necessary resources. Our objective is to evaluate the incidence and epidemiological aspects of community-acquired severe sepsis which require intensive care unit admission. Patients and methodProspective observational population-based study in a population of 180,000 adults over 15 years old and a general hospital with 350 beds and 14 ICU beds. All episodes of community-acquired infection requiring admission to ICU due to severe sepsis were registered over a period of 9 years. The variables analyzed were: age, sex, SAPS II score, length of stay in ICU, type of infection, isolated microorganism, and deaths during their ICU admission. A statistical bivariate analysis and a multiple logistic regression were performed. ResultsNine hundred and seventeen episodes with an average age of 65.2 years. The most frequent infectious focus was pulmonary (55.2%). The average SAPS II severity score index was 37.87 and mortality 19.7%. The annual incidence was 51.54 episodes per 100,000 adult inhabitants, meaning 1.97 ICU beds per day. In the multivariate analysis, the SAPS II score and a known aetiology were demonstrated as mortality risk factors. ConclusionsThis study brings us some epidemiological data from a population-based perspective which help us to care for patients better in our geographical area. The average annual incidence is 51.5 cases per 100,000 adult inhabitants which means that 2 ICU beds per day to attend this population.

Epidemiología de la sepsis grave adquirida en la comunidad. Estudio de base poblacional

Background and objectiveMost studies aimed at getting to know the incidence of severe sepsis have methodological limitations which condition results that are difficult to compare and are inapplicable when it comes to estimating the necessary resources. Our objective is to evaluate the incidence and epidemiological aspects of community-acquired severe sepsis which require intensive care unit admission. Patients and methodProspective observational population-based study in a population of 180,000 adults over 15 years old and a general hospital with 350 beds and 14 ICU beds. All episodes of community-acquired infection requiring admission to ICU due to severe sepsis were registered over a period of 9 years. The variables analyzed were: age, sex, SAPS II score, length of stay in ICU, type of infection, isolated microorganism, and deaths during their ICU admission. A statistical bivariate analysis and a multiple logistic regression were performed. ResultsNine hundred and seventeen episodes with an average age of 65.2 years. The most frequent infectious focus was pulmonary (55.2%). The average SAPS II severity score index was 37.87 and mortality 19.7%. The annual incidence was 51.54 episodes per 100,000 adult inhabitants, meaning 1.97 ICU beds per day. In the multivariate analysis, the SAPS II score and a known aetiology were demonstrated as mortality risk factors. ConclusionsThis study brings us some epidemiological data from a population-based perspective which help us to care for patients better in our geographical area. The average annual incidence is 51.5 cases per 100,000 adult inhabitants which means that 2 ICU beds per day to attend this population.

Bridging the Gap between Theory and Practice in Integrated Care: The Case of the Diabetic Foot Pathway in Tuscany.

Introduction and Background: As diabetic foot (DF) care benefits from integration, monitoring geographic variations in lower limb Major Amputation rate enables to highlight potential lack of Integrated Care. In Tuscany (Italy), these DF outcomes were good on average but they varied within the region. In order to stimulate an improvement process towards integration, the project aimed to shift health professionals’ focus on the geographic variation issue, promote the Population Medicine approach, and engage professionals in a community of practice.Method: Three strategies were thus carried out: the use of a transparent performance evaluation system based on benchmarking; the use of patient stories and benchmarking analyses on outcomes, service utilization and costs that cross-checked delivery- and population-based perspectives; the establishment of a stable community of professionals to discuss data and practices.Results: The project enabled professionals to shift their focus on geographic variation and to a joint accountability on outcomes and costs for the entire patient pathways. Organizational best practices and gaps in integration were identified and improvement actions towards Integrated Care were implemented.Conclusion and Discussion: For the specific category of care pathways whose geographic variation is related to a lack of Integrated Care, a comprehensive strategy to improve outcomes and reduce equity gaps by diffusing integration should be carried out.

Big data analysis for improved mental healthcare: A population-based perspective

Introduction Mental disorder is a key public health challenge due to its high levels of disability and mortality and a leading cause of DALYs (Disability adjusted life years). Therefore, a small improvement on mental care provision and management could generate solid benefits on relieving the social burden of mental diseases. Objective Long-term vision of collaboration between Fujitsu Laboratories, Fujitsu Spain, and Hospital Clinico San Carlos is to generate value through predictive and preventive medicine improving healthcare outcomes for every clinical area, benefiting managers, clinicians, and patients. Aims The aim is to enable a data centric approach towards a value-based healthcare system via health informatics. The project fuses knowledge from heterogeneous sources for obtaining patterns for clinical decision-making. Methods This project leverages a data analytic platform named HIKARI (light in Japanese) to deliver the right information, to the right people, at the right time. HIKARI consists of a data-driven and evidence-based Decision Support and Recommendation System (DSRS), facilitating identification of patterns in large-scale datasets and linking of data from different sources and types. Results Using multiple, heterogeneous datasets, HIKARI detects correlations from data retrospectively and conducts early intervention when signs and symptoms prompt immediate actions. HIKARI also highlights resource consumption patterns and suggests future resource allocation, using real-life data. Conclusions With the advance of ICT, especially data-intensive computing paradigm, approaches mixing individual risk assessment and environmental conditions become increasingly prevalent. HIKARI DSRS can serve as a key tool for individuals and clinicians daily management of mental disorders.

Sex-Specific Predictors of Inpatient Rehabilitation Outcomes After Traumatic Brain Injury

ObjectiveTo identify sex-specific predictors of inpatient rehabilitation outcomes among patients with a traumatic brain injury (TBI) from a population-based perspective. DesignRetrospective cohort study. SettingInpatient rehabilitation. ParticipantsPatients in inpatient rehabilitation for a TBI within 1 year of acute care discharge between 2008/2009 and 2011/2012 (N=1730, 70% men, 30% women). InterventionsNone. Main Outcome MeasuresInpatient rehabilitation length of stay, total FIM score, and motor and cognitive FIM ratings at discharge. ResultsSex, as a covariate in multivariable linear regression models, was not a significant predictor of rehabilitation outcomes. Although many of the predictors examined were similar across men and women, sex-specific multivariable models identified some predictors of rehabilitation outcome that are specific for men and women; mechanism of injury (P<.0001) was a significant predictor of functional outcome only among women, whereas comorbidities (P<.0001) was a significant predictor for men only. ConclusionsPredictors of outcomes after inpatient rehabilitation differed by sex, providing evidence for a sex-specific approach in planning and resource allocation for inpatient rehabilitation services for patients with TBI.

The Burden of Cancer in Korea during 2012: Findings from a Prevalence-Based Approach.

Cancer causes a significant deterioration in health and premature death and is a national socioeconomic burden. This study aimed to measure the burden of cancer using the disability-adjusted life year (DALY) metric based on the newly adopted methodology from the Global Burden of Disease Study in 2010. This study was conducted based on data from the Korean National Cancer Registry. The DALYs were calculated using a prevalence-based method instead of the incidence-based method used by previous studies. The total burden of cancer in 2012 was 3,470.79 DALYs per 100,000 persons. Lung cancer was the most prevalent cancer burden, followed by liver, stomach, colorectal, and breast cancer. The DALYs for lung, liver, stomach, colon and rectum, and pancreatic cancer were high in men, whereas the DALYs for breast, lung, stomach, colorectal, and liver cancer were high in women. Health loss from leukemia and cancer of the brain and nervous system was prevalent for those younger than age 20; from stomach, breast, and liver for those aged 30–50; and from lung, colon and rectum, and pancreas for a large proportion of individuals over the age of 60. The most important differences were that the DALYs were calculated by prevalence and that other components of the DALYs were measured by a population-based perspective. Thus, prevalence-based DALYs could provide more suitable data for decision making in the healthcare field.