Search

Objetivo: Determinar los costes mediante la medición directa, caso a caso, de la infección del sitio quirúrgico en la apendicectomía y la colectomía. Métodos: Diseño: estudio de casos y controles con base poblacional; los casos fueron todos los pacientes diagnosticados de infección de sitio quirúrgico tras apendicectomía o colectomía en SCIAS-Hospital de Barcelona, y los controles una muestra seleccionada aleatoriamente entre los pacientes no infectados que reunían características comunes para el apareamiento. Período de estudio: del 1 de enero de 1998 al 31 de diciembre de 1999. Tipos de apareamiento: a) individual de pacientes agrupados según el diagnóstico principal, el procedimiento quirúrgico principal, la edad y el sexo, y b) individual de pacientes agrupados según el diagnóstico principal, la edad y el sexo, pero utilizando además para la selección de los controles el diagnóstico secundario. Fuentes de información: sistema informático de registros e historias clínicas en soporte electrónico, incluyendo los costes registrados en tiempo real. Contabilidad analítica: programa ADS plus®, que calculó costes reales (paciente por paciente) a partir de datos como el consumo de farmacia, el material sanitario, las pruebas adicionales de diagnóstico y las estancias generadas. Los costes estructurales se imputaron en la matriz de costes a partir del cálculo contable y su impacto en los costes directos. Se consideró coste atribuible a la infección al coste incremental o adicional resultante de la diferencia entre casos y controles. Análisis estadístico: los cálculos estadísticos se realizaron mediante el paquete estadístico SPSS, versión 9.0. Se utilizaron pruebas no paramétricas teniendo en cuenta el tamaño de la muestra. Se aplicó el test de Wilcoxon para variables continuas con el fin de comparar la edad, la duración de las intervenciones quirúrgicas, la estancia hospitalaria y los costes. Los resultados se expresaron como media aritmética. Se consideró un nivel de significación estadística un valor de p < 0,01. Resultados: En el primer apareamiento se incluyeron 23 casos y 23 controles para los pacientes operados de apendicectomía, y 20 casos y 20 controles de colectomía. En el apareamiento 2 la muestra fue de 17 pares de casos y controles en apendicectomía, y 14 pares de casos y controles en colectomía. La infección comportó un aumento de la estancia media entre 7,7 días (apareamiento 1) y 7,3 días (apareamiento 2) en apendicectomía infectada, y entre 17,6 días (apareamiento 1) y 15,4 días (apareamiento 2) en colectomía. Los pacientes con infección de apendicectomía presentaron un coste medio tres veces superior a los no infectados tanto en el apareamiento 1 (2.998,60 frente a 941,89 €, respectivamente; p < 0,0001) como en el apareamiento 2 (2.751,70 frente a 870,81 €, respectivamente; p < 0,0001). Similar hallazgo se observó en la colectomía, tanto en el apareamiento 1 (10.705,34 frente a 2.600,55 €, respectivamente; p < 0,0001) como en el apareamiento 2 (9.081,12 frente a 2.621,39 €, respectivamente; p < 0,0001). El coste medio atribuible a la infección de sitio quirúrgico osciló entre 2.056,71 € (apareamiento 1) y 1.880,89 € (apareamiento 2) en el caso de la apendicectomía, y 8.140,79 € (apareamiento 1) y 6.405,65 € (apareamiento 2) en la colectomía. Conclusiones: En las condiciones del estudio, la infección del sitio quirúrgico determina la prolongación de la estancia hospitalaria de más de una semana en la apendicectomía y de más de dos en la colectomía, con un incremento superior al 300% en el coste directo total.Objective: To determine the costs, with the help of direct case to case measurement, of the surgical site infection in apendicectomy and colectomy. Methods: Design: cases and controls study, population-based, in which the cases were all the patients diagnosed of surgical site infection after apendicectomy or colectomy in SCIAS- Hospital de Barcelona, and the controls were a random sample of noninfected patients that presented common characteristics for matching purposes. Study period: from January 1, 1998, to December 31, 1999. Types of matching: a) individual, patients grouped according to main diagnosis, main surgical procedure, age and gender, and b) patients grouped according to main diagnosis, main surgical procedure, age and gender using in addition, as controls criteria, the number of secondary diagnoses. Data sources: computer system with all the registries and clinical histories in electronic support, including the costs registered in real time. Analytical Accounting: ADS plus® program that calculated the real costs (patient to patient) extracted from real data, such as drugs consumption, medical supplies, additional diagnosis tests and generated stays. The structural costs were imputed in the matrix of costs from the countable calculation and its impact on the direct costs. The cost attributable to the infection was calculated as the additional cost resultant from the difference between cases and controls. Statistical analysis: the statistical calculations were made by means of the statistical package SPSS, version 9.0. Nonparametric tests were used considering the sample size. The test of Wilcoxon for continuous variables, with the purpose of comparing age, operations length, hospital stay and costs, was applied. The results were expressed as arithmetic mean. A level of statistical meaning of p < 0.01 was considered. Results: The first matching included 23 cases and 23 controls for patients operated on apendicectomy and 20 cases and 20 controls for those operated on colectomy. In matching 2, the sample consisted on 17 pairs of cases and controls on apendicectomy and 14 pairs of cases and controls on colectomy. The infection increased the average length of stay between 7.7 days (matching 1) and 7.3 days (matching 2) in cases of infected apendicectomy and between 17.6 days (matching 1) and 15.4 days (matching 2) in cases of infected colectomy. The patients with apendicectomy infection presented an average cost three times higher than the ones not infected, both in matching 1 (2,998.60 versus 941.89 €, respectively; p < 0.0001) and in matching 2 (2,751.70 versus 870.81 €, respectively; p < 0.0001). Similar findings were observed in colectomy both in matching 1 (10,705.34 versus 2,600.55 €, respectively; p < 0.0001) and in matching 2 (9,081.12 versus 2,621.39 €, respectively; p < 0.0001). The average cost of surgical site infection oscillated between 2,056.71 € (matching 1) and 1,880.89 € (matching 2) in apendicectomy and between 8,140.79 € (matching 1) and 6,405.65 € (matching 2) in colectomy. Conclusions: Under the study conditions, the infection of surgical site determines the prolongation of the hospital stay in more than one week in apendicectomy and in more than two in colectomy, with an increase higher than 300% in the total direct cost.

Background: Attention-deficit/hyperactivity disorder (ADHD) is highly heritable, but little is known about the relative effects of transmitted (i.e., direct) and nontransmitted (i.e., indirect) common variant risks. Using parent-offspring trios, we tested whether polygenic liability for neurodevelopmental and psychiatric disorders and lower cognitive ability is overtransmitted to ADHD probands. We also tested for indirect or genetic nurture effects by examining whether nontransmitted ADHD polygenic liability is elevated. Finally, we examined whether complete trios are representative of the clinical ADHD population., Methods: Polygenic risk scores (PRSs) for ADHD, anxiety, autism, bipolar disorder, depression, obsessive-compulsive disorder, schizophrenia, Tourette syndrome, and cognitive ability were calculated in UK control subjects (n = 5081), UK probands with ADHD (n = 857), their biological parents (n = 328 trios), and also a replication sample of 844 ADHD trios., Results: ADHD PRSs were overtransmitted and cognitive ability and obsessive-compulsive disorder PRSs were undertransmitted. These results were independently replicated. Overtransmission of polygenic liability was not observed for other disorders. Nontransmitted alleles were not enriched for ADHD liability compared with control subjects. Probands from incomplete trios had more hyperactive-impulsive and conduct disorder symptoms, lower IQ, and lower socioeconomic status than complete trios. PRS did not vary by trio status., Conclusions: The results support direct transmission of polygenic liability for ADHD and cognitive ability from parents to offspring, but not for other neurodevelopmental/psychiatric disorders. They also suggest that nontransmitted neurodevelopmental/psychiatric parental alleles do not contribute indirectly to ADHD via genetic nurture. Furthermore, ascertainment of complete ADHD trios may be nonrandom, in terms of demographic and clinical factors., (Copyright © 2022 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Few studies were available in exploring the roles of dietary patterns in the development of esophageal cancer, especially in China. This study aimed to investigate the roles of dietary patterns in the risk of esophageal squamous cell carcinoma (ESCC) in a Chinese rural population., Methods: A population-based cases-control study was designed and conducted in Yanting County, Sichuan Province of China during two years (between June 2011 and May 2013). A total of 942 pairs of ESCC cases and controls were recruited. A food frequency questionnaire was adopted to collect information of dietary consumption. Dietary patterns were extracted by using principle component and factor analysis based on 24 dietary groups. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated by using logistic regression model, with adjustment for possible confounding variables., Results: Four major dietary patterns were identified, which were labeled as "prudent", "vegetable and fruits", "processed food" and "alcohol drinking". In comparison of the highest with the lowest quartiles of pattern scores, the processed food pattern (OR: 2.84, 95% CI: 2.13-3.80) and alcohol drinking pattern (OR: 2.69, 95% CI: 1.95-3.71) were significantly associated with an increased risk of ESCC, while the vegetable and fruit pattern (OR: 0.70, 95% CI: 0.53-0.92) was associated with reduced risk by 30%. The prudent pattern was associated with a reduced risk by 33% (OR: 0.67, 95% CI: 0.50-0.88) in a multivariate logistic regression model, but no statistical significance was reached in a composite model., Conclusions: The results suggest an important role of dietary patterns in ESCC. Diets rich in vegetables and fruits may decrease the risk of ESCC, whereas diets rich in processed food and drinking alcohol may increase the risk., (Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Genetic risks and genetic models are often used in design and analysis of genetic epidemiology studies. A genetic model is defined in terms of two genetic risk measures: genotype relative risk and odds ratio. The impacts of choosing a risk measure on the resulting genetic models are studied in the power to detect association and deviation from Hardy-Weinberg equilibrium in cases using genetic relative risk. Extensive simulations demonstrate that the power of a study to detect associations using odds ratio is lower than that using relative risk with the same value when other parameters are fixed. When the Hardy-Weinberg equilibrium holds in the general population, the genetic model can be inferred by the deviation from Hardy-Weinberg equilibrium in only cases. Furthermore, it is more efficient than that based on the deviation from Hardy-Weinberg equilibrium in all cases and controls., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction: The New South Wales (NSW) Cancer, Lifestyle and Evaluation of Risk Study (CLEAR) is an open epidemiological bioresource, using an all cancer unmatched case-spouse control design. Participant characteristics and selected confirmed associations are compared to published estimates: current smoking and lung cancer; country of birth and melanoma; body mass index (BMI) and bowel cancer; and paternal history of prostate cancer and prostate cancer, to illustrate the validity of this design., Material and Methods: Cases are NSW residents, ≥18 years, with an incident cancer of any type. Controls are cancer-free spouses of cases. Participants complete a consent form, a questionnaire, and provide an optional blood sample. For analyses, odds ratios for males and females are calculated for cancers and exposures of interest, by sex-matching controls to cases., Results: 10,816 participants (8569 cases, 2247 controls, 54% female) recruited to-date, median age: 61.6 y cases, 61.3 y controls. The top five cancer types are female breast (n=1691), prostate (n=1102), bowel (n=888), melanoma (n=608), and lung (n=265). Adjusted odds ratios (OR) were: 20.65 (95% CI: 13.25-32.19) for lung cancer in current versus never smokers; 1.16 (1.05-1.28) for bowel cancer per 5 kg/m(2) increment in BMI; 1.41 (1.01-1.96) for melanoma in Australian-born compared to those born in UK/Ireland; and 2.47 (1.82-3.37) for prostate cancer in men with versus without a paternal history of prostate cancer., Discussion: This study design, where controls are the spouses of cases diagnosed with a variety of cancers and which are analysed unmatched, avoids potential biases due to overmatching, considered problematic in standard case-spouse control studies, and illustrates that risk estimates analysed are consistent with the published literature. CLEAR methodology provides a practical design to advance local knowledge on the causes of various leading and emerging cancers., (Copyright © 2015. Published by Elsevier Ltd.)