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C Ineke Neutel

Publications and source records attributed to C Ineke Neutel.

8 recordsLinked to original sources
PubMed2005

Trends in in-patient hospital utilization and surgical procedures for breast, prostate, lung and colorectal cancers in Canada.

OBJECTIVE: To analyse population-based trends of in-patient surgical procedures for breast (female), prostate, lung and colorectal cancers. METHODS: The Hospital Morbidity Files supplied hospital data and the Canadian Cancer Registry, incidence data. Age-adjusted rates were standardized to the 1991 Canadian population. RESULTS: All four cancers showed major changes in trends of surgical procedures. For breast cancer, the rate of in-patient breast conservation surgery (BCS) increased from 1981 to the early 1990s while the rate of mastectomy decreased. Because day surgery was not included, the subsequent in-patient BCS rate stayed level. For prostate cancer, the rate of transurethral prostatectomy was initially high but decreased after 1990, while the rate of radical prostatectomy increased rapidly, only minimally affected by the PSA-related peak in incidence. The lung cancer lobectomy rate in men remained at 10/100,000 after 1986, but in women rose from 3/100,000 to 7/100,000, reflecting increasing lung cancer incidence. For colorectal cancer, right hemicolectomies and anterior resections increased, especially in men. CONCLUSIONS: Surgery trends reflected changes in incidence and treatment preferences. Canadian trends were generally similar to US trends, although the timing of some of the changes differed. Canadians tended to use less invasive procedures such as BCS and anterior resection.

Adult↗
PubMed2005

The epidemiology of long-term benzodiazepine use.

Recommendations for benzodiazepine (BZD) use suggest durations of no more than a few weeks, but studies report use for months, years, or even decades. This article examines the who (who are long-term users), why (why do they use BZD), what (what are patterns of long-term use) and how (how do they compare to all BZD users). The study population is from the National Population Health Survey in Canada which interviewed respondents four times at two-year intervals, asking about specific drugs use as well as demographic, lifestyle and health-related questions. Long-term BZD use was defined as BZD use for two successive cycles. Four percent of the Canadian population used BZD at any one time, half of whom also reported use in the previous cycle. Benzodiazepine users were more likely to be female, elderly, smokers, to prefer speaking a language other than English, to have insurance coverage for medication, and to have completed high school education. Almost none of these determinants predicted long-term use. Persons reporting BZD use in 2000 had an odds ratio (OR) of 38.6 for also using BZD in 1998, were more likely to use antidepressants (OR=8.5) and suffer from conditions such as poor health, stress, and pain. Most of these determinants had no association with long-term use or if they did at a considerably lower OR. Of the 395 BZD users in 2000, almost 48.4% also used BZD in the previous cycle and 17% in all three previous cycles. Benzodiazepine use in any previous cycle made BZD use in 2000 more likely, with use determined by how recent and the frequency of reported use, culminating in a very high OR of 83.3 for use in all three previous cycles. Continued use for any of the individual BZD tended to be largely for the same BZD. We conclude that: (1) the overriding determinant for BZD use was that of previous use; and (2) long-term use was not determined by the same factors as overall use, which is significant in developing approaches to dealing with long-term BZD use.

Benzodiazepines↗
PubMed2004

Shorter hospital stays for breast cancer.

OBJECTIVES: This article examines trends in and factors influencing the length of stay for female breast cancer patients who were hospitalized between 1981 and 2000. DATA SOURCES: The hospital data are from the Hospital Morbidity Database and the Health Person-oriented Information Database, both maintained by Statistics Canada. Data on new cases of breast cancer are from the Canadian Cancer Registry and the National Cancer Incidence Reporting System. ANALYTICAL TECHNIQUES: Descriptive analyses present length of stayfor all hospital admissions with a primary diagnosis of breast cancer, by four-year period and by the patient's age, cancer stage, comorbid conditions and surgical procedures. Logistic regression is used to examine associations between these factors and length of stay. MAIN RESULTS: Since the early 1980s, the average length of stay in hospital for female breast cancer has fallen from 15.1 to 4.5 days. Declines occurred regardless of age group, cancer stage, procedure and comorbid conditions. Average stays first began to fall for less serious cases, but were eventually apparent for even the most serious.

Adult↗
PubMed2003

Can continuing benzodiazepine use be predicted?

The objective of the present study was to examine characteristics of benzodiazepine (BZD) users, as well as try to identify predictors of continuing BZD use. Health-related data were collected twice on the same sample of Canadians two years apart. Drug use was based on the question: "What medications did you take over the last two days?" while other variables used were age, sex, education, marital status, chronic conditions, non-BZD drug use, health status and pain level. Of the 11,624 respondents, 371 (3.2%) reported taking BZDs in 1994. Logistic regression results showed that the highest odds of BZD use were for antidepressant users (OR=10.7, P<0.05), followed by poor health (OR=5.0, P<0.05), pain (OR=3.9, P<0.05) and chronic conditions (OR=3.2, P<0.05). Of the 371 individuals who reported BZD use in 1994, 198 (53.4%) reported BZD use in 1996. Logistic regression showed that none of the variables mentioned above showed a significant association with continuing (including gaps in use) BZD use in 1996. Regarding individual BZDs, it could not be concluded definitively that any BZD is more likely to show continued use than any other, but the possibility of a linear relationship between the proportion of continued use and the half-life of the BZD should be investigated further. Thus, the main predictive factor for continuing use of BZD, as shown by this study, is that of previous use. Whenever a BZD is prescribed, regardless of whether it is a new or repeat prescription, it should be remembered that the likelihood of continuing use is considerable.

Adult↗
PubMed2002

Medication use and risk of falls.

PURPOSE: Injuries due to falls are an important public health concern, particularly for the elderly, and effective prevention is an ongoing endeavour. The present study has two related objectives: (1) to describe associations between drug use and falls in an institutionalized population, and (2) to identify a high risk subgroup within the larger population. METHODS: The initial analysis was based on a population of 227 residents who were followed over a 1-year period. Logistic regression techniques were used to estimate odds ratios (ORs) of the association of falls and drug use. The study of potential 'high-risk' groups employed a case-crossover design to estimate the risk of falling associated with starting a new drug course. RESULTS: Relatively weak ORs for risk of falling were observed for various drug classes; the highest OR was for benzodiazepines (BZD) at OR = 1.8 (unadjusted). Residents taking multiple drugs were at particular risk for falling, e.g. an OR of 6.1 for those using 10+ drugs. The case-crossover analysis indicated that residents starting a new BZD/antipsychotic were at very high risk (OR = 11.4) for experiencing a fall. CONCLUSIONS: Residents who took many different types of medications, as well as residents starting a new BZD/antipsychotics were at greatly increased risk of falling. These are high risk groups where increased monitoring or adjustments to drug regimens could lead to prevention of falls.

Accidental Falls↗
PubMedDate not supplied

Proportion of cancer deaths occurring in hospital, Canada, 1994-2000.

BACKGROUND: Most terminally ill cancer patients would prefer not to die in hospital, but only a minority achieve their wish. Our objective was to examine the proportion of cancer deaths occurring in Canadian hospitals. METHODS: The two sources of data (1994-2000) were: 1) all hospital separations (HS) with a primary diagnosis of cancer and discharge as 'dead'; 2) all death certificates (DC) with cancer as underlying cause of death. Proportions of hospital deaths were estimated with two different numerators: 1) hospital cancer deaths from HS data, and 2) deaths with hospital as location from DC data; the denominator for both were all cancer deaths identified from the DC data. RESULTS: Proportions of hospital deaths from HS data decreased from 55% to 40% over 1994-2000, was slightly lower for females, decreased with age, but varied widely among provinces. Proportions of hospital deaths from DC data started at 80% and showed a small downward trend over the years. While age, sex, and cancer site distributions stayed the same, the proportion of hospital deaths from DC date again varied among provinces. For provinces with the home category completed on the DC data, 1999-2000, Alberta had most home deaths at 15.6% and PEI least at 5.7%. INTERPRETATION: This is the first Canada-wide data on place of death for terminal cancer, which is important for determining and comparing present-day practices, as well as for planning for the future.

Adult↗
PubMedDate not supplied

Trends in prostate cancer incidence, hospital utilization and surgical procedures, Canada, 1981-2000.

BACKGROUND: Numbers of new prostate cancer cases in Canada continue to increase because of increasing prostate cancer incidence, population growth, aging of the population, and earlier detection methods such as PSA (prostate-specific antigen) testing. Concern has been expressed that PSA-related increases in incidence will make unaffordable demands on Canadian hospital resources. Our objective is to relate increases in prostate cancer incidence to trends in hospitalizations and in- patient treatment. METHODS: Hospitalizations with prostate cancer as primary diagnosis were obtained from the Hospital Morbidity Database, estimates of prostate cancer day surgery from the Discharge Abstract Database, newly diagnosed cases from the Canadian Cancer Registry, and prostate cancer deaths from the Vital Statistics Mortality Databases--all for the years 1981-2000. RESULTS: Between 1981-2000, the number of new cases rose from 7,000 to 18,500 with a transient peak, 1991-1994. Hospitalizations rose parallel to the incidence until 1991 but then fell sharply in spite of further increasing incidence. The use of radical prostatectomy (RP) increased steadily, but transurethral prostatectomy and bilateral orchiectomy decreased in the 1990s. Decreases in length of stay and in number of hospitalizations resulted in considerably decreased annual hospital days for all prostate cancer in-patient procedures except RP, which remained level since 1993. CONCLUSIONS: A net decrease in number of in-patient days occurred, despite the increasing number of new prostate cancer cases and the increasing use of radical prostatectomy. We concluded that increases in hospital utilization due to early detection programs, such as PSA testing, are unlikely to overwhelm in-patient services of Canadian hospitals.

Adult↗