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Wyszynski DF, Demetriou L, Renz C, Aliabadi S, Rafailovic D, Shulman LP, Drysdale M, Wurst KE. Use of Sotrovimab in Pregnancy: Experiences from the COVID-19 International Drug Pregnancy Registry. Drug Saf 2024:10.1007/s40264-024-01439-z. [PMID: 38727875 DOI: 10.1007/s40264-024-01439-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Available data regarding the safety and efficacy of sotrovimab in pregnant patients remain limited due to their exclusion from clinical trials. METHODS The COVID-19 International Drug Pregnancy Registry (COVID-PR) was established to gather comprehensive safety data from pregnant women who have received monoclonal antibody (mAb) or antiviral treatments for mild, moderate, or severe coronavirus disease 2019 (COVID-19) during pregnancy. Participants actively contributed self-reported data concerning their COVID-19 symptoms, in addition to sociodemographic and health-related characteristics. Obstetric, neonatal, and infant outcomes were also documented, with follow-up extending up to 12 months after childbirth. RESULTS As of 30 November 2023, sotrovimab was administered to 39 participants enrolled in the COVID-PR. At the time of this report, 26 participants had given birth, with nine deliveries performed via cesarean section. The infants' birthweight ranged from 2381 g to 4762 g, with a mean of 3439.91 g. Twenty-five infants were born at ≥37 weeks. A total of 31 adverse events (AEs) were reported by 12 participants. The most frequently reported AE was gestational hypertension, observed in three participants. COVID-19 re-infection, fatigue, gestational diabetes, headache, and morning sickness were each reported by two participants. Of the reported AEs, eight (in five participants) were classified as serious, including four AEs (prolonged labor, pre-eclampsia, polyhydramnios, premature labor) that affected pregnancy. Seven of these eight serious AEs (SAEs) were found to be unrelated to sotrovimab, with one event (urinary retention) not assessable. A total of 44 AEs were reported in 19 delivered infants or in utero fetuses. The most common were COVID-19 (n = 6 events), ear infection (n = 5 events), neonatal dyspnea (n = 3 events), and respiratory syncytial virus infection (n = 3 events). Sixteen AEs (in 11 infants/fetuses) were classified as serious, including one report each of fetal cardiac disorder, congenital ankyloglossia, persistent right umbilical vein, and congenital hydronephrosis; the latter was considered a major congenital malformation. For all assessable SAEs, causality of sotrovimab treatment was ruled out based on lack of a temporal relationship alone or in combination with absence of a plausible mechanism. CONCLUSION A sizable proportion of sotrovimab-treated participants in the COVID-PR had underlying medical conditions associated with an increased risk of severe COVID-19. None of the assessable SAEs were considered to be related to sotrovimab treatment.
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Affiliation(s)
| | | | | | | | | | - Lee P Shulman
- Division of Clinical Genetics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Malmsiø D, Frost A, Hróbjartsson A. A scoping review finds that guides to authors of protocols for observational epidemiological studies varied highly in format and content. J Clin Epidemiol 2023; 154:156-166. [PMID: 36563971 DOI: 10.1016/j.jclinepi.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/28/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To identify, characterize, and explore author guides on the role, format, and content of protocols for observational epidemiological studies, particularly cohort and case-control studies. STUDY DESIGN AND SETTING Scoping review. We searched for guides in Medline, Embase, Google Scholar, 10 general medical and epidemiological/public health journals, and 10 major funders' websites. Two review authors extracted data. We classified guides as "main" based on word count and number of protocol items, described such guides more comprehensively and analyzed number of citations as an indicator of uptake. RESULTS Thirty-nine protocol guides were included intended for cohort studies (n = 3), case-control studies (n = 1), or epidemiological studies in general (n = 35). Content and format were highly variable. Several guides had a broader focus than protocol development, e.g., also including study conduct and reporting. The guideline developmental process was often reported sparsely. One guide, intended for interventional studies, combined a systematic preparatory process with a primary focus on protocol development. We categorized seven guides as 'main'. In general the guides were cited infrequently, indicating limited uptake. CONCLUSION Guides for authors of protocols for observational epidemiological studies varied highly in format and content. We suggest that such guides should routinely be based on a systematic preparatory process.
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Affiliation(s)
- Daniel Malmsiø
- Department of Clinical Research, University of Southern Denmark, Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Odense, Denmark; Odense University Hospital, Open Patient Data Exploratory Network (OPEN), Odense, Denmark.
| | - Anders Frost
- Department of Clinical Research, University of Southern Denmark, Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Odense, Denmark; Odense University Hospital, Open Patient Data Exploratory Network (OPEN), Odense, Denmark
| | - Asbjørn Hróbjartsson
- Department of Clinical Research, University of Southern Denmark, Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Odense, Denmark; Odense University Hospital, Open Patient Data Exploratory Network (OPEN), Odense, Denmark
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Kwon HS, Song KH, Yu JM, Kim DS, Shon HS, Ahn KJ, Choi SH, Ko SH, Kim W, Lee KH, Nam-Goong IS, Park TS. Framingham Risk Score Assessment in Subjects with Pre-diabetes and Diabetes: A Cross-Sectional Study in Korea. J Obes Metab Syndr 2021; 30:261-270. [PMID: 34470918 PMCID: PMC8526298 DOI: 10.7570/jomes20137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 01/20/2023] Open
Abstract
Background This study aimed to evaluate cardiovascular risk in subjects with pre-diabetes and diabetes in Korea. Methods In this pan-Korean, non-interventional, cross-sectional study, data were collected from medical records of 10 hospitals between November 2013 and June 2014. Subjects (aged ≥40 years) with medical records of dysglycemia and documentation of total cholesterol level, high-density lipoprotein cholesterol level, systolic blood pressure, and smoking status in the past 6 months were included. The primary endpoint was to determine the Framingham risk score (FRS). The relationships between FRS and cardiovascular risk factors, glycated hemoglobin, and insulin usage were determined by multiple linear regression analyses. Results Data from 1,537 subjects with pre-diabetes (n=1,025) and diabetes (n=512) were analyzed. The mean FRS (mean±standard deviation) in subjects with pre-diabetes/diabetes was 13.72±8.77. FRS was higher in subjects with diabetes than pre-diabetes (P<0.001). FRS in men with pre-diabetes was comparable to that in women with diabetes (13.80±7.37 vs. 13.35±7.13). FRS was elevated in subjects who consumed alcohol (2.66, P=0.033) and with obesity-class II (6.10, P=0.015) among subjects with diabetes (n=199), and was elevated in patients with left ventricular hypertrophy (11.10, P=0.005), those who consumed alcohol (3.06, P=0.000), were pre-obese (3.21, P=0.002), or were obesity-class I (2.89, P=0.002) among subjects with pre-diabetes (n=306) in comparison to subjects without these coexisting risk factors. Conclusion Overall, Korean subjects with pre-diabetes and diabetes have an increased cardiovascular risk, which is significantly higher in those subjects with diabetes than with pre-diabetes. The present data can be used to develop measures to prevent and manage cardiovascular complications in Koreans with impaired glucose metabolism.
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Affiliation(s)
- Hyuk Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Ho Song
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Myung Yu
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong Sun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Hospital, Seoul, Korea
| | - Ho Sang Shon
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Kyu Jeung Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Hyun Ko
- Department of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Won Kim
- Medical Department, Sanofi-Aventis Korea, Seoul, Korea
| | | | - Il Seong Nam-Goong
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
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Bérard A. Pharmacoepidemiology Research-Real-World Evidence for Decision Making. Front Pharmacol 2021; 12:723427. [PMID: 34557096 PMCID: PMC8452957 DOI: 10.3389/fphar.2021.723427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/16/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- Anick Bérard
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.,Faculty of Medicine, Université Claude Bernard Lyon 1, Lyon, France.,CHU Sainte-Justine, Montreal, QC, Canada
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Takamatsu K, Ideno Y, Kikuchi M, Yasui T, Maruoka N, Nagai K, Hayashi K. Validity of self-reported diagnoses of gynaecological and breast cancers in a prospective cohort study: the Japan Nurses' Health Study. BMJ Open 2021; 11:e045491. [PMID: 34145012 PMCID: PMC8215237 DOI: 10.1136/bmjopen-2020-045491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To validate the self-reported diagnoses of gynaecological and breast cancers in a nationwide prospective cohort study of nursing professionals: the Japan Nurses' Health Study (JNHS). DESIGN AND SETTING Retrospective analysis of the JNHS. PARTICIPANTS AND MEASURES Data were reviewed for 15 717 subjects. The mean age at baseline was 41.6±8.3 years (median: 41), and the mean follow-up period was 10.5±3.8 years (median: 12). Participants are regularly mailed a follow-up questionnaire once every 2 years. Respondents who self-reported a positive cancer diagnosis were sent an additional confirmation questionnaire and contacted the diagnosing facility to confirm the diagnosis based on medical records. A review panel of experts verified the disease status. Regular follow-up, confirmation questionnaires and expert review were validated for their positive predictive value (PPV) and negative predictive value (NPV). RESULTS New incidences were verified in 37, 47, 26 and 300 cervical, endometrial, ovarian and breast cancer cases, respectively. The estimated incidence rates were 22.0, 25.4, 13.8 and 160.4 per 100 000 person-years. These were comparable with those of national data from regional cancer registries in Japan. For regular follow-up, the corresponding PPVs for cervical, endometrial, ovarian and breast cancer were 16.9%, 54.2%, 45.1% and 81.4%, and the NPVs were 100%, 99.9%, 99.9% and 99.9%, respectively. Adding the confirmation questionnaire improved the PPVs to 31.5%, 88.9%, 76.7% and 99.9%; the NPVs were uniformly 99.9%. Expert review yielded PPVs and NPVs that were all ~100%. CONCLUSIONS Gynaecological cancer cannot be accurately assessed by self-reporting alone. Additionally, the external validity of cancer incidence in this cohort was confirmed.
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Affiliation(s)
- Kiyoshi Takamatsu
- Department of Obstetrics and Gynecology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Yuki Ideno
- Center for Mathematics and Data Science, Gunma University, Maebashi, Japan
| | - Mami Kikuchi
- Center of Regional Medical Research and Education, Gunma University Hospital, Meabashi, Japan
| | - Toshiyuki Yasui
- Department of Reproductive and Menopausal Medicine, University of Tokushima Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Naho Maruoka
- Department of International/Community Health Laboratory Sciences, Gunma University Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kazue Nagai
- Department of International/Community Health Laboratory Sciences, Gunma University Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kunihiko Hayashi
- Department of International/Community Health Laboratory Sciences, Gunma University Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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Mahboub B, Al Zaabi A, Al Ali OM, Ahmed R, Niederman MS, El-Bishbishi R. Real life management of community-acquired Pneumonia in adults in the Gulf region and comparison with practice guidelines: a prospective study. BMC Pulm Med 2015; 15:112. [PMID: 26424530 PMCID: PMC4591061 DOI: 10.1186/s12890-015-0108-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 09/23/2015] [Indexed: 11/25/2022] Open
Abstract
Background Very few data exist on the management of community-acquired pneumonia (CAP) in patients admitted to hospitals in the Gulf region. The objectives of this study were to describe treatment patterns for CAP in 38 hospitals in five Gulf countries (United Arab Emirates, Kuwait, Bahrain, Oman, and Qatar) and to compare the findings to the most recent Infectious Diseases Society of America (IDSA) / American Thoracic Society (ATS) guidelines. Methods This was a prospective, observational study conducted between January 2009 and February 2011. Adult patients hospitalised (excluding intensive care units) for CAP and subsequently discharged were included. Data were collected retrospectively at hospital discharge, and prospectively during two follow-up visits. Data on medical history, mortality-risk scores, diagnostic criteria, antibiotic treatment, isolated pathogens and clinical and radiographic outcomes were collected. Care practices were compared to the IDSA/ATS guidelines. Results A total of 684 patients were included. The majority (82.9 %) of patients were classified as low risk for mortality (pneumonia severity index II and III). The majority of patients fulfilled criteria for treatment success at discharge, although only 77.6 % presented a normalised leukocyte count. Overall, the management of CAP in Gulf countries is in line with the IDSA/ATS guidelines. This applied to the diagnosis of CAP, to the identification of high-risk CAP patients, to the identification of etiologic agent responsible for CAP and to the type of treatment despite the fact that combinations of antimicrobial agents were not consistent with the guidelines in 10 % of patients. In all patients, information about Gram’s staining was not captured as recommended by the IDSA/ATS and in the majority of patients (>85 %) chest radiography was not systematically performed at the post-discharge follow-up visits. Discussion The management of CAP in the Gulf region is globally in line with current IDSA/ATS guidelines, although rates of pathogen characterisation and post-discharge follow-up need to be improved. Conclusion Compliance with established guidelines should be encouraged in order to improve the management of the disease in this region.
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Affiliation(s)
- Bassam Mahboub
- Rashid Hospital, Oud Metha Road, Umm Hurair Area 2, PO Box 4545, Dubai, UAE.
| | | | - Ola Mohamed Al Ali
- Rashid Hospital, Oud Metha Road, Umm Hurair Area 2, PO Box 4545, Dubai, UAE.
| | - Raees Ahmed
- Rashid Hospital Trauma Center, Dubai, United Arab Emirates.
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Mañas A, Cerezo L, de la Torre A, García M, Alburquerque H, Ludeña B, Ruiz A, Pérez A, Escribano A, Manso A, Glaria LA. Epidemiology and prevalence of oropharyngeal candidiasis in Spanish patients with head and neck tumors undergoing radiotherapy treatment alone or in combination with chemotherapy. Clin Transl Oncol 2012; 14:740-6. [PMID: 22960994 DOI: 10.1007/s12094-012-0861-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 12/16/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the oropharyngeal candidiasis (OPC) prevalence in Spanish patients with head and neck cancer undergoing radiotherapy, alone or combined with chemotherapy. Secondary objectives were to determine the prevalence of Candida species colonization, and to explore whether different Candida species colonizing the oral cavity and the treatment were associated with a higher prevalence of OPC. METHODS This is an observational, cross-sectional, multicentre study, conducted in Spanish radiation oncology units. Patients were diagnosed with head and neck cancer and started a radiotherapy treatment alone or combined with chemotherapy at the moment of their inclusion (N = 92). RESULTS The OPC prevalence was 26 %. The identification of colonizing pathogens was performed in 49 patients, and Candida albicans was the dominant yeast (69 %), while non-albicans Candida was only found in 15 patients (31 %). Patients with C. albicans colonization had a significant higher prevalence of OPC compared to patients colonized by non-albicans Candida (p = 0.0273), but no difference was found regarding the OPC prevalence in patients receiving only radiotherapy compared to patients with both radiotherapy and chemotherapy treatments. CONCLUSIONS Our data represent a step further in the knowledge of Candida species present in Spanish patients with head and neck tumors under radiation therapy. This is an essential step to manage the prophylaxis and treatment of OPC, since it might lead to severe clinical complications causing treatment interruption and, thus, representing a reduction in anti-tumor efficacy.
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Affiliation(s)
- Ana Mañas
- Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Madrid, Spain.
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Chang TE, Jing Y, Yeung AS, Brenneman SK, Kalsekar I, Hebden T, McQuade R, Baer L, Kurlander JL, Watkins AK, Siebenaler JA, Fava M. Effect of communicating depression severity on physician prescribing patterns: findings from the Clinical Outcomes in MEasurement-based Treatment (COMET) trial. Gen Hosp Psychiatry 2012; 34:105-12. [PMID: 22264654 DOI: 10.1016/j.genhosppsych.2011.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 12/13/2011] [Accepted: 12/13/2011] [Indexed: 01/30/2023]
Abstract
OBJECTIVE In this secondary analysis from the Clinical Outcomes in MEasurement-based Treatment trial (COMET), we evaluated whether providing primary care physicians with patient-reported feedback regarding depression severity affected pharmacological treatment patterns. METHOD Intervention-arm physicians received their patients' 9-item Patient Health Questionnaire scores monthly. Odds of having no change in antidepressant treatment during the 6-month study period were calculated. Relationships between depression symptom status (partial or nonresponse) at month 3 and treatment changes in months 3 through 6 were assessed. RESULTS Among 503 intervention and 412 usual care (UC) patients with major depressive disorder, most received antidepressant monotherapy at baseline (79.4% UC vs. 88.4% intervention; P=.047). Few switched their baseline antidepressant (17.4%), increased their dose (12.4%) or augmented with a second medication (2%). Odds of having no change in antidepressant therapy did not differ significantly between study arms (odds ratio 1.21; 95% confidence interval 0.78-1.88; P=.392). Few month 3 partial or nonresponders had a regimen change over the following 3 months; the study arms did not differ significantly (partial responders: 4.1% UC vs. 7.7% intervention; P=.429; nonresponders: 14.6% UC vs. 15.9% intervention; P=.888). CONCLUSIONS Among depressed patients treated in primary care, little active management was observed. The lack of treatment modification for the majority of partial and nonresponders was notable.
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Affiliation(s)
- Trina E Chang
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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Joshi SR, Saboo B, Vadivale M, Dani SI, Mithal A, Kaul U, Badgandi M, Iyengar SS, Viswanathan V, Sivakadaksham N, Chattopadhyaya PS, Biswas AD, Jindal S, Khan IA, Sethi BK, Rao VD, Dalal JJ. Prevalence of diagnosed and undiagnosed diabetes and hypertension in India--results from the Screening India's Twin Epidemic (SITE) study. Diabetes Technol Ther 2012; 14:8-15. [PMID: 22050271 DOI: 10.1089/dia.2011.0243] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Despite the rising number of patients with diabetes and hypertension in India, there is a dearth of nationwide, comprehensive prevalence data on these diseases. Our study aimed at collecting data on the prevalence of diabetes and hypertension and the underlying risk factors in various outpatient facilities throughout India. METHODS This cross-sectional study was planned to be conducted in 10 Indian states, one state at a time. It was targeted to enroll about 2,000 patients from 100 centers in each state. Each center enrolled the first 10 patients (≥18 years of age, not pregnant, signed consent) per day on two consecutive days. "Diabetes" and "hypertension" were defined by the 2008 American Diabetes Association and the Joint National Committee's 7(th) Report guidelines, respectively. Patient data (demographics, lifestyle factors, medical history, and laboratory diagnostic results) were collected and analyzed. RESULTS During 2009-2010, in total, 15,662 eligible patients (54.8% males; mean age, 48.9±13.9 years) from eight states were enrolled. Diabetes was prevalent in 5,427 (34.7%) patients, and 7,212 (46.0%) patients had hypertension. Diabetes and hypertension were coexistent in 3,227 (20.6%) patients. Among those whose disease status was not known at enrollment, 7.2% (793 of 11,028) and 22.2% (2,408 of 10,858) patients were newly diagnosed with diabetes and hypertension, respectively; additionally, 18.4% (2,031 of 11,028) were classified as having prediabetes and 60.1% (6,521 of 10,858) as having prehypertension. A positive association (P<0.05) was observed between diabetes/hypertension and age, familial history of either, a medical history of cardiovascular disorders, alcohol consumption, and diet. CONCLUSIONS Our study demonstrates that the substantial burden of diabetes and hypertension is on the rise in India. Patient awareness and timely diagnosis and intervention hold the key to limiting this twin epidemic.
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Affiliation(s)
- Shashank R Joshi
- Department of Endocrinology, Lilavati and Bhatia Hospital and Grant Medical College, Mumbai, India.
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De Hert M, Mauri M, Shaw K, Wetterling T, Doble A, Giudicelli A, Falissard B. The METEOR study of diabetes and other metabolic disorders in patients with schizophrenia treated with antipsychotic drugs. I. Methodology. Int J Methods Psychiatr Res 2010; 19:195-210. [PMID: 20683849 PMCID: PMC6878539 DOI: 10.1002/mpr.322] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Patients with schizophrenia present a two- to three-fold higher prevalence of diabetes, of metabolic syndrome and of cardiovascular morbidity. The reason for this increased prevalence may involve intrinsic vulnerability, lifestyle factors and iatrogenic effects of antipsychotic drugs. The objective of this multinational, cross-sectional, pharmacoepidemiological study was to determine the prevalence of diabetes, lipid disorders, obesity, hypertension and the metabolic syndrome in patients with schizophrenia treated with antipsychotic drugs. Particular attention was taken to acquire data on a wide a range as possible of demographic, clinical and lifestyle variables that may influence the risk of metabolic disorders, which were taken into account in the calculation of prevalence data by propensity scoring. The study included 2270 subjects from 16 European countries, predominantly from Central and Eastern Europe. The proportion of subjects presenting the pathologies of interest was relatively high, ranging from 28% for glycaemic disorders to 70% for lipid disorders.
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Blomgren KJ, Sundström A, Steineck G, Wiholm BE. Interviewer variability - quality aspects in a case-control study. Eur J Epidemiol 2006; 21:267-77. [PMID: 16685577 DOI: 10.1007/s10654-006-0017-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2006] [Indexed: 11/25/2022]
Abstract
Quality assurance and quality control are important for the reliability of case-control studies. Here we describe the procedures used in a previously published study, with emphasis on interviewer variability. To evaluate risk factors for acute pancreatitis, information including previous diagnoses and medication was collected from medical records and by telephone interviews from 462 cases and 1781 controls. Quality assurance procedures included education and training of interviewers and data validity checks. Quality control included a classification test, annual test interviews, expert case validation, and database validation. We found pronounced variations between interviewers. The maximal number of interviews per day varied from 3 to 9. The adjusted average (95% CI) number of diagnoses captured per interview of cases was 4.1 (3.8-4.3) and of controls 3.5 (3.4-3.7) (excluding one deviating interviewer). For drugs, the average (95% CI) number per interview was 3.9 (3.7-4.1) for cases and 3.3 (3.2-3.4) for controls (excluding one deviating interviewer). One of the fourteen interviewers deviated significantly from the others, and more so for controls than for cases. This interviewer's data ;were excluded. Nonetheless, data concerning controls more frequently needed correction and supplementation than for cases. Erroneous coding of diagnoses and medication was also more frequent among controls. Thus, a system for quality control of coding practices is crucial. Variability in interviewers' ability to ascertain information is a possible source of bias in interview-based case-control studies when "blinding" cannot be achieved.
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Affiliation(s)
- Kerstin J Blomgren
- The Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden.
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Altpeter E, Burnand B, Capkun G, Carrel R, Cerutti B, Mäusezahl-Feuz M, Gassner M, Junker C, Künzli N, Lengeler C, Minder C, Rickenbach M, Schorr D, Vader JP, Zemp E. Essentials of good epidemiological practice. ACTA ACUST UNITED AC 2005; 50:12-27. [PMID: 15773018 DOI: 10.1007/s00038-004-4008-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Soto Alvarez J. [Observational studies to evaluate the clinical effectiveness of drugs. Use of guide lists for their design, analysis, and interpretation]. Aten Primaria 2005; 35:156-62. [PMID: 15737273 PMCID: PMC7684423 DOI: 10.1157/13071942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- J Soto Alvarez
- Departamento de Farmacoepidemiología-Farmacoeconomía, Unidad Médica, Pfizer, S.A., Spain.
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Abstract
Scientifically valid data on the safety of drug use during pregnancy are a significant public health need. Data are rarely available on the fetal effects of in utero exposure in human pregnancies, particularly when a drug is first marketed. Data from animal reproductive toxicology studies, which function as a screen for potential human teratogenicity, are usually all that is available in a product's labelling. For practising clinicians, translating known animal risks into an accurate assessment of teratogenic risks in their patients is very difficult, if not impossible. Without human data on the effects of in utero drug exposure, it is difficult for physicians and other healthcare providers (e.g. genetic counsellors) to adequately counsel patients about fetal risks. Therefore, a pregnant woman may decide to unnecessarily terminate a wanted pregnancy or forego needed drug therapy. In spite of the lack of data on the safety of drug use during human pregnancies, pregnant women are exposed to drugs either as prescribed therapy or inadvertently before pregnancy is known (over one-half of pregnancies are unplanned). Because little is known about the teratogenic potential of a drug in humans before marketing, post-marketing surveillance of drug use in pregnancy is critical to the detection of drug-induced fetal effects. The existing passive mechanism of spontaneous reporting of adverse drug effects is inadequate to routinely detect drug-induced fetal risks or lack of such risks. Therefore, post-marketing pregnancy exposure registries are being increasingly used to proactively monitor for major fetal effects and to describe margins of safety associated with drug exposure during pregnancy. However, differing methodological rigour has been applied to the development of pregnancy exposure registries. It is important that all pregnancy registries develop epidemiologically sound written study protocols a priori. It is only through the use of rigorous methodology and procedures that data from pregnancy exposure registries will withstand scientific scrutiny. Successful recruitment of an adequate number of exposed pregnancies, aggressive follow-up, and complete and accurate ascertainment of pregnancy outcome are critical attributes of a well-designed registry.
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Affiliation(s)
- Dianne L Kennedy
- Pregnancy Labeling Task Force, US Food and Drug Administration, Rockville, Maryland 20874, USA.
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16
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MacDonald TM, Beard K, Bruppacher R, Hasford J, Lewis M, Logan RF, McNaughton D, Tubert-Bitter P, Van Ganse E, Moore N. The safety of drugs for OTC use: what evidence is required for an NSAID switch? Pharmacoepidemiol Drug Saf 2002; 11:577-84. [PMID: 12462134 DOI: 10.1002/pds.736] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In recent years there has been a growing demand for safe and effective over-the-counter (OTC) drugs. The demonstration of the safety of OTC products in actual conditions of use is crucial for their wide distribution, since the circumstances of their use may be different from the prescription-only setting. A group of experts met in Geneva, Switzerland, with the aim of exploring the criteria required to show safety equivalence of OTC medications, with specific reference to low-dose non-steroidal anti-inflammatory drugs (NSAIDs) used for analgesia. It was agreed that an acceptable surrogate marker for safety as the primary endpoint in a study designed to show that a new NSAID was not inferior to a current NSAID would be any adverse event leading the patient to consult a physician. A sample size of 10,000 patients in each arm of a two-arm study would be sufficient to show non-inferiority with acceptable relative risk equal to 1.2 with at least 90% power for an event rate of 5%. An example of a possible pharmacy-based randomized study design to demonstrate safety equivalence of OTC analgesics is given.
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Affiliation(s)
- Thomas M MacDonald
- Medicines Monitoring Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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17
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Affiliation(s)
- E B Andrews
- Glaxo Wellcome, Research Triangle Park, North Carolina 27709, USA
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18
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Arnold RG, Kotsanos JG. Panel 3: methodological issues in conducting pharmacoeconomic evaluations--retrospective and claims database studies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 1999; 2:82-7. [PMID: 16674338 DOI: 10.1046/j.1524-4733.1999.02204.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- R G Arnold
- Pharmacon International, New York, NY, USA
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19
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Healey M, Deverka P. Panel 1: methodological issues in pharmacoeconomic evaluations--clinical studies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 1999; 2:73-7. [PMID: 16674336 DOI: 10.1046/j.1524-4733.1999.02202.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- M Healey
- The Institute for Research & Education, HealthSystems Minnesota, Minneapolis, MN, USA
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20
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Meyboom RH. Good practice in the postmarketing surveillance of medicines. PHARMACY WORLD & SCIENCE : PWS 1997; 19:186-90. [PMID: 9297731 DOI: 10.1023/a:1008610722972] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In addition to Good Clinical Trial Practice for the study of experimental drugs, regulations are also needed for good practice in the assessment of medicines after approval (Good PMS Practice, GPP). GPP has to protect the interests of public health at large as well as those of individual patients, investigators and pharmaceutical companies. GPP may be the natural way to solve threatening conflicts between privacy legislation and the public interest.
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Affiliation(s)
- R H Meyboom
- Netherlands Pharmacovigilance Foundation LAREB, Tilburg, The Netherlands
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