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Runkle JD, Sugg MM, Berry A, Reed C, Cowan K, Wertis L, Ryan S. Association of Psychiatric Emergency Visits and Warm Ambient Temperature during Pregnancy: A Time-Stratified Case-Crossover Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:67001. [PMID: 38829735 PMCID: PMC11166382 DOI: 10.1289/ehp13293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Acute exposure to high ambient temperature and heat waves during the warm season has been linked with psychiatric disorders. Emerging research has shown that pregnant people, due to physiological and psychological changes, may be more sensitive to extreme heat, and acute exposure has been linked to increased risk of pregnancy complications; however, few studies have examined psychiatric complications. OBJECTIVE Our objective was to examine the association between acute exposure to warm ambient temperatures and emergency department (ED) visits for mental disorders during pregnancy. METHODS A time-stratified case-crossover design with conditional logistic regression was performed on ∼ 206,000 psychiatric ED visits for pregnant patients in North Carolina, from May to September 2016 to 2019. Daily average ambient temperature was the main exposure and was linked to daily visits by maternal zip code of residence for prenatal mood and anxiety disorders (PMAD), severe mental illness (SMI), mental disorder of pregnancy (MDP), suicidal thoughts (SUIC), and any psychiatric disorder (Any). Effect modification by trimester, residential segregation, economic segregation, urbanicity, and availability of greenspace was also investigated. RESULTS Each 5 ° C increase in same-day exposure to warm ambient temperature on case days was associated with an increase in incidence rate ratio (IRR) for any psychiatric disorder [IRR = 1.07; 95% confidence interval (CI): 1.01, 1.14] including anxiety (IRR = 1.14; 95% CI: 1.00, 1.30), bipolar disorder (IRR = 1.28; 95% CI: 0.98, 1.67), and suicidal thoughts (IRR = 1.28; 95% CI: 1.00, 1.65) compared to control days. In general, the associations were strongest for warm season temperatures on the same day of exposure or for temperatures averaged over the 3 or 6 d preceding the ED visit. The greatest risk of an incident ED admission for PMAD (RR = 1.20; 95% CI: 1.04, 1.39), particularly for anxiety (RR = 1.30; 95% CI: 1.07, 1.59), and any psychiatric disorder (RR = 1.17; 95% CI: 1.07, 1.28) occurred following cumulative exposure to hot temperatures the week before admission. Higher psychiatric burden from temperature was observed in urban areas and on extreme heat days. CONCLUSIONS For this pregnant population in the southeastern United States, short-term exposure to high ambient temperatures during the warm season was associated with a greater risk of ED visits for an array of psychiatric disorders. Findings show that climate-related increases in ambient temperature may contribute to psychiatric morbidity in pregnant people. https://doi.org/10.1289/EHP13293.
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Affiliation(s)
- Jennifer D. Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina, USA
| | - Margaret M. Sugg
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina, USA
| | - Anne Berry
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Charlie Reed
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina, USA
| | - Kristen Cowan
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina, USA
| | - Luke Wertis
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina, USA
| | - Sophie Ryan
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina, USA
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Meng LC, Lin CW, Chuang HM, Chen LK, Hsiao FY. Benzodiazepine Use During Pregnancy and Risk of Miscarriage. JAMA Psychiatry 2024; 81:366-373. [PMID: 38150230 PMCID: PMC10753441 DOI: 10.1001/jamapsychiatry.2023.4912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/30/2023] [Indexed: 12/28/2023]
Abstract
Importance Benzodiazepine use during pregnancy has raised significant concerns due to the potential harmful effects of this drug class on neonates. Studies on the association between benzodiazepine use and the risk of miscarriage are limited. Objective To quantify the risk of miscarriage associated with benzodiazepine use during pregnancy after controlling for unmeasured confounders and exposure time trends. Design, Setting, and Participants This was a nationwide, population-based case-time-control study using Taiwan's National Birth Certificate Application database and the National Health Insurance database. Pregnancies resulting in miscarriage between 2004 and 2018 were included in the case group and were 1:1 matched with exposure time-trend control individuals using disease risk score, considering demographic characteristics and prepregnancy comorbidities. Data were analyzed from August 2022 to March 2023. Exposures Discordant exposures to benzodiazepines during risk period (1-28 days before miscarriage) and 2 reference periods (31-58 days and 181-208 days before the last menstrual period) were compared for each pregnancy. Main Outcomes and Measures Miscarriage was defined as any pregnancy loss occurring between the first prenatal care visit (usually 8 weeks) and the 19th completed week of pregnancy. Results This study comprised a total of 3 067 122 pregnancies among 1 957 601 women, 136 134 of which (4.4%) resulted in miscarriage. The mean (SD) age of the study population was 30.61 (5.91) years. The use of benzodiazepines during pregnancy was associated with an increased risk of miscarriage (odds ratio [OR], 1.69; 95% CI, 1.52-1.87), and consistent findings were observed across multiple sensitivity analyses considering different time windows and accounting for misclassification. In subgroup analyses, an increased risk of miscarriage was associated with each commonly used individual benzodiazepine, ranging from case-time-control ORs of 1.39 (95% CI, 1.17-1.66) for alprazolam to 2.52 (95% CI, 1.89-3.36) for fludiazepam. Conclusions and Relevance This nationwide case-time-control study revealed an increased risk of miscarriage associated with benzodiazepine use during pregnancy after accounting for measurable confounders, and results were unlikely to be due to unmeasured confounding. These findings underscore the necessity for health care professionals to meticulously balance the risk-benefit ratio when considering the use of benzodiazepines to treat psychiatric and sleep disorders during pregnancy.
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Affiliation(s)
- Lin-Chieh Meng
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Hui-Min Chuang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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Gastesi Orbegozo I, Cea-Soriano L, Llorente A, Huerta-Álvarez C. Lack of association between COVID-19 vaccines and miscarriage onset using a case-crossover design. Sci Rep 2024; 14:7275. [PMID: 38538736 PMCID: PMC10973422 DOI: 10.1038/s41598-024-57880-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/22/2024] [Indexed: 04/07/2024] Open
Abstract
Pregnant women might have an increased risk of SARS-COV-2 infection. Although evidence towards the efficacy and safety of COVID-19 is growing still there is room for improvement on the knowledge towards pregnancy adverse events, such as miscarriage. We explored the association of COVID-19 vaccine with the risk of miscarriages using the Real-World. We identified a cohort of vaccinated pregnancies using the BIFAP database which contains systematically recorded data on care patients in Spain (N = 4054). We then restricted it to those women who had a miscarriage using a validated algorithm (N = 607). Among them, we performed a case-crossover design to evaluate the effect of intermittent exposures on the risk of miscarriage. Adjusted Odds Ratio with their confidence intervals were calculated using two analytical approaches: conditional logistic regression and Generalized Linear Mixed-Effects Models. A total of 225 (37.1%) were aged 35-39 years. The most common comorbidities were asthma, migraine, gastritis, and hypothyroidism. A total of 14.7% received only one dose of COVID-19 and 85.3% two doses, respectively. A total of 36.8% of women with one dose and 27.6% with two doses received the vaccine 7 days prior to the miscarriage. Corresponding adjusted estimates for the risk of miscarriage using the conditional logistic regression where as follows: 1.65 (95% CI 0.85-3.23) when using as the sum of 3 control moments among women with one dose, 1.02 (95% CI 0.72-1.46) among women with two doses and 1.03 (95% CI 0.72, 1.46) using the whole study population. Very similar results were obtained when conducting the Generalized Linear Mixed-Effects Models. There was no overall increased risk of miscarriage onset associated with COVID-19 vaccine although contradictory results were found according to the number of doses. Further studies are required with larger sample sizes to assess this association.
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Affiliation(s)
- Irati Gastesi Orbegozo
- Biomedical Research Foundation Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Complutense University of Madrid, Pza. Ramón y Cajal, s/n. Ciudad Universitaria, 28040, Madrid, Spain.
| | - Ana Llorente
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Consuelo Huerta-Álvarez
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Complutense University of Madrid, Pza. Ramón y Cajal, s/n. Ciudad Universitaria, 28040, Madrid, Spain
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Andersen PK, Martinussen T. Discussion of "A formal causal interpretation of the case-crossover design". Biometrics 2022. [PMID: 36052967 DOI: 10.1111/biom.13748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Discussion on "A formal causal interpretation of the case-crossover design" by Zach Shahn, Miguel A. Hernan, and James M. Robins.
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Affiliation(s)
- Per Kragh Andersen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Torben Martinussen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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Walter O, Cougoul P, Maquet J, Bartolucci P, Lapeyre-Mestre M, Lafaurie M, Moulis G. Risk of vaso-occlusive episode after exposure to corticosteroids in patients with sickle cell disease. Blood 2022; 139:3771-3777. [PMID: 35471555 PMCID: PMC11290598 DOI: 10.1182/blood.2021014473] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/16/2022] [Indexed: 11/20/2022] Open
Abstract
Vaso-occlusive episodes (VOEs) are a major concern in patients with sickle cell disease (SCD). Exposure to systemic corticosteroids has been suspected to increase the occurrence of VOEs in case reports or series. No comparative study has been conducted to investigate this risk, which is still debated. Several clinical trials demonstrated the effectiveness of corticosteroids for the treatment of VOEs, but with increased rates of readmission. The aim of the study was to assess the risk of hospitalization for VOE associated with exposure to systemic corticosteroids in patients with SCD. We used a case-case-time-control design in a nationwide population-based cohort built in the French national health insurance database between 2010 and 2018. The population included all patients with SCD with at least 1 hospitalization for VOE. Corticosteroids were identified using out-of-hospital dispensing data. The outcome was the first hospitalization for VOE. The case-case-time-control design induces self-adjustment for time-invariant confounders, including genotype. Analyses were adjusted for time-dependent confounders (infections, red blood transfusions) and stratified by exposure to hydroxyurea. Overall, 5151 patients were included in the main analysis. Corticosteroid exposure was significantly associated with the occurrence of hospitalizations for VOEs: adjusted odds ratio, 3.8; 95% confidence interval [CI], 2.4-5.6). In patients exposed to hydroxyurea, the adjusted odds ratio was 2.6 (95% CI, 1.1-6.4); it was 4.0 (95% CI, 2.5-6.3) in unexposed patients. These results were consistent in children and adults. In conclusion, systemic corticosteroids were associated to an increased risk of hospitalization for VOEs and should be limited in patients with SCD.
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Affiliation(s)
- Ondine Walter
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), and
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
| | - Pierre Cougoul
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
| | - Julien Maquet
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), and
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
| | - Pablo Bartolucci
- Department of Internal Medicine, Reference Center of Sickle Cell Disease, Mondor University Hospital, Créteil, France; and
| | - Maryse Lapeyre-Mestre
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), and
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Margaux Lafaurie
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), and
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Guillaume Moulis
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), and
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
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Shmuel S, Pate V, Pepin MJ, Bailey JC, Golightly YM, Hanson LC, Stürmer T, Naumann RB, Gnjidic D, Lund JL. Effects of anticholinergic and sedative medication use on fractures: A self-controlled design study. J Am Geriatr Soc 2021; 69:3212-3224. [PMID: 34291817 PMCID: PMC8595585 DOI: 10.1111/jgs.17377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/20/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Unintentional falls are a leading cause of injury for older adults, and evidence is needed to understand modifiable risk factors. We evaluated 1-year fall-related fracture risk and whether dispensing of medications with anticholinergic/sedating properties is temporally associated with an increased odds of these fractures. DESIGN A retrospective cohort study with nested self-controlled analyses conducted between January 1, 2014, and December 31, 2016. SETTING Twenty percent nationwide, random sample of US Medicare beneficiaries. PARTICIPANTS New users of medications with anticholinergic/sedating properties who were 66+ years old and had Medicare Parts A, B, and D coverage but no claims for medications with anticholinergic/sedating properties in the year before initiation were eligible. MEASUREMENTS We followed new users of medications with anticholinergic/sedating properties until first non-vertebral, fall-related fracture (primary outcome), Medicare disenrollment, death, or end of study data. We estimated the 1-year risk with corresponding 95% confidence intervals (CIs) of first fracture after new use. We applied the self-controlled case-crossover and case-time-control designs to estimate odds ratios (ORs) and 95% CIs by comparing anticholinergic and/or sedating medication exposure (any vs. none) during a 14-day hazard period preceding the fracture to exposure to these medications during an earlier 14-day control period. RESULTS A total of 1,097,989 Medicare beneficiaries initiated medications with anticholinergic/sedating properties in the study period. The 1-year cumulative incidence of fall-related fracture, accounting for death as a competing risk, was 5.0% (95% CI: 5.0%-5.0%). Using the case-crossover design (n = 41,889), the adjusted OR for the association between anticholinergic/sedating medications and fractures was 1.03 (95% CI: 0.99, 1.08). Accounting for the noted temporal trend using the case-time-control design (n = 209,395), the adjusted OR was 1.60 (95% CI: 1.52, 1.69). CONCLUSION Use of anticholinergic/sedating medication was temporally associated with an increased odds of fall-related fractures. Patients and their healthcare providers should consider pharmacologic and non-pharmacologic treatments for the target condition that are safer.
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Affiliation(s)
- Shahar Shmuel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Virginia Pate
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Marc J. Pepin
- Durham VA Geriatric Research Education and Clinical Center (GRECC), Durham, NC 27705 USA
| | - Janine C. Bailey
- Durham VA Geriatric Research Education and Clinical Center (GRECC), Durham, NC 27705 USA
| | - Yvonne M. Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, CB #7820, Chapel Hill, NC 27599 USA
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Bondurant Hall, CB #7135, Chapel Hill, NC 27599 USA
| | - Laura C. Hanson
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Division of Geriatric Medicine & Palliative Care Program, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Rebecca B. Naumann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Jennifer L. Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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Krogsgaard LW, Petersen I, Plana-Ripoll O, Bech BH, Lützen TH, Thomsen RW, Rytter D. Infections in temporal proximity to HPV vaccination and adverse effects following vaccination in Denmark: A nationwide register-based cohort study and case-crossover analysis. PLoS Med 2021; 18:e1003768. [PMID: 34495975 PMCID: PMC8457493 DOI: 10.1371/journal.pmed.1003768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 09/22/2021] [Accepted: 08/13/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Public trust in the human papilloma virus (HPV) vaccination programme has been challenged by reports of potential severe adverse effects. The reported adverse symptoms were heterogeneous and overlapping with those characterised as chronic fatigue syndrome (CFS) and have been described as CFS-like symptoms. Evidence suggests that CFS is often precipitated by an infection. The aim of the study was to examine if an infection in temporal proximity to HPV vaccination is a risk factor for suspected adverse effects following HPV vaccination. METHODS AND FINDINGS The study was a nationwide register-based cohort study and case-crossover analysis. The study population consisted of all HPV vaccinated females living in Denmark, born between 1974 and 2006, and vaccinated between January 1, 2006 and December 31, 2017. The exposure was any infection in the period ± 1 month around time of first HPV vaccination and was defined as (1) hospital-treated infection; (2) redemption of anti-infective medication; or (3) having a rapid streptococcal test done at the general practitioner. The outcome was referral to a specialised hospital setting (5 national HPV centres opened June 1, 2015) due to suspected adverse effects following HPV vaccination. Multivariable logistic regression was used to estimate the association between infection and later HPV centre referral. The participants were 600,400 HPV-vaccinated females aged 11 to 44 years. Of these, 48,361 (9.7%) females had a hospital-treated infection, redeemed anti-infective medication, or had a rapid streptococcal test ± 1 month around time of first HPV vaccination. A total of 1,755 (0.3%) females were referred to an HPV centre. Having a hospital-treated infection in temporal proximity to vaccination was associated with significantly elevated risk of later referral to an HPV centre (odds ratio (OR) 2.75, 95% confidence interval (CI) 1.72 to 4.40; P < 0.001). Increased risk was also observed among females who redeemed anti-infective medication (OR 1.56, 95% CI 1.33 to 1.83; P < 0.001) or had a rapid streptococcal test (OR 1.45, 95% CI 1.10 to 1.93; P = 0.010). Results from a case-crossover analysis, which was performed to adjust for potential unmeasured confounding, supported the findings. A key limitation of the study is that the HPV centres did not open until June 1, 2015, which may have led to an underestimation of the risk of suspected adverse effects, but stratified analyses by year of vaccination yielded similar results. CONCLUSIONS Treated infection in temporal proximity to HPV vaccination is associated with increased risk for later referral with suspected adverse vaccine effects. Thus, the infection could potentially be a trigger of the CFS-like symptoms in a subset of the referred females. To our knowledge, the study is the first to investigate the role of infection in the development of suspected adverse effects after HPV vaccination and replication of these findings are needed in other studies.
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Affiliation(s)
- Lene Wulff Krogsgaard
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
- * E-mail:
| | - Irene Petersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, United Kingdom
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Aarhus University, Aarhus V, Denmark
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Tina Hovgaard Lützen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | | | - Dorte Rytter
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
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Lin X, Du Z, Liu Y, Hao Y. The short-term association of ambient fine particulate air pollution with hypertension clinic visits: A multi-community study in Guangzhou, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 774:145707. [PMID: 33611009 DOI: 10.1016/j.scitotenv.2021.145707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The association of ambient fine particulate pollution with daily outpatient clinic visits (OCV) for hypertension in China remains to be investigated. OBJECTIVES This study aimed to examine short-term impacts of exposure to fine particulate matter of aerodynamic diameter < 2.5μm (PM2.5) on daily OCV for hypertension, using a large-scale multi-center community database in Guangzhou, one of the most densely-populated cities in Southern China. METHODS We collected a total of 28,548 individual records of OCV from 22 community healthcare facilities in Guangzhou from January 1st to May 7th 2020. Hourly data on air pollutants and daily information on meteorological factors were obtained. According to the World Health Organization air-quality guidelines, daily excessive concentration hours (DECH) was calculated. PM2.5 daily mean, hourly-peak concentration and DECH were used as the exposure variables. Based on a case-time-control design, the Cox regression model was applied to evaluate the short-term relative risks (RR) of daily OCV for hypertension. Sensitivity analyses were conducted, with nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone being adjusted. RESULTS Daily mean and hourly-peak of PM2.5 were significantly associated with daily OCV for hypertension, while weaker associations were observed for DECH. The estimated RRs at lag day 0 were 1.039 (95% confidence interval [CI]: 1.037, 1.040), 1.851 (95%CI: 1.814, 1.888), and 1.287 (95%CI: 1.276, 1.298), respectively, in association with a 1-unit increase in DECH, daily mean, and hourly-peak concentration of PM2.5. For the lagged effect, lag4 models estimated the greatest RRs for PM2.5 DECH and hourly-peak, whereas a lag2 model produced the highest for PM2.5 daily mean. DISCUSSION This study consolidates the evidence for a positive correlation between ambient PM2.5 exposure and risks of hypertensive OCV. It also provides profound insight regarding planning for health services needs and establishing early environmental responses to the worsening air pollution in the communities.
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Affiliation(s)
- Xiao Lin
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Zhicheng Du
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Yu Liu
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China; Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China.
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Kang HR, Jang SC, Shin JY. Association between oseltamivir use and neuropsychiatric adverse events in influenza patients: a nationwide population-based cohort study. Expert Opin Drug Saf 2020; 20:245-253. [PMID: 33183123 DOI: 10.1080/14740338.2021.1850690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: A potential risk of neuropsychiatric adverse events (NPAEs) of oseltamivir has remained controversial by retrospective cohort studies. This nationwide population-based cohort study aimed to assess the risk of NPAEs in influenza patients undergoing oseltamivir treatment (users) compared with a propensity score-matched cohort of patients not receiving oseltamivir (non-users). Research design and methods: Using the Korean National Health Service-Sample Cohort Database, patients diagnosed with incident influenza during 2003-2013 were divided into two cohorts: oseltamivir users and non-users. We calculated adjusted hazard ratios (aHRs) for the 5-day treatment course with oseltamivir using Cox regression analysis. Results: The incidence rate of NPAEs during 5-day oseltamivir treatment was 0.0029 and 0.0023 in oseltamivir users and non-users, respectively. The risk of NPAEs was different according to age, with an increased risk in patients aged 10-19 years (aHR 2.69, 95% CI 1.05-6.93) and a decreased risk in patients aged 0-9 years (aHR 0.46, 95% CI 0.24-0.88). The non-significant positive associations were observed in patients aged 20-64 years and those aged greater than 65 years. Conclusions: Although the reason for the inverse association in children aged 0-9 years is unknown, oseltamivir could increase the risk of NPAEs for children or adolescents aged greater than 10 years.
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Affiliation(s)
- Hye-Rim Kang
- School of Pharmacy, Sungkyunkwan University , Suwon, Gyeonggi-do, South Korea
| | - Suk-Chan Jang
- School of Pharmacy, Sungkyunkwan University , Suwon, Gyeonggi-do, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University , Suwon, Gyeonggi-do, South Korea
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Sun Y, Pedersen LH, Wu CS, Petersen I, Sørensen HT, Olsen J. Antidepressant use during pregnancy and risk of congenital heart defects: A case-time-control study. Pharmacoepidemiol Drug Saf 2019; 28:1180-1193. [PMID: 31359557 DOI: 10.1002/pds.4844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 05/09/2019] [Accepted: 05/31/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE We estimated the association between maternal antidepressant (AD) use in early pregnancy and risk of congenital heart defects. METHODS We applied a case-time-control design with the aim of controlling for confounding from time-invariant factors and compared the results of the design to results from a cohort design in a population of 792 685 singletons born alive in Denmark during 1995-2008. In the case-time-control design, we identified children diagnosed with a congenital heart defect in the first 5 years of life (cases) and compared maternal AD use in the risk period (the first 3 months of pregnancy) and the reference period (gestational months 5-7). A nondiseased control group was included to adjust for time trends of exposure. In the cohort design, we identified children whose mothers redeemed at least one AD prescription in the first 3 months of pregnancy (the exposed) and two other groups including the unexposed children with maternal AD prescriptions in the 12 months before pregnancy. We applied conditional logistic regression and logistic regression to compute odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The case-time-control OR for any congenital heart defect was 1.03 (95% CI, 0.61-1.73), which was similar to the OR (1.09, 95% CI, 0.88-1.35) from the cohort design when we compared the exposed children with the unexposed children with maternal AD use before pregnancy. CONCLUSIONS The case-time-control design provided results similar to the cohort design when the cohort design had a better confounder control strategy. We discussed the strengths and drawbacks of case-time-control design.
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Affiliation(s)
- Yuelian Sun
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Neurology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,National Center of Register-based Research, Department of Economics and Business Economics, Business and Social Science, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Department of Obstetrics and Gynecology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Chun Sen Wu
- Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Irene Petersen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Primary Care and Population Health, University College London, London, UK
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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11
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Huybrechts KF, Bateman BT, Hernández-Díaz S. Use of real-world evidence from healthcare utilization data to evaluate drug safety during pregnancy. Pharmacoepidemiol Drug Saf 2019; 28:906-922. [PMID: 31074570 PMCID: PMC6823105 DOI: 10.1002/pds.4789] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Because preapproval clinical trials typically exclude pregnant women, the evidence on drug safety during pregnancy required to inform drug labeling must come from postapproval controlled observational studies. Common designs have included pregnancy registries and case-control studies. Recently, pregnancy cohorts nested within healthcare utilization databases are increasingly being used. Despite clear advantages, these databases share some important limitations that may threaten the validity of studies emerging from them. METHODS This paper describes the distinctive methodological aspects of conducting drug safety studies in healthcare utilization databases with special emphasis on design and analytic approaches to minimize biases. RESULTS We describe considerations for study design, cohort definition, and follow-up. We then address issues related to exposure ascertainment based on prescription fills, including the importance of the etiologically relevant window and of properly accounting for preterm births. This is followed by a discussion of advantages and challenges when ascertaining maternal and infant outcomes based on secondary data. We then explore useful approaches to address confounding within the context of pregnancy research and of the potential for selection bias when restricting the cohort to live births. Finally, we consider issues related to external validity and statistical significance. The examples are mainly drawn from a pregnancy cohort nested in the Medicaid Analytic Extract. CONCLUSIONS The approaches presented provide guidance regarding the important methodological considerations that need to be attended to in order to generate valid, minimally biased risk when using large healthcare utilization databases for drug safety surveillance in pregnancy.
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Affiliation(s)
- Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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12
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Sommet A, Pariente A. Methods in pharmacoepidemiology. Therapie 2019; 74:187-197. [PMID: 30819408 DOI: 10.1016/j.therap.2018.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/26/2018] [Indexed: 01/04/2023]
Abstract
Pharmacoepidemiology is the study of interactions between drugs and human populations, investigating, in real conditions of life, benefits, risks and use of drugs. Pharmacoepidemiology applies to drugs and their pharmacological evaluations, the different methods also used in epidemiology to assess in real conditions of life, benefits, risks and use of drugs. Pharmacoepidemiologic studies are ad-hoc studies or studies on databases. Specific methods exist to measure drug exposure, as well as indicators of compliance and misuse of drugs. Various designs for descriptive and explanatory studies exist, in a context in which a growing proportion of studies are carried out using medico-administrative data. The limits traditionally affecting the study designs are modified in this context, almost any design selected for the conduct of a study from these databases then deriving from a cohort in whom the information has been recorded prospectively and exhaustively.
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Affiliation(s)
- Agnès Sommet
- Service de pharmacologie médicale et clinique, UMR Inserm 1027, CIC Inserm 1436, faculté de médecine, centre hospitalier universitaire, 31000 Toulouse, France.
| | - Antoine Pariente
- Inserm, Bordeaux population health research centre, team pharmacoepidemiology, UMR 1219, university of Bordeaux, 33076 Bordeaux, France; Pôle de santé publique, centre régional de pharmacovigilance de Bordeaux, service de pharmacologie médicale, CHU de Bordeaux, 33076 Bordeaux, France
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13
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Benevent J, Araujo M, Hurault-Delarue C, Montastruc JL, Sommet A, Lacroix I, Damase-Michel C. Pharmacoepidemiology in pregnancy. Therapie 2019; 74:289-300. [PMID: 30797568 DOI: 10.1016/j.therap.2018.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/12/2018] [Indexed: 02/05/2023]
Abstract
Taking a medication is usually a challenge for a pregnant woman as the beneficial drug effect on the mother has to be considered regarding its potential adverse effects, not only for her but also for her unborn child. As medication use is common in pregnant women, by chance or necessity, it gives the opportunity to evaluate the consequences of prenatal drug exposure in real life through pharmacoepidemiological studies. This paper provides an overview of data sources, study designs and data analysis methods that can be used for pregnancy medication safety studies. In the future, the implementation of responsive international networks may be the keystones of drug evaluation in pregnancy.
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Affiliation(s)
- Justine Benevent
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France; Inserm UMR 1027, faculté de médecine de Toulouse, 31000 Toulouse, France.
| | - Mélanie Araujo
- Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Caroline Hurault-Delarue
- Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Jean-Louis Montastruc
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Agnès Sommet
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Isabelle Lacroix
- Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Christine Damase-Michel
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France; Inserm UMR 1027, faculté de médecine de Toulouse, 31000 Toulouse, France
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14
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Sondergaard KB, Weeke P, Wissenberg M, Schjerning Olsen AM, Fosbol EL, Lippert FK, Torp-Pedersen C, Gislason GH, Folke F. Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case-time-control study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 3:100-107. [PMID: 28025218 DOI: 10.1093/ehjcvp/pvw041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/16/2016] [Indexed: 12/12/2022]
Abstract
Aims Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and have been associated with increased cardiovascular risk. Nonetheless, it remains unknown whether use of NSAIDs is associated with out-of-hospital cardiac arrest (OHCA). Methods and results From the nationwide Danish Cardiac Arrest Registry, all persons with OHCA during 2001-10 were identified. NSAID use 30 days before OHCA was categorized as follows: diclofenac, naproxen, ibuprofen, rofecoxib, celecoxib, and other. Risk of OHCA associated with use of NSAIDs was analysed by conditional logistic regression in case-time-control models matching four controls on sex and age per case to account for variation in drug utilization over time. We identified 28 947 persons with OHCA of whom 3376 were treated with an NSAID up to 30 days before OHCA. Ibuprofen and diclofenac were the most commonly used NSAIDs and represented 51.0% and 21.8% of total NSAID use, respectively. Use of diclofenac (odds ratio [OR], 1.50 [95% confidence interval (CI) 1.23-1.82]) and ibuprofen [OR, 1.31 (95% CI 1.14-1.51)] was associated with a significantly increased risk of OHCA. Use of naproxen [OR, 1.29 (95% CI 0.77-2.16)], celecoxib [OR, 1.13 (95% CI 0.74-1.70)], and rofecoxib (OR, 1.28 [95% CI 0.74-1.70)] was not significantly associated with increased risk of OHCA; however, these groups were characterized by few events. Conclusion Use of non-selective NSAIDs was associated with an increased early risk of OHCA. The result was driven by an increased risk of OHCA in ibuprofen and diclofenac users.
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Affiliation(s)
- Kathrine B Sondergaard
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark
| | - Peter Weeke
- The Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark.,Emergency Medical Services, Copenhagen, the Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup
| | - Anne-Marie Schjerning Olsen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark
| | - Emil L Fosbol
- The Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Freddy K Lippert
- Emergency Medical Services, Copenhagen, the Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup
| | - Christian Torp-Pedersen
- Institute of Health, Science and Technology, Aalborg University, Fredrik Bajers Vej 7D, 9220 Aalborg Ø , Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark.,National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2, 1353 Copenhagen K, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark.,Emergency Medical Services, Copenhagen, the Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup
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15
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Valverde I, Gomez-Ciriza G, Hussain T, Suarez-Mejias C, Velasco-Forte MN, Byrne N, Ordoñez A, Gonzalez-Calle A, Anderson D, Hazekamp MG, Roest AAW, Rivas-Gonzalez J, Uribe S, El-Rassi I, Simpson J, Miller O, Ruiz E, Zabala I, Mendez A, Manso B, Gallego P, Prada F, Cantinotti M, Ait-Ali L, Merino C, Parry A, Poirier N, Greil G, Razavi R, Gomez-Cia T, Hosseinpour AR. Three-dimensional printed models for surgical planning of complex congenital heart defects: an international multicentre study. Eur J Cardiothorac Surg 2018; 52:1139-1148. [PMID: 28977423 DOI: 10.1093/ejcts/ezx208] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/21/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To evaluate the impact of 3D printed models (3D models) on surgical planning in complex congenital heart disease (CHD). METHODS A prospective case-crossover study involving 10 international centres and 40 patients with complex CHD (median age 3 years, range 1 month-34 years) was conducted. Magnetic resonance imaging and computed tomography were used to acquire and segment the 3D cardiovascular anatomy. Models were fabricated by fused deposition modelling of polyurethane filament, and dimensions were compared with medical images. Decisions after the evaluation of routine clinical images were compared with those after inspection of the 3D model and intraoperative findings. Subjective satisfaction questionnaire was provided. RESULTS 3D models accurately replicate anatomy with a mean bias of -0.27 ± 0.73 mm. Ninety-six percent of the surgeons agree or strongly agree that 3D models provided better understanding of CHD morphology and improved surgical planning. 3D models changed the surgical decision in 19 of the 40 cases. Consideration of a 3D model refined the planned biventricular repair, achieving an improved surgical correction in 8 cases. In 4 cases initially considered for conservative management or univentricular palliation, inspection of the 3D model enabled successful biventricular repair. CONCLUSIONS 3D models are accurate replicas of the cardiovascular anatomy and improve the understanding of complex CHD. 3D models did not change the surgical decision in most of the cases (21 of 40 cases, 52.5% cases). However, in 19 of the 40 selected complex cases, 3D model helped redefining the surgical approach.
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Affiliation(s)
- Israel Valverde
- Paediatric Cardiology, Cardiothoracic Surgery and Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain.,Cardiovascular Pathology Unit, Institute of Biomedicine of Seville (IBIS), CIBER-CV, Hospital Virgen de Rocio/CSIC/University of Seville, Seville, Spain.,Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Gorka Gomez-Ciriza
- Paediatric Cardiology, Cardiothoracic Surgery and Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, UK.,Children's Health CMC Dallas and UT Southwestern, Dallas, TX, USA
| | - Cristina Suarez-Mejias
- Paediatric Cardiology, Cardiothoracic Surgery and Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain
| | - Maria N Velasco-Forte
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Byrne
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, UK
| | - Antonio Ordoñez
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville (IBIS), CIBER-CV, Hospital Virgen de Rocio/CSIC/University of Seville, Seville, Spain
| | - Antonio Gonzalez-Calle
- Paediatric Cardiology, Cardiothoracic Surgery and Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain
| | - David Anderson
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Mark G Hazekamp
- Department of Paediatric Cardiology and Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Arno A W Roest
- Department of Paediatric Cardiology and Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jose Rivas-Gonzalez
- Paediatric Cardiology, Cardiothoracic Surgery and Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain
| | - Sergio Uribe
- Radiology Department and Biomedical Imaging Center, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Issam El-Rassi
- Children's Heart Center, American University of Beirut AUBMC, Beirut, Lebanon
| | - John Simpson
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Owen Miller
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Enrique Ruiz
- Paediatric Cardiology Unit, Hospital Regional Universitario Malaga, Malaga, Spain
| | - Ignacio Zabala
- Paediatric Cardiology Unit, Hospital Regional Universitario Malaga, Malaga, Spain
| | - Ana Mendez
- Division of Paediatric Cardiology, Department of Paediatrics, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Begoña Manso
- Paediatric Cardiology, Cardiothoracic Surgery and Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain
| | - Pastora Gallego
- Paediatric Cardiology, Cardiothoracic Surgery and Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain
| | - Freddy Prada
- Paediatric Cardiology Unit, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Massimiliano Cantinotti
- Fondazione G. Monasterio and Institute of Clinical Physiology, CNR-Regione Toscana, Pisa, Italy
| | - Lamia Ait-Ali
- Fondazione G. Monasterio and Institute of Clinical Physiology, CNR-Regione Toscana, Pisa, Italy
| | - Carlos Merino
- Paediatric Cardiology Unit, Hospital Reina Sofía, Córdoba, Spain
| | - Andrew Parry
- Congenital Cardiac Surgery Unit, Bristol Children Hospital, Bristol, UK
| | - Nancy Poirier
- Division of Paediatric Cardiology, Department of Paediatrics, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Gerald Greil
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, UK.,Children's Health CMC Dallas and UT Southwestern, Dallas, TX, USA
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Tomas Gomez-Cia
- Paediatric Cardiology, Cardiothoracic Surgery and Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain
| | - Amir-Reza Hosseinpour
- Paediatric Cardiology, Cardiothoracic Surgery and Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain
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Benevent J, Montastruc F, Damase-Michel C. The importance of pharmacoepidemiology in pregnancy-implications for safety. Expert Opin Drug Saf 2017; 16:1181-1190. [PMID: 28777918 DOI: 10.1080/14740338.2017.1363177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Prescription of medications to pregnant women is usually a challenge as the drug benefit has to be considered regarding its potential adverse effects. As medication use is common in pregnant women, by chance or necessity, it gives the opportunity to evaluate the consequences of prenatal drug exposure in real life through pharmacoepidemiologic studies. Area covered: Data sources are numerous. Some of them have been created for the particular purpose of assessing medications during pregnancy. Augmented databases enable the study of delayed effects in late childhood and provide information on potential confounders. Each data source exhibits strengths and weaknesses. Several designs can be used to assess the safety of medications during pregnancy. Innovative designs have been developed in order to bypass major limits of classical methods. Expert opinion: An efficient system could follow up each pregnant woman, who had taken a medication, and consider her as a precious information for the knowledge of drug potential adverse actions against the child, who must be followed up to identify long term-effects. The diversity of data sources and approaches of pharmacoepidemiologic studies, the implementation of international networks as well as the improvement of adverse signal detection are the keystones of such an evaluation.
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Affiliation(s)
- Justine Benevent
- a Faculté de Médecine , Université Toulouse III, CRPV Midi-Pyrénées, CHU Toulouse, UMR INSERM 1027/CIC 1436 , Toulouse , France
| | - Francois Montastruc
- a Faculté de Médecine , Université Toulouse III, CRPV Midi-Pyrénées, CHU Toulouse, UMR INSERM 1027/CIC 1436 , Toulouse , France
| | - Christine Damase-Michel
- a Faculté de Médecine , Université Toulouse III, CRPV Midi-Pyrénées, CHU Toulouse, UMR INSERM 1027/CIC 1436 , Toulouse , France
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17
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Weinberg CR. Invited Commentary: Self-Control Is a Virtue. Am J Epidemiol 2017; 185:1184-1186. [PMID: 28535173 DOI: 10.1093/aje/kwx075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
The case-crossover design, introduced in 1991 by Malcolm Maclure (Am J Epidemiol. 1991;133(2):144-153), provided a precise and powerful tool for studying short-term effects of transient triggering exposures on abrupt outcomes like myocardial infarction. The design is an example of "self-control." One compares case-time intervals that include experiences that came just before the health event with control-time intervals that capture comparable experiences more remote from the event. Methodologists have since tweaked the general approach, recognizing issues that need to be considered to guard against time-driven confounders. I discuss opportunities for possible expansion and further mining of the data from this ingenious design.
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18
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Ford JB, Schemann K, Patterson JA, Morris J, Herbert RD, Roberts CL. Triggers for Preeclampsia Onset: a Case-Crossover Study. Paediatr Perinat Epidemiol 2016; 30:555-562. [PMID: 27671366 DOI: 10.1111/ppe.12316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Risk factors for preeclampsia are well established, whereas, the triggers associated with timing of preeclampsia onset are not. The aim of this study was to establish whether recent infection or other triggers were associated with timing of preeclampsia onset. METHODS We used a case-crossover design with preeclampsia cases serving as their own controls. Women with singleton pregnancies of ≥20 weeks gestation presenting at three hospitals were eligible for inclusion. Exposures to potential triggers were identified via guided questionnaire. Infective episodes included symptoms lasting >24 h. Preeclampsia was defined as hypertension (BP ≥140 mmHg and/or ≥90 mmHg) and proteinuria (protein/creatinine ratio ≥30 mg/mmol). Conditional logistic regression was used to compare the odds of exposure to potential triggers in the case windows (1-7 days preceding diagnosis of preeclampsia) and control windows (8-14 days prior to diagnosis); unadjusted odds ratios (ORs) are reported. RESULTS Among 286 recruited women, 25 (8.7%) reported a new infection in the 7 days prior to preeclampsia onset and 21 (7.3%) in the 8-14 days prior. There was no significant association between onset of infection in the 7 days prior and preeclampsia diagnosis (OR 1.24, 95% CI 0.65, 2.34). Consumption of caffeine (OR 0.51, 95% CI 0.33, 0.77), spicy food (OR 0.49, 95% CI 0.30, 0.81), and alcohol (OR 0.26, 95% CI 0.10, 0.71) were strongly inversely associated with preeclampsia onset. CONCLUSION Recent infection does not appear to trigger preeclampsia. Decreased consumption of caffeine, spicy food, and alcohol may be prodromal markers. Such behaviours may be early markers of imminent preeclampsia.
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Affiliation(s)
- Jane B Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
| | - Kathrin Schemann
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,New South Wales Ministry of Health, North Sydney, NSW, Australia
| | - Jillian A Patterson
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
| | - Jonathan Morris
- Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,Obstetrics and Gynaecology Department, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Christine L Roberts
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
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Mulder B, Pouwels KB, Schuiling-Veninga CCM, Bos HJ, de Vries TW, Jick SS, Hak E. Antibiotic use during pregnancy and asthma in preschool children: the influence of confounding. Clin Exp Allergy 2016; 46:1214-26. [PMID: 27159872 DOI: 10.1111/cea.12756] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/24/2016] [Accepted: 04/29/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND A recent study suggested that early-life intestinal microbiota may play an important role in the development of childhood asthma, indicating that antibiotics taken during early life or in late pregnancy may be associated with childhood asthma. OBJECTIVE This study aims to assess the association between prenatal antibiotic use and asthma in preschool children using data from the prescription database IADB.nl. To assess the influence of potential confounding, we conducted both a case-sibling and a case-control study and compared the results. METHODS We conducted a case-sibling study in which 1228 children with asthma were compared to 1228 siblings without asthma, using data from the prescription database IADB.nl. In addition, a case-control study was conducted. Asthma in preschool children was defined as ≥ 3 prescriptions for anti-asthma medication within a year before the fifth birthday. Conditional logistic regression was used to estimate crude and adjusted odds ratios (aORs). RESULTS In both the case-sibling and case-control analysis, the use of antibiotics in the third trimester of pregnancy was associated with an increased risk of asthma in preschool children (aOR 1.37; 95% CI 1.02-1.83 and aOR 1.40; 95% CI 1.15-1.47). Time-trend analyses showed that results were not influenced by a time trend in antibiotic exposure. A significant association between exposure to antibiotics in any trimester of pregnancy and the development of asthma in preschool children was observed in the case-control analysis only (aOR 1.46; 95% CI 1.34-1.59). CONCLUSION Antibiotic use in the third trimester of pregnancy was associated with a small increased risk of asthma in preschool children. This association was robust to time-invariant confounding or exposure time trends, further supporting the important role for early-life intestinal microbiota in the development of childhood asthma.
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Affiliation(s)
- B Mulder
- Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - K B Pouwels
- Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - C C M Schuiling-Veninga
- Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H J Bos
- Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - T W de Vries
- Department of Pediatrics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - S S Jick
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Boston Collaborative Drug Surveillance Program, Boston, MA, USA
| | - E Hak
- Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
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Uddin MJ, Groenwold RHH, Ali MS, de Boer A, Roes KCB, Chowdhury MAB, Klungel OH. Methods to control for unmeasured confounding in pharmacoepidemiology: an overview. Int J Clin Pharm 2016; 38:714-23. [PMID: 27091131 DOI: 10.1007/s11096-016-0299-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 04/04/2016] [Indexed: 12/21/2022]
Abstract
Background Unmeasured confounding is one of the principal problems in pharmacoepidemiologic studies. Several methods have been proposed to detect or control for unmeasured confounding either at the study design phase or the data analysis phase. Aim of the Review To provide an overview of commonly used methods to detect or control for unmeasured confounding and to provide recommendations for proper application in pharmacoepidemiology. Methods/Results Methods to control for unmeasured confounding in the design phase of a study are case only designs (e.g., case-crossover, case-time control, self-controlled case series) and the prior event rate ratio adjustment method. Methods that can be applied in the data analysis phase include, negative control method, perturbation variable method, instrumental variable methods, sensitivity analysis, and ecological analysis. A separate group of methods are those in which additional information on confounders is collected from a substudy. The latter group includes external adjustment, propensity score calibration, two-stage sampling, and multiple imputation. Conclusion As the performance and application of the methods to handle unmeasured confounding may differ across studies and across databases, we stress the importance of using both statistical evidence and substantial clinical knowledge for interpretation of the study results.
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Affiliation(s)
- Md Jamal Uddin
- Department of Statistics (Biostatistics and Epidemiology), Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh. .,Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Utrecht, The Netherlands.
| | - Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mohammed Sanni Ali
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Utrecht, The Netherlands
| | - Kit C B Roes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Muhammad A B Chowdhury
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Utrecht, The Netherlands
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Asghar W, Pittman E, Jamali F. Comparative efficacy of esomeprazole and omeprazole: Racemate to single enantiomer switch. ACTA ACUST UNITED AC 2015; 23:50. [PMID: 26573220 PMCID: PMC4647708 DOI: 10.1186/s40199-015-0133-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/05/2015] [Indexed: 12/12/2022]
Abstract
Background Both omeprazole and its S enantiomer (esomeprazole) have been available and used to treat symptoms of gastroesophageal reflux disease (GERD) and conditions associated with excessive stomach acid secretion for more than a decade. Controversy exists over improved efficacy of S enantiomer (esomeprazole) over parent racemate (omeprazole). However, a comparison of the clinical outcomes of these products may reveal the rationale for switching from the racemate to single enantiomer. Since enantiomers of omeprazole are equipotent, we compared the outcomes of equal doses of each product to see if both actually differ in their efficacy’s or the reported superiority of S enantiomer is just a dose effect. Methods A web search was carried out for randomized controlled trials with head-to-head comparisons of omeprazole and S-omeprazole. The data were abstracted and after calculating theodd ratios (OR) for the outcomes reported in each study, the combined overall odd ratios (OR’) were estimated. The random effect inverse variance method with omeprazole as the reference (OR” = 1) was used. Results Out of 1171 studies, 14 were deemed eligible. There was no significant difference in the therapeutic success between omeprazole and S-omeprazole as a part of triple therapy for the treatment of H. pylori in both intention-to-treat (OR’, 1.06; CI, 0.83, 1.36; p = 0.63) as well as per-protocol analysis (OR’, 1.07; CI, 0.84, 1.36; p = 0.57). For the treatment of gastro-oesophageal reflux disease, S-omeprazole was significantly but marginally superior to the racemate (OR’, 1.18; CI, 1.01, 1.38; p = 0.04). The two products were equipotent in all metrics used to assess intragastric pH except for the % patients maintaining a 24 h gastric pH above 4 (1.57; CI, 1.04, 2.381; p = 0.03). Conclusion The therapeutic benefit of chiral switch of omeprazole is questionable considering the substantially greater economic burden involved.
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Affiliation(s)
- Waheed Asghar
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 11361 - 87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Elliot Pittman
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 11361 - 87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Fakhreddin Jamali
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 11361 - 87 Avenue, Edmonton, AB, T6G 2E1, Canada.
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Sun Y, Wu CS, Olsen J. Trimethoprim use before pregnancy and risk of congenital malformation: reanalyzed using a case-crossover design and a case-time-control design. Pharmacoepidemiol Drug Saf 2014; 23:1076-83. [PMID: 25111783 DOI: 10.1002/pds.3691] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/15/2014] [Accepted: 07/18/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE Studies on the safety of drugs used during pregnancy are necessary and important but prone to bias. Using cases as their own controls can reduce bias. We used a case-crossover design and a case-time-control design to estimate the risk of congenital malformation (CM) for children born to mothers who redeemed a trimethoprim prescription shortly before pregnancy. METHODS The study was based on all live born singletons (N = 685 600) in Denmark whose mothers had available information on prescriptions in the Danish National Prescription Registry between 1996 and 2008. We defined 1-3 months before pregnancy as a potential risk period and 13-15 months before pregnancy as a reference period. Two other reference periods were used (7-9 months before pregnancy and months 4-6 of pregnancy). The case-crossover design is dependent on the assumption of a stable trimethoprim prescription over the study period in the source population. To estimate the trend of trimethoprim prescriptions, we used a control group comprising children without CMs. RESULTS Both study designs showed children had a higher risk of overall CM [odds ratio of 1.66, 95% confidence interval (CI): 1.10-2.53 and 1.50, 95%CI: 0.66-3.38, respectively] if their mothers had a trimethoprim prescription in the 3 months before pregnancy and subtypes of CM for example in the musculoskeletal system, which were consistent to the previous findings from a cohort study. CONCLUSIONS This study corroborates that trimethoprim is a potential teratogen when used 3 months before pregnancy and demonstrates the value of case-only approaches for studying, for example, adverse effects of antibiotics in reproductive epidemiology.
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Affiliation(s)
- Yuelian Sun
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Dellicour S, Brasseur P, Thorn P, Gaye O, Olliaro P, Badiane M, Stergachis A, ter Kuile FO. Probabilistic record linkage for monitoring the safety of artemisinin-based combination therapy in the first trimester of pregnancy in Senegal. Drug Saf 2014; 36:505-13. [PMID: 23673815 DOI: 10.1007/s40264-013-0059-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND There are insufficient data on the safety in early pregnancy of the artemisinins, a new class of antimalarials. Assessment of drug teratogenicity requires large sample sizes for an adequate risk-benefit assessment. There is currently limited pharmacovigilance infrastructure in malaria-endemic countries. Monitoring drug safety in early pregnancy is especially challenging, as it requires early pregnancy detection to assess any potential increased risk of miscarriage, prospective follow-up to reduce recall and survival biases, and accurate data on gestational age assessment. Record linkage approaches for pregnancy pharmacovigilance using routinely generated health records could be a pragmatic and cost-effective approach for pharmacovigilance in early pregnancy, but has not been evaluated in resource-poor settings. OBJECTIVE Our objective was to assess the feasibility of record linkage using routinely collected healthcare data as a pragmatic means of monitoring the safety in early pregnancy of artemisinin-based combination therapies (ACTs) in Senegal. METHODS Data (2004-2008) from paper-based registers from outpatient clinics, antenatal care services (ANC) and the delivery unit from the St Joseph dispensary in Mlomp, south-western Senegal, were entered into databases. Record linkage based on a probabilistic matching approach was used to identify pregnancies exposed to ACTs in the first trimester of pregnancy. Two record linkage software packages (Link-Plus and FRIL) were compared and output data were reviewed independently by two investigators. RESULTS Information on 685 pregnancies was extracted, 536 of which were from the geographic catchment area and eligible for record linkage; 94.6 % of them resulted in live births, 2.6 % in stillbirths and 2.8 % in miscarriages. Major congenital malformations were identified in 1.6 % of births. Seventy-three and 75 true matches between pregnancy outcome and the outpatient treatment registers were identified by two different record linkage software packages, respectively. Record linkage identified seven exposures to ACTs in the first trimester, all of which resulted in normal live-births. CONCLUSION Probabilistic record linkage is a potentially cost-effective method to assess the safety of antimalarials in early pregnancy in resource-constrained settings to assess increased risk of overall birth defects, and stillbirths in settings with good existing health records and well defined target populations.
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Affiliation(s)
- Stephanie Dellicour
- Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, Merseyside L3 5QA, UK.
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Consiglio GP, Burden AM, Maclure M, McCarthy L, Cadarette SM. Case-crossover study design in pharmacoepidemiology: systematic review and recommendations. Pharmacoepidemiol Drug Saf 2013; 22:1146-53. [DOI: 10.1002/pds.3508] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/20/2013] [Accepted: 07/29/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Giulia P. Consiglio
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
| | - Andrea M. Burden
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology and Therapeutics; University of British Columbia; Vancouver British Columbia Canada
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
- Women's College Research Institute; Toronto Ontario Canada
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25
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Ye Y, Bond J, Cherpitel CJ, Stockwell T, Macdonald S, Rehm J. Risk of injury due to alcohol: evaluating potential bias using the case-crossover usual-frequency method. Epidemiology 2013; 24:240-3. [PMID: 23348068 DOI: 10.1097/ede.0b013e3182801cb4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The usual-frequency case-crossover method, comparing exposure before an event with typical exposure of the same person, is widely used to estimate the risk of injury related to acute alcohol use. Prior results suggest that risk estimates might be biased upward compared with other methods. METHODS Using data from 15 emergency room studies in seven countries, we compared the usual-frequency case-crossover method with case-control analysis, using noninjury patients as controls. Control-crossover analysis was performed to examine potential bias and to adjust risk estimates. RESULTS The cross-study pooled odds ratio (OR) of injury related to drinking was 4.7 (95% confidence interval = 2.6-8.5) in case-crossover analysis and 2.1 (1.6-2.7) in case-control analysis. A control-crossover analysis found an indication of bias (OR = 2.2 [1.8-2.8]), which was larger among less-frequent drinkers. CONCLUSION Findings suggest that the potential overestimation of injury risk based on the usual-frequency case-crossover method might be best explained by recall bias in usual-frequency estimates.
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Affiliation(s)
- Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, CA 94608, USA.
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Ravera S, van Rein N, de Gier JJ, de Jong-van den Berg LTW. A comparison of pharmacoepidemiological study designs in medication use and traffic safety research. Eur J Epidemiol 2012; 27:473-81. [PMID: 22576759 PMCID: PMC3382653 DOI: 10.1007/s10654-012-9689-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 04/12/2012] [Indexed: 12/29/2022]
Abstract
In order to explore how the choice of different study designs could influence the risk estimates, a case–crossover and case–time–control study were carried out and their outcomes were compared with those of a traditional case–control study design that evaluated the association between the exposure to psychotropic medications and the risk of having a motor vehicle accident (MVA). A record-linkage database availing data for 3,786 cases and 18,089 controls during the period 2000–2007 was used. The study designs (i.e., case–crossover and case–time–control) were derived from published literature, and the following psychotropic medicines were examined: antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants, stratified in the two groups selective serotonin reuptake inhibitors (SSRIs) and other antidepressants. Moreover, in order to further investigate the effects of frequency of psychoactive medication exposure on the outcomes of the case–crossover analysis, the data were also stratified by the number of defined daily doses (DDDs) and days of medication use in the 12 months before the motor vehicle accident. Three-thousand seven-hundred fifty-two cases were included in this second part of the case–crossover analysis. The case–crossover design did not show any statistically significant association between psychotropic medication exposure and MVA risk [e.g., SSRIs—Adj. OR = 1.00 (95 % CI: 0.69–1.46); Anxiolytics—Adj. OR = 0.95 (95 % CI: 0.68–1.31)]. The case–time–control design only showed a borderline statistically significant increased traffic accident risk in SSRI users [Adj. OR = 1.16 (95 % CI: 1.01–1.34)]. With respect to the stratifications by the number of DDDs and days of medication use, the analyses showed no increased traffic accident risk associated with the exposure to the selected medication groups [e.g., SSRIs, <20 DDDs—Adj. OR = 0.65 (95 % CI: 0.11–3.87); SSRIs, 16–150 days—Adj. OR = 0.55 (95 % CI: 0.24–1.24)]. In contrast to the above-mentioned results, our recent case–control study found a statistically significant association between traffic accident risk and exposure to anxiolytics [Adj. OR = 1.54 (95 % CI: 1.11–2.15)], and SSRIs [Adj. OR = 2.03 (95 % CI: 1.31–3.14)]. Case–crossover and case–time–control analyses produced different results than those of our recent case–control study (i.e., case–crossover and case–time–control analyses did not show any statistically significant association whereas the case–control analysis showed an increased traffic accident risk in anxiolytic and SSRI users). These divergent results can probably be explained by the differences in the study designs. Given that the case–crossover design is only appropriate for short-term exposures and the case–time–control design is an elaboration of this latter, it can be concluded that, probably, these two approaches are not the most suitable ones to investigate the relation between MVA risk and psychotropic medications, which, on the contrary, are often use chronically.
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Affiliation(s)
- Silvia Ravera
- Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Quartey G, Feudjo-Tepie M, Wang J, Kim J. Opportunities for minimization of confounding in observational research. Pharm Stat 2011; 10:539-47. [PMID: 22127842 DOI: 10.1002/pst.528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/25/2011] [Accepted: 10/03/2011] [Indexed: 11/12/2022]
Abstract
Observational epidemiological studies are increasingly used in pharmaceutical research to evaluate the safety and effectiveness of medicines. Such studies can complement findings from randomized clinical trials by involving larger and more generalizable patient populations by accruing greater durations of follow-up and by representing what happens more typically in the clinical setting. However, the interpretation of exposure effects in observational studies is almost always complicated by non-random exposure allocation, which can result in confounding and potentially lead to misleading conclusions. Confounding occurs when an extraneous factor, related to both the exposure and the outcome of interest, partly or entirely explains the relationship observed between the study exposure and the outcome. Although randomization can eliminate confounding by distributing all such extraneous factors equally across the levels of a given exposure, methods for dealing with confounding in observational studies include a careful choice of study design and the possible use of advanced analytical methods. The aim of this paper is to introduce some of the approaches that can be used to help minimize the impact of confounding in observational research to the reader working in the pharmaceutical industry.
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Affiliation(s)
- George Quartey
- Statistical Methods and Research, Roche Products Ltd, UK.
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Abstract
Self-matched case-only studies (such as the case-crossover or self-controlled case-series method) control by design for time-invariant confounders (measured or unmeasured), but they do not control for confounders that vary with time. A bidirectional case-crossover design can be used to adjust for exposure-time trends. In pharmacoepidemiology, however, illness often influences future use of medications, making a bidirectional design problematic. Suissa's case-time-control design combines a case-crossover and case-control design, and adjusts for exposure-trend bias in the cases' self-controlled odds ratio by dividing that ratio by the corresponding self-controlled odds ratio in a concurrent matched control group. However, if not well matched, the control group may reintroduce selection bias. We propose a "case-case-time-control" that involves crossover analyses in cases and future-case controls. This person-time sampling strategy improves matching by restricting controls to future cases. We evaluate the proposed study design through simulations and analysis of a theoretically null relationship using Veterans Administration (VA) data. Simulation studies show that the case-case-time-control can adjust for exposure trends while controlling for time-invariant confounders. Use of an inappropriate control group left case-time-control analyses biased by exposure-time trends. When analyzing the relationship between vitamin exposure and stroke, using data on 3192 patients in the VA system, a case-crossover odds ratio of 1.5 (95% confidence interval = 1.3-1.7) was reduced to 1.1 (0.9-1.3) when divided by the concurrent exposure trend odds ratio (1.4) in matched future cases. This applied example demonstrates how our approach can adjust for exposure trends observed across time axes.
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Lin Y, Ueda J, Kikuchi S, Totsuka Y, Wei WQ, Qiao YL, Inoue M. Comparative epidemiology of gastric cancer between Japan and China. World J Gastroenterol 2011; 17:4421-8. [PMID: 22110269 PMCID: PMC3218157 DOI: 10.3748/wjg.v17.i39.4421] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 06/09/2011] [Accepted: 06/16/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify the similarities and differences in gastric cancer epidemiology between Japan and China. METHODS A comprehensive literature search of the PubMed database was performed. The relevant literature published in China was also been cited. Data on incidence and mortality rates in 2008 were obtained from the Cancer Mondial database, published by International Agency for Research on Cancer at http://www-dep.iarc.fr/. RESULTS Gastric cancer remains a significant public health burden in both Japan and China. The prevalence of Helicobacter pylori (H. pylori) colonization is high in the adult populations of both countries. Accumulating evidence from intervention studies in both countries has shown the effectiveness of H. pylori eradication in reducing gastric cancer incidence. There are differences, however, in many aspects of gastric cancer, including patterns of incidence and mortality, trends in the prevalence of H. pylori infection, H. pylori strains, the magnitude of risk of gastric cancer related to H. pylori infection, and associations with dietary habits. Compared with China, Japan has seen a more rapid decline in H. pylori infection among adolescents. While Japanese cohort studies have dominated the literature concerning the associations between gastric cancer and dietary habits, numerous case-control studies in China suggest a positive association between a high intake of preserved fish and vegetables and gastric cancer risk. There is a need for a multidisciplinary research approach to understand the interactions between various strains of H. pylori, host factors, and other lifestyle and environmental factors in gastric carcinogenesis in both countries. CONCLUSION The shared high incidence of gastric cancer and high prevalence of H. pylori, as well as differences in many aspects of gastric cancer, provide an excellent opportunity to establish Sino-Japanese collaborations.
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Naess O, Leyland AH. Analysing the effect of area of residence over the life course in multilevel epidemiology. Scand J Public Health 2010; 38:119-26. [PMID: 21062846 DOI: 10.1177/1403494810384646] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In this paper we present multilevel models of individuals' residential history at multiple time points through the life course and their application and discuss some advantages and disadvantages for their use in epidemiological studies. METHODS Literature review of research using longitudinal multilevel models in studies of neighbourhood effects, statistical multilevel models that take individuals' residential history into account, and the application of these models in the Oslo mortality study. RESULTS Measures of variance have been used to investigate the contextual impact of membership to collectives, such as area of residence, at several time points. The few longitudinal multilevel models that have been used suggest that early life area of residence may have an effect on mortality independently of residence later in life although the proportion of variation attributable to area level is small compared to individual level. The following multilevel models have been developed: simple multilevel models for each year separately, a multiple membership model, a cross-classified model, and finally a correlated cross-classified model. These models have different assumptions regarding the timing of influence through the life course. CONCLUSIONS To fully recognise the origin of adult chronic diseases, factors at all stages of the life course at both individual and area level needs to be considered in order to avoid biased estimates. Important challenges in making life course residential data available for research and assessing how changing administrative coding over time reflect contextual impact need to be overcome before these models can be implemented as normal practice in multilevel epidemiology.
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Affiliation(s)
- Oyvind Naess
- National Institute of Public Health, Oslo, Norway.
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Toh S, Mitchell AA, Anderka M, de Jong-van den Berg LTW, Hernández-Díaz S. Antibiotics and oral contraceptive failure - a case-crossover study. Contraception 2010; 83:418-25. [PMID: 21477683 DOI: 10.1016/j.contraception.2010.08.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/26/2010] [Accepted: 08/28/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evidence on the association between antibiotic use and combined oral contraceptive (COC) failure is controversial. We examined the effect of concomitant antibiotic treatment on the risk of breakthrough pregnancy among COC users. STUDY DESIGNS We performed a case-crossover study of 1330 COC failure cases among 17,721 women from the Slone Epidemiology Center Birth Defects Study (1997-2008) and among 25,941 women from the National Birth Defects Prevention Study (NBDPS, 1997-2005). Self-matched odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by comparing antibiotic use between the 4 weeks before conception ("case period") and the 4-8 weeks before conception ("control period") using conditional logistic regression. A case-time-control analysis was conducted using nonusers of COCs with unplanned pregnancies as controls. RESULTS For the combined data, the self-matched OR was 1.08 (95% CI: 0.63-1.84) and the case-time-control OR was 1.12 (0.63-1.98) for antibiotics overall. The results did not appreciably differ when adjusted for characteristics that might vary between the case and control period. However, among COC failure cases from the NBDPS, allowing a 1-month gap between the case and control period resulted in a self-matched OR of 1.45 (0.85-2.50) and a case-time-control OR of 1.55 (0.86-2.79) for antibiotics overall. CONCLUSIONS We did not find an association between concomitant antibiotic use and the risk of breakthrough pregnancy among COC users. However, due to limited power and potential carryover effects, findings from this study cannot rule out an elevated risk of COC failure among antibiotic users.
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Affiliation(s)
- Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA.
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Zambon A, Polo Friz H, Contiero P, Corrao G. Effect of macrolide and fluoroquinolone antibacterials on the risk of ventricular arrhythmia and cardiac arrest: an observational study in Italy using case-control, case-crossover and case-time-control designs. Drug Saf 2009; 32:159-67. [PMID: 19236122 DOI: 10.2165/00002018-200932020-00008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To compare the effect of macrolide and fluoroquinolone antibacterials on the onset of ventricular arrhythmia and cardiac arrest using three different observational designs. METHODS A population-based case-control study was performed by linking automated databases from the Varese Province of Italy. Cases were all subjects who experienced ventricular arrhythmia or cardiac arrest from July 1998 to December 2003. For each case, up to ten controls were randomly selected after matching for sex, age, practitioner and date of arrhythmia onset. The use of macrolides and fluoroquinolones during two time windows denoted as recent and referent intervals was ascertained. Odds ratios were estimated using case-control, case-crossover and case-time-control approaches. RESULTS 1275 cases and 9189 controls met the inclusion criteria. Adjusted odds ratios (and corresponding 95% CIs) associated with recent exposure to macrolides were 2.13 (1.34, 3.39), 1.70 (0.88, 3.26) and 1.62 (0.78, 3.34) by using case-control, case-crossover and case-time-control designs, respectively. The corresponding estimates for fluoroquinolones were 3.58 (2.51, 5.12), 1.98 (1.19, 3.29) and 1.59 (0.88, 2.87), respectively. CONCLUSIONS Three observational study designs each using entirely different sets of controls consistently showed that recent use of macrolide and fluoroquinolone antibacterials may be associated with increased risk of ventricular arrhythmia and cardiac arrest.
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Affiliation(s)
- Antonella Zambon
- Unit of Biostatistics and Epidemiology, Department of Statistics, University of Milan-Bicocca, Milan, Italy.
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Ananth CV, Peltier MR, Chavez MR, Kirby RS, Getahun D, Vintzileos AM. Recurrence of Ischemic Placental Disease. Obstet Gynecol 2007; 110:128-33. [PMID: 17601907 DOI: 10.1097/01.aog.0000266983.77458.71] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the hypothesis that the presence of preeclampsia, small for gestational age (SGA)-birth, and placental abruption in the first pregnancy confers increased risk in the second pregnancy. METHODS A retrospective cohort study entailing a case-crossover analysis was performed based on women who had two consecutive singleton live births (n=154,810) between 1989 and 1997 in Missouri. Small for gestational age was defined as infants with birth weight below the 10th centile for gestational age. Risk and recurrence of ischemic placental disease was assessed from fitting logistic regression models after adjusting for several confounders. RESULTS Preeclampsia in the first pregnancy was associated with significantly increased risk of preeclampsia (odds ratio 7.03, 95% confidence interval 6.51, 7.59), SGA (odds ratio 1.16, 95% confidence interval 1.06, 1.27), and placental abruption (odds ratio 1.90, 95% confidence interval 1.51, 2.38) in the second pregnancy. Similarly, women with SGA and abruption in the first pregnancy were associated with increased risks of all other conditions in the second pregnancy. CONCLUSION Women with preeclampsia, SGA, and placental abruption in their first pregnancy--conditions that constitute ischemic placental disease--are at substantially increased risk of recurrence of any or all these conditions in their second pregnancy. Although causes of these conditions remain largely speculative, these entities may manifest through a common pathway of ischemic placental disease with significant risk of recurrence.
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Affiliation(s)
- Cande V Ananth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901-1977, USA.
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Kjaer D, Horvath-Puhó E, Christensen J, Vestergaard M, Czeizel AE, Sørensen HT, Olsen J. Use of phenytoin, phenobarbital, or diazepam during pregnancy and risk of congenital abnormalities: a case-time-control study. Pharmacoepidemiol Drug Saf 2007; 16:181-8. [PMID: 16941718 DOI: 10.1002/pds.1288] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Case-control studies are often used to examine putative teratogenic drug effects during organogenesis but these studies are subject to confounding by indication, recall, and participation bias. The case-time-control approach is less susceptible to these sources of bias. We studied congenital abnormalities following exposure to phenytoin, phenobarbital, and diazepam in early pregnancy, i.e., second and third month, compared to mid-pregnancy, i.e., fifth and sixth month of pregnancy. METHODS We analyzed data from the Hungarian Case-Control Surveillance of Congenital Abnormalities (1980-1996) in a case-time-control study. RESULTS The study included 22 843 children with congenital abnormalities (cases) and 38 151 children with no abnormalities (controls). Overall, odds ratio (OR) for congenital abnormalities after exposure to one of the three drugs in early pregnancy was 1.2 (95% confidence interval (CI): 1.0-1.4). Among children exposed to phenytoin OR for congenital abnormalities was 3.7 (95%CI: 0.3-49.6), for children exposed to phenobarbital the OR was 1.1 (95%CI 0.7-1.7), and for diazepam, OR for congenital abnormalities was 1.2 (95%CI: 1.0-1.4). CONCLUSIONS The associations we found between the drugs examined and congenital abnormalities were either only borderline significant or not statistically significant. The case-time-control study provides an interesting way of using existing case-control data to study rare side effect of drugs taken during pregnancy.
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Affiliation(s)
- Dorte Kjaer
- The Danish Epidemiology Science Centre, Department of Epidemiology, Institute of Public Health, University of Aarhus, Aarhus, Denmark.
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Abstract
The review presented here discusses and exemplifies problems in epidemiological studies of drug teratogenesis according to methodology: case-control studies, cohort studies, or total population studies. Sources of errors and the possibility of confounding are underlined. The review stresses the caution with which conclusions have to be drawn when exposure data are retrospective or other possible bias exists. It also stresses the problem with the multiple testing situation that is usually present in the studies. It is therefore difficult to draw any firm conclusion from single studies and still more difficult to draw conclusions on causality. As randomized studies are in most cases out of the question, one has to rely on the type of studies which can be made, but the interpretation of the results should be cautious. The ideal study, next to a randomized one, is a large prospective study with detailed exposure information and detailed and unbiased outcome data. Even so, such a study can mainly be used for identifying possible associations which have to be verified or rejected in new studies. Nearly every finding of a risk increase, if not extremely strong, should only be regarded as a tentative signal to be tested in independent studies.
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Affiliation(s)
- Bengt A J Källén
- Center for Reproduction Epidemiology, Tornblad Institute, University of Lund, SE-223 62 Lund, Sweden.
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Schneider MF, Gange SJ, Margolick JB, Detels R, Chmiel JS, Rinaldo C, Armenian HK. Application of case-crossover and case-time-control study designs in analyses of time-varying predictors of T-cell homeostasis failure. Ann Epidemiol 2005; 15:137-44. [PMID: 15652719 DOI: 10.1016/j.annepidem.2004.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Accepted: 05/17/2004] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the association of sexual behavior and recreational drug exposures with T-cell homeostasis failure (TCHF), which corresponds to the onset of a rapid decline in an individual's T lymphocyte count, which occurs on average approximately 1.75 years prior to an initial diagnosis of acquired immunodeficiency syndrome (AIDS). METHODS A case-crossover design and a case-time-control design, both nested within the Multicenter AIDS Cohort Study of 4954 homosexual and bisexual men initiated in 1983. RESULTS In the case-crossover analysis, use of both recreational drugs and hashish were found to be protective against TCHF (odds ratios < or = 0.41), based on comparisons with four earlier control periods. However, a significant decreasing trend in the prevalence of these exposures was observed over time, thus motivating the implementation of the case-time-control design. Using the latter approach, the associations of drug use (odds ratio=0.53; 95% confidence interval (CI): 0.22, 1.28) and hashish use (odds ratio=0.46; 95% CI: 0.20, 1.05) with TCHF were no longer statistically significant. CONCLUSIONS The difference in inferences between these approaches demonstrates the importance of evaluating temporal trends in exposures when using a case-crossover design.
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Affiliation(s)
- Michael F Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Meyer KA, Williams P, Hernandez-Diaz S, Cnattingius S. Smoking and the risk of oral clefts: exploring the impact of study designs. Epidemiology 2005; 15:671-8. [PMID: 15475715 DOI: 10.1097/01.ede.0000142148.51230.60] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maternal cigarette smoking is a suspected cause of oral clefts, although this association has not been firmly established. We used case-crossover, case-time-control, and bidirectional case-crossover designs to supplement findings from a case-control study of maternal smoking and oral clefts among offspring in a large birth registry. METHODS Data are from the Swedish Medical Birth Registry. From 1983 through 1997 there were 678 recorded cases of cleft palate and 1175 cases of cleft lip with or without palate. Maternal smoking status was ascertained in early pregnancy. Controls for the case-control study were a random sample of infants born without a cleft; controls for the case-crossover designs were nonmalformed infants born to case mothers. RESULTS Cleft palate was positively associated with maternal smoking in all study designs, whereas cleft lip with or without cleft palate was associated with smoking only in the case-control design. In the case-control design, the odds ratios for cleft palate were 1.2 (95% confidence interval = 1.0-1.5) for women who smoked 1 to 9 cigarettes per day and 1.4 (1.1-1.8) for women who smoked 10+ cigarettes per day. In the case-time-control analysis, the odds ratio for cleft palate with maternal smoking was 3.2 (1.3-7.4) and in the bidirectional case-crossover design, the odds ratio was 2.2 (1.1-4.1). CONCLUSIONS An association between smoking and cleft palate was supported by all designs, whereas that between smoking and cleft lip with or without cleft palate was not. Case-only designs are a viable option in birth registries and may yield more information than a case-control design alone.
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Affiliation(s)
- Katie A Meyer
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
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Abstract
Observational research plays an important role in science. Much of human knowledge, including health knowledge, comes from observations, not experiments. Within medicine, observational studies cover a wide scope that ranges from case reports and case series, to descriptive studies, to analytic observational studies for causal questions. These studies often are complementary; each provides a piece of information that can be synthesized into a description and analysis of a health problem in a way that tests hypotheses and advances medical science and has the potential to lead to interventions that can improve health and quality of life. This article reviews the scope of observational studies, principles of causal inference in observational studies, and various types of observational studies with a focus of their applications in rheumatic disorders.
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Affiliation(s)
- Hyon K Choi
- Rheumatology Unit, Department of Medicine, Massachusetts General Hospital, Bulfinch 165, 55 Fruit Street, Boston, MA 02114, USA.
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