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Abstract
ABSTRACT Dijksma, I, Hof, MHP, Lucas, C, and Stuiver, MM. Development and validation of a dynamically updated prediction model for attrition from Marine recruit training. J Strength Cond Res 36(9): 2523-2529, 2022-Whether fresh Marine recruits thrive and complete military training programs, or fail to complete, is dependent on numerous interwoven variables. This study aimed to derive a prediction model for dynamically updated estimation of conditional dropout probabilities for Marine recruit training. We undertook a landmarking analysis in a Cox proportional hazard model using longitudinal data from 744 recruits from existing databases of the Marine Training Center in the Netherlands. The model provides personalized estimates of dropout from Marine recruit training given a recruit's baseline characteristics and time-varying mental and physical health status, using 21 predictors. We defined nonoverlapping landmarks at each week and developed a supermodel by stacking the landmark data sets. The final supermodel contained all but one a priori selected baseline variables and time-varying health status to predict the hazard of attrition from Marine recruit training for each landmark as comprehensive as possible. The discriminative ability (c-index) of the prediction model was 0.78, 0.75, and 0.73 in week one, week 4 and week 12, respectively. We used 10-fold cross-validation to train and evaluate the model. We conclude that this prediction model may help to identify recruits at an increased risk of attrition from training throughout the Marine recruit training and warrants further validation and updates for other military settings.
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Affiliation(s)
- Iris Dijksma
- Amsterdam UMC Location AMC, Epidemiology and Data Science, Master Evidence Based Practice in Health Care, Arizona, Amsterdam, the Netherlands; and
- Defense Health Care Organization, Netherlands Armed Forces, Utrecht, the Netherlands
| | - Michel H.P. Hof
- Amsterdam UMC Location AMC, Epidemiology and Data Science, Master Evidence Based Practice in Health Care, Arizona, Amsterdam, the Netherlands; and
| | - Cees Lucas
- Amsterdam UMC Location AMC, Epidemiology and Data Science, Master Evidence Based Practice in Health Care, Arizona, Amsterdam, the Netherlands; and
| | - Martijn M. Stuiver
- Amsterdam UMC Location AMC, Epidemiology and Data Science, Master Evidence Based Practice in Health Care, Arizona, Amsterdam, the Netherlands; and
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Pontesilli M, Hof MH, Ravelli ACJ, van Altena AJ, Soufan AT, Mol BW, Kostelijk EH, Slappendel E, Consten D, Cantineau AEP, van der Westerlaken LAJ, van Inzen W, Dumoulin JCM, Ramos L, Baart EB, Broekmans FJM, Rijnders PM, Curfs MHJM, Mastenbroek S, Repping S, Roseboom TJ, Painter RC. Effect of parental and ART treatment characteristics on perinatal outcomes. Hum Reprod 2021; 36:1640-1665. [PMID: 33860303 PMCID: PMC8129595 DOI: 10.1093/humrep/deab008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do parental characteristics and treatment with ART affect perinatal outcomes in singleton pregnancies? SUMMARY ANSWER Both parental and ART treatment characteristics affect perinatal outcomes in singleton pregnancies. WHAT IS KNOWN ALREADY Previous studies have shown that singleton pregnancies resulting from ART are at risk of preterm birth. ART children are lighter at birth after correction for duration of gestation and at increased risk of congenital abnormalities compared to naturally conceived children. This association is confounded by parental characteristics that are also known to affect perinatal outcomes. It is unclear to which extent parental and ART treatment characteristics independently affect perinatal outcomes. STUDY DESIGN, SIZE, DURATION All IVF clinics in the Netherlands (n = 13) were requested to provide data on all ART treatment cycles (IVF, ICSI and frozen-thawed embryo transfers (FET)), performed between 1 January 2000, and 1 January 2011, which resulted in a pregnancy. Using probabilistic data-linkage, these data (n = 36 683) were linked to the Dutch Perinatal Registry (Perined), which includes all children born in the Netherlands in the same time period (n = 2 548 977). PARTICIPANTS/MATERIALS, SETTING, METHODS Analyses were limited to singleton pregnancies that resulted from IVF, ICSI or FET cycles. Multivariable models for linear and logistic regression were fitted including parental characteristics as well as ART treatment characteristics. Analyses were performed separately for fresh cycles and for fresh and FET cycles combined. We assessed the impact on the following perinatal outcomes: birth weight, preterm birth below 37 or 32 weeks of gestation, congenital malformations and perinatal mortality. MAIN RESULTS AND THE ROLE OF CHANCE The perinatal outcomes of 31 184 out of the 36 683 ART treatment cycles leading to a pregnancy were retrieved through linkage with the Perined (85% linkage). Of those, 23 671 concerned singleton pregnancies resulting from IVF, ICSI or FET. Birth weight was independently associated with both parental and ART treatment characteristics. Characteristics associated with lower birth weight included maternal hypertensive disease, non-Dutch maternal ethnicity, nulliparity, increasing duration of subfertility, hCG for luteal phase support (compared to progesterone), shorter embryo culture duration, increasing number of oocytes retrieved and fresh embryo transfer. The parental characteristic with the greatest effect size on birth weight was maternal diabetes (adjusted difference 283 g, 95% CI 228–338). FET was the ART treatment characteristic with the greatest effect size on birth weight (adjusted difference 100 g, 95% CI 84–117) compared to fresh embryo transfer. Preterm birth was more common among mothers of South-Asian ethnicity. Preterm birth was less common among multiparous women and women with ‘male factor’ as treatment indication (compared to ‘tubal factor’). LIMITATIONS, REASONS FOR CAUTION Due to the retrospective nature of our study, we cannot prove causality. Further limitations of our study were the inability to adjust for mothers giving birth more than once in our dataset, missing values for several variables and limited information on parental lifestyle and general health. WIDER IMPLICATIONS OF THE FINDINGS Multiple parental and ART treatment characteristics affect perinatal outcomes, with birth weight being influenced by the widest range of factors. This highlights the importance of assessing both parental and ART treatment characteristics in studies that focus on the health of ART-offspring, with the purpose of modifying these factors where possible. Our results further support the hypothesis that the embryo is sensitive to its early environment. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Foreest Medical School, Alkmaar, the Netherlands (grants: FIO 1307 and FIO 1505). B.W.M. reports grants from NHMRC and consultancy for ObsEva, Merck KGaA, iGenomics and Guerbet. F.B. reports research support grants from Merck Serono and personal fees from Merck Serono. A.C. reports travel support from Ferring BV. and Theramex BV. and personal fees from UpToDate (Hyperthecosis), all outside the remit of the current work. The remaining authors report no conflict of interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Pontesilli
- Department of Obstetrics and Gynaecology, Northwest Clinics, Alkmaar, The Netherlands.,Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M H Hof
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A C J Ravelli
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A J van Altena
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A T Soufan
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - E H Kostelijk
- Center for Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - E Slappendel
- Center for Reproductive Medicine, Nij Geertgen Clinic, Elsendorp, The Netherlands
| | - D Consten
- Center for Reproductive Medicine, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - A E P Cantineau
- Center for Reproductive Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - W van Inzen
- Center for Reproductive Medicine, IVF Center Medisch Centrum Kinderwens, Leiderdorp, The Netherlands
| | - J C M Dumoulin
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
| | - L Ramos
- Center for Reproductive Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E B Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F J M Broekmans
- Center for Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P M Rijnders
- Center for Reproductive Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - M H J M Curfs
- Center for Reproductive Medicine, Isala, Zwolle, The Netherlands
| | - S Mastenbroek
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - S Repping
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - T J Roseboom
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - R C Painter
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Gerbens LAA, Apfelbacher CJ, Irvine AD, Barbarot S, de Booij RJ, Boyce AE, Deleuran M, Eichenfield LF, Hof MH, Middelkamp-Hup MA, Roberts A, Schmitt J, Vestergaard C, Wall D, Weidinger S, Williamson PR, Flohr C, Spuls PI. TREatment of ATopic eczema (TREAT) Registry Taskforce: an international Delphi exercise to identify a core set of domains and domain items for national atopic eczema photo- and systemic therapy registries. Br J Dermatol 2018; 180:790-801. [PMID: 29761486 PMCID: PMC7379963 DOI: 10.1111/bjd.16714] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Evidence of immunomodulatory therapies to guide clinical management of atopic eczema (AE) is scarce, despite frequent and often off-label use. Patient registries provide valuable evidence for the effects of treatments under real-world conditions that can inform treatment guidelines, give the opportunity for health economic evaluation and the evaluation of quality of care, as well as pharmacogenetic and dynamic research, which cannot be adequately addressed in clinical trials. OBJECTIVES The TREatment of ATopic eczema (TREAT) Registry Taskforce aims to seek international consensus on a core set of domains and items ('what to measure') for AE research registries, using a Delphi approach. METHODS Participants from six stakeholder groups were included: doctors, nurses, nonclinical researchers, patients, industry and regulatory body representatives. The eDelphi comprised three sequential online rounds, requesting participants to rate the importance of each proposed domain item. Participants could add domain items to the proposed list in round 1. A final consensus meeting was held to ratify the core set. RESULTS Participants (n = 479) from 36 countries accessed the eDelphi platform, of whom 86%, 79% and 74% completed rounds 1, 2 and 3, respectively. At the face-to-face consensus meeting attended by 42 participants the final core set was established containing 19 domains with 69 domain items (49 baseline and 20 follow-up items). CONCLUSIONS This core set of domains and items to be captured by national AE systemic therapy registries will standardize data collection and thereby allow direct comparability across registries and facilitate data pooling between countries. Ultimately, it will provide greater insight into the effectiveness, safety and cost-effectiveness of photo- and systemic immunomodulatory therapies.
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Affiliation(s)
- L A A Gerbens
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - C J Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - A D Irvine
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - S Barbarot
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | | | - A E Boyce
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - M Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - L F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, CA, U.S.A
| | - M H Hof
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Centre, Amsterdam, the Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - A Roberts
- Contributing patient.,Nottingham Support Group for Carers of Children with Eczema, Nottingham, U.K
| | - J Schmitt
- Center for Evidence-based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.,University Allergy Center, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Vestergaard
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - D Wall
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Irish Skin Foundation, Dublin, Ireland
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - P R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, U.K
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - P I Spuls
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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