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[PMID]:29346418
[Au] Autor:Collaco JM; Appel LJ; McGready J; Cutting GR
[Ad] Endereço:Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
[Ti] Título:The relationship of lung function with ambient temperature.
[So] Source:PLoS One;13(1):e0191409, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Lung function is complex trait with both genetic and environmental factors contributing to variation. It is unknown how geographic factors such as climate affect population respiratory health. OBJECTIVE: To determine whether ambient air temperature is associated with lung function (FEV1) in the general population. DESIGN/SETTING: Associations between spirometry data from two National Health and Nutrition Examination Survey (NHANES) periods representative of the U.S. non-institutionalized population and mean annual ambient temperature were assessed using survey-weighted multivariate regression. PARTICIPANTS/MEASUREMENTS: The NHANES III (1988-94) cohort included 14,088 individuals (55.6% female) and the NHANES 2007-12 cohort included 14,036 individuals (52.3% female), with mean ages of 37.4±23.4 and 34.4±21.8 years old and FEV1 percent predicted values of 99.8±15.8% and 99.2±14.5%, respectively. RESULTS: After adjustment for confounders, warmer ambient temperatures were associated with lower lung function in both cohorts (NHANES III p = 0.020; NHANES 2007-2012 p = 0.014). The effect was similar in both cohorts with a 0.71% and 0.59% predicted FEV1 decrease for every 10°F increase in mean temperature in the NHANES III and NHANES 2007-2012 cohorts, respectively. This corresponds to ~2 percent predicted difference in FEV1 between the warmest and coldest regions in the continental United States. CONCLUSIONS: In the general U.S. population, residing in regions with warmer ambient air temperatures was associated with lower lung function with an effect size similar to that of traffic pollution. Rising temperatures associated with climate change could have effects on pulmonary function in the general population.
[Mh] Termos MeSH primário: Ar
Volume Expiratório Forçado
Temperatura Ambiente
[Mh] Termos MeSH secundário: Adulto
Estudos de Coortes
Fatores de Confusão (Epidemiologia)
Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180119
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191409


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[PMID]:28460474
[Au] Autor:Chen BD; Chen XC; Pan S; Yang YN; He CH; Liu F; Ma X; Gai MT; Ma YT
[Ad] Endereço:Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
[Ti] Título:TT genotype of rs2941484 in the human HNF4G gene is associated with hyperuricemia in Chinese Han men.
[So] Source:Oncotarget;8(16):26918-26926, 2017 Apr 18.
[Is] ISSN:1949-2553
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of the study is to investigate the association between the human hepatocyte nuclear factor 4 gamma (HNF4G) gene and hyperuricemia in Chinese Han population. A total of 414 hyperuricemia patients and 406 gender and age-matched normouricemic controls were enrolled. Four single nucleotide polymorphisms were genotyped as genetic markers for the human HNF4G gene (rs2977939, rs1805098, rs2941484, rs4735692). Data were analyzed for two separate groups: men and women. For rs2941484, the genotype distribution frequency in hyperuricemic subjects and was significantly different from that in normouricemic controls in men (P = 0.038). Meanwhile, in recessive model of rs2941484, the distribution frequency of TT genotype and CC+CT genotypes also differed significantly between the hyperuricemia men and normouricemic men (P = 0.011). For the other 3 SNPs in both men and women, there was no difference in the genotype and allele and distribution frequency between the hyperuricemia patients and normouricemic controls. In men, after adjustments for BMI, SBP, DBP, fasting glucose, total cholesterol, triglycerides, low density lipoprotein cholesterol and creatinine, the men with the TT genotype of rs2941484 were found to have significantly higher probability of suffering from hyperuricemia than the ones with CT and CC genotypes (OR = 2.170, P < 0.001). Therefore, TT genotype of rs2941484 in the human HNF4G gene might be a gender-specific genetic marker for hyperuricemia in Chinese Han men.
[Mh] Termos MeSH primário: Alelos
Grupo com Ancestrais do Continente Asiático/genética
Predisposição Genética para Doença
Genótipo
Fator 4 Nuclear de Hepatócito/genética
Hiperuricemia/genética
Polimorfismo de Nucleotídeo Único
[Mh] Termos MeSH secundário: Adulto
Idoso
Biomarcadores
China
Fatores de Confusão (Epidemiologia)
Feminino
Estudos de Associação Genética
Loci Gênicos
Seres Humanos
Hiperuricemia/diagnóstico
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Hepatocyte Nuclear Factor 4)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.18632/oncotarget.15851


  3 / 9505 MEDLINE  
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[PMID]:27779497
[Au] Autor:Schneeweiss S; Eddings W; Glynn RJ; Patorno E; Rassen J; Franklin JM
[Ad] Endereço:From the aDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and bAetion Inc., New York, NY.
[Ti] Título:Variable Selection for Confounding Adjustment in High-dimensional Covariate Spaces When Analyzing Healthcare Databases.
[So] Source:Epidemiology;28(2):237-248, 2017 Mar.
[Is] ISSN:1531-5487
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Data-adaptive approaches to confounding adjustment may improve performance beyond expert knowledge when analyzing electronic healthcare databases and have additional practical advantages for analyzing multiple databases in rapid cycles. Improvements seemed possible if outcome predictors were reliably identified empirically and adjusted. METHODS: In five cohort studies from diverse healthcare databases, we implemented a base-case high-dimensional propensity score algorithm with propensity score decile-adjusted outcome models to estimate treatment effects among prescription drug initiators. The original variable selection procedure based on the estimated bias of each variable using unadjusted associations between confounders and exposure (RRCE) and disease outcome (RRCD) was augmented by alternative strategies. These included using increasingly adjusted RRCD estimates, including models considering >1,500 variables jointly (Lasso, Bayesian logistic regression); using prediction statistics or likelihood-ratio statistics for covariate prioritization; directly estimating the propensity score with >1,500 variables (Lasso, Bayesian regression); or directly fitting an outcome model using all covariates jointly (Lasso, Ridge). RESULTS: In five example studies, most tested augmentations of the base-case hdPS did not meaningfully change estimates in light of wide confidence intervals except for Bayesian regression and Lasso to estimate RRCD, which moved estimates minimally closer to the expectation in three of five examples. The direct outcome estimation with Lasso performed worst. CONCLUSION: Overall, the basic heuristic of variable reduction in high-dimensional propensity score adjustment performed, as well as alternative approaches in diverse settings. Minor improvements in variable selection may be possible using Bayesian outcome regression to prioritize variables for propensity score estimation when outcomes are rare. See video abstract at, http://links.lww.com/EDE/B162.
[Mh] Termos MeSH primário: Algoritmos
Fatores de Confusão (Epidemiologia)
Bases de Dados Factuais
Pontuação de Propensão
[Mh] Termos MeSH secundário: Teorema de Bayes
Estudos de Coortes
Seres Humanos
Funções Verossimilhança
Modelos Logísticos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1097/EDE.0000000000000581


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[PMID]:29372247
[Au] Autor:Inohara T; Xian Y; Liang L; Matsouaka RA; Saver JL; Smith EE; Schwamm LH; Reeves MJ; Hernandez AF; Bhatt DL; Peterson ED; Fonarow GC
[Ad] Endereço:Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
[Ti] Título:Association of Intracerebral Hemorrhage Among Patients Taking Non-Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality.
[So] Source:JAMA;319(5):463-473, 2018 02 06.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Although non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used to prevent thromboembolic disease, there are limited data on NOAC-related intracerebral hemorrhage (ICH). Objective: To assess the association between preceding oral anticoagulant use (warfarin, NOACs, and no oral anticoagulants [OACs]) and in-hospital mortality among patients with ICH. Design, Setting, and Participants: Retrospective cohort study of 141 311 patients with ICH admitted from October 2013 to December 2016 to 1662 Get With The Guidelines-Stroke hospitals. Exposures: Anticoagulation therapy before ICH, defined as any use of OACs within 7 days prior to hospital arrival. Main Outcomes and Measures: In-hospital mortality. Results: Among 141 311 patients with ICH (mean [SD] age, 68.3 [15.3] years; 48.1% women), 15 036 (10.6%) were taking warfarin and 4918 (3.5%) were taking NOACs preceding ICH, and 39 585 (28.0%) and 5783 (4.1%) were taking concomitant single and dual antiplatelet agents, respectively. Patients with prior use of warfarin or NOACs were older and had higher prevalence of atrial fibrillation and prior stroke. Acute ICH stroke severity (measured by the National Institutes of Health Stroke Scale) was not significantly different across the 3 groups (median, 9 [interquartile range, 2-21] for warfarin, 8 [2-20] for NOACs, and 8 [2-19] for no OACs). The unadjusted in-hospital mortality rates were 32.6% for warfarin, 26.5% for NOACs, and 22.5% for no OACs. Compared with patients without prior use of OACs, the risk of in-hospital mortality was higher among patients with prior use of warfarin (adjusted risk difference [ARD], 9.0% [97.5% CI, 7.9% to 10.1%]; adjusted odds ratio [AOR], 1.62 [97.5% CI, 1.53 to 1.71]) and higher among patients with prior use of NOACs (ARD, 3.3% [97.5% CI, 1.7% to 4.8%]; AOR, 1.21 [97.5% CI, 1.11-1.32]). Compared with patients with prior use of warfarin, patients with prior use of NOACs had a lower risk of in-hospital mortality (ARD, -5.7% [97.5% CI, -7.3% to -4.2%]; AOR, 0.75 [97.5% CI, 0.69 to 0.81]). The difference in mortality between NOAC-treated patients and warfarin-treated patients was numerically greater among patients with prior use of dual antiplatelet agents (32.7% vs 47.1%; ARD, -15.0% [95.5% CI, -26.3% to -3.8%]; AOR, 0.50 [97.5% CI, 0.29 to 0.86]) than among those taking these agents without prior antiplatelet therapy (26.4% vs 31.7%; ARD, -5.0% [97.5% CI, -6.8% to -3.2%]; AOR, 0.77 [97.5% CI, 0.70 to 0.85]), although the interaction P value (.07) was not statistically significant. Conclusions and Relevance: Among patients with ICH, prior use of NOACs or warfarin was associated with higher in-hospital mortality compared with no OACs. Prior use of NOACs, compared with prior use of warfarin, was associated with lower risk of in-hospital mortality.
[Mh] Termos MeSH primário: Anticoagulantes/efeitos adversos
Hemorragia Cerebral/induzido quimicamente
Mortalidade Hospitalar
Inibidores da Agregação de Plaquetas/efeitos adversos
Vitamina K/antagonistas & inibidores
Varfarina/efeitos adversos
[Mh] Termos MeSH secundário: Administração Oral
Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/uso terapêutico
Hemorragia Cerebral/mortalidade
Fatores de Confusão (Epidemiologia)
Feminino
Seres Humanos
Masculino
Inibidores da Agregação de Plaquetas/uso terapêutico
Sistema de Registros
Estudos Retrospectivos
Risco
Varfarina/uso terapêutico
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Platelet Aggregation Inhibitors); 12001-79-5 (Vitamin K); 5Q7ZVV76EI (Warfarin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180127
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.21917


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[PMID]:27771142
[Au] Autor:Suzuki E; Tsuda T; Mitsuhashi T; Mansournia MA; Yamamoto E
[Ad] Endereço:Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan. Electronic address: etsuji-s@cc.okayama-u.ac.jp.
[Ti] Título:Errors in causal inference: an organizational schema for systematic error and random error.
[So] Source:Ann Epidemiol;26(11):788-793.e1, 2016 Nov.
[Is] ISSN:1873-2585
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To provide an organizational schema for systematic error and random error in estimating causal measures, aimed at clarifying the concept of errors from the perspective of causal inference. METHODS: We propose to divide systematic error into structural error and analytic error. With regard to random error, our schema shows its four major sources: nondeterministic counterfactuals, sampling variability, a mechanism that generates exposure events and measurement variability. RESULTS: Structural error is defined from the perspective of counterfactual reasoning and divided into nonexchangeability bias (which comprises confounding bias and selection bias) and measurement bias. Directed acyclic graphs are useful to illustrate this kind of error. Nonexchangeability bias implies a lack of "exchangeability" between the selected exposed and unexposed groups. A lack of exchangeability is not a primary concern of measurement bias, justifying its separation from confounding bias and selection bias. Many forms of analytic errors result from the small-sample properties of the estimator used and vanish asymptotically. Analytic error also results from wrong (misspecified) statistical models and inappropriate statistical methods. CONCLUSIONS: Our organizational schema is helpful for understanding the relationship between systematic error and random error from a previously less investigated aspect, enabling us to better understand the relationship between accuracy, validity, and precision.
[Mh] Termos MeSH primário: Fatores de Confusão (Epidemiologia)
Métodos Epidemiológicos
Viés de Seleção
[Mh] Termos MeSH secundário: Seres Humanos
Erros Médicos
Modelos Estatísticos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


  6 / 9505 MEDLINE  
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[PMID]:29206988
[Au] Autor:Zheng Y; Song M; Manson JE; Giovannucci EL; Hu FB
[Ti] Título:Group-Based Trajectory of Body Shape From Ages 5 to 55 Years and Cardiometabolic Disease Risk in 2 US Cohorts.
[So] Source:Am J Epidemiol;186(11):1246-1255, 2017 Dec 01.
[Is] ISSN:1476-6256
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The association of adiposity across the life span with cardiometabolic risk is not completely delineated. We used a group-based modeling approach to identify distinct trajectories of body shape from ages 5 years to 55 years among 84,792 women from the Nurses' Health Study (1976-2010) and 37,706 men from the Health Professionals Follow-up Study (1986-2010) and assessed the associations between these trajectories and incidence of type 2 diabetes and cardiovascular disease (CVD) during a 17-year follow-up period. Compared with those who maintained leanness throughout the life span ("lean-stable" trajectory), participants who maintained a medium body shape ("medium-stable" trajectory) had somewhat increased risk. Those who started lean but had a moderate or marked increase in adiposity ("lean-moderate increase" and "lean-marked increase" trajectories) had even higher risk (e.g., for a "lean-marked increase" trajectory, the hazard ratio for diabetes was 8.11 (95% confidence interval (95% CI): 7.10, 9.27) in women and 2.36 (95% CI: 2.04, 2.74) in men; for CVD, it was 1.38 (95% CI: 1.25, 1.52) in women and 1.28 (95% CI: 1.16, 1.41) in men). Participants who started heavy and became heavier (a "heavy-increase" trajectory) had substantially elevated risk (for diabetes, the hazard ratio was 7.34 (95% CI: 6.40, 8.42) in women and 2.80 (95% CI: 2.37, 3.31) in men; for CVD, it was 1.55 (95% CI: 1.40, 1.71) in women and 1.35 (95% CI: 1.20, 1.53) in men). Our data showed that trajectories of body shape from ages 5 to 55 years were associated with subsequent risk of developing type 2 diabetes and CVD.
[Mh] Termos MeSH primário: Adiposidade
Índice de Massa Corporal
Doenças Cardiovasculares/etiologia
Diabetes Mellitus Tipo 2/etiologia
Suscetibilidade a Doenças
Obesidade/complicações
[Mh] Termos MeSH secundário: Adolescente
Adulto
Doenças Cardiovasculares/epidemiologia
Criança
Pré-Escolar
Fatores de Confusão (Epidemiologia)
Diabetes Mellitus Tipo 2/epidemiologia
Feminino
Seres Humanos
Estudos Longitudinais
Masculino
Meia-Idade
Obesidade/epidemiologia
Modelos de Riscos Proporcionais
Fatores de Risco
Fumar/efeitos adversos
Fumar/metabolismo
Tempo
Estados Unidos/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171213
[Lr] Data última revisão:
171213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1093/aje/kwx188


  7 / 9505 MEDLINE  
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[PMID]:29206986
[Au] Autor:Wilson A; Chiu YM; Hsu HL; Wright RO; Wright RJ; Coull BA
[Ti] Título:Potential for Bias When Estimating Critical Windows for Air Pollution in Children's Health.
[So] Source:Am J Epidemiol;186(11):1281-1289, 2017 Dec 01.
[Is] ISSN:1476-6256
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Evidence supports an association between maternal exposure to air pollution during pregnancy and children's health outcomes. Recent interest has focused on identifying critical windows of vulnerability. An analysis based on a distributed lag model (DLM) can yield estimates of a critical window that are different from those from an analysis that regresses the outcome on each of the 3 trimester-average exposures (TAEs). Using a simulation study, we assessed bias in estimates of critical windows obtained using 3 regression approaches: 1) 3 separate models to estimate the association with each of the 3 TAEs; 2) a single model to jointly estimate the association between the outcome and all 3 TAEs; and 3) a DLM. We used weekly fine-particulate-matter exposure data for 238 births in a birth cohort in and around Boston, Massachusetts, and a simulated outcome and time-varying exposure effect. Estimates using separate models for each TAE were biased and identified incorrect windows. This bias arose from seasonal trends in particulate matter that induced correlation between TAEs. Including all TAEs in a single model reduced bias. DLM produced unbiased estimates and added flexibility to identify windows. Analysis of body mass index z score and fat mass in the same cohort highlighted inconsistent estimates from the 3 methods.
[Mh] Termos MeSH primário: Poluição do Ar/efeitos adversos
Saúde do Lactente
Exposição Materna/efeitos adversos
Material Particulado/efeitos adversos
Resultado da Gravidez/epidemiologia
[Mh] Termos MeSH secundário: Viés
Boston/epidemiologia
Simulação por Computador
Fatores de Confusão (Epidemiologia)
Feminino
Seres Humanos
Lactente
Modelos Lineares
Masculino
Gravidez
Trimestres da Gravidez
Estações do Ano
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Particulate Matter)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171213
[Lr] Data última revisão:
171213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1093/aje/kwx184


  8 / 9505 MEDLINE  
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[PMID]:29059229
[Au] Autor:Wu YD; Lin CH; Chao WC; Liao TL; Chen DY; Chen HH
[Ad] Endereço:Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
[Ti] Título:Association between a history of periodontitis and the risk of systemic lupus erythematosus in Taiwan: A nationwide, population-based, case-control study.
[So] Source:PLoS One;12(10):e0187075, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To examine the association between a history of periodontitis (PD) and incident systemic lupus erythematosus (SLE). METHODS: We used 2003-2012 claims data from the Taiwanese National Health Insurance Database to identify 7,204 incident SLE patients during 2007-2012 as the study group, along with randomly selecting 72,040 non-SLE patients matched (1:10) for age, gender, and first diagnosis date (index date) as the control group. The correlation between PD and SLE risk was estimated using conditional logistic regression analysis, after making adjustments for confounders (including a history of diabetes and number of non-PD related dental visits before the index date). To evaluate the effects of PD severity and the lag time which occurred since the last PD visit on SLE development, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for subgroups of patients with PD according to their number of visits, cumulative cost and also the time gaps between their last PD-related visit and the index date. RESULTS: A statistically significant association between a history of PD and newly diagnosed SLE was observed (OR, 1.21; 95% CI, 1.14-1.28; p-value, <0.001). The association was both dose- and time-dependent and was found to be strongest when the interval between the last PD-related visit and the index date was less than three months (OR, 1.83; 95% CI, 1.61-2.09; p-value, <0.001). The association between PD exposure and SLE risk was consistently significant among subgroups stratified based on age, gender, or DM status. CONCLUSIONS: The results of this nationwide, population-based, case-control study suggest that there is a significant association between a history of PD and incident SLE in Taiwan. This weak association is limited to lack of information on individual smoking status in the database.
[Mh] Termos MeSH primário: Lúpus Eritematoso Sistêmico/epidemiologia
Periodontite/complicações
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Fatores de Confusão (Epidemiologia)
Feminino
Seres Humanos
Lúpus Eritematoso Sistêmico/complicações
Masculino
Meia-Idade
Fatores de Risco
Taiwan/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171024
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0187075


  9 / 9505 MEDLINE  
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[PMID]:28973247
[Au] Autor:Chang SH; Chou IJ; Yeh YH; Chiou MJ; Wen MS; Kuo CT; See LC; Kuo CF
[Ad] Endereço:Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
[Ti] Título:Association Between Use of Non-Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding in Nonvalvular Atrial Fibrillation.
[So] Source:JAMA;318(13):1250-1259, 2017 10 03.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Non-vitamin K oral anticoagulants (NOACs) are commonly prescribed with other medications that share metabolic pathways that may increase major bleeding risk. Objective: To assess the association between use of NOACs with and without concurrent medications and risk of major bleeding in patients with nonvalvular atrial fibrillation. Design, Setting, and Participants: Retrospective cohort study using data from the Taiwan National Health Insurance database and including 91 330 patients with nonvalvular atrial fibrillation who received at least 1 NOAC prescription of dabigatran, rivaroxaban, or apixaban from January 1, 2012, through December 31, 2016, with final follow-up on December 31, 2016. Exposures: NOAC with or without concurrent use of atorvastatin; digoxin; verapamil; diltiazem; amiodarone; fluconazole; ketoconazole, itraconazole, voriconazole, or posaconazole; cyclosporine; erythromycin or clarithromycin; dronedarone; rifampin; or phenytoin. Main Outcomes and Measures: Major bleeding, defined as hospitalization or emergency department visit with a primary diagnosis of intracranial hemorrhage or gastrointestinal, urogenital, or other bleeding. Adjusted incidence rate differences between person-quarters (exposure time for each person during each quarter of the calendar year) of NOAC with or without concurrent medications were estimated using Poisson regression and inverse probability of treatment weighting using the propensity score. Results: Among 91 330 patients with nonvalvular atrial fibrillation (mean age, 74.7 years [SD, 10.8]; men, 55.8%; NOAC exposure: dabigatran, 45 347 patients; rivaroxaban, 54 006 patients; and apixaban, 12 886 patients), 4770 major bleeding events occurred during 447 037 person-quarters with NOAC prescriptions. The most common medications co-prescribed with NOACs over all person-quarters were atorvastatin (27.6%), diltiazem (22.7%), digoxin (22.5%), and amiodarone (21.1%). Concurrent use of amiodarone, fluconazole, rifampin, and phenytoin with NOACs had a significant increase in adjusted incidence rates per 1000 person-years of major bleeding than NOACs alone: 38.09 for NOAC use alone vs 52.04 for amiodarone (difference, 13.94 [99% CI, 9.76-18.13]); 102.77 for NOAC use alone vs 241.92 for fluconazole (difference, 138.46 [99% CI, 80.96-195.97]); 65.66 for NOAC use alone vs 103.14 for rifampin (difference, 36.90 [99% CI, 1.59-72.22); and 56.07 for NOAC use alone vs 108.52 for phenytoin (difference, 52.31 [99% CI, 32.18-72.44]; P < .01 for all comparisons). Compared with NOAC use alone, the adjusted incidence rate for major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin and was not significantly different for concurrent use of verapamil; diltiazem; cyclosporine; ketoconazole, itraconazole, voriconazole, or posaconazole; and dronedarone. Conclusions and Relevance: Among patients taking NOACs for nonvalvular atrial fibrillation, concurrent use of amiodarone, fluconazole, rifampin, and phenytoin compared with the use of NOACs alone, was associated with increased risk of major bleeding. Physicians prescribing NOAC medications should consider the potential risks associated with concomitant use of other drugs.
[Mh] Termos MeSH primário: Anticoagulantes/efeitos adversos
Fibrilação Atrial/tratamento farmacológico
Hemorragia/induzido quimicamente
Polimedicação
[Mh] Termos MeSH secundário: Administração Oral
Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/uso terapêutico
Fibrilação Atrial/complicações
Fatores de Confusão (Epidemiologia)
Interações Medicamentosas
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Pontuação de Propensão
Estudos Retrospectivos
Taiwan
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171004
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.13883


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[PMID]:28957435
[Au] Autor:Stein K; Pearson RM; Stein A; Fazel M
[Ad] Endereço:Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
[Ti] Título:The predictive value of childhood recurrent abdominal pain for adult emotional disorders, and the influence of negative cognitive style. Findings from a cohort study.
[So] Source:PLoS One;12(9):e0185643, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recurrent abdominal pain (RAP) in childhood is common, with no explanatory pathology identified in the majority of cases. Previous studies have consistently demonstrated an association between childhood RAP and later emotional distress disorders. The aim of this study was to replicate this finding through the analysis of a large dataset, and explore how a negative style of thinking could potentially influence this relationship. METHODS: The Avon Longitudinal Study of Parents and Children (ALSPAC) is a population cohort of children born in the Avon area of the UK, between 1991-1992. Data on childhood RAP was collected via maternal reports at 3, 4, 7 and 9 years. Mood, anxiety and cognitive style were measured at age 18. We controlled for various confounding factors, including maternal anxiety and the child's pre-existing psychopathology. Logistic regression models were used to examine associations, and moderation effects of cognitive style were analysed using likelihood ratios. RESULTS: Experiencing RAP at any one time-point is associated with an increased odds of depression and/or anxiety disorder at 18 (OR = 1.41, 95% CI 1.09-1.83). We found a dose-response relationship and each additional marker of RAP was associated with a 26% (CI: 7% to 47%) increase in risk of having a mood and/or anxiety disorder. Individuals who attribute adversity to global, stable or personal factors were at amplified risk. CONCLUSIONS: Childhood RAP predicts depression and anxiety disorders at 18 and should be targeted for early intervention. Individuals with a negative cognitive style may be particularly vulnerable, suggesting that cognitive interpretations of physical symptoms could play an important role in long-term health outcomes.
[Mh] Termos MeSH primário: Dor Abdominal/psicologia
Ansiedade/etiologia
Cognição
Depressão/etiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Fatores de Confusão (Epidemiologia)
Seres Humanos
Estudos Longitudinais
Recidiva
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170929
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185643



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