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1.
BMC Med Genet ; 21(1): 54, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183743

RESUMO

BACKGROUND: The ABCG2 rs2231142 single nucleotide polymorphism (SNP) is one of the most significant genetic variants associated with hyperuricemia (HUA) in Asian populations. However, the risk of ABCG2 rs2231142 variants for HUA could interact with other important HUA risk variants and cardiovascular factors. This study investigated the effects of the combined association among ABCG2 rs2231142 and multiple HUA genetic variants or cardiovascular risk factors on HUA risk and serum uric acid (sUA) levels in an elderly Chinese population. METHODS: A total of 1206 participants over 65 years old were enrolled in this study. Physical and laboratory examinations were performed for all participants. The ABCG2 rs2231142, SLC2A9 rs3733591, and SLC22A12 rs893006 SNPs were assayed using a standardized protocol. Logistic regression analysis and liner regression were adjusted respectively to account for the association between ABCG2 rs2231142 and other genetic variants, as well as between cardiovascular risk factors and HUA risk and sUA levels. RESULTS: The prevalence of HUA was 14.71% in the elderly community-dwelling population. The ABCG2 rs2231142 risk T allele was associated with HUA risk (odds ratio (OR) = 1.63, 95% confidence interval (CI): 1.27-2.11; p = 1.65 × 10- 4) and with increased sUA levels (Beta = 0.16, p = 6.75 × 10- 9) in the whole study population. Linear regression analysis showed that the mean sUA level increased linearly with the number of risk alleles of the three candidate genetic variants (Beta = 0.18, p = 1.94 × 10- 12) The joint effect of the ABCG2 rs2231142 T allele and cardiovascular risk factors (obesity, hypertension and dyslipidemia) was also associated with increased HUA risk and sUA levels. Each copy of the risk T allele was significantly associated with enhanced HUA risk in patients with hypertriglyceridemia (OR = 2.52, 95% CI: 1.33-4.60; p = 0.003) compared to controls. CONCLUSION: Our findings reinforce the importance of the ABCG2 rs2231143 variant as a crucial genetic locus for HUA in Chinese populations and demonstrated the combined effects of multiple genetic risk variants and cardiovascular risk exposures on HUA risk and increased sUA level.


Assuntos
Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Doenças Cardiovasculares/etiologia , Genes Modificadores , Proteínas Facilitadoras de Transporte de Glucose/genética , Hiperuricemia/genética , Proteínas de Neoplasias/genética , Transportadores de Ânions Orgânicos/genética , Proteínas de Transporte de Cátions Orgânicos/genética , Polimorfismo de Nucleotídeo Único , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/genética , Envelhecimento/fisiologia , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Estudos de Coortes , Modificador do Efeito Epidemiológico , Epistasia Genética , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Hiperuricemia/sangue , Hiperuricemia/epidemiologia , Vida Independente/estatística & dados numéricos , Masculino , Fatores de Risco , Ácido Úrico/sangue
2.
Mayo Clin Proc ; 95(1): 90-100, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902433

RESUMO

OBJECTIVE: To compare the safety of metformin vs sulfonylureas in patients with type 2 diabetes by chronic kidney disease (CKD) stage. PATIENTS AND METHODS: This retrospective cohort study included adults in Manitoba, Canada, with type 2 diabetes, an incident monotherapy prescription for metformin or a sulfonylurea, and a serum creatinine measurement from April 1, 2006, to March 31, 2017. Patients were stratified by estimated glomerular filtration rate (eGFR) into the following groups: eGFR of 90 or greater, 60 to 89, 45 to 59, 30 to 44, or less than 30 mL/min/1.73 m2. Outcomes included all-cause mortality, cardiovascular events, and major hypoglycemic episodes. Baseline characteristics were used to calculate propensity scores and perform inverse probability of treatment weights analysis, and eGFR group was examined as an effect modifier for each outcome. RESULTS: The cohort consisted of 21,996 individuals (19,990 metformin users and 2006 sulfonylurea users). Metformin use was associated with lower risk for all-cause mortality (hazard ratio [HR], 0.48; 95% CI, 0.40-0.58; P<.001), cardiovascular events (HR, 0.67; 95% CI, 0.52-0.86; P=.002), and major hypoglycemic episodes (HR, 0.14; 95% CI, 0.09-0.20; P<.001) when compared with sulfonylureas. CKD was a significant effect modifier for all-cause mortality (P=.002), but not for cardiovascular events or major hypoglycemic episodes. CONCLUSION: Sulfonylurea monotherapy is associated with higher risk for all-cause mortality, major hypoglycemic episodes, and cardiovascular events compared with metformin. Although the presence of CKD attenuated the mortality benefit, metformin may be a safer alternative to sulfonylureas in patients with CKD.


Assuntos
Diabetes Mellitus Tipo 2 , Hipoglicemia , Metformina , Insuficiência Renal Crônica , Compostos de Sulfonilureia , Canadá/epidemiologia , Doenças Cardiovasculares/epidemiologia , Creatinina/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/estatística & dados numéricos , Modificador do Efeito Epidemiológico , Feminino , Taxa de Filtração Glomerular , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Metformina/administração & dosagem , Metformina/efeitos adversos , Pessoa de Meia-Idade , Mortalidade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Compostos de Sulfonilureia/administração & dosagem , Compostos de Sulfonilureia/efeitos adversos
3.
Nurs Res ; 69(1): 62-68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31609896

RESUMO

BACKGROUND: Although nursing intervention studies typically focus on testing hypothesized differences between intervention and control groups, moderator variables can reveal for whom or under what circumstances an intervention may be most effective. OBJECTIVES: The aim of the study was to explain and illustrate moderator effects using data from a nursing intervention study to improve cognitive abilities in those with a chronic health condition. METHODS: The sample consisted of 178 individuals with multiple sclerosis participating in an experimental study of a cognitive intervention. General linear models were used for analyses. Interaction terms were created to represent moderator effects on three outcomes: self-reported cognitive abilities, use of memory strategies, and verbal memory performance. RESULTS: The Charlson comorbidity index significantly moderated the intervention effect on self-perceived cognitive abilities. Years of education significantly moderated the intervention effect on use of memory strategies. Scores on a general self-efficacy measure significantly moderated the intervention effect on the Controlled Verbal Learning Test-Second Edition. DISCUSSION: These analyses highlight the key role that moderator effects can play in nursing research. Although random assignment to groups can control potentially biasing effects of extraneous differences among individuals in intervention and control groups, those very differences may suggest fruitful avenues for hypothesis generating research about what works best for whom in intervention studies.


Assuntos
Pesquisa Biomédica/métodos , Doença Crônica/enfermagem , Disfunção Cognitiva/enfermagem , Modificador do Efeito Epidemiológico , Esclerose Múltipla/enfermagem , Cuidados de Enfermagem/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
PLoS One ; 14(11): e0224516, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31756190

RESUMO

The purpose of the study was to examine the role of objective and subjective measures of neighborhood crime and disorder on substance use among a nationally representative sample of 4525 Jamaicans aged 12-65 years. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by sex. Approximately 39% of the study population reported past-month alcohol use; 10% past-month tobacco use; and 15% past-month marijuana use. In fully adjusted models, past-month alcohol and tobacco use were associated with perceived neighborhood disorder (p<0.05). The likelihood of alcohol use was 1.12 (95%CI:1.04, 1.20) times greater among participants who perceived higher neighborhood disorder. The likelihood of tobacco use was 1.22 (95%CI: 1.01, 1.46) times greater among participants who perceived higher neighborhood disorder. A significant test for interaction in adjusted models (P<0.2) suggested that the associations between substance use and perceived neighborhood disorder varied by sex. Examination of stratified models indicated that the role of perceived neighborhood disorder on alcohol and tobacco consumption varied among females, but not males. Females who perceived higher levels of neighborhood disorder had an increased likelihood of past-month alcohol and tobacco use (RRa:1.25 95%CI:1,07, 1.45; RRa:1.73 95%CI: 1.10, 2.67). Objective neighborhood crime measures were not associated with alcohol, tobacco, or marijuana use. The study findings provide evidence for the importance of considering subjective and objective neighborhood measures when examining relations with health outcome and demonstrate that perceptions of context and contextual exposures are not uniform across populations within neighborhoods. Interventions focused on building community trust and social cohesion (e.g. neighborhood community watch groups) and greening of blighted or abandoned spaces may help increase the sense of safety and order, reducing stress and maladaptive coping such as substance use.


Assuntos
Crime/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Meio Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Criança , Modificador do Efeito Epidemiológico , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
7.
Rheumatology (Oxford) ; 58(11): 1991-1999, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31329968

RESUMO

OBJECTIVES: Observational cohort studies in early RA are a key source of evidence, despite inconsistencies in methodological approaches. This narrative review assesses the spectrum of methodologies used in addressing centre-level effect and case-mix adjustment in early RA observational cohort studies. METHODS: An electronic search was undertaken to identify observational prospective cohorts of >100 patients recruited from two or more centres, within 2 years of an RA or early inflammatory arthritis diagnosis. References and author publication lists of all studies from eligible cohorts were assessed for additional cohorts. RESULTS: Thirty-four unique cohorts were identified from 204 studies. Seven percent of studies considered centre in their analyses, most commonly as a fixed effect in regression modelling. Reporting of case-mix variables in analyses varied widely. The number of variables considered in case-mix adjustment was higher following publication of the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement in 2007. CONCLUSION: Centre effect is unreported or inadequately accounted for in the majority of RA observational cohorts, potentially leading to spurious inferences and obstructing comparisons between studies. Inadequate case-mix adjustment precludes meaningful comparisons between centres. Appropriate methodology to account for centre and case-mix adjustment should be considered at the outset of analyses.


Assuntos
Artrite Reumatoide , Estudos de Coortes , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Estudos Observacionais como Assunto/estatística & dados numéricos , Projetos de Pesquisa/estatística & dados numéricos , Viés , Modificador do Efeito Epidemiológico , Humanos , Estudos Observacionais como Assunto/métodos , Análise de Regressão
9.
Trials ; 20(1): 334, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174597

RESUMO

BACKGROUND: 'Conditional trial design' is a framework for efficiently planning new clinical trials based on a network of relevant existing trials. The framework considers whether new trials are required and how the existing evidence can be used to answer the research question and plan future research. The potential of this approach has not been fully realized. METHODS: We conducted an online survey among trial statisticians, methodologists, and users of evidence synthesis research using referral sampling to capture opinions about the conditional trial design framework and current practices among clinical researchers. The questions included in the survey were related to the decision of whether a meta-analysis answers the research question, the optimal way to synthesize available evidence, which relates to the acceptability of network meta-analysis, and the use of evidence synthesis in the planning of new studies. RESULTS: In total, 76 researchers completed the survey. Two out of three survey participants (65%) were willing to possibly or definitely consider using evidence synthesis to design a future clinical trial and around half of the participants would give priority to such a trial design. The median rating of the frequency of using such a trial design was 0.41 on a scale from 0 (never) to 1 (always). Major barriers to adopting conditional trial design include the current regulatory paradigm and the policies of funding agencies and sponsors. CONCLUSIONS: Participants reported moderate interest in using evidence synthesis methods in the design of future trials. They indicated that a major paradigm shift is required before the use of network meta-analysis is regularly employed in the design of trials.


Assuntos
Ensaios Clínicos como Assunto/métodos , Medicina Baseada em Evidências/métodos , Projetos de Pesquisa , Ensaios Clínicos como Assunto/estatística & dados numéricos , Interpretação Estatística de Dados , Modificador do Efeito Epidemiológico , Europa (Continente) , Medicina Baseada em Evidências/estatística & dados numéricos , Humanos , Modelos Estatísticos , Metanálise em Rede , Projetos de Pesquisa/estatística & dados numéricos , Tamanho da Amostra , Inquéritos e Questionários
10.
PLoS One ; 14(6): e0218331, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31194828

RESUMO

Based on recent findings that interrogator intonation can enhance interrogative suggestibility during recall phases, the present study tested influences of interrogator intonation on memory performance even as early as at the encoding stage. We experimentally manipulated interrogator intonation during encoding of a story to be recalled in immediate and delayed subsequent memory tests (Experiment 1, N = 50). As expected, a symmetrically structuring vs. an isolating-emphasizing speaking style generally increased the amount of freely recalled details. In a more fine-grained experiment (N = 50), we additionally manipulated emphasized story details and tested recall rates for peripheral, neutral, and central items. We found that emphasized peripheral details of the story were easier reproduced than central details realized in a neutral fashion, whereas the opposite pattern emerged for emphasized central details. Results are discussed in terms of their implications for forensic (interrogation) contexts and their legal psychological relevance.


Assuntos
Modificador do Efeito Epidemiológico , Rememoração Mental/fisiologia , Comportamento Verbal/fisiologia , Adulto , Cognição , Emoções , Feminino , Humanos , Masculino , Memória/fisiologia , Fala , Adulto Jovem
11.
BMC Pharmacol Toxicol ; 20(1): 34, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138326

RESUMO

BACKGROUND: The aim of this study was to investigate the association between statin use and new-onset diabetes in clinical settings and to assess its effect modification (heterogeneity) among patients with various medical histories and current medications. METHODS: In a total of 12,177 Japanese patients without diabetes, from December 2004 to November 2012, we identified 500 statin users and 500 matched non-users using propensity-score matching. Patients were followed until December 2017. We estimated the hazard ratios of new-onset diabetes associated with statin use. We also tested the heterogeneity of the treatment effect by evaluating subgroup interactions in subgroups according to sex, age, medical history, and current medication. RESULTS: New-onset diabetes had occurred in 71 patients (13.6%) with statin use and 43 patients (8.3%) with non-use at 5 years (hazard ratio, 1.66; 95% confidence interval [CI], 1.11 to 2.48; P = 0.0143), and in 78 patients (15.6%) with statin use and 48 patients (9.6%) with non-use at 10 years (hazard ratio, 1.61; 95% CI, 1.10 to 2.37; P = 0.0141). There were no significant treatment-by-subgroup interactions in all subgroups defined according to sex, age, medical history, and current medication. CONCLUSIONS: In patients with various clinical backgrounds, those who received statin therapy had a higher risk of new-onset diabetes at 5 and 10 years than those who did not receive it. Effect modification of statins on new-onset diabetes was not found in patient populations defined according to various comorbid diseases or concomitant drugs.


Assuntos
Diabetes Mellitus/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Modificador do Efeito Epidemiológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
PLoS One ; 14(4): e0215652, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31026300

RESUMO

BACKGROUND: Multi-mode data collection is widely used in surveys. Since several modes of data collection are successively applied in such design (e.g. self-administered questionnaire after face-to-face interview), partial nonresponse occurs if participants fail to complete all stages of the data collection. Although such nonresponse might seriously impact estimates, it remains currently unexplored. This study investigates the determinants of nonresponse to a self-administered questionnaire after having participated in a face-to-face interview. METHODS: Data from the Belgian Health Interview Survey 2013 were used to identify determinants of nonresponse to self-administered questionnaire (n = 1,464) among those who had completed the face-to-face interview (n = 8,133). The association between partial nonresponse and potential determinants was explored through multilevel logistic regression models, encompassing a random interviewer effect. RESULTS: Significant interviewer effects were found. Almost half (46.6%) of the variability in nonresponse was attributable to the interviewers, even in the analyses controlling for the area as potential confounder. Partial nonresponse was higher among youngsters, non-Belgian participants, people with a lower educational levels and those belonging to a lower income household, residents of Brussels and Wallonia, and people with poor perceived health. Higher odds of nonresponse were found for interviews done in the last quarters of the survey-year. Regarding interviewer characteristics, only the total number of interviews carried out throughout the survey was significantly associated with nonresponse to the self-administered questionnaire. CONCLUSIONS: The results indicate that interviewers play a crucial role in nonresponse to the self-administered questionnaire. Participant characteristics, interview circumstances and interviewer characteristics only partly explain the interviewer variability. Future research should examine further interviewer characteristics that impact nonresponse. The current study emphasises the importance of training and motivating interviewers to reduce nonresponse in multi-mode data collection.


Assuntos
Coleta de Dados/estatística & dados numéricos , Modificador do Efeito Epidemiológico , Inquéritos Epidemiológicos/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Bélgica , Coleta de Dados/métodos , Feminino , Inquéritos Epidemiológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multinível , Fatores Socioeconômicos , Adulto Jovem
13.
BMC Res Notes ; 12(1): 156, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894221

RESUMO

OBJECTIVES: In pragmatic trials, the new treatment is compared with usual care (heterogeneous control arm) that makes the comparison of the new treatment with each treatment within the control arm more difficult. The usual assumption is that we can fully capture the relations between different quantities. In this paper we use simulation to assess the performance of statistical methods that adjust for confounding when the assumed relations are not true. The true relations contain a mediator and heterogeneity with or without confounding, but the assumption is that there is no mediator and that confounding and heterogeneity are fully captured. The statistical methods that are compared include multivariable logistic regression, propensity score, disease risk score, inverse probability weighting, doubly robust inverse probability weighting and standardisation. RESULTS: The misconception that there is no mediator can cause to misleading comparative effectiveness of individual treatments when a method that estimates the conditional causal effect is used. Using a method that estimates the marginal causal effect is a better approach, but not for all scenarios.


Assuntos
Fatores de Confusão Epidemiológicos , Interpretação Estatística de Dados , Modificador do Efeito Epidemiológico , Modelos Estatísticos , Ensaios Clínicos Pragmáticos como Assunto/normas , Projetos de Pesquisa/normas , Humanos
14.
BMC Med Res Methodol ; 19(1): 60, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30876402

RESUMO

BACKGROUND: Interviewers can substantially affect self-reported data. This may be due to random variation in interviewers' ability to put respondents at ease or in how they frame questions. It may also be due to systematic differences such as social distance between interviewer and respondent (e.g., by age, gender, ethnicity) or different perceptions of what interviewers consider socially desirable responses. Exploration of such variation is limited, especially in stigmatized populations. METHODS: We analyzed data from a randomized controlled trial of HIV self-testing amongst 965 female sex workers (FSWs) in Zambian towns. In the trial, 16 interviewers were randomly assigned to respondents. We used hierarchical regression models to examine how interviewers may both affect responses on more and less sensitive topics, and confound associations between key risk factors and HIV self-test use. RESULTS: Model variance (ICC) at the interviewer level was over 15% for most topics. ICC was lower for socio-demographic and cognitively simple questions, and highest for sexual behaviour, substance use, violence and psychosocial wellbeing questions. Respondents reported significantly lower socioeconomic status and more sex-work related violence to female interviewers. Not accounting for interviewer identity in regressions predicting HIV self-test behaviour led to coefficients moving from non-significant to significant. CONCLUSIONS: We found substantial interviewer-level effects for prevalence and associational outcomes among Zambian FSWs, particularly for sensitive questions. Our findings highlight the importance of careful training and response monitoring to minimize inter-interviewer variation, of considering social distance when selecting interviewers and of evaluating whether interviewers are driving key findings in self-reported data. TRIAL REGISTRATION: clinicaltrials.gov NCT02827240 . Registered 11 July 2016.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , HIV-1/patogenicidade , Programas de Rastreamento/métodos , Profissionais do Sexo/estatística & dados numéricos , Adulto , Análise por Conglomerados , Modificador do Efeito Epidemiológico , Feminino , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários , Zâmbia/epidemiologia
15.
Obesity (Silver Spring) ; 27(4): 653-661, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30900409

RESUMO

OBJECTIVE: This study aimed to investigate whether the association between a validated genetic profile risk score for BMI (GPRS-BMI) (based on 93 single-nucleotide polymorphisms) and phenotypic obesity (BMI) was modified by the combined categories of physical activity (PA) and sedentary behaviors in a large population-based study. METHODS: This study included cross-sectional baseline data from 338,216 white European adult men and women aged 37 to 73 years. Interaction effects of GPRS-BMI with the combined categories of PA and sedentary behaviors on BMI were investigated. RESULTS: There was a significant interaction between GPRS-BMI and the combined categories of objectively measured PA and total sedentary behavior (P[interaction] = 3.5 × 10-6 ); among physically inactive and highly sedentary individuals, BMI was higher by 0.60 kg/m2 per 1-SD increase in GPRS-obesity (P = 8.9 × 10-50 ), whereas the relevant BMI difference was 38% lower among physically active individuals and those with low sedentary time (ß: 0.37 kg/m2 ; P = 2.3 × 10-51 ). A similar pattern was observed for the combined categories of objective PA and TV viewing (inactive/high TV viewing ß: 0.60 vs. active/low TV viewing ß: 0.40 kg/m2 ; P[interaction] = 2.9 × 10-6 ). CONCLUSIONS: This study provides evidence that combined categories of PA and sedentary behaviors modify the extent to which genetic predisposition to obesity results in higher BMI.


Assuntos
Exercício Físico/fisiologia , Obesidade/epidemiologia , Obesidade/genética , Comportamento Sedentário , Adulto , Idoso , Índice de Massa Corporal , Estudos de Coortes , Estudos Transversais , Modificador do Efeito Epidemiológico , Grupo com Ancestrais do Continente Europeu/genética , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Fatores de Risco
16.
JAMA Netw Open ; 2(3): e190194, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30821826

RESUMO

Importance: Prognosis of early-stage extranodal natural killer/T-cell lymphoma (NKTCL) is usually estimated and stratified at diagnosis, but how the prognosis actually evolves over time for patients who survived after curative treatment is unknown. Objective: To assess conditional survival and failure hazard over time based on risk categories, previous survival, and treatment. Design, Setting, and Participants: This retrospective cohort study reviewed the clinical data of 2015 patients with early-stage NKTCL treated with radiotherapy identified from the China Lymphoma Collaborative Group multicenter database between January 1, 2000, and December 31, 2015. Patients were stratified into low-, intermediate- and high-risk groups according to a previously established prognostic model. Median follow-up was 61 months for surviving patients. Data analysis was performed from December 1, 2017, to January 30, 2018. Exposures: All patients received radiotherapy with or without chemotherapy. Main Outcomes and Measures: Conditional survival defined as the survival probability, given patients have survived for a defined time, and annual hazard rates defined as yearly event rate. Results: A total of 2015 patients were included in the study (mean [SD] age, 43.3 [14.6] years; 1414 [70.2%] male); 1628 patients (80.8%) received radiotherapy with chemotherapy, and 387 (19.2%) received radiotherapy without chemotherapy. The 5-year survival rates increased from 69.1% (95% CI, 66.6%-71.4%) at treatment to 85.3% (95% CI, 81.7%-88.2%) at year 3 for conditional overall survival and from 60.9% (95% CI, 58.3%-63.3%) at treatment to 84.4% (95% CI, 80.6%-87.6%) at year 3 for conditional failure-free survival. The annual hazards decreased from 13.7% (95% CI, 13.0%-14.3%) for death and 22.1% (95% CI, 21.0%-23.1%) for failure at treatment to less than 5% after 3 years (death: range, 0%-3.9% [95% CI, 3.7%-4.2%]; failure: 1.2% [95% CI, 1.0%-1.4%] to 4.2% [95% CI 3.9%-4.6%]). Intermediate-risk (11.4% [95% CI, 10.5%-12.3%]) and high-risk (21.6% [95% CI, 20.0%-23.2%]) patients had initially higher but significantly decreased death hazards after 3 years (<6%, range: 0%-5.9% [95% CI, 5.2%-6.7%]), whereas low-risk patients maintained a constantly lower death hazard of less than 5% (range, 0%-4.8%; 95% CI, 4.4%-5.3%). In high-risk patients, radiotherapy combined with non-anthracycline-based regimens were associated with higher conditional overall survival before year 3 compared with anthracycline-based regimens (hazard ratio [HR] for death, 1.49; 95% CI, 1.13-1.95; P = .004 at treatment; HR, 1.60; 95% CI, 1.07-2.39; P = .02 at 1 year; and HR, 1.77; 95% CI, 0.94-3.33; P = .07 at 2 years) or radiotherapy alone (HR, 2.42; 95% CI, 1.73-3.39; P < .001 at treatment; HR, 1.82; 95% CI, 1.05-3.17; P = .03 at 1 year; and HR, 2.69; 95% CI, 1.23-5.90; P = .01 at 2 years). Conclusions and Relevance: The survival probability increased and the hazards of failure decreased in a risk-dependent manner among patients with early NKTCL after radiotherapy. These dynamic data appear to provide accurate information on disease processes and continual survival expectations and may help researchers design additional prospective clinical trials and formulate risk-adapted therapies and surveillance strategies.


Assuntos
Quimiorradioterapia , Linfoma Extranodal de Células T-NK , Adulto , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Quimiorradioterapia/estatística & dados numéricos , China/epidemiologia , Modificador do Efeito Epidemiológico , Feminino , Humanos , Linfoma Extranodal de Células T-NK/diagnóstico , Linfoma Extranodal de Células T-NK/mortalidade , Linfoma Extranodal de Células T-NK/patologia , Linfoma Extranodal de Células T-NK/terapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Análise de Sobrevida , Taxa de Sobrevida
18.
BMJ Open ; 9(1): e023069, 2019 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-30670510

RESUMO

OBJECTIVES: The typical approach of survey data collection is to use interviewers who are not from the study site and do not know the participants, yet the implications of this approach on data quality have seldom been investigated. We examine the relationship between interviewer-respondent familiarity and selected family planning outcomes, and whether this relationship changes over time between 2015 and 2016. SETTING: We use data from the Performance Monitoring and Accountability 2020 Project in Kongo Central Province, Democratic Republic of Congo. PARTICIPANTS: Participants include representative samples of women of reproductive ages (15 to 49), 1565 interviewed in 2015 and 1668 in 2016. The study used a two-stage cluster design: first randomly selecting enumeration areas (EAs), then randomly selecting households within each EA. DESIGN: We first identify individual characteristics associated with familiarity between RE and respondent. Next, we examine the relationship between RE-respondent acquaintance and family planning outcomes. Finally, we use two waves of data to examine whether this relationship changes over time between 2015 and 2016. RESULTS: In multivariate analysis, interviewer-respondent acquaintance is significantly associated with last birth unintended (OR 1.91, 95% CI 1.17 to 3.13) and reported infertility in 2015 (OR 2.26, 95% CI 1.03 to 4.95); and any contraceptive use (OR 1.51, 95% CI 1.01 to 2.28), traditional contraceptive use (OR 1.79, 95% CI 1.10 to 2.89), reported infidelity (OR 1.89, 95% CI 1.02 to 3.49) and age at first sex (coefficient -0.48, 95% CI -0.96 to -0.01) in 2016. The impact of acquaintance on survey responses changed over time for any contraceptive use (OR 2.09, 95% CI 1.33 to 3.30). CONCLUSIONS: The standard in many large-scale surveys is to use interviewers from outside the community. Our results show that interviewer-respondent acquaintance is associated with a range of family planning outcomes; therefore, we recommend that the approach to hiring interviewers be examined and reconsidered in survey data collection efforts.


Assuntos
Comportamento Contraceptivo/psicologia , Serviços de Planejamento Familiar/estatística & dados numéricos , Pesquisadores/psicologia , Sujeitos da Pesquisa/psicologia , Relações Pesquisador-Sujeito/psicologia , Adolescente , Adulto , Comportamento Contraceptivo/estatística & dados numéricos , Estudos Transversais , República Democrática do Congo , Modificador do Efeito Epidemiológico , Feminino , Humanos , Entrevistas como Assunto , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Inquéritos e Questionários , Adulto Jovem
19.
Joint Bone Spine ; 86(4): 445-449, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30316973

RESUMO

In medicine, the positive Hawthorne effect is defined as decreased symptom expression due to being observed. This effect occurs in addition to the decrease in symptom experience due to the placebo effect. Symptom overexpression, in contrast, whether related to conscious or to unconscious factors, defines the negative Hawthorne effect, which should be distinguished from the nocebo effect, defined as an increase in symptom experience. For instance, the negative Hawthorne effect can result in patients who seem fully relaxed evaluating their pain intensity at 11 on a 10-point Scale. The negative Hawthorne effect stems from multiple factors including a wish to receive greater consideration or priority management status; concern about failing to meet criteria for receiving a new treatment or being included in a therapeutic trial; conformism related to cultural factors or to circumstance (e.g., avoiding the canceling of a surgical procedure in the event of a last-minute improvement); disease mongering; a desire to be taken seriously by family and friends; a quest for secondary benefits; use of the evaluation to express frustration about being ill or bitterness at receiving a lower level of support; a gap between the expectation of complete relief and the true effectiveness of treatments; and pain exacerbation, with loss of reliability of pain intensity measurements, due to anxiety, guilt, depression, nervosity, catastrophizing, kinesiophobia, or repeated evaluations using methods that involve negative suggestions such as considering the worst pain imaginable. A sequence of a strong negative Hawthorne effect before treatment prescription followed by a strong positive Hawthorne effect after treatment initiation may make a greater contribution than the placebo effect to the improvements produced by treatments for pain.


Assuntos
Catastrofização/psicologia , Modificador do Efeito Epidemiológico , Manejo da Dor , Dor/psicologia , Qualidade de Vida , Ansiedade/psicologia , Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Dor Crônica/psicologia , Dor Crônica/terapia , Feminino , Humanos , Masculino , Efeito Nocebo , Dor/diagnóstico , Medição da Dor , Medição de Risco
20.
Br J Math Stat Psychol ; 72(1): 136-154, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30468259

RESUMO

The reporting and interpretation of effect size estimates are widely advocated in many academic journals of psychology and related disciplines. However, such concern has not been adequately addressed for analyses involving interactions between categorical and continuous variables. For the purpose of improving current practice, this article presents fundamental features and theoretical developments for the variance of standardized slopes as a desirable standardized effect size measure for the degree of disparity between several slope coefficients. To estimate the effect size, a consistent and nearly unbiased estimator is described and a simple refinement is emphasized for extreme situations whenever appropriate. The essential problems of power and sample size calculations for testing the equality of slope coefficients are also considered. According to the analytic justification and empirical assessment, the exact approach has a clear advantage over the approximate methods. Both SAS and R computer codes are provided to facilitate practical accessibility of the proposed techniques in interaction studies.


Assuntos
Modificador do Efeito Epidemiológico , Projetos de Pesquisa , Tamanho da Amostra , Algoritmos , Classificação , Simulação por Computador , Interpretação Estatística de Dados , Humanos , Método de Monte Carlo , Análise de Regressão
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