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1.
Springerplus ; 4: 328, 2015.
Article in English | MEDLINE | ID: mdl-26180748

ABSTRACT

OBJECTIVES: The mechanism of the increased risk of cardiovascular disease in rheumatoid arthritis (RA) remains uncertain. We had the opportunity to compare the causes and ages of death in a population of osteoarthritis (OA) and RA patients who had had similar lower limb disability. METHODS: Death certificates were sought for a population of OA and RA patients who had had knee joint replacements performed by a single orthopaedic surgeon over a 10 year period with a minimum follow up period of 18 years. Primary cause of death was assigned by a blinded clinician and compared between the populations. Competing risk analysis was used to compare RA and OA populations for cardiovascular deaths. RESULTS: The total population was 607 (294 OA; 313 RA). 85% (249) of the OA and 79% (246) of the RA patients had deceased at the time of study in 2008. 85% of the death certificates were found. The RA patients were operated an average of 7.5 years younger and also died 7.5 years younger. The causes of death were similar in the two populations. The ages at death were consistently and similarly older for the OA group for all causes of death. There was a 9% increased risk of cardiovascular death in the RA group but this was not statistically different from the OA group. CONCLUSIONS: OA and RA patients, controlled for lower limb disability, have similar causes of death including cardiovascular disease. However, the RA patients died significantly younger. Cause of death is likely to be related to things that OA and RA share, such as disability and some treatments e.g. NSAIDs, whereas age at death relates to differences, such as age of onset and inflammation.

2.
Influenza Other Respir Viruses ; 7 Suppl 2: 72-75, 2013 Sep.
Article in English | MEDLINE | ID: mdl-24034488

ABSTRACT

Vaccination of immunocompromised patients is recommended in many national guidelines to protect against severe or complicated influenza infection. However, due to uncertainties over the evidence base, implementation is frequently patchy and dependent on individual clinical discretion. We conducted a systematic review and meta-analysis to assess the evidence for influenza vaccination in this patient group. Healthcare databases and grey literature were searched and screened for eligibility. Data extraction and assessments of risk of bias were undertaken in duplicate, and results were synthesised narratively and using meta-analysis where possible. Our data show that whilst the serological response following vaccination of immunocompromised patients is less vigorous than in healthy controls, clinical protection is still meaningful, with only mild variation in adverse events between aetiological groups. Although we encountered significant clinical and statistical heterogeneity in many of our meta-analyses, we advocate that immunocompromised patients should be targeted for influenza vaccination.


Subject(s)
Immunocompromised Host , Influenza Vaccines/immunology , Influenza, Human/prevention & control , Vaccination/methods , Antibodies, Viral/blood , Humans , Influenza Vaccines/administration & dosage
3.
PLoS One ; 6(12): e29249, 2011.
Article in English | MEDLINE | ID: mdl-22216224

ABSTRACT

BACKGROUND: Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events. METHODOLOGY/PRINCIPAL FINDINGS: Electronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results were synthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I(2) and publication bias was assessed using Begg's funnel plot and Egger's regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR]=0.23; 95% confidence interval [CI]=0.16-0.34; p<0.001) and laboratory confirmed influenza infection (OR=0.15; 95% CI=0.03-0.63; p=0.01) through vaccinating immunocompromised patie nts compared to placebo or unvaccinated controls. We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonal influenza A(H1N1), A(H3N2) and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified. CONCLUSIONS/SIGNIFICANCE: Infection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed is generally weak, although the directions of effects are consistent. Areas for further research are identified.


Subject(s)
Health Policy , Immunocompromised Host , Influenza Vaccines/therapeutic use , Public Health , Humans , Influenza Vaccines/adverse effects , Influenza Vaccines/immunology , Placebos
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