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1.
Med. clín (Ed. impr.) ; 154(5): 163-170, mar. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-186628

RESUMEN

Objetivos: Analizar el riesgo de fractura calculado por FRAX(R) y la frecuencia de alto riesgo de fractura en la población general en España. Métodos: EPISER2016 es un estudio transversal multicéntrico de base poblacional de la prevalencia de las enfermedades reumáticas en población adulta en España. Un total de 3.154 sujetos de edad igual o superior a 40 años (1.184 hombres y 1.970 mujeres) se seleccionaron mediante muestreo aleatorio estratificado. Las preguntas relacionadas con los factores de riesgo de fractura se realizaron mediante encuesta telefónica. El riesgo de fractura principal (RFP) y de cadera (RFC) se calcularon con la versión española de la herramienta FRAX(R), sin la inclusión de la densidad mineral ósea. Para definir alto riesgo de fractura, se utilizaron los umbrales RFP≥20%, RFP≥10%, RFP≥7,5% y RFC≥3%. Resultados: La mediana (rango intercuartílico) del RFP fue 2,61% (1,55-6,34%) en mujeres y 1,67% (1,15-2,87%) en hombres; la del RFC fue 0,39% (0,14-1,86%) y 0,18% (0,07-0,77%). El 3,83% de las mujeres y ningún hombre tenían un RFP≥20%; el 15,71% y el 1,14% tenían un RFP≥10%; el 20,62% y el 2,21%, un RFP≥7,5%; y el 19,27% y el 8,05%, un RFC≥3%. En las mujeres de 65 años o más, el RFC fue alto en el 58,09%. Conclusiones: EPISER2016 nos ha permitido conocer el riesgo de fractura calculado por FRAX(R) y la prevalencia de alto riesgo de fractura en la población general según los diversos umbrales utilizados en España


Objectives: To analyse the risk of fracture calculated by FRAX(R) and the frequency of high risk of fracture in the general population in Spain. Methods: EPISER2016 is a multicentre cross-sectional population-based study of the prevalence of rheumatic diseases in the adult population in Spain. 3,154 subjects aged ≥40 years (1,184 men and 1,970 women) were selected by stratified random sampling. The questions related to fracture risk factors were asked by telephone survey. The risk of major osteoporotic fracture (MOFR) and hip fracture (HFR) were calculated with the Spanish version of the FRAX(R) tool, without the inclusion of bone mineral density. To define high fracture risk, the MOFR≥20%, MOFR≥10%, MOFR≥7.5% and HFR≥3% thresholds were used. Results: The median (interquartile range) of the MOFR was 2.61% (1.55-6.34%) in women and 1.67% (1.15-2.87%) in men, whereas that of the HFR was 0.39% (0.14-1.86%) and 0.18% (0.07-0.77%); 3.83% of women and no men had a MOFR≥20%; 15.71% and 1.14% had a MOFR≥10%; 20.62% and 2.21%, a MOFR≥7.5%; and 19.27% and 8.05%, an HFR≥3%. In women aged 65 and over, the HFR was high in 58.09%. Conclusions: EPISER2016 enabled us to establish the risk of fracture calculated by FRAX(R) and the prevalence of high risk of fracture in the general population according to the different thresholds used in Spain


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Fracturas Óseas/diagnóstico , Algoritmos , Factores de Riesgo , Medición de Riesgo/métodos , Fracturas Óseas/etiología , España , Estudios Transversales , Encuestas y Cuestionarios
2.
N C Med J ; 81(2): 106-110, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32132251

RESUMEN

Though suicide is the second leading cause of death among adolescents, it continues to be difficult to predict. Recent research has led to the development of the ideation-to-action framework, which provides a new conceptualization of suicide risk. The implications of this approach for assessment and intervention in medical settings are discussed.


Asunto(s)
Suicidio/prevención & control , Adolescente , Humanos , Medición de Riesgo/métodos , Ideación Suicida , Intento de Suicidio/psicología
3.
Bone Joint J ; 102-B(3): 280-284, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114813

RESUMEN

AIMS: Although internal hemipelvectomy is associated with a high incidence of morbidity, especially wound complications, few studies have examined rates of wound complications in these patients or have identified factors associated with the consequences. The present study aimed to: 1) determine the rate of wound and other complications requiring surgery after internal hemipelvectomy; and 2) identify factors that affect the rate of wound complications and can be used to stratify patients by risk of wound complications. METHODS: The medical records of 123 patients undergoing internal hemipelvectomy were retrospectively reviewed, with a focus on both overall complications and wound complications. Logistic regression analyses were performed to examine the association between host, tumour, and surgical factors and rates of postoperative wound complications. RESULTS: The overall rate of postoperative complications requiring surgery was 49.6%. Wound complications were observed in 34.1% of patients, hardware-related complications in 13.2%, graft-related complications in 9.1%, and local recurrence in 5.7%. On multivariate analysis, extrapelvic tumour extension (odds ratio (OR) 23.28; 95% confidence interval (CI), 1.97 to 274.67; p = 0.012), both intra- and extrapelvic tumour extension (OR 46.48; 95% CI, 3.50 to 617.77; p = 0.004), blood transfusion ≥ 20 units (OR 50.28; 95% CI, 1.63 to 1550.32; p = 0.025), vascular sacrifice of the internal iliac artery (OR 64.56; 95% CI, 6.33 to 658.43; p < 0.001), and use of a structural allograft (OR, 6.57; 95% CI, 1.70 to 25.34; p = 0.001) were significantly associated with postoperative wound complications. CONCLUSION: Internal hemipelvectomy is associated with high rates of morbidity, especially wound complications. Several host, tumour, and surgical variables are associated with wound complications. The ability to stratify patients by risk of wound complications can help refine surgical and wound-healing planning and may lead to better outcomes in patients undergoing internal hemipelvectomy. Cite this article: Bone Joint J 2020;102-B(3):280-284.


Asunto(s)
Hemipelvectomía/efectos adversos , Neoplasias Pélvicas/cirugía , Medición de Riesgo/métodos , Dehiscencia de la Herida Operatoria/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Pélvicas/diagnóstico , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Estados Unidos/epidemiología , Adulto Joven
4.
Medicine (Baltimore) ; 99(9): e19303, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118749

RESUMEN

BACKGROUND: Several studies have shown a relationship between psoriasis and hypertension, but no meta-analysis has been restricted to studies that adjusted for confounders. The aim of the study was to estimate the association between psoriasis and hypertension with adjustment for covariates. METHODS: A systematic literature search in the MEDLINE, Embase, Cochrane databases, and Google Scholar was conducted to identify relevant studies which reported the association of psoriasis with the risk of hypertension published up to November 2018 in English. Data analysis was performed with Stata V.12, and Begg adjusted rank correlation test and Egger regression asymmetry test were used to detect publication bias. RESULTS: A total of 16 adjusted-for-covariates studies, involving 50,291 cases with hypertension in 255,132 psoriasis patients and 76,547 cases with hypertension in 814,631 controls (no psoriasis), were included in this meta-analysis. The results indicated that psoriasis was associated with an increased risk of hypertension compared to those without psoriasis, and the prevalence of hypertension in severe psoriasis patients was higher than that in mild psoriasis patients, and the risk of hypertension in psoriasis patients was higher than that in nonpsoriasis patients in Europe and Asia. CONCLUSION: We conducted this meta-analysis using the adjusted-for-covariates odds ratio, demonstrating that psoriasis was associated with an increased risk of hypertension compared to those without psoriasis.


Asunto(s)
Hipertensión/diagnóstico , Psoriasis/diagnóstico , Correlación de Datos , Humanos , Hipertensión/fisiopatología , Oportunidad Relativa , Psoriasis/fisiopatología , Medición de Riesgo/métodos
5.
Medicine (Baltimore) ; 99(9): e19352, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118775

RESUMEN

Serum albumin is a marker of nutritional and frailty status. This study aimed to assess the association between serum albumin at the time of admission and the risk of acute respiratory failure (ARF) in hospitalized patientsThis cohort study, performed at a tertiary referral hospital, included all hospitalized adult patients from January 2009 to December 2013 who had serum albumin measurement and were not on mechanical ventilation within 24 hours of hospital admission. Serum albumin was stratified into 2.4, 2.5 to 2.9, 3.0 to 3.4, 3.5 to 3.9, 4.0 to 4.4, and ≥4.5 g/dL. Multivariate logistic regression analysis was performed to obtain adjusted odds ratio (OR) of risk of ARF requiring mechanical ventilation based on various admission serum albumin levels.Of 12,719 patients, ARF requiring mechanical ventilation occurred in 1128 (8.9%) during hospitalization. Hypoalbuminemia was associated with increased risk of ARF, in particular when serum albumin was ≤2.4 g/dL. Compared with serum albumin of 4.0-4.4 g/dL, serum albumin ≤2.4 g/dL at admission was associated with 2.38-time higher odds of ARF during hospitalization (OR 2.38, 95% confidence interval [CI] 1.84-3.07). In contrast, elevated serum albumin ≥4.5 g/dL was associated with lower odds of ARF (OR 0.68, 95% CI 0.48-0.97).Admission serum albumin level lower than 3.5 g/dL was associated with a higher risk of ARF requiring mechanical ventilation, whereas elevated serum albumin level at least 4.5 g/dL was associated with a lower risk of ARF. Therefore, admission albumin level at admission might be useful in the prediction of ARF during hospitalization.


Asunto(s)
Hospitalización/estadística & datos numéricos , Síndrome de Dificultad Respiratoria del Adulto/sangre , Medición de Riesgo/métodos , Albúmina Sérica/análisis , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Oportunidad Relativa , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Estudios Retrospectivos , Medición de Riesgo/normas , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
6.
Medicine (Baltimore) ; 99(9): e19407, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118794

RESUMEN

Immunosuppression can lead to hepatitis B virus (HBV) reactivation in hepatitis B core antigen antibodies (anti-HBc) positive patients, especially those undergoing chemotherapy, although there is limited data on solid organ recipients, especially lung transplantation. Our aim was to analyze the risk of HBV reactivation and the potential impact of anti-HBc-positive status (both donors and recipients) on prognosis in a lung, kidney, and liver transplantation cohort.Retrospective analysis including data from all transplants in adults (2011-2012) in a tertiary hospital, with prospective HBV serology study to assess the risk of reactivation and its possible impact on survival.In total, 392 transplant recipients were included (196 kidney, 113 lung, 83 liver). Pre-transplantation anti-HBc screening was more frequent in liver recipients (P < .001) and donors (P < .001) than in kidney or lung. Fifty-five (14%) recipients were anti-HBc-positive and were not undergoing antiviral prophylaxis. Three (5.4%) cases of HBV reactivation occurred: 2 in pre-transplant anti-HBc-positive recipients and 1 with prior unknown anti-HBc status. All were HBeAg+ with HBV deoxyribonucleic acid (DNA) >10E8 IU/mL and only mild fibrosis. Baseline recipient anti-HBc positive status was the only factor associated with HBV reactivation. No reactivation cases occurred in lung or kidney recipients of anti-HBc positive grafts. Survival was lower in lung transplants, especially in human immunodeficiency virus-infected patients and those with prior immunosuppression.Anti-HBc positive status is a risk factor for HBV reactivation in solid organ recipients. Anti-HBc testing is highly recommended in solid-organ transplant recipients in order to identify those anti-HBc positive and therefore candidates for periodical hepatitis B surface antigen (HBsAg) and HBV DNA screening after transplant.


Asunto(s)
Hepatitis B/fisiopatología , Trasplante de Órganos/efectos adversos , Receptores de Trasplantes/estadística & datos numéricos , Activación Viral , Adulto , Anciano , Femenino , Antígenos del Núcleo de la Hepatitis B/análisis , Antígenos del Núcleo de la Hepatitis B/sangre , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Órganos/métodos , Estudios Prospectivos , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/normas , España , Análisis de Supervivencia
7.
J Frailty Aging ; 9(1): 44-50, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32150213

RESUMEN

BACKGROUND: In older people, diabetes is associated with an increased risk of falls and frailty. The value of using posturography for evaluating the risk of falling is unclear. In theory, a time-scale analysis should increase the metrological properties of the posturography assessment. OBJECTIVES: This study aimed to determine which posturographic parameters can be used to identify fall-risk patients in a frail diabetic older population and to assess their interest in comparison to usual clinical trials for gait and balance. DESIGN: This is a prospective observational cohort. SETTINGS: frail or pre-frail diabetic patients, in Bordeaux, France. PARTICIPANTS: 84 patients were included in the study (mean age 80.09 years, 64.5% of men).Criteria for inclusion were: age over 70 years, diabetes mellitus for over 2 years, and at least one of the Fried's frailty criteria. MEASUREMENTS: Gait and balance assessments were undertaken at baseline: Static posturography, the timed up and go test, short physical performance battery, and (gait) walking speed. Raw data from posturography were used for wavelet analysis. Data on self reported new falls were collected prospectively during 6 months. RESULTS: The posturography parameter most useful was area of 90% confidence ellipse of statokinesigram (COP90area): area under the ROC curve AUC = 0.617 (95% CI, 0.445-0.789) and OR=1.003 (95%CI 1.000-1.005) p =0.05. The optimum clinical test was the time to walk over 4m AUC=0.735 (95%CI, 0.587-0.882) and OR=1.42 (95%CI 1.08-1.87) p= 0.013. CONCLUSION: Posturography has limited utility for assessment of falls risk in frail older people with diabetes. Gait and balance clinical assessments such as walking speed continue to retain their value.


Asunto(s)
Accidentes por Caídas , Diabetes Mellitus/epidemiología , Anciano Frágil/estadística & datos numéricos , Balance Postural/fisiología , Anciano , Anciano de 80 o más Años , Femenino , Francia/epidemiología , Humanos , Masculino , Estudios Prospectivos , Reproducibilidad de los Resultados , Medición de Riesgo/métodos
8.
Am Surg ; 86(2): 83-89, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167053

RESUMEN

The ACS NSQIP Surgical Risk Calculator is designed to estimate the chance of an unfavorable outcome after surgery. Our goal was to evaluate the accuracy of the calculator in our emergency general surgery population. Surgical outcomes were compared to predicted risk. The risk was calculated with surgeon adjustment scores (SASs) of 1 (no adjustment), 2 (risk somewhat higher), and 3 (risk significantly higher than estimate). Two hundred and twenty-seven patients met the inclusion criteria. An SAS of 1 or 2 accurately predicted risk of mortality (5.7% and 8.5% predicted versus 7.9% actual), whereas a risk adjustment of 3 indicated significant overestimation of mortality rate (14.8% predicted). There was good overall prediction performance for most variables with no clear preference for SAS 1, 2, or 3. Poor correlation was seen with SSI, urinary tract infection, and length of stay variables. The ACS NSQIP Surgical Risk Calculator yields valid predictions in the emergency general surgery population, and the data support its use to inform conversations about outcome expectations.


Asunto(s)
Urgencias Médicas , Medición de Riesgo/métodos , Procedimientos Quirúrgicos Operativos/mortalidad , Exactitud de los Datos , Humanos , Tiempo de Internación , Modelos Logísticos , Persona de Mediana Edad , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/mortalidad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Infecciones Urinarias/mortalidad , Heridas y Traumatismos/clasificación , Heridas y Traumatismos/mortalidad , Heridas y Traumatismos/cirugía
9.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(2): 219-223, 2020 Feb 06.
Artículo en Chino | MEDLINE | ID: mdl-32074714

RESUMEN

Risk assessment is a necessary technical means to protect human health and environmental safety. Traditional risk assessment based on toxicity data obtained from animal experiments was difficult to meet the need for risk assessment for a large number of chemicals due to the low throughput, long cycle, high cost and uncertainty of extrapolation to human exposure dose. The proposed risk assessment frameworks, the model of action (MOA) and the adverse outcome pathway (AOP), pointed the way for us to develop new and efficient evaluation methods. In this review, the basic concepts and contents of MOA and AOP, as well as the relationship between them, were introduced. Taking acrylamide (AA) as an example, this review briefly described the application of MOA/AOP framework in chemical risk assessment, so as to provide theoretical guidance for better application of MOA/AOP framework in chemical risk assessment.


Asunto(s)
Acrilamida/toxicidad , Medición de Riesgo/métodos , Rutas de Resultados Adversos , Humanos , Pruebas de Toxicidad
10.
BMJ ; 368: m160, 2020 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-32071114

RESUMEN

OBJECTIVES: To identify and summarise existing indices for measuring multimorbidity beyond disease counts, to establish which indices include mental health comorbidities or outcomes, and to develop recommendations based on applicability, performance, and usage. DESIGN: Systematic review. DATA SOURCES: Seven medical research databases (Medline, Web of Science Core Collection, Cochrane Library, Embase, PsycINFO, Scopus, and CINAHL Plus) from inception to October 2018 and bibliographies and citations of relevant papers. Searches were limited to English language publications. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Original articles describing a new multimorbidity index including more information than disease counts and not focusing on comorbidity associated with one specific disease. Studies were of adults based in the community or at population level. RESULTS: Among 7128 search results, 5560 unique titles were identified. After screening against eligibility criteria the review finally included 35 papers. As index components, 25 indices used conditions (weighted or in combination with other parameters), five used diagnostic categories, four used drug use, and one used physiological measures. Predicted outcomes included mortality (18 indices), healthcare use or costs (13), hospital admission (13), and health related quality of life (7). 29 indices considered some aspect of mental health, with most including it as a comorbidity. 12 indices are recommended for use. CONCLUSIONS: 35 multimorbidity indices are available, with differing components and outcomes. Researchers and clinicians should examine existing indices for suitability before creating new ones. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017074211.


Asunto(s)
Indicadores de Salud , Multimorbilidad , Sesgo , Servicios de Salud Comunitaria , Medicina Basada en la Evidencia/métodos , Humanos , Trastornos Mentales/epidemiología , Calidad de Vida , Reproducibilidad de los Resultados , Medición de Riesgo/métodos
11.
BMJ ; 368: m127, 2020 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-32041693

RESUMEN

OBJECTIVE: To examine the validity and findings of studies that examine the accuracy of algorithm based smartphone applications ("apps") to assess risk of skin cancer in suspicious skin lesions. DESIGN: Systematic review of diagnostic accuracy studies. DATA SOURCES: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, CPCI, Zetoc, Science Citation Index, and online trial registers (from database inception to 10 April 2019). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies of any design that evaluated algorithm based smartphone apps to assess images of skin lesions suspicious for skin cancer. Reference standards included histological diagnosis or follow-up, and expert recommendation for further investigation or intervention. Two authors independently extracted data and assessed validity using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2 tool). Estimates of sensitivity and specificity were reported for each app. RESULTS: Nine studies that evaluated six different identifiable smartphone apps were included. Six verified results by using histology or follow-up (n=725 lesions), and three verified results by using expert recommendations (n=407 lesions). Studies were small and of poor methodological quality, with selective recruitment, high rates of unevaluable images, and differential verification. Lesion selection and image acquisition were performed by clinicians rather than smartphone users. Two CE (Conformit Europenne) marked apps are available for download. SkinScan was evaluated in a single study (n=15, five melanomas) with 0% sensitivity and 100% specificity for the detection of melanoma. SkinVision was evaluated in two studies (n=252, 61 malignant or premalignant lesions) and achieved a sensitivity of 80% (95% confidence interval 63% to 92%) and a specificity of 78% (67% to 87%) for the detection of malignant or premalignant lesions. Accuracy of the SkinVision app verified against expert recommendations was poor (three studies). CONCLUSIONS: Current algorithm based smartphone apps cannot be relied on to detect all cases of melanoma or other skin cancers. Test performance is likely to be poorer than reported here when used in clinically relevant populations and by the intended users of the apps. The current regulatory process for awarding the CE marking for algorithm based apps does not provide adequate protection to the public. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016033595.


Asunto(s)
Dermoscopía/métodos , Melanoma/diagnóstico , Aplicaciones Móviles , Neoplasias Cutáneas/diagnóstico , Teléfono Inteligente , Algoritmos , Biopsia , Dermoscopía/instrumentación , Reacciones Falso Negativas , Reacciones Falso Positivas , Humanos , Melanoma/patología , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Piel/diagnóstico por imagen , Piel/patología , Neoplasias Cutáneas/patología
13.
JAMA ; 323(7): 627-635, 2020 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-32068817

RESUMEN

Importance: Polygenic risk scores comprising millions of single-nucleotide polymorphisms (SNPs) could be useful for population-wide coronary heart disease (CHD) screening. Objective: To determine whether a polygenic risk score improves prediction of CHD compared with a guideline-recommended clinical risk equation. Design, Setting, and Participants: A retrospective cohort study of the predictive accuracy of a previously validated polygenic risk score was assessed among 4847 adults of white European ancestry, aged 45 through 79 years, participating in the Atherosclerosis Risk in Communities (ARIC) study and 2390 participating in the Multi-Ethnic Study of Atherosclerosis (MESA) from 1996 through December 31, 2015, the final day of follow-up. The performance of the polygenic risk score was compared with that of the 2013 American College of Cardiology and American Heart Association pooled cohort equations. Exposures: Genetic risk was computed for each participant by summing the product of the weights and allele dosage across 6 630 149 SNPs. Weights were based on an international genome-wide association study. Main Outcomes and Measures: Prediction of 10-year first CHD events (including myocardial infarctions, fatal coronary events, silent infarctions, revascularization procedures, or resuscitated cardiac arrest) assessed using measures of model discrimination, calibration, and net reclassification improvement (NRI). Results: The study population included 4847 adults from the ARIC study (mean [SD] age, 62.9 [5.6] years; 56.4% women) and 2390 adults from the MESA cohort (mean [SD] age, 61.8 [9.6] years; 52.2% women). Incident CHD events occurred in 696 participants (14.4%) and 227 participants (9.5%), respectively, over median follow-up of 15.5 years (interquartile range [IQR], 6.3 years) and 14.2 (IQR, 2.5 years) years. The polygenic risk score was significantly associated with 10-year CHD incidence in ARIC with hazard ratios per SD increment of 1.24 (95% CI, 1.15 to 1.34) and in MESA, 1.38 (95% CI, 1.21 to 1.58). Addition of the polygenic risk score to the pooled cohort equations did not significantly increase the C statistic in either cohort (ARIC, change in C statistic, -0.001; 95% CI, -0.009 to 0.006; MESA, 0.021; 95% CI, -0.0004 to 0.043). At the 10-year risk threshold of 7.5%, the addition of the polygenic risk score to the pooled cohort equations did not provide significant improvement in reclassification in either ARIC (NRI, 0.018, 95% CI, -0.012 to 0.036) or MESA (NRI, 0.001, 95% CI, -0.038 to 0.076). The polygenic risk score did not significantly improve calibration in either cohort. Conclusions and Relevance: In this analysis of 2 cohorts of US adults, the polygenic risk score was associated with incident coronary heart disease events but did not significantly improve discrimination, calibration, or risk reclassification compared with conventional predictors. These findings suggest that a polygenic risk score may not enhance risk prediction in a general, white middle-aged population.


Asunto(s)
Enfermedad Coronaria/genética , Predisposición Genética a la Enfermedad , Herencia Multifactorial , Medición de Riesgo/métodos , Anciano , Estudios de Cohortes , Enfermedad Coronaria/epidemiología , Femenino , Estudio de Asociación del Genoma Completo , Genotipo , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Oportunidad Relativa , Fenotipo , Polimorfismo de Nucleótido Simple , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Riesgo
14.
JAMA ; 323(7): 636-645, 2020 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-32068818

RESUMEN

Importance: The incremental value of polygenic risk scores in addition to well-established risk prediction models for coronary artery disease (CAD) is uncertain. Objective: To examine whether a polygenic risk score for CAD improves risk prediction beyond pooled cohort equations. Design, Setting, and Participants: Observational study of UK Biobank participants enrolled from 2006 to 2010. A case-control sample of 15 947 prevalent CAD cases and equal number of age and sex frequency-matched controls was used to optimize the predictive performance of a polygenic risk score for CAD based on summary statistics from published genome-wide association studies. A separate cohort of 352 660 individuals (with follow-up to 2017) was used to evaluate the predictive accuracy of the polygenic risk score, pooled cohort equations, and both combined for incident CAD. Exposures: Polygenic risk score for CAD, pooled cohort equations, and both combined. Main Outcomes and Measures: CAD (myocardial infarction and its related sequelae). Discrimination, calibration, and reclassification using a risk threshold of 7.5% were assessed. Results: In the cohort of 352 660 participants (mean age, 55.9 years; 205 297 women [58.2%]) used to evaluate the predictive accuracy of the examined models, there were 6272 incident CAD events over a median of 8 years of follow-up. CAD discrimination for polygenic risk score, pooled cohort equations, and both combined resulted in C statistics of 0.61 (95% CI, 0.60 to 0.62), 0.76 (95% CI, 0.75 to 0.77), and 0.78 (95% CI, 0.77 to 0.79), respectively. The change in C statistic between the latter 2 models was 0.02 (95% CI, 0.01 to 0.03). Calibration of the models showed overestimation of risk by pooled cohort equations, which was corrected after recalibration. Using a risk threshold of 7.5%, addition of the polygenic risk score to pooled cohort equations resulted in a net reclassification improvement of 4.4% (95% CI, 3.5% to 5.3%) for cases and -0.4% (95% CI, -0.5% to -0.4%) for noncases (overall net reclassification improvement, 4.0% [95% CI, 3.1% to 4.9%]). Conclusions and Relevance: The addition of a polygenic risk score for CAD to pooled cohort equations was associated with a statistically significant, yet modest, improvement in the predictive accuracy for incident CAD and improved risk stratification for only a small proportion of individuals. The use of genetic information over the pooled cohort equations model warrants further investigation before clinical implementation.


Asunto(s)
Enfermedad de la Arteria Coronaria/genética , Predisposición Genética a la Enfermedad , Herencia Multifactorial , Medición de Riesgo/métodos , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Estudio de Asociación del Genoma Completo , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Riesgo
15.
Arch. bronconeumol. (Ed. impr.) ; 56(1): 23-27, ene. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-186462

RESUMEN

Introducción: El objetivo del estudio es evaluar las modificaciones del riesgo de mortalidad y morbilidad cardiorrespiratoria calculada mediante los modelos de riesgo Eurolung 1 y 2 en los últimos 20 años para identificar variaciones en la selección de los pacientes o en la práctica quirúrgica que hayan conducido a cambios en el riesgo de muerte y complicaciones tras resecciones anatómicas pulmonares. Método: Análisis retrospectivo de una serie de 2435 casos consecutivos sometidos a resección pulmonar anatómica. La población fue dividida en tres períodos de tiempo: 1994-2006 (976 casos), 2007-2015 (945 casos) y 2016-2017 (420 casos). Se aplicaron los modelos Eurolung 1 y 2 a la serie y se calculó la probabilidad individual de efectos adversos. Se comparó dicha probabilidad media, así como la prevalencia o las medias de cada una de las variables que constituyen los modelos en cada período y se representó gráficamente la evolución del riesgo. Resultados: Se observó un descenso progresivo de ambos efectos adversos a lo largo del tiempo. La prevalencia de las variables binarias, excepto enfermedad coronaria, fue mayor en el último período. El porcentaje de neumonectomías y de resecciones ampliadas descendió en los dos últimos períodos y el número de casos abordados por VATS se incrementó considerablemente en 2016-2017. Conclusiones: El descenso del número de neumonectomías y el incremento de la tasa de procedimientos mínimamente invasivos se consideran las variables más relacionadas con la disminución del riesgo. Otros cambios en las características clínicas de los pacientes no parecen haber influido en los resultados


Introduction: The aim of this study is to evaluate changes in the risk of cardiorespiratory mortality and morbidity calculated by Eurolung risk models 1 and 2 in the last 20 years, and to identify variations in patient selection or surgical practice that might have altered the risk of death and complications after anatomical lung resections. Method: This was a retrospective analysis of a series of 2,435 consecutive patients who underwent anatomical lung resection. The population was divided into three time periods: 1994-2006 (976 cases), 2007-2015 (945 cases), and 2016-2017 (420 cases). Eurolung models 1 and 2 were applied to the series, and the individual probability of adverse effects was calculated. We compared this mean probability, and the prevalence or means of each of the variables included in the models in each period and plotted the evolution of the risk. Results: A progressive decrease was observed in both adverse effects over time. The prevalence of the binary variables, except for coronary heart disease, was higher in the last period. The percentage of pneumonectomies and extended resections fell in the last two periods and the number of cases treated with VATS increased substantially in 2016-2017. Conclusions: The decline in the number of pneumonectomies and the increase in the rate of minimally invasive procedures appear to be the variables most closely associated with decreased risk. Other changes in the clinical characteristics of the patients do not seem to have influenced the outcomes


Asunto(s)
Humanos , Gestión de Riesgos , Medición de Riesgo/métodos , Neoplasias Pulmonares/epidemiología , Neumonectomía/métodos , Complicaciones Posoperatorias/etiología , Factores de Riesgo , Indicadores de Morbimortalidad , Estudios Retrospectivos , Paro Cardíaco/terapia , Complicaciones Posoperatorias/mortalidad
16.
BMJ ; 368: l6670, 2020 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-31911452

RESUMEN

Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.


Asunto(s)
Neoplasias/diagnóstico , Medición de Riesgo/métodos , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo , Biopsia/métodos , Pruebas de Química Clínica , Diagnóstico Diferencial , Humanos , Hallazgos Incidentales , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología
17.
Sports Health ; 12(2): 181-188, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31961778

RESUMEN

CONTEXT: The Landing Error Scoring System (LESS) is a clinical tool often used in research and practice to identify athletes presenting high injury-risk biomechanical patterns during a jump-landing task. OBJECTIVE: To systematically review the literature addressing the psychometric properties of the LESS. DATA SOURCES: Three electronic databases (PubMed, Web of Science, and Scopus) were searched on March 28, 2018, using the term "Landing Error Scoring System." STUDY SELECTION: All studies using the LESS as main outcome measure and addressing its reliability, validity against motion capture system, and predictive validity were included. Original English-language studies published in peer-reviewed journals were reviewed. Studies using modified versions of the LESS were excluded. STUDY DESIGN: Systematic literature review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Study design, population, LESS testing procedures, LESS scores, statistical analysis, and main results were extracted from studies using a standardized template. RESULTS: Ten studies met inclusion criteria and were appraised using Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. The overall LESS score demonstrated good-to-excellent intrarater (intraclass correlation coefficient [ICC], 0.82-0.99), interrater (ICC, 0.83-0.92), and intersession reliability (ICC, 0.81). The validity of the overall LESS score against 3-dimensional jump-landing biomechanics was good when individuals were divided into 4 quartiles based on LESS scores. The validity of individual LESS items versus 3-dimensional motion capture data was moderate-to-excellent for most of the items addressing key risk factors for anterior cruciate ligament (ACL) injury. The predictive value of the LESS for ACL and other noncontact lower-extremity injuries remains uncertain based on the current scientific evidence. CONCLUSION: The LESS is a reliable screening tool. However, further work is needed to improve the LESS validity against motion capture system and confirm its predictive validity for ACL and other noncontact lower-extremity injuries.


Asunto(s)
Prueba de Esfuerzo/métodos , Extremidad Inferior/lesiones , Ejercicio Pliométrico , Medición de Riesgo/métodos , Fenómenos Biomecánicos , Humanos , Incidencia , Reproducibilidad de los Resultados , Factores de Riesgo
18.
Mayo Clin Proc ; 95(1): 69-76, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31902431

RESUMEN

OBJECTIVE: To assess the impact of stroke volume index (SVI) and left ventricular ejection fraction (LVEF) on prognosis in patients with severe aortic stenosis, comparing those undergoing transcatheter aortic valve replacement (TAVR) and those with surgical AVR (SAVR). PATIENTS AND METHODS: A total of 742 patients from the CoreValve US Pivotal High-Risk Trial randomized to TAVR (n=389) or SAVR (n=353) from February 2011 to September 2012 were stratified by an SVI of 35 mL/m2 and LVEF of 50% for comparing all-cause mortality at 1 year. RESULTS: The prevalence of an SVI of less than 35 mL/m2 in patients who underwent TAVR and SAVR was 35.8% (125 of 349) and 31.3% (96 of 307), respectively; LVEF of less than 50% was present in 18.1% (63 of 348) and 19.6% (60 of 306), respectively. Among patients with an SVI of less than 35 mL/m2, 1-year mortality was similar between patients with TAVR and SAVR (16.3% vs 22.2%; P=.25). However, in those with an SVI of 35 mL/m2 or greater, 1-year mortality was lower in those with TAVR than SAVR (10.3% vs 17.3%; P=.03). In patients with an LVEF of less than 50%, mortality was not affected by AVR approach (P>.05). In patients with an LVEF of 50% or higher, TAVR was associated with lower mortality than SAVR when SVI was preserved (9.8% vs 18.6%; P=.01). Mortality was not affected by SVI within the same AVR approach when LVEF was 50% or higher. CONCLUSION: In patients with severe aortic stenosis at high risk, there is a significant interaction between AVR approach and the status of SVI and LVEF. When LVEF or SVI was reduced, prognosis was similar regardless of AVR approach. In those with preserved LVEF or SVI, TAVR was associated with a better prognosis than SAVR. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01240902.


Asunto(s)
Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Volumen Sistólico , Reemplazo de la Válvula Aórtica Transcatéter , Función Ventricular Izquierda , Anciano , Anciano de 80 o más Años , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/cirugía , Correlación de Datos , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/estadística & datos numéricos , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Reemplazo de la Válvula Aórtica Transcatéter/estadística & datos numéricos , Resultado del Tratamiento
19.
J Clin Psychiatry ; 81(2)2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31995677

RESUMEN

OBJECTIVE: A nominal group process followed by a modified Delphi method was used to survey expert opinions on best practices for tardive dyskinesia (TD) screening, diagnosis, and treatment and to identify areas lacking in clinical evidence. PARTICIPANTS: A steering committee of 11 TD experts met in nominal group format to prioritize questions to be addressed and identify core bibliographic materials and criteria for survey panelists. Of 60 invited experts, 29 (23 psychiatrists and 6 neurologists) agreed to participate. EVIDENCE: A targeted literature search of PubMed (search term: tardive dyskinesia) and recommendations of the steering committee were used to generate core bibliographic material. Inclusion criteria were as follows: (1) review articles, meta-analyses, guidelines, or clinical trials; (2) publication in English between 2007 and 2017; (3) > 3 pages in length; and (4) publication in key clinical journals with impact factors ≥ 2.0. Of 29 references that met these criteria, 18 achieved a score ≥ 5 (calculated as the number of steering committee votes multiplied by journal impact factor and number of citations divided by years since publication) and were included. CONSENSUS PROCESS: Two survey rounds were conducted anonymously through electronic media from November 2017 to January 2018; responses were collected, collated, and analyzed. Respondent agreement was defined a priori as unanimous (100%), consensus (75%-99%), or majority (50%-74%). For questions using a 5-point Likert scale, agreement was based on percentage of respondents choosing ≥ 4 ("agree completely" or "agree"). Round 1 survey included questions on TD screening, diagnosis, and treatment. Round 2 questions were refined per panelist feedback and excluded Round 1 questions with < 25% agreement and > 75% agreement (unless feedback suggested further investigation). CONCLUSIONS: Consensus was reached that (1) a brief, clinical assessment for TD should be performed at every clinical encounter in patients taking antipsychotics; (2) even mild movements in 1 body area may represent possible TD; (3) management requires an overall evaluation of treatment, including reassessment of antipsychotics and anticholinergics as well as consideration of vesicular monoamine transporter 2 (VMAT2) inhibitors; and (4) informed discussions with patients/caregivers are essential.


Asunto(s)
Antipsicóticos , Antagonistas Colinérgicos , Tamizaje Masivo/métodos , Administración del Tratamiento Farmacológico/normas , Examen Neurológico/métodos , Discinesia Tardía , Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Antagonistas Colinérgicos/administración & dosificación , Antagonistas Colinérgicos/efectos adversos , Consenso , Técnica Delfos , Monitoreo de Drogas/métodos , Monitoreo de Drogas/normas , Humanos , Guías de Práctica Clínica como Asunto , Medición de Riesgo/métodos , Discinesia Tardía/inducido químicamente , Discinesia Tardía/diagnóstico , Discinesia Tardía/terapia , Proteínas de Transporte Vesicular de Monoaminas/antagonistas & inhibidores
20.
BMJ ; 368: l7057, 2020 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996343

RESUMEN

OBJECTIVE: To study the impact of maternal smoking during pregnancy on fractures in offspring during different developmental stages of life. DESIGN: National register based birth cohort study with a sibling comparison design. SETTING: Sweden. PARTICIPANTS: 1 680 307 people born in Sweden between 1983 and 2000 to women who smoked (n=377 367, 22.5%) and did not smoke (n=1 302 940) in early pregnancy. Follow-up was until 31 December 2014. MAIN OUTCOME MEASURE: Fractures by attained age up to 32 years. RESULTS: During a median follow-up of 21.1 years, 377 970 fractures were observed (the overall incidence rate for fracture standardised by calendar year of birth was 11.8 per 1000 person years). The association between maternal smoking during pregnancy and risk of fracture in offspring differed by attained age. Maternal smoking was associated with a higher rate of fractures in offspring before 1 year of age in the entire cohort (birth year standardised fracture rates in those exposed and unexposed to maternal smoking were 1.59 and 1.28 per 1000 person years, respectively). After adjustment for potential confounders the hazard ratio for maternal smoking compared with no smoking was 1.27 (95% confidence interval 1.12 to 1.45). This association followed a dose dependent pattern (compared with no smoking, hazard ratios for 1-9 cigarettes/day and ≥10 cigarettes/day were 1.20 (95% confidence interval 1.03 to 1.39) and 1.41 (1.18 to 1.69), respectively) and persisted in within-sibship comparisons although with wider confidence intervals (compared with no smoking, 1.58 (1.01 to 2.46)). Maternal smoking during pregnancy was also associated with an increased fracture incidence in offspring from age 5 to 32 years in whole cohort analyses, but these associations did not follow a dose dependent gradient. In within-sibship analyses, which controls for confounding by measured and unmeasured shared familial factors, corresponding point estimates were all close to null. Maternal smoking was not associated with risk of fracture in offspring between the ages of 1 and 5 years in any of the models. CONCLUSION: Prenatal exposure to maternal smoking is associated with an increased rate of fracture during the first year of life but does not seem to have a long lasting biological influence on fractures later in childhood and up to early adulthood.


Asunto(s)
Fracturas Óseas , Mujeres Embarazadas/psicología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Fumar , Adulto , Factores de Edad , Niño , Correlación de Datos , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/epidemiología , Humanos , Lactante , Masculino , Embarazo , Sistema de Registros/estadística & datos numéricos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Suecia/epidemiología
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