ABSTRACT
Antecedentes: El consumo de medicamentos durante el embarazo se ha incrementado en las últimas décadas. Objetivo: Identificar el riesgo de anomalías congénitas (AC) asociado a la utilización de medicamentos en atención ambulatoria en embarazadas residentes en la Comunitat Valenciana. Métodos: Estudio de casos-controles, considerando caso a menores de un año nacidos vivos en 2009-2010 diagnosticados de AC y residentes en la Comunitat Valenciana, obtenidos del registro poblacional de AC. Los controles se seleccionaron del Registro de Metabolopatías y la medicación prescrita y dispensada se obtuvo del módulo Gestión Integral de Prestación Farmacéutica. Se calcularon las odds ratio (OR) y los intervalos de confianza al 95% y las OR ajustadas mediante regresión logística. Resultados: Se identificaron 1.913 casos y 3.826 controles. Los grupos de medicamentos más frecuentemente prescritos y dispensados fueron: los que actúan sobre los sistemas musculoesquelético, nervioso, respiratorio, sobre la sangre y órganos hematopoyéticos, y antiinfecciosos. Los medicamentos más habituales fueron: ibuprofeno, dexketoprofeno, paracetamol, amoxicilina, sulfato de hierro y una combinación de ácido fólico. Se identificó un aumento del riesgo de anomalías congénitas significativo para los fármacos de acción sobre el sistema musculoesquelético (OR ajustada de 1,14 [intervalo de confianza al 95% 1,02-1,28]). Se observó una disminución del riesgo significativa en el grupo que actúa sobre la sangre y los órganos hematopoyéticos (OR ajustada de 0,87 [intervalo de confianza al 95% 0,78-0,98]). Conclusiones: Se han identificado asociaciones de medicamentos con AC en mujeres embarazadas residentes en la Comunitat Valenciana, tanto para fármacos que actúan como factores de riesgo de AC como para fármacos que actúan como factores protectores de AC (AU)
Background: Despite the potential risks of drug use during pregnancy, consumption has increased in recent decades. Objective: To identify the risk of congenital anomalies (CA) associated with the use of drugs in primary care in pregnant women residents in the Valencia Region. Methods: A case-control study, considering a case as a less than one year old live birth in 2009-2010, diagnosed with a CA and resident in the Valencia Region, obtained from the CA population-based registry. Controls were selected from the Metabolic Disease Registry, and the drugs prescribed and dispensed from the Integral Management of Pharmaceutical Services. Crude odds ratio (OR) was calculated with its 95% confidence intervals and adjusted OR was calculated using logistic regression. Results: A total of 1,913 cases and 3,826 controls were identified. The most frequently used drug groups were those acting on the musculoskeletal, nervous and respiratory systems, on the blood and blood forming organs, and anti-infection drugs. The most common drugs used were ibuprofen, dexketoprofen, paracetamol, amoxicillin, ferrous sulphate, and a combination of folic acid. A significantly increased risk of CA was identified for drugs acting on the musculoskeletal system (adjusted OR 1.14 [95% confidence interval 1.02-1.28]). A significantly decreased risk was observed for drugs acting on the blood and blood forming organs (adjusted OR 0.87 [95% confidence interval 0.78-0.98]). Conclusions: Associations between drugs and CA in pregnant women resident in the Valencia Region have been identified for drugs that act as risk factors of CA, and for drugs that act as protective factors of CA (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Pregnancy Complications/drug therapy , Drug Utilization/statistics & numerical data , Abnormalities, Drug-Induced/epidemiology , Pregnancy Outcome , Risk Factors , Case-Control Studies , Drug-Related Side Effects and Adverse Reactions/epidemiologyABSTRACT
Objetivo: Evaluar la validez del Conjunto Mínimo Básico de Datos (CMBD) para identificar anomalías congénitas mayores en la Comunitat Valenciana. Métodos: Se realizó un estudio epidemiológico retrospectivo. Del CMBD se seleccionaron las altas en menores de un año nacidos en 2007, residentes en la Comunitat Valenciana con código de anomalía congénita (740-759 CIE9-MC) y una muestra aleatoria de menores de un año sin altas con estos códigos. Tras revisar la documentación clínica, se clasificaron como verdaderos positivos y negativos y falsos positivos y negativos. Se calcularon el valor predictivo positivo y negativo y la sensibilidad. Se analizaron la concordancia de los diagnósticos entre el CMBD y la documentación clínica utilizando la prueba kappa. Resultados: Se identificaron 2305 altas de 1651 pacientes. En los 544 pacientes de la muestra, 4 tenían alguna anomalía congénita mayor. El valor predictivo positivo fue del 56,4% (intervalo de confianza del 95% [IC95%]: 53,9-58,8) y el negativo fue del 99,3% (IC95%: 98,6-100,0). La sensibilidad del CMBD fue del 68,6% (IC95%: 66,1-71,1). Los códigos más frecuentes en los verdaderos positivos fueron: 745.5 (Comunicación interauricular), 745.4 (Comunicación interventricular) y 747.0 (Ductus arterioso persistente), y en los falsos positivos: 747.0, 745.5 y 752.51 (Criptorquidia). El 25,5% de los diagnósticos con anomalía congénita del CMBD no estaban en la historia clínica. Considerando todos los diagnósticos codificados en el CMBD, la concordancia fue de 0,70 (IC95%: 0,68-0,72). Conclusiones: El CMBD es la principal fuente de información para la identificación de casos para el Registro Poblacional de Anomalías Congénitas de la Comunitat Valenciana, pero su principal limitación es el elevado número de casos falsos positivos que detecta (AU)
Objective: To assess the validity of the Spanish Minimum Basic Data Set (MBDS) for identifying major congenital anomalies in the Valencian Community. Methods: A retrospective epidemiological study was carried out. Children under the age of one year, born in 2007 and residing in the Valencian Community with congenital anomalies code 740-759 CIE9-MC, were selected from the MBDS, in addition to a random sample of children under the age of 1 year without these discharge codes. Having reviewed the clinical documentation, the cases were classified as true positives and negatives and false positives and negatives. Positive and negative predictive value and sensitivity were calculated. The kappa test was applied to analyse diagnostic consistency between the MBDS and the clinical documentation. Results: A total of 2305 discharges of 1651 patients were identified. 4 out of the 5434 patients sampled had a major congenital abnormality. The positive predictive value was 56.4% (95% confidence interval [95%CI]: 53.9-58.8) and the negative predictive value was 99.3% (95%CI: 98.6-100.0). MBDS sensitivity was 68.6% (95%CI: 66.1-71.1). The most common codes in the true positives were: 745.5 (atrial septal defect), 745.4 (ventricular septal defect) and 747.0 (patent ductus arteriosus) and in the false positives: 747.0, 745.5 and 752.51 (cryptorchidism). 25.5% of diagnoses with congenital anomaly from the MBDS were not in the clinical documentation. Considering all diagnoses coded in the MBDS, the correlation was 0.70 (95%CI: 0.68-0.72) Conclusions: The MBDS is the main source of information to detect cases in the registry of congenital anomalies of the Valencian Community. Its main limitation is the high number of false positive cases detected (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Congenital Abnormalities/epidemiology , Medical Records/statistics & numerical data , Patient Discharge/standards , Diseases Registries/statistics & numerical data , Registries/standards , Retrospective Studies , False Positive Reactions , Patient Discharge Summaries/standardsABSTRACT
OBJECTIVE: To assess the validity of the Spanish Minimum Basic Data Set (MBDS) for identifying major congenital anomalies in the Valencian Community. METHODS: A retrospective epidemiological study was carried out. Children under the age of one year, born in 2007 and residing in the Valencian Community with congenital anomalies code 740-759 CIE9-MC, were selected from the MBDS, in addition to a random sample of children under the age of 1 year without these discharge codes. Having reviewed the clinical documentation, the cases were classified as true positives and negatives and false positives and negatives. Positive and negative predictive value and sensitivity were calculated. The kappa test was applied to analyse diagnostic consistency between the MBDS and the clinical documentation. RESULTS: A total of 2305 discharges of 1651 patients were identified. 4 out of the 5434 patients sampled had a major congenital abnormality. The positive predictive value was 56.4% (95% confidence interval [95%CI]: 53.9-58.8) and the negative predictive value was 99.3% (95%CI: 98.6-100.0). MBDS sensitivity was 68.6% (95%CI: 66.1-71.1). The most common codes in the true positives were: 745.5 (atrial septal defect), 745.4 (ventricular septal defect) and 747.0 (patent ductus arteriosus) and in the false positives: 747.0, 745.5 and 752.51 (cryptorchidism). 25.5% of diagnoses with congenital anomaly from the MBDS were not in the clinical documentation. Considering all diagnoses coded in the MBDS, the correlation was 0.70 (95%CI: 0.68-0.72) CONCLUSIONS: The MBDS is the main source of information to detect cases in the registry of congenital anomalies of the Valencian Community. Its main limitation is the high number of false positive cases detected.
Subject(s)
Congenital Abnormalities/diagnosis , Datasets as Topic , Congenital Abnormalities/epidemiology , False Negative Reactions , False Positive Reactions , Female , Humans , Infant , Infant, Newborn , Male , Patient Discharge , Predictive Value of Tests , Retrospective Studies , Sampling Studies , Sensitivity and Specificity , Spain/epidemiologyABSTRACT
BACKGROUND: Despite the potential risks of drug use during pregnancy, consumption has increased in recent decades. OBJECTIVE: To identify the risk of congenital anomalies (CA) associated with the use of drugs in primary care in pregnant women residents in the Valencia Region. METHODS: A case-control study, considering a case as a less than one year old live birth in 2009-2010, diagnosed with a CA and resident in the Valencia Region, obtained from the CA population-based registry. Controls were selected from the Metabolic Disease Registry, and the drugs prescribed and dispensed from the Integral Management of Pharmaceutical Services. Crude odds ratio (OR) was calculated with its 95% confidence intervals and adjusted OR was calculated using logistic regression. RESULTS: A total of 1,913 cases and 3,826 controls were identified. The most frequently used drug groups were those acting on the musculoskeletal, nervous and respiratory systems, on the blood and blood forming organs, and anti-infection drugs. The most common drugs used were ibuprofen, dexketoprofen, paracetamol, amoxicillin, ferrous sulphate, and a combination of folic acid. A significantly increased risk of CA was identified for drugs acting on the musculoskeletal system (adjusted OR 1.14 [95% confidence interval 1.02-1.28]). A significantly decreased risk was observed for drugs acting on the blood and blood forming organs (adjusted OR 0.87 [95% confidence interval 0.78-0.98]). CONCLUSIONS: Associations between drugs and CA in pregnant women resident in the Valencia Region have been identified for drugs that act as risk factors of CA, and for drugs that act as protective factors of CA.
Subject(s)
Abnormalities, Drug-Induced/epidemiology , Pregnancy Complications/drug therapy , Adult , Ambulatory Care , Case-Control Studies , Female , Humans , Infant, Newborn , Male , Pregnancy , Risk Factors , Spain/epidemiology , Young AdultABSTRACT
Objetivo: Explorar con perspectiva de género las vivencias de madres y padres en los primeros momentos tras el diagnóstico de una anomalía congénita cardiaca en un/una hijo/a, integrando la visión de personal sanitario que atiende a estos/as menores y a sus familiares. Método: Estudio de diseño cualitativo. Se realizaron cuatro entrevistas en profundidad a personal sanitario y cuatro grupos de discusión con madres y padres residentes en la Comunitat Valenciana. Los participantes se seleccionaron mediante muestreo intencionado. El análisis del discurso se trianguló entre ambas técnicas y entre investigadores, y se verificaron los resultados con madres, padres y profesionales sanitarios. Resultados: Existen diferencias entre madres y padres en la manera de expresar emocionalmente y afrontar el diagnóstico de una enfermedad grave en un/una hijo/a. Sin embargo, ambos progenitores manifiestan la necesidad de disponer de apoyo psicológico formal, y valoran positivamente el apoyo informal de otros/as padres/madres con vivencias similares. Conclusiones: La vivencia de la enfermedad en un/una hijo/a es diferente para madres y padres. Desde los servicios de salud debería prestarse atención al bienestar psicológico de las familias, incorporando los grupos de apoyo entre iguales y las asociaciones de pacientes como activos en salud (AU)
Objective: To explore, from a gender perspective, the experiences of mothers and fathers of children with congenital heart disease at the time of diagnosis, including the opinions of medical staff taking care of these children and their families. Methods: Qualitative research. Four individual interviews with medical staff and four focus groups with mothers and fathers living in Valencia Region (Spain) were carried out. Participants were selected by purposive sampling. The discourse analysis was triangulated between techniques and researchers and the results were verified with mothers, fathers and medical staff. Results: Mothers and fathers differed in the way they expressed their emotions and in how they accepted the diagnosis of a serious illness in their child. However, both parents expressed the need for psychological support and highly appreciated the informal support from other parents with similar experiences. Conclusions: The experience of the disease in a child is experienced differently by mothers and fathers. Health servies should pay attention to the psychological well-being of families, by including peer support groups and patient associations, which can play an important role as health assets (AU)
Subject(s)
Humans , Heart Defects, Congenital/psychology , Quality of Life/psychology , Sickness Impact Profile , Mothers/statistics & numerical data , Fathers/statistics & numerical data , Attitude of Health Personnel , Sex Distribution , Qualitative ResearchABSTRACT
OBJECTIVE: To explore, from a gender perspective, the experiences of mothers and fathers of children with congenital heart disease at the time of diagnosis, including the opinions of medical staff taking care of these children and their families. METHODS: Qualitative research. Four individual interviews with medical staff and four focus groups with mothers and fathers living in Valencia Region (Spain) were carried out. Participants were selected by purposive sampling. The discourse analysis was triangulated between techniques and researchers and the results were verified with mothers, fathers and medical staff. RESULTS: Mothers and fathers differed in the way they expressed their emotions and in how they accepted the diagnosis of a serious illness in their child. However, both parents expressed the need for psychological support and highly appreciated the informal support from other parents with similar experiences. CONCLUSIONS: The experience of the disease in a child is experienced differently by mothers and fathers. Health servies should pay attention to the psychological well-being of families, by including peer support groups and patient associations, which can play an important role as health assets.
Subject(s)
Fathers/psychology , Heart Defects, Congenital/psychology , Mothers/psychology , Adult , Child , Child, Preschool , Emotions , Female , Focus Groups , Health Services Needs and Demand , Humans , Infant , Interviews as Topic , Male , Middle Aged , Parent-Child Relations , Professional-Family Relations , Qualitative Research , Social Support , Socioeconomic Factors , SpainABSTRACT
BACKGROUND: This study describes the incidence and outcomes of European patients requiring renal replacement therapy (RRT) for kidney failure due to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 12 renal registries providing individual RRT patient data to the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry in 1993-2012 participated. PREDICTOR: Cause of primary kidney disease: AAV (ie, granulomatosis with polyangiitis [Wegener] and microscopic polyangiitis) versus 3 separate matched control groups without AAV: (1) primary glomerulonephritis, (2) diabetes mellitus, and (3) disease other than diabetes mellitus as the cause of primary kidney disease, including glomerulonephritis (termed "nondiabetes"). OUTCOMES: Incidence, causes of death, and survival. MEASUREMENTS: ERA-EDTA primary renal disease codes. RESULTS: 2,511 patients with AAV (1,755, granulomatosis with polyangiitis; 756, microscopic polyangiitis) were identified, representing an incidence of 1.05 per million population (pmp) for granulomatosis with polyangiitis (predominating in Northern Europe) and 0.45 pmp for microscopic polyangiitis (prevailing in Southern Europe). Kidney transplantation was performed in 558 (22.2%) patients with vasculitis. The 10-year probability for survival on RRT after day 91 was 32.5% (95% CI, 29.9%-35.1%) in patients with vasculitis. Survival on RRT after day 91 did not differ between AAV and matched nondiabetes patients. Patient and transplant survival after kidney transplantation, adjusted for time period and country, was better in AAV than in matched nondiabetes patients (HRs of 0.81 [95% CI, 0.67-0.99] and 0.82 [95% CI, 0.69-0.96], respectively). LIMITATIONS: No data for extrarenal manifestations, treatment, and relapses. CONCLUSIONS: Geographical differences in the incidence of RRT for kidney failure due to granulomatosis with polyangiitis and microscopic polyangiitis copied their distribution in the general population. Overall survival on RRT after day 91 for patients with AAV was similar to that for patients with nondiabetes diagnoses. Our results suggest that patients with AAV are suitable candidates for kidney transplantation with favorable survival outcomes.
Subject(s)
Granulomatosis with Polyangiitis/mortality , Granulomatosis with Polyangiitis/therapy , Kidney Failure, Chronic/mortality , Microscopic Polyangiitis/mortality , Microscopic Polyangiitis/therapy , Registries , Adult , Case-Control Studies , Cause of Death , Disease Progression , Disease-Free Survival , Europe , Female , Granulomatosis with Polyangiitis/diagnosis , Humans , Kaplan-Meier Estimate , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Kidney Function Tests , Kidney Transplantation/methods , Kidney Transplantation/mortality , Male , Microscopic Polyangiitis/diagnosis , Middle Aged , Prognosis , Proportional Hazards Models , Renal Dialysis/methods , Renal Dialysis/mortality , Severity of Illness Index , Societies, Medical , Survival RateABSTRACT
We explored the influence of morphology on geographic differences in 5-year survival for non-Hodgkin lymphoma (NHL) diagnosed in 1990-1994 and followed for 5years: 16,955 cases from 27 EUROCARE-3 cancer registries, and 22,713 cases from 9 US SEER registries. Overall 5-year relative survival was 56.1% in EUROCARE west, 47.1% in EUROCARE east and 56.3% in SEER. Relative excess risk (RER) of death was 1.05 (95% confidence interval (CI) 1.01-1.10) in EUROCARE west, 1.52 (95% CI 1.44-1.60) in EUROCARE east (SEER reference). Excess risk of death was significantly above reference (diffuse B lymphoma) for Burkitt's and NOS lymphoma; not different for lymphoblastic and other T-cell; significantly below reference (in the order of decreasing relative excess risk) for NHL NOS, mantle cell/centrocytic, lymphoplasmacytic, follicular, small lymphocytic/chronic lymphocytic leukaemia, other specified NHL and cutaneous morphologies. Interpretation of marked variation in survival with morphology is complicated by classification inconsistencies. The completeness and standardisation of cancer registry morphology data needs to be improved.
