Association Relative Risk Research Articles

Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review

ObjectiveTo investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews.DesignSystematic review.Eligibility criteriaStudies that compared the association between conflicts...

The association between fertility treatments and the incidence of paediatric cancer: A systematic review and meta-analysis

BackgroundIt is important to explore the association between different fertility treatments and the incidence of paediatric cancer, as this will provide crucial guidance for clinical decision-making. Previous studies have explored the relationship between fertility treatments and different types of cancer in offspring, but the results are controversial. MethodTwo authors searched PubMed, Embase, Web of Science and Cochrane databases independently to acquire qualified studies. Then, the same authors extracted data from these studies and analysed these data using RevMan 5.3. Main resultsEleven case–control studies and 16 cohort studies were included in this review and meta-analysis. The relative risk of association between in vitro fertilisation (IVF) and paediatric cancer incidence was 1.01 (95% confidence interval [CI]: 0.80–1.28) in cohort studies and 1.09 (95% CI: 0.74–1.58) in case–control studies. The relative risk of association between intracytoplasmic sperm injection (ICSI) and paediatric cancer incidence was 0.97 (95% CI: 0.80–1.17) in cohort studies. The relative risk of association between fertility drugs and paediatric cancer incidence was 1.07 (95% CI: 0.68–1.69) in cohort studies and 1.12 (95% CI: 0.90–1.41) in case–control studies. The relative risk of association between frozen embryo transfer and paediatric cancer incidence was 1.37 (95% CI: 1.04–1.81) in natural pregnancy controls and 1.28 (95% CI: 0.96–1.69) in fresh embryo transfer controls. ConclusionThere is no evidence that IVF, ICSI and fertility drugs are associated with an increase in paediatric cancer incidence in offspring; however, frozen embryo transfer is associated with an increase in paediatric cancer incidence in the offspring, but this finding needs further research and attention.

2520. Epidemiology, Clinical Manifestations, and Outcomes of the 2017–2018 Influenza Season Among Hospitalized Patients at a Tertiary Care Center

Background2017–2018 Influenza season showed widespread activity and is expected to be of “high severity.”MethodsRetrospective chart review of patients with Influenza admitted from September 1, 2017 to April 1, 2018. Diagnosis was confirmed by Rapid flu test (RIDT) or Target Enriched Multiplex PCR (TEM PCR). Demographic, clinical, lab, treatment, and outcomes data were obtained. Analysis included prevalence and relative risk (RR)Results220 patients were identified (47% males, 73% White). Median age was 70 years (range 18–99). 65% had Flu A and 27% Flu B. 81% came from home, 17% from a facility (nursing home, assisted living). 49% had flu vaccination (Figure 1). Flu strain and vaccination status had no association RR 1.31 (95% CI 0.85–2.01, P = 0.21). Common comorbidities were lung disease 44%, obesity 41%, DM 36%, CAD 34%, CHF 31% (Figure 2). Common presentations were respiratory 79% and constitutional 53%. 68% were hypoxic and 4% hypotensive on arrival. 42% had new CXR/CT finding and 55% had pneumonia. Sensitivity of RIDT was 38%. 91% were treated with oseltamivir (21% within 48 hours of flu detection). Median treatment duration was 5 days. Hospitalizations peaked in January (Figure 3). Median length of hospital stay was 6 days. 23% had severe flu (needed NPPV 13%, intubation 12%, pressor 5%, ICU stay 16%) which showed significant association with arrival from facility RR 2.21 (95% CI 1.36–3.56, P = 0.001), lung disease RR 1.91 (95% CI 1.17–3.14, P = 0.01) and co-detection of respiratory pathogen (TEM PCR/sputum culture/serology) RR 2.65 (CI 1.60–4.38, P = 0.0001), but none with age >65 RR 1.46 (95% 0.83–2.56, P = 0.18), flu type RR 1.59 (95% CI 0.85–2.98, P = 0.14), active smoking RR 1.40 (95% CI 0.79–2.47, P = 0.24) or vaccination RR 1.21 (95% CI 0.70–2.12, P = 0.48). Fatality rate was 6% with significant association with arrival from facility RR 4.56 (95% CI 1.55–13.40, P = 0.006).Conclusion2017–2018 Influenza season among hospitalized patients involved more elderly and peaked in January. Sensitivity of flu swab was 38% calling for better utilization of TEM PCR in hospitalized patients. Severe flu had significant association with arrival from facility, lung disease and co-detection of respiratory pathogen. Fatality had significant association with arrival from facility. Confounders not accounted. Disclosures All authors: No reported disclosures.

Prevalence of Cerebral Palsy among 8-Year-Old Children in 2010 and Preliminary Evidence of Trends in Its Relationship to Low Birthweight.

The public health objective for cerebral palsy (CP) in the United States is to reduce the percentage of children with CP who were born low birthweight (LBW, <2500 g) by 10% between 2006 and 2020. This study reports the prevalence of CP in a constant surveillance area for the years 2006, 2008, and 2010 and describes initial progress towards the CP public health objective. Data on children with CP at age 8 years were ascertained by the Autism and Developmental Disabilities Monitoring (ADDM) Network, a population-based surveillance system that monitored CP in four areas of the United States. CP prevalence in 2010 was 2.9 per 1000 [95% confidence interval (CI) 2.6, 3.2], down from 3.5 (95% CI 3.2, 3.9) in the same surveillance area in 2006. Among CP cases with no documented postneonatal aetiology, 49.1% (95% CI 42.9, 55.2) were born LBW in 2010 compared with 54.3% (95% CI 48.4, 60.1) in 2006. In 2010, 28.1% (95% CI 22.9, 30.4) were born very low birthweight (VLBW, <1500 g) compared with 35.4% (95% CI 30.0, 41.2) in 2006. The relative risks for associations between CP and both LBW and VLBW also declined, though not significantly, during the study period. Declines in the associations between CP and LBW categories may have contributed to declines during the study period in both the prevalence of CP and the percentage of children with CP who were born LBW or VLBW. Ongoing monitoring of these trends is warranted.

Antidepressant Use in Pregnancy and the Risk for Cardiac Defects

The use of antidepressants during pregnancy has increased, with prevalences of 8% to 13% in the United States. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants during pregnancy. Because varied associations between drug use and fetal congenital cardiac malformations have been reported, this cohort study was performed to assess the risk for congenital cardiac defects after parturient use of antidepressants. The study cohort was drawn from the Medicaid Analytic eXtract for 2000 to 2007. This data set contains individual-level demographic and Medicaid enrollment information as well as data on all filled outpatient medication prescriptions. The exposure period extended from the date of the last menstrual period through day 90 of pregnancy (first trimester). Exposure categories were any SSRI, paroxetine, sertraline, fluoxetine, tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), bupropion, and other antidepressants. The reference group comprised parturients without antidepressant use during the first trimester. Congenital cardiac malformations included any cardiac malformation, right ventricular outflow tract obstruction, ventricular septal defect, and other cardiac malformations. Covariates included sociodemographic information; known or suspected risk factors of congenital cardiac malformations; use of teratogenic, other psychotropic, antidiabetic, and antihypertensive medications; and number of distinct prescription drugs used. Logistic regression analysis was used to estimate odds ratios for cardiac malformations. Because the odds ratio is an excellent approximation of the risk ratio in the case of rare outcomes, results are reported as relative risks (RRs). Of 949,504 eligible pregnancies, during the first trimester, 64,389 women (6.8%) used an antidepressant, 46,144 women (4.9%) were exposed to an SSRI, 5954 (0.6%) were exposed to a TCA, 6904 (0.7%) were exposed to an SNRI, 8856 (0.9%) were exposed to bupropion, and 7055 (0.7%) were exposed to other antidepressants. Sertraline was used by 14,040 women; paroxetine, by 11,126; and fluoxetine, by 11,048. Cardiac malformations were diagnosed in 6403 infants who were not exposed to an antidepressant during the first trimester (72.3 cardiac malformations per 10,000 infants) compared with 580 infants who were exposed (90.1 cardiac malformations per 10,000 infants). This higher unadjusted risk among exposed infants was observed for each specific type of malformation examined. In unadjusted analyses, the RR of any cardiac malformation was 1.25 with SSRIs (95% CI, 1.13–1.38), 0.98 with TCAs (95% CI, 0.72–1.32), 1.51 with SNRIs (95% CI, 1.20–1.90), 1.19 with bupropion (95% CI, 0.95–1.49), and 1.46 with other antidepressants (95% CI, 1.16–1.83). The propensity-score–adjusted RR of any cardiac malformation was 1.06 among women exposed to SSRIs (95% CI, 0.93–1.22), 0.77 for exposure to TCAs (95% CI, 0.52–1.14), 1.20 for exposure to SNRIs (95% CI, 0.91–1.57), 0.92 for exposure to bupropion (95% CI, 0.69–1.22), and 1.21 for exposure to other antidepressants (95% CI, 0.91–1.60). No significant associations were found between paroxetine and right ventricular outflow obstruction (1.07; 95% CI, 0.59–1.93) or between sertraline and ventricular septal defect (1.04; 95% CI, 0.76–1.41). The RR of cardiac malformations associated with SSRI use was 1.04 for those on antidepressant monotherapy (95% CI, 0.90–1.21) and 1.17 for polytherapy (95% CI, 0.90–1.53). Relative risks for associations between cardiac malformations and maternal diabetes, use of an anticonvulsant agent, and multifetal pregnancy were 3.7, 1.6, and 2.9, respectively (95% CI, 3.4–4.0; 95% CI, 1.3–1.8; and 95% CI, 2.8–3.1, respectively). After adjustment for depression and other confounding factors, these results fail to support previous findings of an association between antidepressant use and cardiac anomalies. Evidence implies low absolute risks and argues against important cardiac teratogenic effects associated with the most commonly used antidepressants.

Eficacia de tres tipos de surfactante exógeno en prematuros con enfermedad de membrana hialina

Introduction: Hyaline membrane disease is an important cause of neonatal mortality. The objective of this research is to evaluate the efficacy of three different exogenous surfactants in premature infants. Patients and Method: A retrospective cohort analysis in 93 preterm infants ≥ 24 weeks and birth weight ≥ 500 g was performed, 31 infants for each surfactant. Exposure consisted of the 1st dose of bovactant (Alveofact ® ) 50 mg/kg, beractant (Survanta ® ) 100 mg/kg initially, and poractant alfa (Curosurf ® ) 200 mg/kg. The variables included duration of mechanical ventilation, duration of oxygen therapy, hospital stay, need for second dose of surfactant, adverse events surfactant administration and prematurity complications. Mortality and bronchopulmonary dysplasia (BPD) were evaluated. Statistical analysis was performed using Stata ® 11.0, X 2 or Fisher exact test for qualitative variables and ALNOVA or Kruskal-Wallis tests for quantitative and association relative risk, all with 95% confidence level. Results: There were no gender, weight and gestational age differences at birth among the three groups. No statistically significant differences were found regarding duration of mechanical ventilation, duration of oxygen therapy, administration of a second dose of surfactant, hospital stay and complications among the three groups. Adverse events related to surfactant administration occurred for beractant and poractant alpha. There were 30 (32.3%) deaths, 8 (25.8%) associated to bovactant, 10 (32.3%) to beractant and 12 (38.7%) to poractant alpha (p > 0.05). Mortality and/or BDP occurred in 10 (32.2%) infants who received bovactant, 10 (32.2%) beractant and 14 (45.2%) with poractant alpha (p > 0.05). Conclusions: The primary and secondary outcomes among the three surfactants tested were similar, taking into account the limitations of the work.