Validity of ICD-9 and ICD-10 codes used to identify acute liver injury: a study in three European data sources

This is the peer reviewed version of the following article: Forns, J. [et al.]. Validity of ICD-9 and ICD-10 codes used to identify acute liver injury: a study in three European data sources. "Pharmacoepidemiology and drug safety", 6 Juny 2019, vol. 28, núm. 7, p. 965-975, which has been published in final form at 10.1002/pds.4803. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."Purpose Validating cases of acute liver injury (ALI) in health care data sources is challenging. Previous validation studies reported low positive predictive values (PPVs). Methods Case validation was undertaken in a study conducted from 2009 to 2014 assessing the risk of ALI in antidepressants users in databases in Spain (EpiChron and SIDIAP) and the Danish National Health Registers. Three ALI definitions were evaluated: primary (specific hospital discharge codes), secondary (specific and nonspecific hospital discharge codes), and tertiary (specific and nonspecific hospital and outpatient codes). The validation included review of patient profiles (EpiChron and SIDIAP) and of clinical data from medical records (EpiChron and Denmark). ALI cases were confirmed when liver enzyme values met a definition by an international working group. Results Overall PPVs (95% CIs) for the study ALI definitions were, for the primary ALI definition, 84% (60%-97%) (EpiChron), 60% (26%-88%) (SIDIAP), and 74% (60%-85%) (Denmark); for the secondary ALI definition, 65% (45%-81%) (EpiChron), 40% (19%-64%) (SIDIAP), and 70% (64%-77%) (Denmark); and for the tertiary ALI definition, 25% (18%-34%) (EpiChron), 8% (7%-9%) (SIDIAP), and 47% (42%-52%) (Denmark). The overall PPVs were higher for specific than for nonspecific codes and for hospital discharge than for outpatient codes. The nonspecific code “unspecified jaundice” had high PPVs in Denmark. Conclusions PPVs obtained apply to patients using antidepressants without preexisting liver disease or ALI risk factors. To maximize validity, studies on ALI should prioritize hospital specific discharge codes and should include hospital codes for unspecified jaundice. Case validation is required when ALI outpatient cases are considered.Peer ReviewedPostprint (author's final draft

Factors Associated With Sexual Risk Behaviour Among Young People In Catalonia

Background: Sexual behavior in young people is influenced by external factors that may increase their vulnerability. Objective: to describe sexual behavior and other indicators of sexual and reproductive health among young people (16 to 24 years) in Catalonia and to identify factors associated with sexual risk behaviors. Methods: Cross-sectional study in 2012 carried out by an online survey from a panel of population (n=800). Factors associated with not using a condom at last sexual intercourse were evaluated using multivariate logistic regression models. Results: 76.1% of boys and 83.3% of girls reported having had complete sexual intercourse (p=0.012). The proportion of boys and girls who reported casual partners was 39.7% and 22.5%, respectively. 31.4% of boys and 10.3% of girls reported having contacted partners through Internet. Not using a condom at first sexual intercourse showed significant association with reporting not using a condom in the last sexual intercourse, for both, boys (OR=2.50) and girls (OR=3.18). Having contacted partners through the Internet (OR=2.29) was associated with this risky sexual behavior in boys, and having used the emergency contraception 3 or more times (OR=3.38) was associated in girls. Conclusions: There are differences in the sexual behavior of young people by sex, being condom use at first sexual relationship a good predictor of condom use at last sexual intercourse. Boys show a higher number of casual partners than girls, as well as a higher use of the Internet to contact sexual partners

The dynamic DNA methylomes of double-stranded DNA viruses associated with human cancer

The natural history of cancers associated with virus exposure is intriguing, since only a minority of human tissues infected with these viruses inevitably progress to cancer. However, the molecular reasons why the infection is controlled or instead progresses to subsequent stages of tumorigenesis are largely unknown. In this article, we provide the first complete DNA methylomes of double-stranded DNA viruses associated with human cancer that might provide important clues to help us understand the described process. Using bisulfite genomic sequencing of multiple clones, we have obtained the DNA methylation status of every CpG dinucleotide in the genome of the Human Papilloma Viruses 16 and 18 and Human Hepatitis B Virus, and in all the transcription start sites of the Epstein-Barr Virus. These viruses are associated with infectious diseases (such as hepatitis B and infectious mononucleosis) and the development of human tumors (cervical, hepatic, and nasopharyngeal cancers, and lymphoma), and are responsible for 1 million deaths worldwide every year. The DNA methylomes presented provide evidence of the dynamic nature of the epigenome in contrast to the genome. We observed that the DNA methylome of these viruses evolves from an unmethylated to a highly methylated genome in association with the progression of the disease, from asymptomatic healthy carriers, through chronically infected tissues and pre-malignant lesions, to the full-blown invasive tumor. The observed DNA methylation changes have a major functional impact on the biological behavior of the viruses

Guía de cribado del cáncer de cuello de útero en España, 2014

Justificación de la Guía de cribado del cáncer de cuello de útero en España, 2014 El cáncer de cuello uterino (CCU) es la tercera neoplasia más frecuente en el mundo en las mujeres. El cribado de mujeres sanas mediante citología cervical ha demostrado claramente su eficacia, puesto que su aplicación de forma adecuada y sistemática en determinados países ha conseguido reducir en un 70-80% la incidencia y mortalidad por CCU. Este beneficio se debe a la detección de lesiones premalignas asintomáticas cuyo diagnóstico y tratamiento evita su progresión a carcinoma invasor..

Factors Associated With Sexual Risk Behaviour Among Young People In Catalonia

Background: Sexual behavior in young people is influenced by external factors that may increase their vulnerability. Objective: to describe sexual behavior and other indicators of sexual and reproductive health among young people (16 to 24 years) in Catalonia and to identify factors associated with sexual risk behaviors. Methods: Cross-sectional study in 2012 carried out by an online survey from a panel of population (n=800). Factors associated with not using a condom at last sexual intercourse were evaluated using multivariate logistic regression models. Results: 76.1% of boys and 83.3% of girls reported having had complete sexual intercourse (p=0.012). The proportion of boys and girls who reported casual partners was 39.7% and 22.5%, respectively. 31.4% of boys and 10.3% of girls reported having contacted partners through Internet. Not using a condom at first sexual intercourse showed significant association with reporting not using a condom in the last sexual intercourse, for both, boys (OR=2.50) and girls (OR=3.18). Having contacted partners through the Internet (OR=2.29) was associated with this risky sexual behavior in boys, and having used the emergency contraception 3 or more times (OR=3.38) was associated in girls. Conclusions: There are differences in the sexual behavior of young people by sex, being condom use at first sexual relationship a good predictor of condom use at last sexual intercourse. Boys show a higher number of casual partners than girls, as well as a higher use of the Internet to contact sexual partners

Determinantes de las conductas sexuales de riesgo en jovenes de Cataluña

Background: Sexual behavior in young people is influenced by external factors that may increase their vulnerability. Objective: to describe sexual behavior and other indicators of sexual and reproductive health among young people (16 to 24 years) in Catalonia and to identify factors associated with sexual risk behaviors. Methods: Cross-sectional study in 2012 carried out by an online survey from a panel of population (n=800). Factors associated with not using a condom at last sexual intercourse were evaluated using multivariate logistic regression models. Results: 76.1% of boys and 83.3% of girls reported having had complete sexual intercourse (p=0.012). The proportion of boys and girls who reported casual partners was 39.7% and 22.5%, respectively. 31.4% of boys and 10.3% of girls reported having contacted partners through Internet. Not using a condom at first sexual intercourse showed significant association with reporting not using a condom in the last sexual intercourse, for both, boys (OR= 2.50) and girls (OR= 3.18). Having contacted partners through the Internet (OR=2.29) was associated with this risky sexual behavior in boys, and having used the emergency contraception 3 or more times (OR=3.38) was associated in girls. Conclusions: There are differences in the sexual behavior of young people by sex, being condom use at first sexual relationship a good predictor of condom use at last sexual intercourse. Boys show a higher number of casual partners than girls, as well as a higher use of the Internet to contact sexual partners.Fundamentos: La conducta sexual en jóvenes se ve influida por factores externos que pueden favorecer una disminución del control de la situación y mayor desprotección. Objetivo: describir y comparar según sexo la conducta sexual y otros indicadores de salud sexual y reproductiva en jóvenes (16-24 años) en Cataluña e identificar factores asociados a las conductas sexuales de riesgo. Métodos: Estudio transversal realizado en 2012 mediante encuesta en línea a partir de un panel de población (n=800). Se identificaron factores asociados al no uso del preservativo (no UP) en la última relación sexual con penetración (RS) mediante modelos de regresión logística multivariantes. Resultados: El 76,1% de los chicos y el 83,3% de las chicas declararon RS alguna vez (p=0,012). El 39,7% de los chicos y el 22,5% de las chicas tuvieron parejas ocasionales, siendo el uso de Internet para contactar parejas del 31,4% y 10,3%, respectivamente. Entre los factores asociados al no UP durante la última RS destacó no haber usado preservativo en la primera RS (OR=2,50 en chicos y OR=3,18 en chicas). Haber contactado parejas sexuales por Internet se mostró asociado en chicos (OR=2,29) y haber usado la anticoncepción de emergencia ≥3 veces en chicas (OR=3,38). Conclusiones: Se observan diferencias en la conducta sexual de los jóvenes según sexo, siendo el uso del preservativo en la primera relación sexual un buen predictor de su uso en la última. Los chicos presentan mayor número de parejas ocasionales que las chicas y utilizan más las nuevas tecnologías de la información para contactar estas parejas

Determinantes de las conductas sexuales de riesgo en jovenes de Cataluña

Fundamentos: La conducta sexual en jóvenes se ve influida por factores externos que pueden favorecer una disminución del control de la situación y mayor desprotección. Objetivo: describir y comparar según sexo la conducta sexual y otros indicadores de salud sexual y reproductiva en jóvenes (16-24 años) en Cataluña e identificar factores asociados a las conductas sexuales de riesgo. Métodos: Estudio transversal realizado en 2012 mediante encuesta en línea a partir de un panel de población (n=800). Se identificaron factores asociados al no uso del preservativo (no UP) en la última relación sexual con penetración (RS) mediante modelos de regresión logística multivariantes. Resultados: El 76,1% de los chicos y el 83,3% de las chicas declararon RS alguna vez (p=0,012). El 39,7% de los chicos y el 22,5% de las chicas tuvieron parejas ocasionales, siendo el uso de Internet para contactar parejas del 31,4% y 10,3%, respectivamente. Entre los factores asociados al no UP durante la última RS destacó no haber usado preservativo en la primera RS (OR=2,50 en chicos y OR=3,18 en chicas). Haber contactado parejas sexuales por Internet se mostró asociado en chicos (OR=2,29) y haber usado la anticoncepción de emergencia ≥3 veces en chicas (OR=3,38). Conclusiones: Se observan diferencias en la conducta sexual de los jóvenes según sexo, siendo el uso del preservativo en la primera relación sexual un buen predictor de su uso en la última. Los chicos presentan mayor número de parejas ocasionales que las chicas y utilizan más las nuevas tecnologías de la información para contactar estas parejas

Validity of ICD-9 and ICD-10 codes used to identify acute liver injury: A study in three European data sources

Acute liver injury; Antidepressants; PharmacoepidemiologyLesió hepàtica aguda; Antidepressius; FarmacoepidemiologiaLesión hepática aguda; Antidepresivos; FarmacoepidemiologíaPURPOSE: Validating cases of acute liver injury (ALI) in health care data sources is challenging. Previous validation studies reported low positive predictive values (PPVs). METHODS: Case validation was undertaken in a study conducted from 2009 to 2014 assessing the risk of ALI in antidepressants users in databases in Spain (EpiChron and SIDIAP) and the Danish National Health Registers. Three ALI definitions were evaluated: primary (specific hospital discharge codes), secondary (specific and nonspecific hospital discharge codes), and tertiary (specific and nonspecific hospital and outpatient codes). The validation included review of patient profiles (EpiChron and SIDIAP) and of clinical data from medical records (EpiChron and Denmark). ALI cases were confirmed when liver enzyme values met a definition by an international working group. RESULTS: Overall PPVs (95% CIs) for the study ALI definitions were, for the primary ALI definition, 84% (60%-97%) (EpiChron), 60% (26%-88%) (SIDIAP), and 74% (60%-85%) (Denmark); for the secondary ALI definition, 65% (45%-81%) (EpiChron), 40% (19%-64%) (SIDIAP), and 70% (64%-77%) (Denmark); and for the tertiary ALI definition, 25% (18%-34%) (EpiChron), 8% (7%-9%) (SIDIAP), and 47% (42%-52%) (Denmark). The overall PPVs were higher for specific than for nonspecific codes and for hospital discharge than for outpatient codes. The nonspecific code "unspecified jaundice" had high PPVs in Denmark. CONCLUSIONS: PPVs obtained apply to patients using antidepressants without preexisting liver disease or ALI risk factors. To maximize validity, studies on ALI should prioritize hospital specific discharge codes and should include hospital codes for unspecified jaundice. Case validation is required when ALI outpatient cases are considered

Validity of ICD-9 and ICD-10 codes used to identify acute liver injury: a study in three European data sources

This is the peer reviewed version of the following article: Forns, J. [et al.]. Validity of ICD-9 and ICD-10 codes used to identify acute liver injury: a study in three European data sources. "Pharmacoepidemiology and drug safety", 6 Juny 2019, vol. 28, núm. 7, p. 965-975, which has been published in final form at 10.1002/pds.4803. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."Purpose Validating cases of acute liver injury (ALI) in health care data sources is challenging. Previous validation studies reported low positive predictive values (PPVs). Methods Case validation was undertaken in a study conducted from 2009 to 2014 assessing the risk of ALI in antidepressants users in databases in Spain (EpiChron and SIDIAP) and the Danish National Health Registers. Three ALI definitions were evaluated: primary (specific hospital discharge codes), secondary (specific and nonspecific hospital discharge codes), and tertiary (specific and nonspecific hospital and outpatient codes). The validation included review of patient profiles (EpiChron and SIDIAP) and of clinical data from medical records (EpiChron and Denmark). ALI cases were confirmed when liver enzyme values met a definition by an international working group. Results Overall PPVs (95% CIs) for the study ALI definitions were, for the primary ALI definition, 84% (60%-97%) (EpiChron), 60% (26%-88%) (SIDIAP), and 74% (60%-85%) (Denmark); for the secondary ALI definition, 65% (45%-81%) (EpiChron), 40% (19%-64%) (SIDIAP), and 70% (64%-77%) (Denmark); and for the tertiary ALI definition, 25% (18%-34%) (EpiChron), 8% (7%-9%) (SIDIAP), and 47% (42%-52%) (Denmark). The overall PPVs were higher for specific than for nonspecific codes and for hospital discharge than for outpatient codes. The nonspecific code “unspecified jaundice” had high PPVs in Denmark. Conclusions PPVs obtained apply to patients using antidepressants without preexisting liver disease or ALI risk factors. To maximize validity, studies on ALI should prioritize hospital specific discharge codes and should include hospital codes for unspecified jaundice. Case validation is required when ALI outpatient cases are considered.Peer Reviewe