Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study

Objective To investigate whether pre-eclampsia is more common in first pregnancies solely because fewer affected women, who presumably have a higher risk of recurrence, go on to have subsequent pregnancies

Infective endocarditis and cancer in the elderly

Little is known about the magnitude of the association between infective endocarditis and cancer, and about the natural history of cancer patients with concomitant diagnosis of infective endocarditis. We used the SEER-Medicare linked database to identify individuals aged 65 years or more diagnosed with colorectal, lung, breast, or prostate cancer, and without any cancer diagnosis (5 % random Medicare sample from SEER areas) between 1992 and 2009. We identified infective endocarditis from the ICD-9 diagnosis of each admission recorded in the Medpar file and its incidence rate 90 days around cancer diagnosis. We also estimated the overall survival and CRC-specific survival after a concomitant diagnosis of infective endocarditis. The peri-diagnostic incidence of infective endocarditis was 19.8 cases per 100,000 person-months for CRC, 5.7 cases per 100,000 person-months for lung cancer, 1.9 cases per 100,000 person-months for breast cancer, 4.1 cases per 100,000 person-months for prostate cancer and 2.4 cases per 100,000 person-months for individuals without cancer. Two-year overall survival was 46.4 % (95 % CI 39.5, 54.5 %) for stage I–III CRC patients with concomitant endocarditis and 73.1 % (95 % CI 72.9, 73.3 %) for those without it. In this elderly population, the incidence of infective endocarditis around CRC diagnosis was substantially higher than around the diagnosis of lung, breast and prostate cancers. A concomitant diagnosis of infective endocarditis in patients with CRC diagnosis is associated with shorter survival

Actualización de material docente basado en Jupyter Notebook para su uso dentro del Plan de Internacionalización

La iniciativa de este proyecto viene justificada a la vista del gran interés generado por algunos de los materiales docentes diseñados por nuestro grupo en anteriores proyectos, en los que se vienen desarrollando diferentes herramientas docentes basadas en el uso de Jupyter Notebooks. A la vista del impacto generado, y teniendo en cuenta que la evolución del proyecto Jupyter, así como las aplicaciones de distintas herramientas asociadas a Jupyter Notebook, es continua, nos planteamos como objetivo principal del presente proyecto la actualización y la puesta a disposición en inglés de nuestra producción de los últimos años

Hypertension in Women of Reproductive Age in the United States: NHANES 1999-2008

Objective: To examine the epidemiology of hypertension in women of reproductive age. Methods: Using NHANES from 1999–2008, we identified 5,521 women age 20–44 years old. Hypertension status was determined using blood pressure measurements and/or self-reported medication use. Results: The estimated prevalence of hypertension in women of reproductive age was 7.7% (95% confidence interval (CI): 6.9%–8.5%). The prevalence of anti-hypertensive pharmacologic therapy was 4.2% (95% CI 3.5%–4.9%). The prevalence of hypertension was relatively stable across the study period; the age and race adjusted odds of hypertension in 2007–2008 did not differ significantly from 1999–2000 (odds ratio 1.2, CI 0.8 to 1.7, p = 0.45). Significant independent risk factors associated with hypertension included older age, non-Hispanic black race (compared to non-Hispanic whites), diabetes mellitus, chronic kidney disease, and higher body mass index. The most commonly used antihypertensive medications included diuretics, angiotensin-converting enzyme inhibitors (ACE), and beta blockers. Conclusion: Hypertension occurs in about 8% of women of reproductive age. There are remarkable differences in the prevalence of hypertension between racial/ethnic groups. Obesity is a risk factor of particular importance in this population because it affects over 30% of young women in the U.S., is associated with more than 4 fold increased risk of hypertension, and is potentially modifiable

O gerenciamento de casos como uma oportunidade para a área da saúde: experiências do usuário

Highlights: Case management allows nurses to have visibility of their professional role, where personalized education, care plan and timely communication. Case management must consider the dyad: person with chronic disease and family caregiver (may be a principal) to reconcile the care plan and agree on therapeutic goals. The care encounter is characterized by a 40-minute assessment, a visit from 30 minutes to 2 hours, and subsequent follow-up meetings on demand. Technological tools are an important part of the implementation of case management in nursing. Introduction: People with multimorbidity and their caregivers are beginning to be recognized as emerging subjects of health systems.  In Colombia there is no differentiated approach to care for this population, as well as its health-disease process.  Objective: To understand the experience of people with multimorbidity and their caregivers after receiving a case management intervention.  Methods and materials: It is a qualitative study in which 33 participants among people with multimorbidity and their caregivers who received intervention with case managers were interviewed, a comparative analysis and use to tools analytics grounded theory. Results: There are 3 dimensions that are, the actors where nursing becomes relevant as a reliable source of care; the Care Meeting, as a space created within case management to maintain trust and; Results in the health system, where the need to integrate this type of outbreak into the Colombian Health Model is confirmed. Discussion: Complementary qualitative evidence data from the central study with a greater impact on the quality of care through the therapeutic relationship at home. Conclusion: The dyad requires home support for self-management of the disease based on trust, empathy, empowerment and administrative management carried out by case managers. How to cite this article: Chaparro-Diaz, Lorena; Valbuena-Castiblanco, Cindy Lorena; Carreño-Moreno, Sonia; Hernández-Zambrano, Sandra Milena; Carrillo-Algarra, Ana Julia. Case management as an opportunity for healthcare: user experiences. Revista Cuidarte. 2023;14(3):e2923. http://dx.doi.org/10.15649/cuidarte.2923Introducción: Las personas con multimorbilidad y sus cuidadores empiezan a ser reconocidos como sujetos emergentes en los sistemas de salud. En Colombia no existe un abordaje diferenciado para la atención de esta población, así como de su proceso de salud-enfermedad. Objetivo:  Entender las experiencias de personas con multimorbilidad y sus cuidadores tras recibir una intervención de gestión de casos. Materiales y métodos: Estudio cualitativo en el que se entrevistó a 33 participantes con multimorbilidad y sus cuidadores que recibieron una intervención por parte de gestores de casos; se realizó un análisis comparativo y se utilizaron herramientas analíticas de la teoría fundamentada. Resultados: Existen tres dimensiones: los actores, donde la enfermería cobra relevancia como fuente confiable de cuidado; la reunión de atención o cuidado, como un espacio creado en la gestión de casos para mantener la confianza; y resultados en el sistema de salud, donde se confirma la necesidad de integrar este tipo de avance en el modelo de salud colombiano. Discusión: Los datos cualitativos complementarios del estudio central evidencian un mayor impacto en la calidad del cuidado a través de la relación terapéutica en el hogar. Conclusión: La díada requiere acompañamiento domiciliario para la autogestión de la enfermedad que esté basado en la confianza, la empatía, el empoderamiento y la gestión administrativa llevada a cabo por los gestores de casos.    Como citar este artículo: Chaparro-Diaz, Lorena; Valbuena-Castiblanco, Cindy Lorena; Carreño-Moreno, Sonia; Hernández-Zambrano, Sandra Milena; Carrillo-Algarra, Ana Julia. Case management as an opportunity for healthcare: user experiences. Revista Cuidarte. 2023;14(3):e2923. http://dx.doi.org/10.15649/cuidarte.2923Introdução: As pessoas com multimorbidade e seus cuidadores estão começando a ser reconhecidos como sujeitos emergentes dos sistemas de saúde.  Na Colômbia, não há uma abordagem diferenciada para o atendimento dessa população, bem como para seu processo saúde-doença.  Objetivo: Compreender a experiência de pessoas com multimorbidade e seus cuidadores após receberem uma intervenção de gerenciamento de casos.  Métodos e materiais: Trata-se de um estudo qualitativo no qual foram entrevistados 33 participantes entre pessoas com multimorbidade e seus cuidadores que receberam intervenção com gerentes de caso, uma análise comparativa e o uso de ferramentas analíticas da teoria fundamentada. Resultados: Existem três dimensões que são: os atores onde a enfermagem se torna relevante como uma fonte confiável de cuidados; a Reunião de Cuidados, como um espaço criado dentro do gerenciamento de casos para manter a confiança e; Resultados no sistema de saúde, onde a necessidade de integrar esse tipo de surto no modelo de saúde colombiano é confirmada.  Discussão: Dados complementares de evidências qualitativas do estudo central com maior impacto na qualidade do atendimento por meio da relação terapêutica no domicílio.  Conclusão: A díade requer apoio domiciliar para o autogerenciamento da doença com base na confiança, empatia, empoderamento e gerenciamento administrativo realizado pelos gerentes de caso. Como citar este artigo: Chaparro-Diaz, Lorena; Valbuena-Castiblanco, Cindy Lorena; Carreño-Moreno, Sonia; Hernández-Zambrano, Sandra Milena; Carrillo-Algarra, Ana Julia. Case management as an opportunity for healthcare: user experiences. Revista Cuidarte. 2023;14(3):e2923. http://dx.doi.org/10.15649/cuidarte.292

Harnessing the Medicaid Analytic eXtract (MAX) to Evaluate Medications in Pregnancy: Design Considerations

Background: In the absence of clinical trial data, large post-marketing observational studies are essential to evaluate the safety and effectiveness of medications during pregnancy. We identified a cohort of pregnancies ending in live birth within the 2000–2007 Medicaid Analytic eXtract (MAX). Herein, we provide a blueprint to guide investigators who wish to create similar cohorts from healthcare utilization data and we describe the limitations in detail. Methods: Among females ages 12–55, we identified pregnancies using delivery-related codes from healthcare utilization claims. We linked women with pregnancies to their offspring by state, Medicaid Case Number (family identifier) and delivery/birth dates. Then we removed inaccurate linkages and duplicate records and implemented cohort eligibility criteria (i.e., continuous and appropriate enrollment type, no private insurance, no restricted benefits) for claim information completeness. Results: From 13,460,273 deliveries and 22,408,810 child observations, 6,107,572 pregnancies ending in live birth were available after linkage, cleaning, and removal of duplicate records. The percentage of linked deliveries varied greatly by state, from 0 to 96%. The cohort size was reduced to 1,248,875 pregnancies after requiring maternal eligibility criteria throughout pregnancy and to 1,173,280 pregnancies after further applying infant eligibility criteria. Ninety-one percent of women were dispensed at least one medication during pregnancy. Conclusions: Mother-infant linkage is feasible and yields a large pregnancy cohort, although the size decreases with increasing eligibility requirements. MAX is a useful resource for studying medications in pregnancy and a spectrum of maternal and infant outcomes within the indigent population of women and their infants enrolled in Medicaid. It may also be used to study maternal characteristics, the impact of Medicaid policy, and healthcare utilization during pregnancy. However, careful attention to the limitations of these data is necessary to reduce biases

Identification of Phthalates in Medications and Dietary Supplement Formulations in the United States and Canada

Background: In animal studies, some ortho-phthalates, including di(2-ethylhexyl) phthalate (DEHP) and di-n-butyl phthalate (DBP), have been shown to be reproductive and developmental toxicants. Human studies show widespread population exposure to background levels of phthalates. Limited evidence suggests that particularly high exposure levels may result from orally ingested medicinal products containing phthalates as excipients (inactive ingredients)

Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States

Objective: To determine whether use of serotonin or non-serotonin reuptake inhibitors near to delivery is associated with postpartum hemorrhage. Design Cohort study. Setting 2000-07 nationwide Medicaid data (Medicaid Analytic eXtract). Population 106 000 pregnant women aged 12-55 with a diagnosis of mood or anxiety disorder. Women were categorized into four mutually exclusive exposure groups according to pharmacy dispensing data: current (delivery date), recent (1-30 days before delivery date), past (1-5 months before delivery date), and no exposure (reference group). Main outcome measures Risk of postpartum hemorrhage by timing of exposure and by serotonin or non-serotonin reuptake inhibitors, classes of antidepressant, and antidepressant types. Relative risks and 95% confidence intervals adjusted for delivery year, risk factors for postpartum hemorrhage, indicators of severity of mood/anxiety disorder, other indications for antidepressants, and other drugs. High dimensional propensity score (hdPS) methods were used to empirically identify and adjust for additional factors. Results: 12 710 (12%) women had current exposure to serotonin reuptake inhibitor monotherapy, and 1495 (1.4%) women had current exposure to non-serotonin reuptake inhibitor monotherapy. The risk of postpartum hemorrhage was 2.8% among women with mood/anxiety disorders but no exposure to antidepressants, 4.0% in the current users of serotonin reuptake inhibitors, 3.8% in the current users of non-serotonin reuptake inhibitors, 3.2% in the recent users of serotonin reuptake inhibitors, 3.1% in the recent users of non-serotonin reuptake inhibitors, 2.5% in the past users of serotonin reuptake inhibitors, and 3.4% in the past users of non-serotonin reuptake inhibitors. Compared with no exposure, women with current exposure to serotonin reuptake inhibitors had a 1.47-fold increased risk of postpartum hemorrhage (95% confidence interval 1.33 to 1.62) and women with current non-serotonin reuptake inhibitor exposure had a 1.39-fold increased risk (1.07 to 1.81). Results were similar with hdPS adjustment. Women with current exposure to serotonin reuptake inhibitors had an adjusted excess risk of 1.26% (0.90% to 1.62%), with a number needed to harm of 80, and for women with current exposure to non-serotonin reuptake inhibitors the excess risk was 1.03% (0.07% to 1.99%), with a number needed to harm of 97. For exposure to serotonin reuptake inhibitors the relative risk was 1.19 (1.03 to 1.38) for recent exposure and 0.93 (0.82 to 1.06) for past exposure; for non-serotonin reuptake inhibitors the figures were 1.17 (0.80 to 1.70) and 1.26 (1.00 to 1.59), respectively. Current exposure to selective serotonin reuptake inhibitor monotherapy was also associated with postpartum hemorrhage (1.42, 1.27 to 1.57), as was current serotonin norepinephrine (noradrenaline) reuptake inhibitor (1.90, 1.37 to 2.63) and tricyclic monotherapy (1.77, 0.90 to 3.47). All types of selective serotonin reuptake inhibitors available for analysis and venlafaxine, a serotonin norepinephrine reuptake inhibitor, were significantly associated with postpartum hemorrhage. Conclusions: Exposure to serotonin and non-serotonin reuptake inhibitors, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclics, close to the time of delivery was associated with a 1.4 to 1.9-fold increased risk for postpartum hemorrhage. While potential confounding by unmeasured factors cannot be ruled out, these findings suggest that patients treated with antidepressants during late pregnancy are more likely to experience postpartum hemorrhage

Incidence of COVID-19 in Children and Young People Who Play Federated Football

[Abstract] Aim: To determine the incidence of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection in children and young people who play federated football. Methods: Prospective study, from October 2020 to January 2021, in players aged 4 to 19 years from federated football clubs in Galicia, Spain (N = 23,845). Outbreaks and cases of SARS-CoV-2 infection were recorded. The cumulative incidence was compared with the incidence registered in Galicia in the same age range. Results: The cumulative incidence was 29.8 cases per 10,000 licenses in 4 months, lower than the incidence registered in the general population for all ages and both sexes (283.7 per 10,000 inhabitants; rate ratio = 9.5). It was higher in January (40.7 per 10,000), coinciding with the population peak. More cases were registered in futsal (42.9 vs 27.5 per 10,000) and competitions with periodic screenings (127.4 vs 9.1 per 10,000). There were 2 outbreaks in 2389 teams (0.08%). Conclusion: The results support the safety of football practice in children and young people with prevention protocols