scholarly journals Recurrence of WHO-defined fast breathing pneumonia among infants, its occurrence and predictors in Pakistan: a nested case–control analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e035277
Author(s):  
Nick Brown ◽  
Arjumand Rizvi ◽  
Salima Kerai ◽  
Muhammad Imran Nisar ◽  
Najeeb Rahman ◽  
...  
Keyword(s):  
Air Quality ◽  
Nutritional Status ◽  
Indoor Air ◽  
Low Income ◽  
Conditional Logistic Regression ◽  
Randomised Trial ◽  
Poor Quality ◽  
Case Control ◽  
Urban Setting ◽  
Control Analysis

ObjectivesStudies in low-income and middle-income countries have shown an adverse association between environmental exposures including poverty. There is little literature from South Asia. We aimed to test the associations between housing, indoor air pollution and children’s respiratory health and recurrent fast breathing pneumonia in a poor urban setting in Pakistan.SettingPrimary health centres in a periurban slum in Karachi, Pakistan.MethodsNested matched case–control study within a non-inferiority randomised controlled trial of fast breathing pneumonia (Randomised Trial of Amoxicillin vs Placebo for Pneumonia (RETAPP)) in periurban slums of Karachi, Pakistan. Cases were children aged 2–60 months enrolled in RETAPP with fast breathing pneumonia who presented again with fast breathing between 8 weeks and 12 months after full recovery. Controls, selected in a 2:1 ratio, were age-matched participants who did not represent. Multivariable conditional logistic regression analysis was undertaken to explore associations with potentially modifiable environmental predictors including housing type, indoor air quality, exposure to tobacco smoke, outdoor pollution, household crowding, water and sanitation quality, nutritional status, immunisation completeness, breast feeding and airways hyperactivity.ResultsFast breathing recurred in 151 (3.7%) of children out of the total (4003) enrolled in the trial. Poor-quality housing of either katcha or mixed type strongly predicted recurrence with adjusted matched ORs 2.43 (95% CI 1.02 to 5.80) and 2.44 (1.11 to 5.38), respectively. Poor air quality, cooking fuel, inadequate ventilation, nutritional status, water, sanitation and hygiene (WASH) index, wheeze at first presentation and group of initial trial assignment were not independently predictive of recurrence.ConclusionPoor-quality housing independently predicted recurrence of fast breathing pneumonia.Trial registration numberNCT02372461

Thermal comfort and indoor air quality in low-income housing in Spain: The influence of airtightness and occupant behaviour

2019 ◽  
Vol 199 ◽  
pp. 102-114 ◽  
Author(s):  
Jesica Fernández-Agüera ◽  
Samuel Domínguez-Amarillo ◽  
Carmen Alonso ◽  
Fernando Martín-Consuegra
Keyword(s):  
Air Quality ◽  
Thermal Comfort ◽  
Indoor Air Quality ◽  
Indoor Air ◽  
Low Income ◽  
Occupant Behaviour ◽  
Low Income Housing

ACE inhibitor use and risk of cataract: a case–control analysis

2019 ◽  
Vol 103 (11) ◽  
pp. 1561-1565 ◽  
Author(s):  
Claudia Becker ◽  
Susan S Jick ◽  
Christoph R Meier
Keyword(s):  
Observational Study ◽  
Index Date ◽  
Antihypertensive Drugs ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Sensitivity Analyses ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Control Analysis ◽  
Increased Risk

Background/AimUse of ACE inhibitors (ACEIs) has been associated with an increased risk of cataract in a previous observational study in humans. In contrast, ACEIs were associated with beneficial effects on cataract development in experimental studies. We assessed the risk of cataract in relation to exposure to ACEI and other antihypertensive drugs.MethodsThis is a case-control study based on data from the UK-based Clinical Practice Research Datalink (CPRD). We included first-time cataract patients aged ≥40 years between 1995 and 2015 and an equal number of cataract-free controls. We matched the controls to cases on age, sex, general practice, date of first cataract (ie, index date) and years of history in the CPRD prior to the index date. We assessed the number of prescriptions for ACEI and other antihypertensive drugs in detail and explored the use of single ACEI substances. We performed conditional logistic regression and conducted various sensitivity analyses to test the robustness of our findings. We calculated the risk of cataract associated with previous exposure to ACEI, measured as OR with 95% CIs, and adjusted the multivariable model for body mass index, smoking, diabetes, hypertension, prescriptions of systemic corticosteroids and other antihypertensive drugs.ResultsWe identified 206 931 cataract cases and the same number of matched controls. Use of ACEI was not associated with a materially altered risk of cataract compared with non-use of ACEI, neither in the main analysis (OR 1.06, 95% CI 1.04 to 1.08) nor in any of the sensitivity or stratified analyses.ConclusionIn our large observational study, use of ACEI was not associated with an altered risk of cataract.

scholarly journals Delivering integrated hypertension care at private health facilities in urban Pakistan: a process evaluation

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101613 ◽  
Author(s):  
Muhammad Amir Khan ◽  
John D Walley ◽  
Nida Khan ◽  
Muhammad Ahmar Khan ◽  
Saima Ali ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Low Income ◽  
Service Providers ◽  
Randomised Trial ◽  
Lifestyle Changes ◽  
Urban Setting ◽  
Care Providers ◽  
Care Intervention ◽  
Low Middle Income Countries ◽  
Clinical Records

BackgroundIn Pakistan about 18% of all adults are affected by hypertension, and only one in eight of the prevalent cases have their hypertension controlled. As in many other low-middle income countries, a public–private partnership approach is being considered for delivering non-communicable disease care in urban areas.AimThis process evaluation was undertaken to understand how an integrated care intervention was experienced by the care providers and patients, and to inform modifications before possible scaling.Design & settingThe mixed-methods study was conducted as part of a cluster randomised trial on integrated hypertension care at 26 private clinics.MethodThe care practices were assessed by analysing the clinical records of 1138 registered patients with hypertension. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data.ResultsDistrict-led objective selection and context-sensitive staff training helped to get the clinics engaged in partnership working. About one-third of patients with hypertension had associated diabetes or renal compromise. The prescription of drugs is influenced by multiple non-clinical considerations of providers and patients. Many doctors allowed the use of home-based remedies as supplements to the prescribed allopathic drugs. Female patients faced more challenges in managing lifestyle changes. The intervention improved adherence to follow-up visits, but patient attrition remained a challenge.ConclusionThe integrated hypertension care intervention at private clinics is feasible, and leads to improved diagnosis and treatment in low-income country urban setting. The authors recommend continued implementation research and informed scaling of hypertension care at private clinics.

scholarly journals Association between glycemic control and risk of venous thromboembolism in diabetic patients: a nested case–control study

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah H. R. Charlier ◽  
Christian Meier ◽  
Susan S. Jick ◽  
Christoph R. Meier ◽  
Claudia Becker
Keyword(s):  
Venous Thromboembolism ◽  
Glycemic Control ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Diabetic Patients ◽  
Control Analysis ◽  
Using Data ◽  
Nested Case Control ◽  
The Impact ◽  
Hba1c Levels

Abstract Background Previous studies suggested an elevated risk of venous thromboembolism (VTE) among patients with type 2 diabetes mellitus (T2DM), with a possible sex difference. The impact of glycemic control on the risk of VTE is unclear. Our objective was to analyze the association between glycemic control and the risk of unprovoked (idiopathic) VTE in men and women with T2DM. Methods We conducted a nested case–control analysis (1:4 matching) within a cohort of patients with incident T2DM between 1995 and 2019 using data from the CPRD GOLD. We excluded patients with known risk factors for VTE prior to onset of DM. Cases were T2DM patients with an unprovoked treated VTE. The exposure of interest was glycemic control measured as HbA1c levels. We conducted conditional logistic regression analyses adjusted for several confounders. Results We identified 2′653 VTE cases and 10′612 controls (53.1% females). We found no association between the HbA1c level and the risk of VTE in our analyses. However, when the most recent HbA1c value was recorded within 90 days before the index date, women with HbA1c levels > 7.0% had a 36–55% increased relative risk of VTE when compared to women with HbA1c > 6.5–7.0%. Conclusions Our study raises the possibility that female T2DM patients with HbA1c levels > 7% may have a slightly higher risk for unprovoked VTE compared to women with HbA1c levels > 6.5–7.0%. This increase may not be causal and may reflect differences in life style or other characteristics. We observed no effect of glycemic control on the risk of VTE in men.

Matched case control analysis of breast cancer specific factors impacting risk of developing SARS-Cov-2 infection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18579-e18579
Author(s):  
Joanna Zurko ◽  
Aniko Szabo ◽  
Yee Chung Cheng ◽  
Sailaja Kamaraju ◽  
John Burfeind ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Triple Negative ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Control Analysis ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

e18579 Background: Patients with cancer have increased risk of developing SARS-Cov-2 (COVID-19) infection. It is unknown if characteristics related to breast cancer increase the risk of COVID-19 infection. In this retrospective matched case control study, we aim to identify breast cancer related risk factors associated with developing COVID-19 and describe outcomes of patients with breast cancer diagnosed with COVID-19. Methods: Women with breast cancer treated at the Medical College of Wisconsin and diagnosed with COVID-19 between March and December 2020 served as cases. Women with breast cancer without COVID-19 diagnosis within the same time frame were identified as potential controls. Controls were chosen by matching for age (≥60 vs <60), obesity (BMI <30 vs ≥30), county (Milwaukee vs suburban), race (white vs non-white) and diabetes mellitus (DM) with 3:1 matching planned. Univariate comparisons between cases and controls were done via Rao-Scott stratified chi-square test for categorical outcomes and stratified t-test for continuous variables. Conditional logistic regression was done to evaluate the joint effect of multiple characteristics on the odds of being a COVID-19 case. Results: Twenty-five cases and 77 controls were identified. All cases were fully matched by age, obesity, county, and race with 3 cases not able to be matched for DM. Mean age was 54.6 vs 54.9 (p=0.88), BMI 31.0 vs 31.6 (p=0.69), 48% lived in Milwaukee county and 68% were white (cases 24% black & 8% American Indian; controls 32% black). Regarding COVID outcomes, 24.0% (n=6) of cases were hospitalized, median length of stay was 2 days, 8% (n=2) needed oxygen, 4% (n=1) were intubated and 4% (n=1) died due to COVID-19. COVID-19 led to treatment delays in 40% of cases. On univariate analysis of cases vs controls, 64 vs 75% were ER/PR+ (p=0.31), 6.5 vs 5.2% HER2+ (p=0.34), and 9.0 vs 4.2% triple negative (p=0.10). There were no significant differences in breast cancer stage. At time of COVID diagnosis (or last clinic contact if control), 16 vs 14% had active disease (p=0.81), 72 vs 74% were on active treatment (p=0.85), with 21 vs 4% being on chemotherapy (p=0.007), and 44 vs 52% on endocrine therapy (p=0.49). On conditional logistic regression, being on active chemotherapy (OR 5.8, p=0.043) significantly increased the likelihood of developing COVID with a trend seen for triple negative disease (OR 2.8, p=0.12). Conclusions: In this matched case control study of patients with breast cancer, active chemotherapy was significantly associated with an increased likelihood of developing COVID-19 with a trend seen for triple negative disease. Rates of death due to COVID-19 were overall low. Our analysis was limited by small numbers and an inability to fully match patients for DM. These findings support continued strict precautions for those on active chemotherapy and warrants further analysis in those with triple negative disease.

scholarly journals The Nutritional Status at Six Months Isn't Associated to 6- 24 Month Child Mortality in the Supplementation Context: Case Control Matched Study from Rural Area of Burkina Faso

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1407-1407
Author(s):  
Franck Garanet
Keyword(s):  
Multivariate Analysis ◽  
Nutritional Status ◽  
Rural Area ◽  
Child Mortality ◽  
Conditional Logistic Regression ◽  
Child Death ◽  
Case Control ◽  
Food Supplementation ◽  
Birth Season ◽  
Significance Level

Abstract Objectives The death of children is a good indicator of health level and social development of country. In the context of food supplementation, the factors associated with child death remain little known.We examined the relation between nutritional status and child mortality in the context of food supplementation in rural area. Methods We conducted matched case-control study nested in a cohort of child mother-pairs followed in the context of food supplementation. Conditional logistic regression was used to examine relation between nutritional status and child death. A significance level of 0.05 was considered significant. We use diagram causal model to identified variables for regression. Results A total of 104 deaths and 208 controls were included in the study. The mean age of mothers was 26.13 ± 6 years. The only factor associated with univariate and multivariate analysis in the model used was the age of the mothers. In univariate, deceased children were 54% less likely to be born to mothers aged 20 to 34 compared to children born to mothers under 20 years of age. (AOR = 0.46, 95% CI = [0.23–0.91] and P = 0.027). The nutritional status of children, socio-economic status, birth season, vaccinal status, and twins were not associated with the death of children in multivariate analysis. Conclusions Nutritional status isn't associate at child death in the context of food supplementation. Supplementation would therefore reduce the deaths of malnourished children. Funding Sources None to declare.

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