Multiple sclerosis relapse risk in the postoperative period: Effects of invasive surgery and anesthesia

Background: Postoperative multiple sclerosis (MS) relapses are a concern among patients and providers. Objective: To determine whether MS relapse risk is higher postoperatively. Methods: Data were extracted from medical records of MS patients undergoing surgery at a tertiary center (2000–2016). Conditional logistic regression estimated within-patient unadjusted and age-adjusted odds of postoperative versus preoperative relapse. Results: Among 281 patients and 609 surgeries, 12 postoperative relapses were identified. The odds of postoperative versus preoperative relapse in unadjusted (odds ratio (OR) = 0.56, 95% confidence interval (CI) = 0.18–1.79; p = 0.33) or age-adjusted models (OR = 0.66, 95% CI = 0.20–2.16; p = 0.49) were not increased. Conclusions: Surgery/anesthesia exposure did not increase postoperative relapse risk. These findings require confirmation in larger studies.

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A novel weighting method to remove bias from within-subject exposure dependency in case-crossover studies

BMC Medical Research Methodology ◽

10.1186/s12874-021-01408-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kiyoshi Kubota ◽

Thu-Lan Kelly ◽

Tsugumichi Sato ◽

Nicole Pratt ◽

Elizabeth Roughead ◽

...

Keyword(s):

Logistic Regression ◽

Crossover Study ◽

Odds Ratio ◽

Time Trends ◽

Rate Ratio ◽

Conditional Logistic Regression ◽

Time Varying ◽

Weighting Method ◽

Case Crossover ◽

Crossover Studies

Abstract Background Case-crossover studies have been widely used in various fields including pharmacoepidemiology. Vines and Farrington indicated in 2001 that when within-subject exposure dependency exists, conditional logistic regression can be biased. However, this bias has not been well studied. Methods We have extended findings by Vines and Farrington to develop a weighting method for the case-crossover study which removes bias from within-subject exposure dependency. Our method calculates the exposure probability at the case period in the case-crossover study which is used to weight the likelihood formulae presented by Greenland in 1999. We simulated data for the population with a disease where most patients receive a cyclic treatment pattern with within-subject exposure dependency but no time trends while some patients stop and start treatment. Finally, the method was applied to real-world data from Japan to study the association between celecoxib and peripheral edema and to study the association between selective serotonin reuptake inhibitor (SSRI) and hip fracture in Australia. Results When the simulated rate ratio of the outcome was 4.0 in a case-crossover study with no time-varying confounder, the proposed weighting method and the Mantel-Haenszel odds ratio reproduced the true rate ratio. When a time-varying confounder existed, the Mantel-Haenszel method was biased but the weighting method was not. When more than one control period was used, standard conditional logistic regression was biased either with or without time-varying confounding and the bias increased (up to 8.7) when the study period was extended. In real-world analysis with a binary exposure variable in Japan and Australia, the point estimate of the odds ratio (around 2.5 for the association between celecoxib and peripheral edema and around 1.6 between SSRI and hip fracture) by our weighting method was equal to the Mantel-Haenszel odds ratio and stable compared with standard conditional logistic regression. Conclusion Case-crossover studies may be biased from within-subject exposure dependency, even without exposure time trends. This bias can be identified by comparing the odds ratio by the Mantel-Haenszel method and that by standard conditional logistic regression. We recommend using our proposed method which removes bias from within-subject exposure dependency and can account for time-varying confounders.

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Venous Thromboembolism in Patients With Thrombocytopenia: Risk Factors, Treatment, and Outcome

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029615613158 ◽

2015 ◽

Vol 23 (4) ◽

pp. 345-350 ◽

Cited By ~ 4

Author(s):

Jens Kristian Baelum ◽

Espen Ellingsen Moe ◽

Mads Nybo ◽

Pernille Just Vinholt

Keyword(s):

Risk Factors ◽

Platelet Count ◽

Venous Thromboembolism ◽

Blood Cells ◽

Medical Records ◽

Odds Ratio ◽

Conditional Logistic Regression ◽

University Hospital ◽

Hospital Department ◽

Bleeding Episodes

Background: Venous thromboembolism (VTE) is a frequent and potentially lethal condition. Venous thrombi are mainly constituted of fibrin and red blood cells, but platelets also play an important role in VTE formation. Information about VTE in patients with thrombocytopenia is, however, missing. Objectives: To identify VTE risk factors and describe treatment and outcome (bleeding episodes and mortality) in patients with thrombocytopenia. Patients/Methods: Patients with thrombocytopenia (platelet count <100 × 109/L) admitted to Odense University Hospital, Denmark, between April 2000 and April 2012 were included. Fifty cases had experienced VTE. Controls without VTE were matched 3:1 with cases on sex and hospital department. Medical records were examined, and data were analyzed using conditional logistic regression. Results: In multivariate analysis, platelet count <50 × 109/L (odds ratio [OR] 0.22, P < .05) and chronic liver disease (OR 0.05, 95% confidence interval [CI] 0.01-0.58) reduced the risk of VTE. Surgery (OR 6.44, 95% CI 1.37-30.20) and previous thromboembolism (OR 6.16, 95% CI 1.21-31.41) were associated with an increased VTE risk. Ninety-two percent of cases were treated with anticoagulants. There was no difference in bleeding incidence between cases and controls. Conclusions: Several known VTE risk factors also seems to apply in patients with thrombocytopenia. Also, patients with thrombocytopenia may be VTE risk stratified based on platelet count and comorbidities. Finally, patients having thrombocytopenia with VTE seem to be safely treated with anticoagulants without increased occurrence of bleeding.

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VP26 Comparing Statistical Methods For Meta-Analysis Of Rare Event Data

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317003166 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 158-159

Author(s):

Tarang Sharma ◽

Peter Gøtzsche ◽

Oliver Kuss

Keyword(s):

Logistic Regression ◽

Adverse Events ◽

Odds Ratio ◽

Meta Analysis ◽

Conditional Logistic Regression ◽

Rare Event ◽

Sensitivity Analyses ◽

Analysis Methods ◽

Binomial Regression ◽

Events Data

INTRODUCTION:We aimed to identify the validity and robustness of effect estimates for serious rare adverse events in clinical study reports of antidepressant trials, across different meta-analysis methods for rare binary events data (1,2).METHODS:Four serious rare adverse events (all-cause mortality, suicidality, aggressive behaviour and akathisia) were meta-analyzed using different methods (3). The Yusuf-Peto odds ratio (OR), which ignores studies with no events in the treatment arms, was compared with the alternative approaches of generalized linear mixed models (GLMM), conditional logistic regression, a Bayesian approach using Markov Chain Monte Carlo (MCMC) and a beta-binomial regression model.RESULTS:Though the estimates for the four outcomes did not change substantially across the different analysis methods, the Yusuf-Peto method underestimated the treatment harm and overstimated its precision, especially when the estimated odds ratio (OR) deviated greatly from 1. For example the OR for suicidality for children and adolescents was 2.39 (95 percent Confidence Interval, CI 1.32 to 4.33, using the Yusuf-Peto method), but increased to 2.64 (95 percent CI 1.33 to 5.26) using conditional logistic regression, to 2.69 (95 percent CI 1.19 to 6.09) using beta-binomial, to 2.73 (95 percent CI 1.37 to 5.42) using the GLMM and finally to 2.87 (95 percent CI 1.42 to 5.98) using the MCMC approach.CONCLUSIONS:The method used for meta-analysis of rare events data influences the estimates obtained and the exclusion of double zero-event studies can give misleading results. To ensure reduction of bias and erroneous inferences, sensitivity analyses should be performed using different methods and we recommend that the Yusuf-Peto approach should no longer be used. Other methods, in particular the beta-binomial method that was shown to be superior, should be considered instead.

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Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

Multiple Sclerosis Journal ◽

10.1177/1352458518763080 ◽

2018 ◽

Vol 25 (4) ◽

pp. 591-600 ◽

Cited By ~ 4

Author(s):

Caroline Lavie ◽

Fabien Rollot ◽

Françoise Durand-Dubief ◽

Romain Marignier ◽

Iuliana Ionescu ◽

...

Keyword(s):

Multiple Sclerosis ◽

Logistic Regression ◽

Regression Analysis ◽

Odds Ratio ◽

Post Partum ◽

Neuraxial Analgesia ◽

Increased Risk ◽

Obstetrical Analgesia ◽

The Impact ◽

Risk Of Relapse

Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

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A Novel Weighting Method to Remove Bias from Within-subject Exposure Dependency in Case-crossover Studies

10.21203/rs.3.rs-381953/v1 ◽

2021 ◽

Author(s):

Kiyoshi Kubota ◽

Lan Kelly ◽

Tsugumichi Sato ◽

Nicole Pratt ◽

Elizabeth Roughead ◽

...

Keyword(s):

Logistic Regression ◽

Crossover Study ◽

Odds Ratio ◽

Time Trends ◽

Rate Ratio ◽

Conditional Logistic Regression ◽

Time Varying ◽

Weighting Method ◽

Case Crossover ◽

Crossover Studies

Abstract Background:Case-crossover studies have been widely used in various fields including pharmacoepidemiology. Vines and Farrington indicated in 2001 that when within-subject exposure dependency exists, conditional logistic regression can be biased. However, this bias has not been well studied.Methods:We have extended findings by Vines and Farrington to develop a weighting method for the case-crossover study which removes bias from within-subject exposure dependency. Our method calculates the exposure probability at the case period in the case-crossover study which is used to weight the likelihood formulae presented by Greenland in 1999. We simulated data for the population with a disease where most patients receive a cyclic treatment pattern with within-subject exposure dependency but no time trends while some patients stop and start treatment. Finally, the method was applied to real-world data from Japan to study the association between celecoxib and peripheral edema and to study the association between selective serotonin reuptake inhibitor (SSRI) and hip fracture in Australia.Results:When the simulated rate ratio of the outcome was 4.0 in a case-crossover study with no time-varying confounder, the proposed weighting method and the Mantel-Haenszel odds ratio reproduced the true rate ratio. When a time-varying confounder existed, the Mantel-Haenszel method was biased but the weighting method was not. When more than one control period was used, standard conditional logistic regression was biased either with or without time-varying confounding and the bias increased (up to 9.4) when the study period was extended. In real-world analysis with a binary exposure variable in Japan and Australia, the point estimate of the odds ratio (around 2.5 for the association between celecoxib and peripheral edema and around 1.6 between SSRI and hip fracture) by our weighting method was equal to the Mantel-Haenszel odds ratio and stable compared with standard conditional logistic regression. Conclusion:Case-crossover studies may be biased from within-subject exposure, even without exposure time trends. This bias can be identified by comparing the odds ratio calculated by the Mantel-Haenszel method and that by standard conditional logistic regression. Our proposed method will remove bias from within-subject exposure dependency and can account for time-varying confounders.

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Influence of a Teaching Session on Breast Self-Examination and Adherence Among Pregnant and Lactating Women in Ibadan, Nigeria

Journal of Global Oncology ◽

10.1200/jgo.19.18000 ◽

2019 ◽

Vol 5 (Supplement_1) ◽

pp. 9-9

Author(s):

Stella O. Odedina ◽

IkeOluwapo O. Ajayi ◽

Imran O. Morhason-Bello ◽

Adedokun Babatundetuk ◽

Dezheng Huo ◽

...

Keyword(s):

Breast Cancer ◽

Logistic Regression ◽

Health Facility ◽

Odds Ratio ◽

Conditional Logistic Regression ◽

Teaching Session ◽

Integral Control ◽

Breast Self Examination ◽

Self Examination

PURPOSE Educating women on how to examine their breasts can raise breast cancer awareness and early detection rates, especially in low- and middle-income countries. In this study, the influence of a teaching session on breast self-examination (BSE) during pregnancy was evaluated. METHODS A quasi-experimental study design was used. A total of 1,248 pregnant women whose pregnancies had a gestational age of 26 weeks or less were recruited from three antenatal clinics representing three tiers of the health care system in Nigeria. They were interviewed using a structured questionnaire, including BSE practice, and taught how to perform BSE using the MammaCare technique at recruitment. At 6 months postpartum, 729 participants were available for phone interview on BSE practice. Adherence to BSE was measured as a binary outcome comparing BSE performances at recruitment with follow-up. Conditional logistic regression analysis was used to determine the differences in BSE practices pre- and postintervention. Multiple logistic regression was used to identify predictors for adherence to BSE training at α = 0.05. RESULTS Participants’ mean age was 30.4 ± 4.9 years, 401 (55.0%) attended a secondary health facility for antenatal care, and 78 (10.7%) had breast disorders at recruitment. Two hundred fifty-three (34.7%) said they practiced BSE before recruitment, and 380 (52.1%) did so at follow-up (odds ratio, 1.91; CI, 1.51 to 2.42). Women less likely to adhere were those with breast disorders detected at recruitment (adjusted odds ratio [aOR], 0.55; CI, 0.32 to 0.95) and women recruited from primary and secondary health facilities compared with those from a tertiary health facility (aOR, 0.41; CI, 0.17 to 0.98; aOR, 0.18; CI, 0.11 to 0.29, respectively). CONCLUSION Educational interventions can significantly improve screening practices, even if only one session, and should serve as an integral control for breast cancer.

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Metoclopramide and Levosulpiride Use and Subsequent Levodopa Prescription in the Korean Elderly: The Prescribing Cascade

Journal of Clinical Medicine ◽

10.3390/jcm8091496 ◽

2019 ◽

Vol 8 (9) ◽

pp. 1496 ◽

Cited By ~ 3

Author(s):

Youn Huh ◽

Do-Hoon Kim ◽

Moonyoung Choi ◽

Joo-Hyun Park ◽

Do-Young Kwon ◽

...

Keyword(s):

Adverse Event ◽

Logistic Regression ◽

Health Insurance ◽

Odds Ratio ◽

Conditional Logistic Regression ◽

Control Group ◽

Dopaminergic Drugs ◽

Prescribing Cascade ◽

Korean Elderly ◽

Age And Sex

The aim of this study was to investigate the prescribing cascade phenomenon of dopaminergic drugs such as levodopa in the management of gastroprokinetic drugs induced parkinsonism. Based on the Korea National Health Insurance Service (NHIS)-Senior Cohort Database, we analyzed patients aged ≥65 years, between 2009 and 2013, who obtained new prescriptions for levodopa through the NHIS during this period. Those who were prescribed levodopa from 2002 to 2008 were excluded, only patients who were prescribed metoclopramide and levosulpiride within 90 days of receiving the levodopa prescription were included. Those who did not receive levodopa were used as a control group for 1:3 age and sex matching. We assessed 1824 and 1197 levodopa cases for metoclopramide and levosulpiride use, respectively. The matched controls for each levodopa case were 5472 and 3591, respectively. We used conditional logistic regression to determine the odds ratio (OR) for initiation of levodopa therapy in patients using metoclopramide and levosulpiride, relative to nonusers, after adjusting for age, sex, and exposure to antipsychotic medication. Both metoclopramide (OR = 3.04; 95% confidence interval, CI, 2.46–3.77) and levosulpiride (OR = 3.32; 95% CI, 2.56–4.3) users were three times more likely to begin using medication containing levodopa, compared to nonusers. Metoclopramide and levosulpiride were frequently prescribed within 90 days of receiving a prescription for levodopa. Before prescribing levodopa, it should be considered whether the adverse event is actually a side effect caused by metoclopramide and levosulpiride.

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Logistic regression analysis of environmental and other variables and incidences of tuberculosis in respiratory patients

Scientific Reports ◽

10.1038/s41598-020-79023-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Ashutosh K. Pathak ◽

Mukesh Sharma ◽

Subodh K. Katiyar ◽

Sandeep Katiyar ◽

Pavan K. Nagar

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Natural Gas ◽

Odds Ratio ◽

Rural Electrification ◽

Unadjusted Odds Ratio ◽

Pulmonary Tb ◽

Urban Rural ◽

Gender Based ◽

And Gender

AbstractThe objective of this study was to examine the association of 14 variables with TB in respiratory patients. The variables included: urban/rural, persons in 1200 sqft area, TB in family, crowding, smoking (family member), gender, age, education, smoking, workplace, kitchen location, cooking fuel, ventilation, and kerosene uses. Eight hundred respiratory patients were tested for sputum positive pulmonary TB; 500 had TB and 300 did not. An analysis of the unadjusted odds ratio (UOR) and adjusted OR (AOR) was undertaken using logistic regression to link the probability of TB incidences with the variables. There was an inconsistency in the significance of variables using UOR and AOR. A subset model of 4 variables (kerosene uses, ventilation, workplace, and gender) based on significant AOR was adjudged acceptable for estimating the probability of TB incidences. Uses of kerosene (AOR 2.62 (1.95, 3.54)) consistently related to incidences of TB. It was estimated that 50% reduction in kerosene uses could reduce the probability of TB by 13.29% in respiratory patients. The major recommendation was to replace kerosene uses from households with a supply of clean fuel like liquid petroleum or natural gas and rural electrification.

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Exposure to passive smoking during adolescence is associated with an increased risk of developing multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458520912500 ◽

2020 ◽

pp. 135245852091250 ◽

Cited By ~ 1

Author(s):

Ditte Bang Oturai ◽

Helle Bach Søndergaard ◽

Nils Koch-Henriksen ◽

Christina Andersen ◽

Julie Hejgaard Laursen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Logistic Regression ◽

Environmental Factors ◽

Passive Smoking ◽

Odds Ratio ◽

Blood Donors ◽

Propensity Scores ◽

Increased Risk ◽

Female Case ◽

Never Smokers

Background: Environmental factors are associated with acquiring multiple sclerosis (MS) particularly in adolescence. Objective: To test for association between MS and exposure to passive smoking at the age of 10–19. Methods: A total of 919 patients from the Danish MS Registry and Biobank and 3419 healthy blood donors who had not smoked before the age of 19 were targeted. We analyzed separately for each sex and for those never-smokers (cohort 1) and active smokers above the age of 19 (cohort 2). All participants completed standardized questionnaires about smoking and lifestyle. We matched cases and controls in the ratio of 1:2 by propensity scores discarding unmatchable individuals and used logistic regression adjusted for all covariates and interactions. Results: After matching, we included 110/213 male cases/controls and 232/377 female case/controls in cohort 1. In cohort 2, the numbers were 160/320 and 417/760, respectively. Among women in cohort 1, the odds ratio (OR) for MS by passive smoking at the age of 10–19 was 1.432 ( p = 0.037) but in men it was 1.232 ( p = 0.39). Among men in cohort 2, OR was 1.593 ( p = 0.022) but among women it was only 1.102 ( p = 0.44). Conclusion: Among never smokers, female MS cases were more often than female controls reported with passive smoking between the age of 10 and 19, and among smokers above the age of 19, male MS patients were more often than male controls reported with passive smoking.

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Hubungan Jenis Persalinan dan Prematuritas dengan Hiperbilirubinemia di RS Persahabatan

Jurnal Vokasi Indonesia ◽

10.7454/jvi.v1i1.8 ◽

2013 ◽

Vol 1 (1) ◽

Author(s):

Elsa Roselina ◽

Saroha Pinem ◽

Rochimah Rochimah

Keyword(s):

Logistic Regression ◽

Statistical Analysis ◽

Research Design ◽

Medical Records ◽

Odds Ratio ◽

Case Control ◽

P Value ◽

Maternal Factor ◽

Multivariable Logistic Regression

ABSTRACT. Hyperbilirubinemia refers to an excessive level of accumulated bilirubin in the blood and ischaracterized by jaundice, or icterus, a yellowish discoloration of the skin and other organs. There are two riskfactors that related to hyperbilirubinemia. Those factors are maternal factor and neonates‟ factor. The aim ofthis research knew which variables which catagorized as maternal factor and neonates‟ factor that related tohyperbilirubinemia in Persahabatan hospital. This research used medical records from 216 neonates andhis/her mother from October 2008 until October 2009 as samples. Research design was case control, with used5% level of significant and 80% power. The statistical analysis was multivariable logistic regression. Factorsthat related to hyperbilirubinemia in Persahabatan hospital were type of labor (p value 0.000) andprematurity (p value 0.022). Type of labor is a dominant variable that related to hyperbilirubinemia andneonates from un-spontaneous labor has probability to be hyperbilirubinemia 50.193 times than neonates fromspontaneous labor after controlled by prematurity (odds ratio 50.193).Keywords: hyperbilirubinemia, type of labor, prematurity

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