scholarly journals Successful use of tapering strips for hyperbolic reduction of antidepressant dose: a cohort study

2021 ◽  
Vol 11 ◽  
pp. 204512532110393
Author(s):  
Peter C. Groot ◽  
Jim van Os
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Response Rate ◽  
Antidepressant Medication ◽  
Questionnaire Response ◽  
The Third ◽  
Median Period ◽  
Antidepressant Use ◽  
To Come ◽  
The One

Background: Tapering strips facilitate antidepressant discontinuation, allowing for personalised titration of discontinuation to the intensity of withdrawal. A tapering strip consists of antidepressant or other medication, packaged in a 28-day roll of daily pouches, each with the same or slightly lower dose than the one before. Previous studies demonstrated 70% real-world effectiveness of tapering strips. Here, we present a third, questionnaire-based retrospective cohort study in a large sample. Methods: Patients whose doctor had prescribed tapering strips between October 2015 and December 2018 were sent a questionnaire for participation after completion of tapering between December 2015 and January 2020. Of 1240 individuals who returned a questionnaire (response rate: 59%), 987 (80%) used an antidepressant, of whom 824 (83%) had wished to discontinue their antidepressant. Results: The sample was demographically representative of antidepressant users in the Netherlands. Less than 40% of participants had heard of tapering strips through their clinicians – Internet was the most frequent source. Of the 824 individuals, 341 (41%) had used strips for tapering venlafaxine, 206 (25%) for paroxetine and 277 (34%) for other antidepressants. Median duration of antidepressant use was 5–10 years, and most (71%) had tried to come off without tapering strips at least once. Most patients (72%) were able to discontinue their antidepressant, using a median of two strips to taper over a median period of 56 days. Females and individuals with (1) more severe experience of withdrawal during the use of tapering strips, (2) more years of use of antidepressant medication and (3) more previous attempts at discontinuation were less likely to be able to discontinue their antidepressant medication with tapering strips. Conclusion: The results of this study validate, for the third time, the observation that tapering strips can address the problem of antidepressant withdrawal symptoms in individuals attempting to discontinue antidepressants.

scholarly journals Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuzo Suzuki ◽  
Kazutaka Mori ◽  
Yuya Aono ◽  
Masato Kono ◽  
Hirotsugu Hasegawa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Disease Progression ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Survival Times ◽  
Antifibrotic Therapy ◽  
Median Period

Abstract Background Currently, there are two antifibrotics used to treat idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. Antifibrotics slow disease progression by reducing the annual decline of forced vital capacity (FVC), which possibly improves outcomes in IPF patients. During treatment, patients occasionally switch antifibrotic treatments. However, prognostic implication of changing antifibrotics has not yet been evaluated. Methods This multi-center retrospective cohort study examined 262 consecutive IPF patients who received antifibrotic therapy. Antifibrotic agents were switched in 37 patients (14.1%). The prognoses were compared between the patient cohort that switched antifibrotics (Switch-IPF) and those without (Non-Switch-IPF) using propensity-score matched analyses. Results The median period between the initiation of antifibrotic therapy and the drug switch was 25.8 (12.7–35.3) months. The most common reasons for the switch were disease progression (n = 17) followed by gastrointestinal disorders (n = 12). Of the 37 patients that switched antifibrotics, only eight patients disrupted switched antifibrotics by their adverse reactions. The overall prognosis of the Switch-IPF cohort was significantly better than the Non-Switch-IPF cohort (median periods: 67.2 vs. 27.1 months, p < 0.0001). In propensity-score matched analyses that were adjusted to age, sex, FVC (%), history of acute exacerbation, and usage of long-term oxygen therapy, the Switch-IPF cohort had significantly longer survival times than the Non-Switch-IPF group (median 67.2 vs. 41.3 months, p = 0.0219). The second-line antifibrotic therapy showed similar survival probabilities than those in first-line antifibrotic therapy in multistate model analyses. Conclusion Switching antifibrotics is feasible and may improve prognosis in patients with IPF. A further prospective study will be required to confirm clinical implication of switching the antifibrotics.

scholarly journals Impact of Blood Urea Nitrogen and Creatinine Levels on Maternal and Fetal Outcomes of Pregnancy: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Guifang Deng ◽  
Lanlan Wu ◽  
Yao Liu ◽  
Zengyou Liu ◽  
Hengying Chen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Blood Urea Nitrogen ◽  
Retrospective Cohort Study ◽  
Pregnancy Outcomes ◽  
Retrospective Cohort ◽  
Fetal Outcomes ◽  
Urea Nitrogen ◽  
The Third ◽  
Fourth Quartile

Abstract Background: Blood urea nitrogen (BUN) and creatinine (SCr) are associated with gestational diabetes mellitus (GDM). However, there were limited data in the literature on the influence of BUN and SCr on maternal and fetal outcomes of pregnancy. We aimed to examine the association of BUN and SCr levels during gestation with the risk of selected adverse pregnancy outcomes.Methods: This retrospective cohort study included 1606 singleton mothers aged 22-44 years. Both BUN and SCr levels were collected and measured during the second (16-18th week), third (28-30th week) trimesters of gestation respectively and followed up pregnancy outcomes. Statistical analysis was used multivariate logistic regression. Results: In the multivariate adjusted logistic regression model, the highest level of SCr in the second trimester increased the risk of PROM by 45% (95% CI, 1.01-2.09). In the third trimester of gestation, compared with those in the lowest quartile, BUN levels in the highest quartile decreased the risk of macrosomia and LGA by 60%(95% CI, 0.20-0.78), 66%(95% CI, 0.21,0.55) , respectively, and increased the risk of SGA by 137%(1.06, 5.31), 186%(1.29,6.34) in the third and fourth quartiles, respectively. The adjusted OR (95%CI) for macrosomia in the fourth quartile was 0.46 (0.24, 0.87), for SGA in the third quartiles was 2.36 (1.10, 5.10), and for LGA in the fourth quartile was 0.61 (0.41,0.91) compared with those in the first quartile of SCr levels. The elevated changes of BUN (> 0.64mmol/L) was the risk factor of SGA (OR: 2.11, 95%CI: 1.03,4.32).Conclusion: Higher BUN and SCr levels during the 28-30th week of gestation even those towards the upper limit of the normal range can act as a warning sign of the impending SGA. Elevated changes of BUN and SCr during pregnancy also associated with the lower birth weight.

scholarly journals A foodborne outbreak of norovirus gastroenteritis associated with a Christmas dinner in Porto, Portugal, December 2008

2009 ◽  
Vol 14 (41) ◽  
Author(s):  
J R Mesquita ◽  
M S Nascimento
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Graduate Students ◽  
Retrospective Cohort ◽  
Food Item ◽  
Response Rate ◽  
Foodborne Outbreak ◽  
Norovirus Gastroenteritis ◽  
Norovirus Gii ◽  
Risk Ratios

An outbreak of acute norovirus gastroenteritis was detected and epidemiologically linked to a Christmas dinner reunion of 22 recent graduate students in a restaurant in Porto, Portugal, in December 2008. A retrospective cohort study was carried out using online standardised questionnaires. Sixteen primary and three secondary cases were identified and the risk ratios with 95% confidence intervals for each food item were calculated. The response rate to the online questionnaires was 96%. The outbreak met all four Kaplan’s criteria and the attack rate was 73%. Norovirus GII.4 2006b was detected in stools and emesis samples of two primary cases. The ingestion of soup and lettuce salad was considered a risk factor for this norovirus outbreak, as determined by statistical analysis. Our investigation demonstrated two routes of transmission of norovirus starting with foodborne exposure followed by secondary person-to-person spread. To our knowledge this is the first study identifying norovirus as the causative agent of a foodborne outbreak in Portugal.

scholarly journals Outcome of antidepressant drug discontinuation with taperingstrips after 1–5 years

2020 ◽  
Vol 10 ◽  
pp. 204512532095460 ◽  
Author(s):  
Peter C. Groot ◽  
Jim van Os
Keyword(s):  
Success Rate ◽  
Antidepressant Drug ◽  
Public Health Problem ◽  
Drug Discontinuation ◽  
Median Length ◽  
Short Term ◽  
Term Outcome ◽  
Antidepressant Use ◽  
To Come ◽  
The One

Background: Stopping antidepressants is often difficult due to withdrawal. Taperingstrips were developed to facilitate antidepressant discontinuation according to the recently described Horowitz-Taylor method, allowing for personalised titration of discontinuation to the intensity of withdrawal. A taperingstrip consists of antidepressant or other medication, packaged in a 28-day roll of small daily pouches, each with the same or slightly lower dose than the one before it. We previously reported that the short-term success rate of antidepressant taperingstrips was 71%. Here, we examine longer-term outcome after 1–5 years. Methods: Patients whose doctor had ordered taperingstrips between January 2015 and December 2019 were sent a questionnaire for participation in anonymised research in January 2020. Of 1012, 483 participated, of whom 408 (85%) had attempted antidepressant tapering. Results: Of the 408 patients included, 192 (47%) had used strips for tapering venlafaxine, 142 (35%) for paroxetine and 74 (18%) for other antidepressants. Median length of antidepressant use was 4 years, and most (61%) had tried to come off without taperingstrips at least once. After 1–5 years, 270 patients (66%) remained off antidepressants after tapering their antidepressant, 6 (2%) had successfully reduced their medication, 87 (21%) had restarted due to (self-reported) relapse, 35 had restarted for another indication (9%), and 10 (3%) reported another outcome. People with more severe experience of withdrawal prior to tapering, and people who had been on antidepressants for a shorter period of time, were more likely to remain off medication after 1–5 years. Conclusion: The previously reported 71% short-term success rate of taperingstrips in the most severely affected group, was matched by a 68% rate after 1–5 years. The evidence-based approach of personal tapering to counter withdrawal, as used for drugs causing withdrawal, for example, benzodiazepines, may represent a simple solution for an important antidepressant-related public health problem, without extra costs.

scholarly journals Factors associated with re-initiation of antidepressant treatment following discontinuation during pregnancy: a register-based cohort study

2020 ◽  
Vol 23 (5) ◽  
pp. 709-717
Author(s):  
Anna Wikman ◽  
Alkistis Skalkidou ◽  
Anna-Karin Wikström ◽  
Erik Lampa ◽  
Michael S. Kramer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Psychiatric Illness ◽  
Antidepressant Treatment ◽  
Nordic Country ◽  
Antidepressant Medication ◽  
High Educational Level ◽  
Maternal Characteristics ◽  
Discontinuation Of Treatment ◽  
Antidepressant Use ◽  
High Educational

Abstract Antidepressant treatment when facing a pregnancy is an important issue for many women and their physicians. We hypothesized that women with a greater burden of pre-pregnancy psychiatric illness would be more likely to re-initiate antidepressants following discontinuation of treatment during pregnancy. A register-based cohort study was carried out including 38,595 women who gave birth between the 1st of January 2007 and the 31st of December 2014, who had filled a prescription for an antidepressant medication in the year prior to conception. Logistic regressions were used to explore associations between maternal characteristics and antidepressant treatment discontinuation or re-initiation during pregnancy. Most women discontinued antidepressant treatment during pregnancy (n = 29,095, 75.4%), of whom nearly 12% (n = 3434, 11.8%) re-initiated treatment during pregnancy. In adjusted analyses, parous women (aOR 1.22, 95% CI 1.12–1.33), with high educational level (aOR 1.21, 95% CI 1.08–1.36); born within the EU (excluding Nordic countries, aOR 1.41, 95% CI 1.03–1.92) or a Nordic country (aOR 1.42, 95% CI 1.22–1.65); who more often reported prior hospitalizations due to psychiatric disorders (aOR 1.50, 95% CI 1.10–2.03, for three or more episodes); and had longer duration of pre-pregnancy antidepressant use (aOR 6.10, 95% CI 5.48–6.77, for >2 years antidepressant use), were more likely to re-initiate antidepressants than were women who remained off treatment. Women with a greater burden of pre-pregnancy psychiatric illness were more likely to re-initiate antidepressants. Thus, pre-pregnancy psychiatric history may be particularly important for weighing the risks and benefits of discontinuing antidepressants during pregnancy.

scholarly journals Perinatal Outcomes of Monochorionic-Diamniotic Twin Pregnancies Uncomplicated at 28 Weeks of Gestation

2016 ◽  
Vol 7 ◽  
pp. JCM.S38895 ◽  
Author(s):  
Shunji Suzuki
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Second Trimester ◽  
Perinatal Complications ◽  
Third Trimester ◽  
The Third ◽  
Perinatal Center ◽  
Twin Pregnancies

We examined the prevalence of specific perinatal complications of monochorionic-diamniotic twin pregnancies in cases without any abnormal findings until the second trimester of pregnancy. This was a retrospective cohort study performed at a tertiary perinatal center in Tokyo, Japan. There were 88 cases of uncomplicated monochorionic-diamniotic twin pregnancies at 28 weeks of gestation. In five of them (5.7%), there were serious complications associated with placental circulatory imbalance between the twins during the third trimester of pregnancy. Two cases were complicated by twin–twin transfusion syndrome, two cases were complicated by twin anemia–polycythemia sequence, and one case was complicated by acute twin–twin transfusion syndrome. In the five cases, no abnormal ultrasonographic findings or symptoms were recognized one or two weeks prior to the diagnosis. Fifty-eight cases (65.9%) were delivered at term uneventfully. Serious complications due to placental circulatory imbalance between twins occurred in about 6% of cases during the third trimester of pregnancy.

scholarly journals Demographic and clinical factors associated with different antidepressant treatments: a retrospective cohort study design in a UK psychiatric healthcare setting

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022170 ◽  
Author(s):  
Andrea C Fernandes ◽  
David Chandran ◽  
Mizanur Khondoker ◽  
Michael Dewey ◽  
Hitesh Shetty ◽  
...  
Keyword(s):  
Cohort Study ◽  
Study Design ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Healthcare Setting ◽  
Clinical Factors ◽  
Factors Associated ◽  
Antidepressant Treatments ◽  
Cohort Study Design ◽  
Antidepressant Use

ObjectiveTo investigate the demographic and clinical factors associated with antidepressant use for depressive disorder in a psychiatric healthcare setting using a retrospective cohort study design.SettingData were extracted from a de-identified data resource sourced from the electronic health records of a London mental health service. Relative risk ratios (RRRs) were obtained from multinomial logistic regression analysis to ascertain the probability of receiving common antidepressant treatments relative to sertraline.ParticipantsPatients were included if they received mental healthcare and a diagnosis of depression with antidepressant treatment between March and August 2015 and exposures were measured over the preceding 12 months.ResultsOlder age was associated with increased use of all antidepressants compared with sertraline, except for negative associations with fluoxetine (RRR 0.98; 95% CI 0.96 to 0.98) and a combination of two selective serotonin reuptake inhibitors (SSRIs) (0.98; 95% CI 0.96 to 0.99), and no significant association with escitalopram. Male gender was associated with increased use of mirtazapine compared with sertraline (2.57; 95% CI 1.85 to 3.57). Previous antidepressant, antipsychotic and mood stabiliser use were associated with newer antidepressant use (ie, selective norepinephrine reuptake inhibitors, mirtazapine or a combination of both), while affective symptoms were associated with reduced use of citalopram (0.58; 95% CI 0.27 to 0.83) and fluoxetine (0.42; 95% CI 0.22 to 0.72) and somatic symptoms were associated with increased use of mirtazapine (1.60; 95% CI 1.00 to 2.75) relative to sertraline. In patients older than 25 years, past benzodiazepine use was associated with a combination of SSRIs (2.97; 95% CI 1.32 to 6.68), mirtazapine (1.94; 95% CI 1.20 to 3.16) and venlafaxine (1.87; 95% CI 1.04 to 3.34), while past suicide attempts were associated with increased use of fluoxetine (2.06; 95% CI 1.10 to 3.87) relative to sertraline.ConclusionThere were several factors associated with different antidepressant receipt in psychiatric healthcare. In patients aged >25, those on fluoxetine were more likely to have past suicide attempt, while past use of antidepressant and non-antidepressant use was also associated with use of new generation antidepressants, potentially reflecting perceived treatment resistance.

scholarly journals Assessment of the Value of Rescreening for Syphilis in the Third Trimester of Pregnancy

2006 ◽  
Vol 2006 ◽  
pp. 1-3 ◽  
Author(s):  
Rodney K. Edwards ◽  
Margaret Bennett ◽  
Carrie Langstraat ◽  
Daina Greene
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Prenatal Screening ◽  
Single Center ◽  
Third Trimester ◽  
Prenatal Visit ◽  
The Third ◽  
Upper Limit ◽  
Study Interval ◽  
Obstetric Population

Objectives. Our aim is evaluating the need for repeating tests for syphilis on pregnant women in the third trimester. Study design. A single-center retrospective cohort study was performed on all women delivering7/03–6/04. Results. During the study interval, 2244 women delivered at our hospital. Of those women having available records and attending at least one prenatal visit, 1940(98.9%)were screened for syphilis at the first prenatal visit. Of the 1627 women beginning prenatal care prior to 27 weeks and delivering after 32 weeks, 1377(84.6%)were rescreened in the third trimester. No cases of syphilis were identified with either the initial (upper limit of 95% CI0.24%) or repeat (upper limit of 95% CI0.34%) screening. Conclusions. In our obstetric population, syphilis is so uncommon that mandated prenatal screening on more than one occasion seems unjustified and laws requiring repeated screening should be reevaluated.

scholarly journals Motherhood and the Machine

2014 ◽  
Vol 22 (2) ◽  
pp. 62-69
Author(s):  
Miglena Nikolchina
Keyword(s):  
Animal Studies ◽  
Significant Contribution ◽  
Ethical Perspective ◽  
Theoretical Orientations ◽  
The Third ◽  
Battlestar Galactica ◽  
To Come ◽  
The One ◽  
Philosophical Debates ◽  
Present Text

In her conceptualization of the human as defined by the capacity for revolt Kristeva unavoidably touches upon issues of robotization, technology, and the virtual. The concepts of animal and machine, however, although they do appear occasionally and in important ways, are never at the focus of her inquiries and are absent in her “New Forms of Revolt.” Yet these two concepts to a large extent define the field of contemporary philosophical debates of the human giving rise to three major theoretical orientations. On the one hand, there is the trend which tries to come to terms with technological novelties and the merging of human and machine that they imply. This trend unfolds under the rubric of “transhuman” or “posthuman” and of the “enhancement” of man. The second trend predominates in animal studies. Mostly in an ethical perspective but also ontologically, this trend, to which Derrida’s later writing made a significant contribution, questions the idea of the “human exception” and the rigorous distinction between man and animal on which this exception rests. While apparently antagonistic, both trends align the human with the animal and oppose it to technology. The third trend collapses the distinctions on which the previous two rely through the lens of biopolitics: drawing on Heidegger, Kojève, and Foucault, it regards contemporary technological transformations as amounting to the animalization of man.  The human disappears in the animal, in the machine, or in the indistinguishability of the two, confirming what Agamben has described as the inoperativeness of the anthropological machine. The present text turns to Kristeva’s conceptions of motherhood and revolt as introducing a powerful inflection in this tripartite field. Remarkably, it is precisely new sagas of rebellious machines like Battlestar “Galactica” that foreground the relevance of Kristeva’s approach.

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