Annals of Clinical Epidemiology
Online ISSN : 2434-4338
Volume 2, Issue 4
Displaying 1-4 of 4 articles from this issue
SEMINAR
  • Miho Ishimaru
    Article type: SEMINAR
    2020 Volume 2 Issue 4 Pages 85-94
    Published: 2020
    Released on J-STAGE: October 01, 2020
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    High-dimensional propensity score analysis automatically selects independent variables for calculating propensity scores, using a vast amount of information from real-world health care databases. This technique can reduce confounding by indication or unmeasured confounders more precisely compared with conventional propensity score analysis. High-dimensional propensity score analysis assumes that proxy information for important unmeasured confounders can be obtained from the underlying data. The number of published studies using high-dimensional propensity score analysis has increased, with pharmacoepidemiology as the main area in which these studies have been published. This report explains the main assumption and the limitations of this analytical method and provides step-by-step procedures to implement the method.

ORIGINAL ARTICLE
  • Kazufumi Takeuchi, Izumi Sato, Masato Takeuchi, Tomotsugu Seki, Yohei ...
    Article type: ORIGINAL ARTICLE
    2020 Volume 2 Issue 4 Pages 95-106
    Published: 2020
    Released on J-STAGE: October 01, 2020
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    BACKGROUND

    Oral anticoagulant treatments (OATs) are used in patients with atrial fibrillation (AF) to prevent complications. However, continuous treatment with OATs during chemotherapy in AF patients with cancer is controversial due to increased bleeding concerns. Thus, we aimed to evaluate whether OAT treatment decreased the risk of cardiogenic thromboembolism in those patients.

    METHODS

    We conducted a retrospective cohort study using a Japanese administrative database including patients with AF aged ≥18 years who underwent chemotherapy between 2008 and 2017 and had used OATs before starting chemotherapy. We divided patients into two groups; continuous users and discontinuous users of OATs within 90 days after starting chemotherapy. We calculated the incidence of cardiogenic thromboembolism. Also, we estimated the hazard ratio (HR) and 95% confidence intervals (CIs) of it using Cox proportional hazards models, including matched propensity scores (PSs), to adjust for comorbidities.

    RESULTS

    Of a total 6,542 patients in the study cohort, 4,916 (75.1%) patients continued OAT treatment (mean age, 76.2 years; 75.9% male) and 1,596 (24.9%) patients discontinued OAT treatment (mean age, 76.2 years; 76.6% male). PS matching created a cohort of 1,596 matched pairs. The incidence of cardiogenic thromboembolism among the continuation group and the discontinuation group were 11.18 and 16.97 per 1,000 person-years, respectively. Adjusted HR was not different in the two groups (0.65, 95% CI: 0.39–1.07).

    CONCLUSIONS

    Prescription of OATs at least once within 90 days after initiating chemotherapy in AF patients with cancer was not significantly associated with the incidence of cardiogenic thromboembolism.

  • Hiraku Funakoshi, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
    Article type: ORIGINAL ARTICLE
    2020 Volume 2 Issue 4 Pages 107-112
    Published: 2020
    Released on J-STAGE: October 01, 2020
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    BACKGROUND

    Cerebral vasospasm (CVS) occurs in 17% to 40% of patients with aneurysmal subarachnoid hemorrhage (aSAH). Various measures have been implemented to prevent CVS, including fasudil hydrochloride. However, data are lacking on the preventive effect of fasudil hydrochloride on CVS. The present study was performed to examine the association between postprocedural early administration of fasudil hydrochloride and outcomes in patients undergoing treatments for aSAH using a national inpatient database in Japan.

    METHODS

    Patients aged ≥18 years who were admitted because of aSAH from July 2010 to March 2014 and underwent clipping surgery or intravascular coil embolization within 72 hours from admission were eligible. We defined preventive fasudil hydrochloride as that administered within 1 day after the intervention. The outcomes were 30-day in-hospital mortality and the modified Rankin scale (mRS) score at discharge. We used instrumental variable methods to analyze the differences in the risk of these outcomes between patients with and without preventive fasudil hydrochloride.

    RESULTS

    Of 23,843 eligible patients, 77.1% received preventive fasudil hydrochloride. The overall 30-day in-hospital mortality rate was 2.2%, and the proportion of a good neurological outcome (mRS score of ≤2) was 65.0%. Instrumental variable analyses showed no significant difference in 30-day in-hospital mortality (risk difference, −1.8%; 95% confidence interval, −3.8% to 2.0%), but demonstrated a significant difference in an mRS score of ≤2 at discharge (risk difference, 7.8%; 95% confidence interval, 3.4% to 12.3%).

    CONCLUSION

    Early administration of fasudil hydrochloride after treatment for aSAH could be associated with a better neurological outcome at discharge.

  • Sachiko Yamamoto-Kataoka, Sayaka Shimizu, Yasukazu Hijikata, Shunichi ...
    Article type: ORIGINAL ARTICLE
    2020 Volume 2 Issue 4 Pages 113-120
    Published: 2020
    Released on J-STAGE: October 01, 2020
    JOURNAL OPEN ACCESS FULL-TEXT HTML

    BACKGROUND

    Low back pain (LBP) is an important problem in occupational health, but little is known about LBP in nursery school teachers.

    METHODS

    To determine the prevalence of LBP that needed medical treatment, LBP in their lifetime, factors associated with LBP, and work environment in nursery school teachers, we performed a cross-sectional study at Sakyo-ku in Kyoto City. We used multivariable logistic regression models to assess factors associated with LBP that needed medical treatment during the year.

    RESULTS

    Of 410 teachers in 21 nursery schools, 154 (37.6%) participated in the study. Sixty-four teachers (41.8%) had LBP that needed medical treatment during the year, and 128 (83.7%) had LBP in their lifetime. As factors associated with LBP, age (adjusted odds ratio [AOR] [per 10-year increase], 1.48; 95% confidence interval [95%CI], 1.06–2.07), unnatural posture (AOR, 5.14; 95%CI, 1.51–17.45), mental health (AOR, 1.89; 95%CI, 1.07–3.33), and psychological demand from job (AOR, 1.92; 95%CI, 1.24–2.97) were suggested. Three of 15 nursery schools employed industrial physicians, and precautions of LBP were taken in two schools.

    CONCLUSIONS

    Further investigations if intervention of these factors associated with LBP as work management to prevent LBP in nursery schools reduced their LBP are required.

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