Cíle: Kohortová studie si kladla za cíl zjistit úroveň úmrtnosti mezi různě definovanými skupinami (kohortami) uživatelů drog a porovnat ji s úrovní úmrtnosti v běžné populaci. Zároveň se studie zaměřila na rozdíly v úmrtnosti uživatelů drog z hlediska pohlaví a typu užívané drogy. Metodika: Pro analýzu úmrtnosti byla použita metoda retrospektivní kohortové studie; v období 1997–2002 byly sledovány čtyři předem definované skupiny uživatelů drog. V ČR byly pro studii k dispozici dva soubory osob hospitalizovaných pro poruchy související s užíváním drog (12 207 a 2 824 osob), soubor injekčních uživatelů s hlášenou virovou hepatitidou (3 037 osob) a soubor uživatelů v opiátové substituční léčbě (704 osob). Výsledky: Přímo standardizovaná míra úmrtnosti dosahuje podle kohorty 16–33 na 1000 osoboroků sledování, u všech kohort je vyšší u mužů než u žen. V průběhu sledovaného období byl zaznamenán pokles úrovně úmrtnosti. Mortalita uživatelů drog je 8–11krát vyšší než úmrtnost v běžné populaci, nejvyšší je mezi polyvalentními uživateli a uživateli opiátů, relativně nejnižší mezi uživateli stimulancií. Závěr: Úroveň úmrtnosti uživatelů drog v ČR je srovnatelná s mortalitou v jiných evropských zemích – ve srovnání s dalšími kohortami dosahuje dokonce nižší úrovně. Potvrdila se existence rozdílů v úrovni úmrtnosti mezi jednotlivými kohortami; další studie by se měly zaměřit na vliv léčby na úroveň mortality uživatelů drog.

Aims: The cohort study aimed to find the level of mortality among different groups (cohorts) of drug users and compare it with the mortality rate of the general population. At the same time, the study focused on differences in mortality levels according to gender and type of drug used. Methods: A retrospective cohort mortality study was conducted. In 1997–2002, 4 defined groups of drug users were followed. These included two cohorts of hospitalized persons for drug-related behavioral disorders (12,207 and 2,824 persons), cohort of injecting drug users with reported viral hepatitis (3,037 persons) and substitution treatment clients (704 persons). Findings: Direct standardized mortality rate reached 16–33 per 1000 person-years of follow-up, depending on the cohort. In all cohorts, mortality was higher among men than women. In the follow-up period, mortality observed a consecutive decrease. The level of mortality among drug users was 8–11 times higher compared to general population. The highest mortality was observed for polyvalent and opiate users, relatively lowest for stimulants users. Conclusions: The level of mortality of drug users in the Czech Republic is comparable to mortality in other European countries; compared to other cohorts, the mortality level in CR is relatively lower. The study proved differences in mortality levels by cohorts; further research should focus on the impact of treatment on the mortality levels.

• MeSH
• kohortové studie MeSH
• lidé MeSH
• mortalita trendy   MeSH
• poruchy spojené s užíváním psychoaktivních látek epidemiologie   mortalita   terapie   MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• artritida MeSH
• epidemiologické studie MeSH
• kohortové studie MeSH
• tuberkulóza MeSH
• Publikační typ
• vysokoškolské kvalifikační práce MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• pneumologie a ftizeologie
• ortopedie

BACKGROUND: High-efficacy therapies in multiple sclerosis are traditionally used after unsuccessful treatment with first-line disease modifying therapies. We hypothesised that early commencement of high-efficacy therapy would be associated with reduced long-term disability. We therefore aimed to compare long-term disability outcomes between patients who started high-efficacy therapies within 2 years of disease onset with those who started 4-6 years after disease onset. METHODS: In this retrospective international observational study, we obtained data from the MSBase registry and the Swedish MS registry, which prospectively collect patient data that are specific to multiple sclerosis as part of routine clinical care. We identified adult patients (aged ≥18 years) with relapsing-remitting multiple sclerosis, with at least 6 years of follow-up since disease onset, and who started the high-efficacy therapy (rituximab, ocrelizumab, mitoxantrone, alemtuzumab, or natalizumab) either 0-2 years (early) or 4-6 years (late) after clinical disease onset. We matched patients in the early and late groups using propensity scores calculated on the basis of their baseline clinical and demographic data. The primary outcome was disability, measured with the Expanded Disability Status Score (EDSS; an ordinal scale of 0-10, with higher scores indicating increased disability), at 6-10 years after disease onset, assessed with a linear mixed-effects model. FINDINGS: We identified 6149 patients in the MSBase registry who had been given high-efficacy therapy, with data collected between Jan 1, 1975, and April 13, 2017, and 2626 patients in the Swedish MS Registry, with data collected between Dec 10, 1997, and Sept 16, 2019. Of whom, 308 in the MSBase registry and 236 in the Swedish MS registry were eligible for inclusion. 277 (51%) of 544 patients commenced therapy early and 267 (49%) commenced therapy late. For the primary analysis, we matched 213 patients in the early treatment group with 253 in the late treatment group. At baseline, the mean EDSS score was 2·2 (SD 1·2) in the early group and 2·1 (SD 1·2) in the late group. Median follow-up time for matched patients was 7·8 years (IQR 6·7-8·9). In the sixth year after disease onset, the mean EDSS score was 2·2 (SD 1·6) in the early group compared with 2·9 (SD 1·8) in the late group (p<0·0001). This difference persisted throughout each year of follow-up until the tenth year after disease onset (mean EDSS score 2·3 [SD 1·8] vs 3·5 [SD 2·1]; p<0·0001), with a difference between groups of -0·98 (95% CI -1·51 to -0·45; p<0·0001, adjusted for proportion of time on any disease-modifying therapy) across the 6-10 year follow-up period. INTERPRETATION: High-efficacy therapy commenced within 2 years of disease onset is associated with less disability after 6-10 years than when commenced later in the disease course. This finding can inform decisions regarding optimal sequence and timing of multiple sclerosis therapy. FUNDING: National Health and Medical Research Council Australia and MS Society UK.

• MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• databáze faktografické MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• posuzování pracovní neschopnosti MeSH
• registrace MeSH
• retrospektivní studie MeSH
• roztroušená skleróza terapie   MeSH
• tendenční skóre MeSH
• věk při počátku nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Švédsko MeSH

BACKGROUND: Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse. METHODS: We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group. RESULTS: Mean age was 48.3 years (range; 23-83) while the mean BMI was 25.7 kg/m2 (range; 15-49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52). CONCLUSIONS: Minimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.

• MeSH
• dospělí MeSH
• hysterektomie metody   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• mladý dospělý MeSH
• nádory děložního čípku chirurgie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• staging nádorů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

OBJECTIVE: Intensive Care Units (ICU) acquired Pneumonia (ICU-AP) is one of the most frequent nosocomial infections in critically ill patients. Our aim was to determine the effects of having an ICU-AP in immunosuppressed patients with acute hypoxemic respiratory failure. DESIGN: Post-hoc analysis of a multinational, prospective cohort study in 16 countries. SETTINGS: ICU. PATIENTS: Immunosuppressed patients with acute hypoxemic respiratory failure. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: The original cohort had 1611 and in this post-hoc analysis a total of 1512 patients with available data on hospital mortality and occurrence of ICU-AP were included. ICU-AP occurred in 158 patients (10.4%). Hospital mortality was higher in patients with ICU-AP (14.8% vs. 7.1% p < 0.001). After adjustment for confounders and centre effect, use of vasopressors (Odds Ratio (OR) 2.22; 95%CI 1.46-3.39) and invasive mechanical ventilation at day 1 (OR 2.12 vs. high flow oxygen; 95%CI 1.07-4.20) were associated with increased risk of ICU-AP while female gender (OR 0.63; 95%CI 0.43-94) and chronic kidney disease (OR 0.43; 95%CI 0.22-0.88) were associated with decreased risk of ICU-AP. After adjustment for confounders and centre effect, ICU-AP was independently associated with mortality (Hazard Ratio 1.48; 95%CI 14.-1.91; P = 0.003). CONCLUSIONS: The attributable mortality of ICU-AP has been repetitively questioned in immunosuppressed patients with acute respiratory failure. This manuscript found that ICU-AP represents an independent risk factor for hospital mortality.

• MeSH
• jednotky intenzivní péče MeSH
• kohortové studie MeSH
• lidé MeSH
• mortalita v nemocnicích MeSH
• pneumonie * epidemiologie   MeSH
• prospektivní studie MeSH
• respirační insuficience * epidemiologie   MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Ovarian cancer risk in BRCA1 and BRCA2 mutation carriers has been shown to decrease with longer duration of oral contraceptive use. Although the effects of using oral contraceptives in the general population are well established (approximately 50% risk reduction in ovarian cancer), the estimated risk reduction in mutation carriers is much less precise because of potential bias and small sample sizes. In addition, only a few studies on oral contraceptive use have examined the associations of duration of use, time since last use, starting age, and calendar year of start with risk of ovarian cancer. OBJECTIVE: This study aimed to investigate in more detail the associations of various characteristics of oral contraceptive use and risk of ovarian cancer, to provide healthcare providers and carriers with better risk estimates. STUDY DESIGN: In this international retrospective study, ovarian cancer risk associations were assessed using oral contraceptives data on 3989 BRCA1 and 2445 BRCA2 mutation carriers. Age-dependent-weighted Cox regression analyses were stratified by study and birth cohort and included breast cancer diagnosis as a covariate. To minimize survival bias, analyses were left truncated at 5 years before baseline questionnaire. Separate analyses were conducted for each aspect of oral contraceptive use and in a multivariate analysis, including all these aspects. In addition, the analysis of duration of oral contraceptive use was stratified by recency of use. RESULTS: Oral contraceptives were less often used by mutation carriers who were diagnosed with ovarian cancer (ever use: 58.6% for BRCA1 and 53.5% BRCA2) than by unaffected carriers (ever use: 88.9% for BRCA1 and 80.7% for BRCA2). The median duration of use was 7 years for both BRCA1 and BRCA2 carriers who developed ovarian cancer and 9 and 8 years for unaffected BRCA1 and BRCA2 carriers with ovarian cancer, respectively. For BRCA1 mutation carriers, univariate analyses have shown that both a longer duration of oral contraceptive use and more recent oral contraceptive use were associated with a reduction in the risk of ovarian cancer. However, in multivariate analyses, including duration of use, age at first use, and time since last use, duration of oral contraceptive use proved to be the prominent protective factor (compared with <5 years: 5-9 years [hazard ratio, 0.67; 95% confidence interval, 0.40-1.12]; >10 years [hazard ratio, 0.37; 95% confidence interval, 0.19-0.73]; Ptrend=.008). The inverse association between duration of use and ovarian cancer risk persisted for more than 15 years (duration of ≥10 years; BRCA1 <15 years since last use [hazard ratio, 0.24; 95% confidence interval, 0.14-0.43]; BRCA1 >15 years since last use [hazard ratio, 0.56; 95% confidence interval, 0.18-0.59]). Univariate results for BRCA2 mutation carriers were similar but were inconclusive because of limited sample size. CONCLUSION: For BRCA1 mutation carriers, longer duration of oral contraceptive use is associated with a greater reduction in ovarian cancer risk, and the protection is long term.

• MeSH
• dospělí MeSH
• genetická predispozice k nemoci MeSH
• kohortové studie MeSH
• kontraceptiva orální aplikace a dávkování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mutace * MeSH
• nádory vaječníků epidemiologie   genetika   prevence a kontrola   MeSH
• následné studie MeSH
• proporcionální rizikové modely MeSH
• protein BRCA1 genetika   MeSH
• protein BRCA2 genetika   MeSH
• retrospektivní studie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

• MeSH
• fenotyp MeSH
• genotyp MeSH
• idiopatické střevní záněty genetika   MeSH
• kohortové studie MeSH
• sérologické testy MeSH
• těhotenství MeSH
• výsledek těhotenství MeSH
• ženy MeSH
• Check Tag
• těhotenství MeSH
• Geografické názvy
• Evropa MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• gastroenterologie
• genetika, lékařská genetika
• NLK Publikační typ
• studie

OBJECTIVE: The aim of this study was to analyse longitudinal development of prognostic awareness in advanced cancer patients and their families. METHODS: This was a longitudinal cohort study, involving 134 adult cancer patients, 91 primary family caregivers and 21 treating oncologists. Key eligibility criterion for patients was life expectancy less than 1 year (estimated by their oncologists using the 12-month surprised question). Structured interviews, including tools to measure prognostic awareness, health information needs, and demographics were conducted face to face or via phone three times over 9 months. Forty-four patients completed all three phases of data collection. RESULTS: Only 16% of patients reported accurate prognostic awareness, 58% being partially aware. Prognostic awareness of both patients and family caregivers remained stable over the course of the study, with only small non-significant changes. Gender, education, type of cancer, spirituality or health information needs were not associated with the level of prognostic awareness. Family caregivers reported more accurate prognostic awareness, which was not associated with patients' own prognostic awareness (agreement rate 59%, weighted kappa 0.348, CI = 0.185-0.510). CONCLUSIONS: Prognostic awareness appears to be a stable concept over the course of the illness. Clinicians must focus on the initial patients' understanding of the disease and be able to communicate the prognostic information effectively from the early stages of patients' trajectory.

• MeSH
• kohortové studie MeSH
• lidé MeSH
• longitudinální studie MeSH
• nádory * terapie   MeSH
• osoby pečující o pacienty * MeSH
• prognóza MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Tralokinumab is a human monoclonal antibody targeting interleukin-13 that is approved for the treatment of moderate-severe atopic dermatitis. Studies analyzing the efficacy and safety of tralokinumab in a real-world setting are scarce. RESEARCH DESIGN AND METHODS: A European, multicentric, real-world, retrospective cohort study was defined to assess the effectiveness and safeness profile of tralokinumab, investigating the achievement of pre-specified treatment goals; and to detect potential differences in terms of effectiveness and safeness across some selected patient subcohorts. RESULTS: A total of 194 adult patients were included in this study. A significant improvement in physician-assessed disease severity was detected at each follow-up visit as compared with baseline and similar trend was observed for patient-reported outcomes and quality of life. No meaningful difference in effectiveness was found when considering patient age (<65 versus ≥65 years), neither dissecting patient cohort in dupilumab-naive vs dupilumab-treated subjects. Among tralokinumab-treated patients, 88% achieved at least one currently identified real-world therapeutic goal at week 16. CONCLUSIONS: This retrospective multicenter study confirmed the effectiveness and safeness of tralokinumab throughout 32 weeks of observation, showing the achievement of therapeutic goals identified in both trial and real-world settings in a large proportion of tralokinumab-treated patients.

• MeSH
• atopická dermatitida * diagnóza   farmakoterapie   MeSH
• cíle MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• kohortové studie MeSH
• kvalita života MeSH
• lidé MeSH
• monoklonální protilátky škodlivé účinky   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Objective: To evaluate if the morphology of the mandibular symphysis is associated with the development of gingival recession. Materials and methods: A cohort of 177 patients was followed longitudinally for up to 5 years post-treatment. Based on the width of the symphysis, participants were divided into three groups: narrow (n = 57); average (n = 63), and wide symphysis (n = 57). Morphology of the symphysis and inclination of incisors were measured on lateral cephalometric radiographs before treatment (Ts), at the end of treatment (T0) and 5 years after treatment (T5). Gingival recession and the change of clinical crown heights in mandibular incisors were measured on plaster models made at TS, T0, and T5. Results: From TS to T5 the change in inclination was comparable in the narrow, average, and wide groups. At T5, gingival labial recession was present in 19.3 per cent of patients with narrow symphysis, 20.6 per cent with average symphysis, and 14 per cent of patients with wide symphysis. The difference was not significant. The mean change of clinical crown height was <1 mm (TS - T5). The regression model showed some evidence that incisor inclination at Ts might have been associated with the change of mean clinical crown height (-2.51, 95% CI: -4.6 to -0.4, P = 0.02). The logistic regression model demonstrated that H1 (Height 1) might be associated with the development of gingival recession (OR = 0.75, 95% CI: 0.58 to 0.96, P = 0.03). Conclusion: Within the limitations of this study, there is no evidence that the overall morphology of the mandibular symphysis is associated with gingival recession development.

• MeSH
• dítě MeSH
• kefalometrie metody   MeSH
• kohortové studie MeSH
• lidé MeSH
• longitudinální studie MeSH
• mandibula patologie   MeSH
• mladiství MeSH
• ortodoncie korekční škodlivé účinky   MeSH
• retrospektivní studie MeSH
• řezáky patologie   MeSH
• ústup dásní etiologie   patologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH