Publications by authors named "Amaya Azcoaga-Lorenzo"
Background: Subclinical hypothyroidism (SCH) is a biochemical thyroid disorder characterised by elevated levels of Thyroid Stimulating Hormone (TSH) together with normal levels of thyroid hormones. Evidence on the benefits of treatment is limited, resulting in persistent controversies relating to its clinical management.
Aim: This study describes the demographic and clinical characteristics of patients identified as having subclinical hypothyroidism in Wales between 2000 and 2021, the annual cumulative incidence during this period and the testing and treatment patterns associated with this disorder.
There is still limited understanding of how chronic conditions co-occur in patients with multimorbidity and what are the consequences for patients and the health care system. Most reported clusters of conditions have not considered the demographic characteristics of these patients during the clustering process. The study used data for all registered patients that were resident in Fife or Tayside, Scotland and aged 25 years or more on 1st January 2000 and who were followed up until 31st December 2018.
View Article and Find Full Text PDFBackground: Primary care electronic health records (EHR) are widely used to study long-term conditions in epidemiological and health services research. Therefore, it is important to understand how well the recorded prevalence of these conditions in EHRs, compares to other reliable sources overall, and varies by socio-demographic characteristics. We aimed to describe the prevalence and socio-demographic variation of cardiovascular, renal, and metabolic (CRM) and mental health (MH) conditions in a large, nationally representative, English primary care database and compare with prevalence estimates from other population-based studies.
View Article and Find Full Text PDFDetection and evaluation of signals associated with exposure to individual and combination of medications in pregnancy: a signal detection study protocol.
BMJ Open
October 2023
Article Synopsis
- The study addresses the issue of polypharmacy in pregnant women, highlighting the need for more research on the safety of their complex medication plans, particularly focusing on adverse and protective effects of various medications during pregnancy.
- It employs real-world data from the UK to conduct a pharmacovigilance study assessing medication safety in women during the preconception period and the first trimester.
- A multidisciplinary expert team will analyze and reach consensus on the signals of associations between medication exposure and pregnancy outcomes to filter out misleading data for further evaluation.
Article Synopsis
- Multimorbidity (presence of multiple health conditions) is prevalent among pregnant women, with 16.8% experiencing it and 3.6% having complex multimorbidity (four or more conditions) in a study of over 27,000 pregnancies.
- The prevalence of multimorbidity increases with maternal age, ranging from 10.2% in younger women (15-19) to 21.4% in those aged 40-44.
- Pregnant women with multimorbidity have higher rates of preterm birth (PTB), at 11.6%, compared to 6.7% in those without, and 15.6% in those with complex multimorbidity.*
Background: Multimorbidity, smoking status, and pregnancy are identified as three risk factors associated with more severe outcomes following a SARS-CoV-2 infection, thus vaccination uptake is crucial for pregnant women living with multimorbidity and a history of smoking. This study aimed to examine the impact of multimorbidity, smoking status, and demographics (age, ethnic group, area of deprivation) on vaccine hesitancy among pregnant women in Wales using electronic health records (EHR) linkage.
Methods: This cohort study utilised routinely collected, individual-level, anonymised population-scale linked data within the Secure Anonymised Information Linkage (SAIL) Databank.
Article Synopsis
- This study developed a core outcome set for future research on pregnant women with multimorbidity to tackle issues of inconsistent outcome reporting across studies.
- The development process involved a systematic literature search, focus groups, and Delphi surveys engaging diverse stakeholders, including affected women and healthcare professionals.
- The final core outcome set identified 11 key outcomes, including maternal death, severe morbidity, and baby survival rates, which should be consistently measured in related research.
Article Synopsis
- A qualitative study was conducted to identify important outcomes for pregnant women with multiple long-term health conditions by involving women, their partners, and healthcare professionals in focus groups.
- The study found 63 outcomes related to maternal health, child health, and healthcare utilization, with new outcomes discovered that haven't been previously emphasized in the literature.
- Participants highlighted the importance of care processes, particularly the need for effective information sharing during transitions in healthcare, showing a consensus on the significance of various outcomes across different stakeholders.
Background: Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK.
Methods: Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000-2019).
Article Synopsis
- - The study investigates how diseases like psychosis, diabetes, and congestive heart failure coexist and develop over time, focusing on their impact on life expectancy in Wales from 2000 to 2019.
- - Researchers used a large set of health data from the Wales Multimorbidity e-Cohort, modeling disease trajectories and their effects on overall mortality while adjusting for factors like sex, age, and socio-economic status.
- - Findings reveal that the order in which these diseases are acquired significantly affects life expectancy, indicating a complex interplay of multimorbidity that warrants targeted public health strategies.
Objective: To develop international consensus on the definition and measurement of multimorbidity in research.
Design: Delphi consensus study.
Setting: International consensus; data collected in three online rounds from participants between 30 November 2020 and 18 May 2021.
Objectives: The use of medications among pregnant women has been rising over the past few decades but the reporting of polypharmacy has been sporadic. The objective of this review is to identify literature reporting the prevalence of polypharmacy among pregnant women, the prevalence of multimorbidity in women taking multiple medications in pregnancy and associated effects on maternal and offspring outcomes.
Design: MEDLINE and Embase were searched from their inception to 14 September 2021 for interventional trials, observational studies and systematic reviews reporting on the prevalence of polypharmacy or the use of multiple medications in pregnancy were included.
Article Synopsis
- * Researchers will analyze data from UK health records spanning from 2000 to 2019, examining various health outcomes during different stages: antenatal, peripartum, postnatal, and long-term mental health.
- * Ethical approval has been secured, and findings are set to be published in peer-reviewed journals and presented at major conferences for wider dissemination.
Article Synopsis
- The study looks at how many pregnant women are taking multiple medications, which has become more common over the last 20 years.
- It gathered data from a big medical records database to see how often women used 2 or more medicines during pregnancy.
- The findings show that about 25% of women used multiple medications in their first trimester, and some risk factors for this include being overweight, from certain ethnic groups, or being a smoker.
Article Synopsis
- Current UK vaccination policy targets high-risk individuals for future COVID-19 booster doses, but the specific groups that would benefit the most remain uncertain.
- A study analyzed data from 30 million people across the UK to identify risk factors for severe COVID-19 outcomes in those who completed their primary vaccination and received a booster dose of certain vaccines.
- The findings highlighted that from late December 2021 to February 2022, only a small percentage of vaccinated individuals experienced severe COVID-19 outcomes, indicating the effectiveness of the vaccination program, especially when considering variations in risk factors.
There is a need for better understanding of the risk of thrombocytopenic, haemorrhagic, thromboembolic disorders following first, second and booster vaccination doses and testing positive for SARS-CoV-2. Self-controlled cases series analysis of 2.1 million linked patient records in Wales between 7th December 2020 and 31st December 2021.
View Article and Find Full Text PDFAim: This umbrella review summarises and compares synthesised evidence on the impact of subclinical hypothyroidism and its management on long-term clinical outcomes.
Methods: We conducted comprehensive searches on MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, the PROSPERO register, Epistemonikos Database and PDQ Evidence from inception to February and July 2021 using keywords on subclinical hypothyroidism, treatment with levothyroxine, monitoring and primary outcomes (all-cause mortality, cardiovascular events, stroke, frailty fractures and quality of life). Only systematic reviews and meta-analyses on adult patient populations were considered.
Objective: (1) To estimate the pooled prevalence of multimorbidity in all age groups, globally. (2) To examine how measurement of multimorbidity impacted the estimated prevalence.
Methods: In this systematic review and meta-analysis, we conducted searches in nine bibliographic databases (PsycINFO, Embase, Global Health, Medline, Scopus, Web of Science, Cochrane Library, CINAHL and ProQuest Dissertations and Theses Global) for prevalence studies published between database inception and 21 January 2020.
Background: Although maternal death is rare in the United Kingdom, 90% of these women had multiple health/social problems. This study aims to estimate the prevalence of pre-existing multimorbidity (two or more long-term physical or mental health conditions) in pregnant women in the United Kingdom (England, Northern Ireland, Wales and Scotland).
Study Design: Pregnant women aged 15-49 years with a conception date 1/1/2018 to 31/12/2018 were included in this population-based cross-sectional study, using routine healthcare datasets from primary care: Clinical Practice Research Datalink (CPRD, United Kingdom, n = 37,641) and Secure Anonymized Information Linkage databank (SAIL, Wales, n = 27,782), and secondary care: Scottish Morbidity Records with linked community prescribing data (SMR, Tayside and Fife, n = 6099).
Objectives: Develop a novel algorithm to categorise alcohol consumption using primary care electronic health records (EHRs) and asses its reliability by comparing this classification with self-reported alcohol consumption data obtained from the UK Biobank (UKB) cohort.
Design: Cross-sectional study.
Setting: The UKB, a population-based cohort with participants aged between 40 and 69 years recruited across the UK between 2006 and 2010.
Background: Subclinical hypothyroidism is a thyroid disorder diagnosed from the laboratory blood test results of otherwise asymptomatic patients. It has been associated with poor cardiovascular outcomes, mortality and progression to overt thyroid hormone deficiency. Current guidelines on the management of subclinical hypothyroidism differ because of conflicting evidence on long-term treatment benefits.
View Article and Find Full Text PDFArticle Synopsis
- The study focuses on developing a core outcome set (COS) for maternal and offspring health in pregnant women who have pre-existing multimorbidity, which may negatively impact health outcomes.
- It employs a four-stage design: a systematic literature search, focus groups for personal insights, a Delphi survey for prioritization, and a consensus meeting to finalize the outcomes.
- Ethical approval has been granted by the University of Birmingham, ensuring the study follows proper ethical guidelines and will effectively gather and disseminate relevant findings.
Objectives: We investigated the association between multimorbidity among patients hospitalised with COVID-19 and their subsequent risk of mortality. We also explored the interaction between the presence of multimorbidity and the requirement for an individual to shield due to the presence of specific conditions and its association with mortality.
Design: We created a cohort of patients hospitalised in Scotland due to COVID-19 during the first wave (between 28 February 2020 and 22 September 2020) of the pandemic.
Background: The UK COVID-19 vaccination programme has prioritised vaccination of those at the highest risk of COVID-19 mortality and hospitalisation. The programme was rolled out in Scotland during winter 2020-21, when SARS-CoV-2 infection rates were at their highest since the pandemic started, despite social distancing measures being in place. We aimed to estimate the frequency of COVID-19 hospitalisation or death in people who received at least one vaccine dose and characterise these individuals.
View Article and Find Full Text PDFBackground: A systematic understanding of how multimorbidity has been constructed and measured is unavailable. This review aimed to examine the definition and measurement of multimorbidity in peer-reviewed studies internationally.
Methods: We systematically reviewed studies on multimorbidity, via a search of nine bibliographic databases (Ovid [PsycINFO, Embase, Global Health, and MEDLINE], Web of Science, the Cochrane Library, CINAHL Plus, Scopus, and ProQuest Dissertations & Theses Global), from inception to Jan 21, 2020.