Publications by authors named "Smeeth L"

Background: Although drug interactions between clarithromycin/erythromycin/fluconazole and direct oral anticoagulants (DOACs) are mechanistically plausible, it is uncertain whether they are clinically relevant.

Objective: To investigate the association between co-prescribed DOACs and antimicrobials and bleeding, cardiovascular disease and mortality.

Methods: We identified DOAC users in the Clinical Practice Research Datalink Aurum from 1/1/2011-29/3/2021.

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Background: Direct oral anticoagulants (DOACs) have been reported to be associated with a higher risk of mortality compared with an older alternative, warfarin using primary care data in the United Kingdom (UK). However, other studies observed contradictory findings. We therefore aimed to investigate the association between mortality and warfarin, compared with DOACs.

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Multimorbidity data is typically analysed by tallying disease counts, which overlooks nuanced relationships among conditions. We identified clusters of multimorbidity and subpopulations with varying risks and examined their association with all-cause mortality using a data-driven approach. We analysed 8-year follow-up data of people ≥35 years who were part of the CRONICAS Cohort Study, a multisite cohort from Peru.

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Article Synopsis
  • The study investigates the potential drug interaction between direct oral anticoagulants (DOACs) and statins (specifically atorvastatin and simvastatin) regarding bleeding risks and cardiovascular outcomes.
  • Analyzing data from a large cohort, the results indicate that there is no significant difference in risk for major outcomes when DOACs are co-prescribed with atorvastatin/simvastatin compared to other statins.
  • However, in certain cases, users of atorvastatin and simvastatin showed increased odds of specific bleeding events and higher mortality rates when initiating DOAC therapy, suggesting the need for careful monitoring.
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Background: In utero exposure to infections might set the stage for a chain of events leading to a wide spectrum of long-term health outcomes observed in children and adolescents. This proposal aims to investigate whether syphilis, zika, dengue and chikungunya during pregnancy can increase the risk of the offspring developing a non-infectious chronic condition during childhood and adolescence.

Objectives: 1) Estimate the risk of non-infectious chronic conditions associated to syphilis, zika, dengue and chikungunya during pregnancy and when appropriate, explore if the risk varies by timing during pregnancy when the infection is acquired (first, second or third trimester) and severity (such as severe or mild dengue); 2) Investigate whether in uterus exposure to maternal infection affects the growth pattern of children and adolescents; 3) Examine the extent to which the relationship between maternal infection and non-infectious chronic outcomes are mediated by intrauterine growth restriction and preterm birth.

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Introduction: We undertook phenotypic characterization of early-onset and late-onset type 2 diabetes (T2D) in adult black African and white European populations with recently diagnosed T2D to explore ethnic differences in the manifestation of early-onset T2D.

Research Design And Methods: Using the Uganda Diabetes Phenotype study cohort of 500 adult Ugandans and the UK StartRight study cohort of 714 white Europeans with recently diagnosed islet autoantibody-negative T2D, we compared the phenotypic characteristics of participants with early-onset T2D (diagnosed at <40 years) and late-onset T2D (diagnosed at ≥40 years).

Results: One hundred and thirty-four adult Ugandans and 113 white Europeans had early-onset T2D.

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Background: Stroke prevention guidance for patients with atrial fibrillation (AF) uses evidence generated from randomised controlled trials (RCTs). However, applicability to patient groups excluded from trials remains unknown. Real-world patient data provide an opportunity to evaluate outcomes in a trial analogous population of direct oral anticoagulants (DOACs) users and in patients otherwise excluded from RCTs; however, there remains uncertainty on the validity of methods and suitability of the data.

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Background: Electronic health records (EHRs) have the potential to be used to produce detailed disease burden estimates. In this study we created disease estimates using national EHR for three high burden conditions, compared estimates between linked and unlinked datasets and produced stratified estimates by age, sex, ethnicity, socio-economic deprivation and geographical region.

Methods: EHRs containing primary care (Clinical Practice Research Datalink), secondary care (Hospital Episode Statistics) and mortality records (Office for National Statistics) were used.

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Background: Direct oral anticoagulants (DOACs) are commonly co-prescribed with amiodarone/diltiazem/verapamil, but whether there is a drug interaction between these drugs is unclear.

Objective: The purpose of this study was to investigate the risk of clinical outcomes associated with concomitant use of DOACs and amiodarone/diltiazem/verapamil.

Methods: We identified DOAC users in the Clinical Practice Research Datalink Aurum from January 1, 2011, to December 31, 2019.

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Article Synopsis
  • The text indicates that there is a correction to a previously published article.
  • The article in question is identified by its DOI (Digital Object Identifier) number, which is 10.1371/journal.pgph.0002601.
  • This correction likely addresses errors or updates related to the research findings or content of the original article.
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Importance: Fluoroquinolone use has been associated with increased risk of uveitis and retinal detachment in noninterventional studies, but the findings have been conflicting and causality is unclear.

Objective: To estimate the association of systemic fluoroquinolone use with acute uveitis or retinal detachment, using multiple analyses and multiple databases to increase the robustness of results.

Design, Setting, And Participants: This cohort study used data from the Clinical Practice Research Datalink Aurum and GOLD UK primary care records databases, which were linked to hospital admissions data.

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Background: Type 2 diabetes is common in relatively lean individuals in sub-Saharan Africa. It is unclear whether phenotypic differences exist between underweight and normal-weight African patients with type 2 diabetes. This study compared specific characteristics between underweight (body mass index <18.

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Article Synopsis
  • Electronic health records (EHRs) are essential for researching medical products and informing public health, but reproducibility in EHR research is a significant challenge.
  • OpenSAFELY is an open-source software platform created during the COVID-19 pandemic to improve the reproducibility of research using EHRs by standardizing workflows and ensuring consistent computational environments.
  • The platform promotes transparency by enforcing code-sharing, providing an audit trail for data usage, and integrating tools that support reproducible research practices.
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Five-alpha reductase inhibitors (5ARIs) are used in the management of benign prostatic hyperplasia (BPH). 5ARIs prevent the conversion of testosterone to dihydrotestosterone, which is important in prostate development. It has been suggested that 5ARIs can be used a chemopreventative agent for prostate cancer.

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Objective: To compare the effectiveness of three commonly prescribed oral antidiabetic drugs added to metformin for people with type 2 diabetes mellitus requiring second line treatment in routine clinical practice.

Design: Cohort study emulating a comparative effectiveness trial (target trial).

Setting: Linked primary care, hospital, and death data in England, 2015-21.

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Introduction: 4.2 million individuals in the UK have type 2 diabetes, a known risk factor for dementia and mild cognitive impairment (MCI). Diabetes treatment may modify this association, but existing evidence is conflicting.

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Background: Although some systemic infections are associated with Parkinson's disease (PD), the relationship between herpes zoster (HZ) and PD is unclear.

Objective: The objective is to investigate whether HZ is associated with incident PD risk in a matched cohort study using data from the US Department of Veterans Affairs.

Methods: We compared the risk of PD between individuals with incident HZ matched to up to five individuals without a history of HZ using Cox proportional hazards regression.

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Population-based prospective studies, such as UK Biobank, are valuable for generating and testing hypotheses about the potential causes of human disease. We describe how UK Biobank's study design, data access policies, and approaches to statistical analysis can help to minimize error and improve the interpretability of research findings, with implications for other population-based prospective studies being established worldwide.

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Article Synopsis
  • The study investigates how different hypertension guidelines (JNC-7 and ACC/AHA 2017) relate to 10-year mortality outcomes in a cohort from the PERU MIGRANT Study, finding a significant association between hypertension levels and increased mortality risk.
  • Analyzed data from 976 participants showed that hypertension prevalence nearly doubled when applying the ACC/AHA guidelines compared to JNC-7, and 6.4% of the participants died during the 10-year follow-up.
  • Those classified with pre-hypertension and hypertension were found to have significantly higher risks of death—2.1 times and 5.1 times, respectively—indicating the importance
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Background: We investigated perinatal outcomes among live births from international migrant and local-born mothers in a cohort of low-income individuals in Brazil.

Methods: We linked nationwide birth registries to mortality records and socioeconomic data from the CIDACS Birth Cohort and studied singleton live births of women aged 10-49 years from 1 January 2011 to 31 December 2018. We used logistic regressions to investigate differences in antenatal care, adverse pregnancy outcomes, and neonatal (i.

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Background: Non-invasive diabetes risk models are a cost-effective tool in large-scale population screening to identify those who need confirmation tests, especially in resource-limited settings.

Aims: This study aimed to evaluate the ability of six non-invasive risk models (Cambridge, FINDRISC, Kuwaiti, Omani, Rotterdam, and SUNSET model) to identify screen-detected diabetes (defined by HbA1c) among Ghanaian migrants and non-migrants.

Study Design: A multicentered cross-sectional study.

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Article Synopsis
  • * Existing literature emphasizes the need for improved real-time health data linkages and the importance of international data interoperability to better respond to future health crises.
  • * The review calls for greater investment in team science, public trust in scientific methods, and policy processes, particularly advocating for broader participation in clinical trials in low- and middle-income countries.
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