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Buch ; Dissertation / Habilitation: Pharmacoepidemiologic studies on cardiovascular drugs

Merlo, Juan

with special reference to the effectiveness and safety of blood pressure lowering drugs

1998

Verfasserangabe	Juan Merlo
Sprache	Englisch
Umfang	126 S. : graph. Darst.
Erscheinungsland	Schweden
Dokumenttyp	Buch ; Dissertation / Habilitation
Dissertation / Habilitation	Lund, Univ., Diss., 1998
HBZ-ID	HT008389224
ISBN	91-628-2949-1 ; 978-91-628-2949-0
Datenquelle	Katalog ZB MED Medizin, Gesundheit

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Artikel ; Online: Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) within an intersectional framework.

Merlo, Juan

Social science & medicine (1982)

2017 Band 203, Seite(n) 74–80

Abstract: Background: Analyzing Body Mass Index as a didactical example, the study by Evans, Williams, Onnela, and Subramanian (EWOS study) introduce a novel methodology for the investigation of socioeconomic disparities in health. By using multilevel analysis to ...

Abstract	Background: Analyzing Body Mass Index as a didactical example, the study by Evans, Williams, Onnela, and Subramanian (EWOS study) introduce a novel methodology for the investigation of socioeconomic disparities in health. By using multilevel analysis to model health inequalities within and between strata defined by the intersection of multiple social and demographic dimensions, the authors provide a better understanding of the health heterogeneity existing in the population. Their innovative methodology allows for gathering inductive information on a large number of stratum-specific interactions of effects and, simultaneously, informs on the discriminatory accuracy of such strata for predicting individual health. Their study provides an excellent answer to the call for suitable quantitative methodologies within the intersectionality framework. Rationale: The EWOS study is a well-written tutorial; thus, in this commentary, I will not repeat the explanation of the statistical/epidemiological concepts. Instead, I will share with the reader a number of thoughts on the theoretical consequences derived from the application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) in (social) epidemiology in general, and within the intersectional framework in particular. MAIHDA is a reorganization of concepts that allows for a better understanding of the distribution and determinants of individual health and disease risk in the population. Conclusions: By applying MAIHD within an intersectional framework, the EWOS study provides a superior theoretical and quantitative instrument for documenting health disparities and it should become the new gold standard for investigating health disparities in (social) epidemiology. This approach is more appropriate for eco-social perspectives than the habitual probabilistic strategy based on differences between group average risks. However, both, the translation of intersectionality theory into (social) epidemiology and the intersectional quantitative methodology (especially for generalized linear models) are still under development.
Mesh-Begriff(e)	Body Mass Index ; Health Status Disparities ; Humans ; Models, Theoretical ; Multilevel Analysis ; Reproducibility of Results ; Socioeconomic Factors
Sprache	Englisch
Erscheinungsdatum	2017-12-26
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	4766-1
ISSN	1873-5347 ; 0037-7856 ; 0277-9536
ISSN (online)	1873-5347
ISSN	0037-7856 ; 0277-9536
DOI	10.1016/j.socscimed.2017.12.026
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: A tutorial for conducting intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

Evans, Clare R / Leckie, George / Subramanian, S V / Bell, Andrew / Merlo, Juan

SSM - population health

2024 Band 26, Seite(n) 101664

Abstract: Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA) is an innovative approach for investigating inequalities, including intersectional inequalities in health, disease, psychosocial, socioeconomic, and ... ...

Abstract	Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA) is an innovative approach for investigating inequalities, including intersectional inequalities in health, disease, psychosocial, socioeconomic, and other outcomes. I-MAIHDA and related MAIHDA approaches have conceptual and methodological advantages over conventional single-level regression analysis. By enabling the study of inequalities produced by numerous interlocking systems of marginalization and oppression, and by addressing many of the limitations of studying interactions in conventional analyses, intersectional MAIHDA provides a valuable analytical tool in social epidemiology, health psychology, precision medicine and public health, environmental justice, and beyond. The approach allows for estimation of average differences between intersectional strata (stratum inequalities), in-depth exploration of interaction effects, as well as decomposition of the total individual variation (heterogeneity) in individual outcomes within and between strata. Specific advice for conducting and interpreting MAIHDA models has been scattered across a burgeoning literature. We consolidate this knowledge into an accessible conceptual and applied tutorial for studying both continuous and binary individual outcomes. We emphasize I-MAIHDA in our illustration, however this tutorial is also informative for understanding related approaches, such as
Sprache	Englisch
Erscheinungsdatum	2024-03-26
Erscheinungsland	England
Dokumenttyp	Journal Article
ISSN	2352-8273
ISSN	2352-8273
DOI	10.1016/j.ssmph.2024.101664
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Socioeconomic disparities in attention deficit hyperactivity disorder (ADHD) in Sweden: An intersectional ecological niches analysis of individual heterogeneity and discriminatory accuracy (IEN-AIHDA).

Hornborg, Christoffer / Axrud, Rebecca / Vicente, Raquel Pérez / Merlo, Juan

PloS one

2023 Band 18, Heft 11, Seite(n) e0294741

Abstract: We aimed (i) to gain a better understanding of the demographic and socioeconomical distribution of ADHD risk in Sweden; and (ii) to contribute to the critical discussion on medicalization, i.e., the tendency to define and treat behavioural and social ... ...

Abstract	We aimed (i) to gain a better understanding of the demographic and socioeconomical distribution of ADHD risk in Sweden; and (ii) to contribute to the critical discussion on medicalization, i.e., the tendency to define and treat behavioural and social problems as medical entities. For this purpose, we analysed the risk of suffering from ADHD in the whole Swedish population aged between 5 and 60 years, across 96 different strata defined by combining categories of gender, age, income, and country of birth. The stratified analysis evidenced considerable risk heterogeneity, with prevalence values ranging from 0.03% in high income immigrant women aged 50-59, to 6.18% in middle income immigrant boys aged 10-14. Our study questions the established idea that behavioural difficulties conceptualized as ADHD should be primarily perceived as a neurological abnormality. Rather, our findings suggest that there is a strong sociological component behind how some individuals become impaired and subject to medicalization.
Mesh-Begriff(e)	Male ; Humans ; Female ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Attention Deficit Disorder with Hyperactivity/diagnosis ; Attention Deficit Disorder with Hyperactivity/epidemiology ; Sweden/epidemiology ; Socioeconomic Disparities in Health ; Income ; Intersectional Framework
Sprache	Englisch
Erscheinungsdatum	2023-11-20
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0294741
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Reevaluating the protective effect of smoking on preeclampsia risk through the lens of bias.

Rodriguez-Lopez, Merida / Escobar, Maria Fernanda / Merlo, Juan / Kaufman, Jay S

Journal of human hypertension

2023 Band 37, Heft 5, Seite(n) 338–344

Abstract: Preeclampsia is a hypertensive disorder that is usually diagnosed after 20 weeks' gestation. Despite the deleterious effect of smoking on cardiovascular disease, it has been frequently reported that smoking has a protective effect on preeclampsia risk ... ...

Abstract	Preeclampsia is a hypertensive disorder that is usually diagnosed after 20 weeks' gestation. Despite the deleterious effect of smoking on cardiovascular disease, it has been frequently reported that smoking has a protective effect on preeclampsia risk and biological explanations have been proposed. However, in this manuscript, we present multiple sources of bias that could explain this association. First, key concepts in epidemiology are reviewed: confounder, collider, and mediator. Then, we describe how eligibility criteria, losses of women potentially at risk, misclassification, or performing incorrect adjustments can create bias. We provide examples to show that strategies to control for confounders may fail when they are applied to variables that are not confounders. Finally, we outline potential approaches to manage this controversial effect. We conclude that there is probably no single epidemiological explanation for this counterintuitive association.
Mesh-Begriff(e)	Pregnancy ; Female ; Humans ; Pre-Eclampsia/diagnosis ; Pre-Eclampsia/epidemiology ; Pre-Eclampsia/etiology ; Smoking/adverse effects ; Smoking/epidemiology ; Bias ; Hypertension/epidemiology ; Cardiovascular Diseases
Sprache	Englisch
Erscheinungsdatum	2023-04-11
Erscheinungsland	England
Dokumenttyp	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	639472-3
ISSN	1476-5527 ; 0950-9240
ISSN (online)	1476-5527
ISSN	0950-9240
DOI	10.1038/s41371-023-00827-9
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Mapping sociodemographic and geographical differences in human papillomavirus non-vaccination among young girls in Sweden.

Wemrell, Maria / Vicente, Raquel Perez / Merlo, Juan

Scandinavian journal of public health

2022 Band 51, Heft 2, Seite(n) 288–295

Mesh-Begriff(e)	Female ; Humans ; Sweden ; Human Papillomavirus Viruses ; Papillomavirus Infections/prevention & control ; Immunization Programs ; Parents ; Uterine Cervical Neoplasms/epidemiology ; Uterine Cervical Neoplasms/prevention & control ; Papillomavirus Vaccines
Chemische Substanzen	Papillomavirus Vaccines
Sprache	Englisch
Erscheinungsdatum	2022-02-04
Erscheinungsland	Sweden
Dokumenttyp	Journal Article
ZDB-ID	1475054-5
ISSN	1651-1905 ; 1403-4948
ISSN (online)	1651-1905
ISSN	1403-4948
DOI	10.1177/14034948221075410
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Invited commentary: multilevel analysis of individual heterogeneity-a fundamental critique of the current probabilistic risk factor epidemiology.

Merlo, Juan

American journal of epidemiology

2014 Band 180, Heft 2, Seite(n) 208–12; discussion 213–4

Abstract: In this issue of the Journal, Dundas et al. (Am J Epidemiol. 2014;180(2):197-207) apply a hitherto infrequent multilevel analytical approach: multiple membership multiple classification (MMMC) models. Specifically, by adopting a life-course approach, ... ...

Abstract	In this issue of the Journal, Dundas et al. (Am J Epidemiol. 2014;180(2):197-207) apply a hitherto infrequent multilevel analytical approach: multiple membership multiple classification (MMMC) models. Specifically, by adopting a life-course approach, they use a multilevel regression with individuals cross-classified in different contexts (i.e., families, early schools, and neighborhoods) to investigate self-reported health and mental health in adulthood. They provide observational evidence suggesting the relevance of the early family environment for launching public health interventions in childhood in order to improve health in adulthood. In their analyses, the authors distinguish between specific contextual measures (i.e., the association between particular contextual characteristics and individual health) and general contextual measures (i.e., the share of the total interindividual heterogeneity in health that appears at each level). By doing so, they implicitly question the traditional probabilistic risk factor epidemiology including classical "neighborhood effects" studies. In fact, those studies use simple hierarchical structures and disregard the analysis of general contextual measures. The innovative MMMC approach properly responds to the call for a multilevel eco-epidemiology against a widespread probabilistic risk factors epidemiology. The risk factors epidemiology is not only reduced to individual-level analyses, but it also embraces many current "multilevel analyses" that are exclusively focused on analyzing contextual risk factors.
Mesh-Begriff(e)	Female ; Health Status ; Humans ; Male ; Residence Characteristics ; Schools ; Social Class ; Social Environment
Sprache	Englisch
Erscheinungsdatum	2014-07-15
Erscheinungsland	United States
Dokumenttyp	Comment ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwu108
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Geographical and sociodemographic differences in statin dispensation after acute myocardial infarction in Sweden: a register-based prospective cohort study applying analysis of individual heterogeneity and discriminatory accuracy (AIHDA) for basic comparisons of healthcare quality.

Merlo, Juan / Öberg, Johan / Khalaf, Kani / Perez-Vicente, Raquel / Leckie, George

BMJ open

2023 Band 13, Heft 9, Seite(n) e063117

Abstract: Background: In Sweden, as in many other countries, official monitoring of healthcare quality is mostly focused on geographical disparities in relation to a desirable benchmark. However, current evaluations could be improved by considering: (1) The ... ...

Abstract	Background: In Sweden, as in many other countries, official monitoring of healthcare quality is mostly focused on geographical disparities in relation to a desirable benchmark. However, current evaluations could be improved by considering: (1) The intersection of other relevant axes of inequity like age, sex, income and migration status; and (2) The existence of individual heterogeneity around averages. Therefore, using an established quality indicator (ie, dispensation of statins after acute myocardial infarction, AMI), we valuate both geographical and sociodemographic inequalities and illustrate how the analysis of individual heterogeneity and discriminatory accuracy (AIHDA) enhances such evaluations. Population and methods: We applied AIHDA and calculated the area under the receiver operating characteristics curve (AUC) of regional and sociodemographic differences in the statin dispensations of 35 044 patients from 21 Swedish regions and 24 sociodemographic strata who were discharged from the hospital with an AMI diagnosis between January 2011 and December 2013. Following the Swedish National Board of Health and Welfare, we used a benchmark value of 90%. Results: Dispensation of stains after AMI in Sweden did not reach the desired target of 90%. Regional differences were absent/very small (AUC=0.537) while sociodemographic differences were small (AUC=0.618). Women, especially those with immigrant background and older than 65 years, have the lowest proportions of statin dispensations after AMI. Conclusions: As the AUC statistics are small, interventions trying to achieve the benchmark value should be universal. However, special emphasis should nevertheless be directed towards women, especially older women with immigrant backgrounds.
Mesh-Begriff(e)	Humans ; Female ; Aged ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Sweden/epidemiology ; Prospective Studies ; Myocardial Infarction/epidemiology ; Socioeconomic Factors
Chemische Substanzen	Hydroxymethylglutaryl-CoA Reductase Inhibitors
Sprache	Englisch
Erscheinungsdatum	2023-09-28
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-063117
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Overuse of the psychoactive analgesics' opioids and gabapentinoid drugs in patients having surgery for nerve entrapment disorders.

Dahlin, Lars B / Perez, Raquel / Nyman, Erika / Zimmerman, Malin / Merlo, Juan

Scientific reports

2023 Band 13, Heft 1, Seite(n) 16248

Abstract: Knowledge about risks for overuse of psychoactive analgesics in patients having primary surgery for carpal tunnel syndrome (CTS) or ulnar nerve entrapment (UNE), or both, is limited. We investigated if patients with those nerve entrapment disorders have ... ...

Abstract	Knowledge about risks for overuse of psychoactive analgesics in patients having primary surgery for carpal tunnel syndrome (CTS) or ulnar nerve entrapment (UNE), or both, is limited. We investigated if patients with those nerve entrapment disorders have a higher risk of overuse of psychoactive analgesics (i.e., opioids and gabapentinoid drugs) before, after, and both before and after surgery than observed in the general population after accounting for demographical and socioeconomic factors. Using a large record linkage database, we analysed 5,966,444 individuals (25-80 years), residing in Sweden December 31st, 2010-2014, of which 31,380 underwent surgery 2011-2013 for CTS, UNE, or both, applying logistic regression to estimate relative risk (RR) and 95% confidence interval (CI). Overall, overuse of the psychoactive analgesics was low in the general population. Compared to those individuals, unadjusted RR (95% CI) of overuse ranged in patients between 2.77 (2.57-3.00) with CTS after surgery and 6.21 (4.27-9.02) with both UNE and CTS after surgery. These risks were only slightly reduced after adjustment for demographical and socioeconomic factors. Patients undergoing surgery for CTS, UNE, or both, have a high risk of overuse of psychoactive analgesics before, after, and both before and after surgery.
Mesh-Begriff(e)	Humans ; Nerve Compression Syndromes ; Analgesics, Opioid/therapeutic use ; Carpal Tunnel Syndrome/drug therapy ; Carpal Tunnel Syndrome/surgery ; Ulnar Nerve Compression Syndromes ; Patients
Chemische Substanzen	Analgesics, Opioid
Sprache	Englisch
Erscheinungsdatum	2023-09-27
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-43253-0
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Mapping socio-geographical disparities in the occurrence of teenage maternity in Colombia using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

Mattsson, Hedda / Gustafsson, Johanna / Prada, Sergio / Jaramillo-Otoya, Laura / Leckie, George / Merlo, Juan / Rodriguez-Lopez, Merida

International journal for equity in health

2024 Band 23, Heft 1, Seite(n) 36

Abstract: Background: The prevalence of teenage pregnancy in Colombia is higher than the worldwide average. The identification of socio-geographical disparities might help to prioritize public health interventions.: Aim: To describe variation in the ... ...

Abstract	Background: The prevalence of teenage pregnancy in Colombia is higher than the worldwide average. The identification of socio-geographical disparities might help to prioritize public health interventions. Aim: To describe variation in the probability of teenage maternity across geopolitical departments and socio-geographical intersectional strata in Colombia. Methods: A cross-sectional study based on live birth certificates in Colombia. Teenage maternity was defined as a woman giving birth aged 19 or younger. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was applied using multilevel Poisson and logistic regression. Two different approaches were used: (1) intersectional: using strata defined by the combination of health insurance, region, area of residency, and ethnicity as the second level (2) geographical: using geopolitical departments as the second level. Null, partial, and full models were obtained. General contextual effect (GCE) based on the variance partition coefficient (VPC) was considered as the measure of disparity. Proportional change in variance (PCV) was used to identify the contribution of each variable to the between-strata variation and to identify whether this variation, if any, was due to additive or interaction effects. Residuals were used to identify strata with potential higher-order interactions. Results: The prevalence of teenage mothers in Colombia was 18.30% (95% CI 18.20-18.40). The highest prevalence was observed in Vichada, 25.65% (95% CI: 23.71-27.78), and in the stratum containing mothers with Subsidized/Unaffiliated healthcare insurance, Mestizo, Rural area in the Caribbean region, 29.08% (95% CI 28.55-29.61). The VPC from the null model was 1.70% and 9.16% using the geographical and socio-geographical intersectional approaches, respectively. The higher PCV for the intersectional model was attributed to health insurance. Positive and negative interactions of effects were observed. Conclusion: Disparities were observed between intersectional socio-geographical strata but not between geo-political departments. Our results indicate that if resources for prevention are limited, using an intersectional socio-geographical approach would be more effective than focusing on geopolitical departments especially when focusing resources on those groups which show the highest prevalence. MAIHDA could potentially be applied to many other health outcomes where resource decisions must be made.
Mesh-Begriff(e)	Pregnancy ; Adolescent ; Humans ; Female ; Multilevel Analysis ; Cross-Sectional Studies ; Colombia/epidemiology ; Public Health ; Ethnicity
Sprache	Englisch
Erscheinungsdatum	2024-02-23
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	2092056-8
ISSN	1475-9276 ; 1475-9276
ISSN (online)	1475-9276
ISSN	1475-9276
DOI	10.1186/s12939-024-02123-5
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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