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Baldasano, Jordi Sunyer" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Ferran" "apellidos" => "Ballester" ] 1 => array:2 [ "nombre" => "Xavier" "apellidos" => "Querol" ] 2 => array:2 [ "nombre" => "Sylvia" "apellidos" => "Medina" ] 3 => array:2 [ "nombre" => "José M." "apellidos" => "Baldasano" ] 4 => array:2 [ "nombre" => "Jordi" "apellidos" => "Sunyer" ] 5 => array:1 [ "colaborador" => "participantes en el Taller AIRNET en Barcelona" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911107719738?idApp=WGSE" "url" => "/02139111/0000002100000001/v2_201301241555/S0213911107719738/v2_201301241555/es/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S0213911107720605" "issn" => "02139111" "doi" => "10.1016/S0213-9111(07)72060-5" "estado" => "S300" "fechaPublicacion" => "2007-09-01" "aid" => "72060" "copyright" => "Sociedad Española de Salud Pública y Administración Sanitaria" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "err" "cita" => "Gac Sanit. 2007;21:437" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1775 "formatos" => array:3 [ "EPUB" => 112 "HTML" => 1258 "PDF" => 405 ] ] "es" => array:6 [ "idiomaDefecto" => true "cabecera" => "Fe de errores" "tienePdf" => "es" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "437" ] ] "contienePdf" => array:1 [ "es" => true ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911107720605?idApp=WGSE" "url" => "/02139111/0000002100000005/v1_201301241557/S0213911107720605/v1_201301241557/es/main.assets" ] ] "es" => array:14 [ "idiomaDefecto" => true "titulo" => "Aplicación de modelos estructurales marginales para estimar los efectos de la terapia antirretroviral en 5 cohortes de seroconvertores al virus de la inmunodeficiencia humana" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "76" "paginaFinal" => "83" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Santiago Pérez-Hoyos, Inmaculada Ferreros, Miguel A. Hernán" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Santiago" "apellidos" => "Pérez-Hoyos" "email" => array:1 [ 0 => "perez_san@gva.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff2" ] 2 => array:2 [ "etiqueta" => "¿" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Inmaculada" "apellidos" => "Ferreros" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff3" ] ] ] 2 => array:3 [ "nombre" => "Miguel A." "apellidos" => "Hernán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff4" ] ] ] 3 => array:2 [ "colaborador" => "GEMES" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff5" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Escuela Valenciana de Estudios en Salud (EVES), Valencia, España" "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Departament d’Infermeria Comunitaria, Medicina Preventiva i Salut Pública i Història de la Ciencia, Universitat d’Alacant, Alacant, España" "etiqueta" => "b" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Departamento de Salud Pública, Universidad Miguel Hernández, Alacant, España" "etiqueta" => "c" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Departamento de Epidemiología, Escuela de Salud Pública, Universidad de Harvard, Boston, Estados Unidos" "etiqueta" => "d" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "Grupo de Estudio Multicéntrico Español de Seroconvertores (ver la relación completa de sus miembros en el anexo)" "etiqueta" => "e" "identificador" => "aff5" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Dr. Santiago Pérez-Hoyos. Escuela Valenciana de Estudios en Salud (EVES). Joan de Garay, 21. 46017 Valencia. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Marginal structural models application to estimate the effects of antiretroviral therapy in 5 cohorts of HIV seroconverters" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-02-14" "fechaAceptado" => "2006-10-18" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec13987" "palabras" => array:4 [ 0 => "Modelos estructurales marginales" 1 => "Análisis de supervivencia" 2 => "Eficacia de los tratamientos" 3 => "Sida" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec13988" "palabras" => array:4 [ 0 => "Marginal structural models" 1 => "Survival analysis" 2 => "Treatment efficacy" 3 => "AIDS" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivosLos métodos convencionales tienen limitaciones para ajustar por factores de confusión dependientes del tiempo para evaluar la efectividad poblacional de tratamientos en estudios observacionales. En este trabajo se muestra un nuevo tipo de metodología, los modelos estructurales marginales (MEM), y se estima la efectividad de la terapia antirretroviral de gran actividad (TARGA) sobre la incidencia de sida o muerte. Sujetos y métodosSe identificaron los sujetos sin TARGA seguidos a partir de 1997 en las cohortes de seroconvertores al virus de la inmunodeficiencia humana (VIH) del proyecto GEMES (Grupo de Estudio Multicéntrico Español de Seroconvertores). Para estimar el efecto sobre la incidencia de sida o muerte, se obtuvieron los parámetros de un MEM mediante una regresión logística ponderada por probabilidad inversa. La estimación de los pesos se basó en el recuento de CD4, el tiempo desde la seroconversión, el sexo, la edad, la categoría de trasmisión y el tratamiento previo. ResultadosLos 917 sujetos elegibles se siguieron durante una media de 3,4 años, durante los cuales se observaron 139 desenlaces de interés. El 42,1% de los participantes recibió TARGA durante el estudio. La tasa relativa fue de 1,01 (intervalo de confianza [IC] del 95%, 0,68-1,49) mediante un modelo de Cox convencional sin covariables, y de 0,90 (IC del 95%, 0,61-1,32) mediante un modelo de Cox convencional con covariables cambiantes en el tiempo. La tasa relativa causal estimada por un MEM fue de 0,74 (IC del 95%, 0,49-1,12). ConclusionesEl efecto beneficioso del TARGA encontrado por los MEM está bien establecido, pero los modelos convencionales no pudieron detectarlo. El uso de un MEM permitió ajustar apropiadamente por la variable CD4, que es a la vez una variable de confusión dependiente del tiempo y está afectada por el uso previo de tratamiento." ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectivesStandard methods to evaluate population effectiveness of treatments in observational studies have important limitations to appropriately adjust for time-dependent confounders. In this paper, we describe a recently developed methodological approach, marginal structural models (MSM), and use it to estimate the effectiveness of highly active antiretroviral therapy (HAART) on AIDS or death incidence. Subjects and methodsWe analyzed all subjects followed after 1997 as part of the GEMES project (comprised by several cohorts of HIV seroconverters in Spain) and who had not used HAART before the start of follow-up. To estimate the effect of HAART on AIDS or death incidence, we estimated the parameters of a marginal structural Cox model by fitting an inverse probability weighted logistic regression model. The estimation of the weights was based on CD4 count, time since seroconversion, sex, age, transmission category and previous treatment. Results917 eligible subjects were followed for an average of 3.4 years and we observed 139 events. 42.1% of the participants received HAART during the study. The estimated rate ratio was 1.01 (95% confidence interval [CI], 0.68- 1.49) using a Cox model without covariates and 0.90 (95% CI, 0.61-1.32) using a Cox model with time-dependent covariates. The causal rate ratio estimated for MSM was 0.74, (95% CI, 0.49-1.12). ConclusionsThe beneficial effect of HAART estimated by the MSM, but largely missed by conventional methods, is consistent with the findings of previous randomized studies. The MSM appropriately adjusted for the time-dependent covariate CD4 count, which is both a time-varying confounder and is affected by prior treatment." ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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Gaceta Sanitaria

ISSN: 0213-9111

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