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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Biases can arise at various stages of research, from study design and data collection to analysis and interpretation. Recognizing and addressing these biases is essential to ensure the validity and reliability of epidemiological findings.Broadly speaking, biases in epidemiology fall into three main categories: selection bias, information bias, and confounding. A more detailed description of possible biases is:  
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Bias refers to any tendency that prevents a question from being considered unprejudiced. In research, bias occurs when one outcome or answer is selected or encouraged over others in sampling or testing. Bias can occur during any research phase, including study design, data collection, analysis, and publication.
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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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Selection bias in rheumatic disease research.

Hyon K Choi1, Uyen-Sa Nguyen2, Jingbo Niu2

  • 1Section of Rheumatology and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany Street, Suite 200, Boston, MA 02118, USA.

Nature Reviews. Rheumatology
|April 2, 2014
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Summary

Identifying modifiable risk factors for rheumatic diseases is vital, but selection bias can undermine research validity. This review highlights selection bias issues in rheumatology, offering strategies to prevent misleading findings in osteoarthritis and rheumatoid arthritis studies.

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Area of Science:

  • Rheumatology
  • Epidemiology
  • Biostatistics

Background:

  • Rheumatic conditions pose a significant global health burden.
  • Identifying modifiable risk factors is key to reducing disease impact.
  • Research validity is threatened by various biases, notably selection bias.

Purpose of the Study:

  • To review major selection bias issues in rheumatic disease research.
  • To explain how selection bias can lead to unexpected findings like the 'risk factor paradox'.
  • To provide recommendations for mitigating selection bias in future studies.

Main Methods:

  • Literature review focusing on selection bias in rheumatology.
  • Discussion of specific types of selection bias: index event bias, differential loss to follow-up, prevalent user bias, and immortal time bias.
  • Analysis of bias impact on osteoarthritis (OA) and rheumatoid arthritis (RA) research.

Main Results:

  • Selection bias is a pervasive and often underestimated issue in rheumatic disease research.
  • Index event bias can explain phenomena like the 'risk factor paradox' in OA and RA.
  • Differential loss to follow-up, prevalent user bias, and immortal time bias also significantly impact study validity.

Conclusions:

  • Selection bias can fundamentally mislead rheumatology research findings.
  • Awareness and proactive strategies are crucial to avoid and minimize selection bias.
  • Implementing suggested methods will enhance the reliability of future rheumatology research.