Long-term Adverse Health Outcomes Research Articles

Work careers in adults separated temporarily from their parents in childhood during World War II

IntroductionTraumatic experiences, such as separation from parents in childhood causing early life stress (ELS) may increase the risk of adverse long-term health outcomes and biological age-related changes. This may have an impact on work career. Our aim was to examine long term consequences of ELS due to temporary separation from parents during World War II (WWII) in relation to work career. Material and methodsThe Helsinki Birth Cohort Study comprises 13,345 individuals born in Helsinki, Finland, between the years 1934–1944. From the original cohort, 1781 individuals were identified as being separated temporarily from their parents due to World War II. Information on date and type of pension was provided by the Finnish Centre for Pensions and the Social Insurance Institution of Finland. The cohort members either transitioned into old age pension at the statutory retirement age or retired earlier and transitioned into disability, unemployment, part-time pension or died before retirement. ResultsThose who were separated were more likely to have transitioned into disability pension (RRR: 1.26: 95% CI: 1.06–1.48), especially due to diseases of the musculoskeletal system (OR: 1.57; 95% CI: 1.20–2.07), or into unemployment pension (RRR: 1.25; 95% CI: 1.02–1.53) compared with those not separated from their parents. Longer duration of separation was associated with early exit from the workforce compared with non-separation. ConclusionsExposure to ELS may have an impact upon lifetime work career. Early interventions preventing exposure to ELS or mitigating its negative effects may prolong future work careers along with healthier aging across the life-span.

Metabolic syndrome among adults with type 2 diabetes in a Saudi teaching hospital: A comparative prevalence study using WHO and ATP III definitions.

Objective:Metabolic syndrome (MetS) has become a global health concern and is a reliable predictor of long-term adverse health outcomes. This study aimed to determine the prevalence of MetS and its components in a group of Saudi adults with type 2 diabetes using the World Health Organization (WHO) and Adult Treatment Panel (ATP) III definitions, and to examine agreement between both definitions.Methods:This cross-sectional study included adults with type 2 diabetes who were followed up at the family medicine and endocrinology clinics of King Abdulaziz University Hospital (KAUH) from January to March 2018. An interview-administered questionnaire was designed to collect demographic data, anthropometric measurements, and medical history. We used the 1999 WHO and 2001 ATP III definitions for diagnosing MetS.Results:The study included 155 diabetes patients. The overall prevalence of MetS components (three of more components) among patients was 80% according to the WHO criteria and 85.8% according to the ATP III criteria. The kappa statistics demonstrated good agreement between both definitions (κ = 0.751, p < 0.001). The sensitivity and specificity of diagnosing MetS using the WHO versus ATP III criteria were 92.5% and 95.5%, respectively. There was weak positive association between the number of MetS components and the number of diabetic complications.Conclusions:MetS was highly prevalent among Saudi adults with type 2 diabetes regardless of the diagnostic criteria. It is, therefore, imperative that clinicians identify MetS in this patient population and educate them on the importance of adherence to treatment and therapeutic lifestyle changes.

Atopic dermatitis, educational attainment and psychological functioning: a national cohort study.

Atopic dermatitis (AD) might adversely affect academic performance, possibly through influences on psychological functioning such as stress resilience. To investigate the association of atopic dermatitis with stress resilience, cognitive function and educational attainment. We used data from a national cohort of men who underwent a military conscription examination at ages 17-20 years in Sweden between 1969 and 1976. All potential conscripts met a physician who assessed current or previous history of AD. Stress resilience was measured by a psychologist using a semistructured interview. The conscription assessment included a written cognitive function test. The highest level of education achieved was identified through record linkage. The study population included 234 715 men, 1673 (0·7%) of whom had a diagnosis of AD. AD was associated with a greater risk of low stress resilience [adjusted relative risk ratio (RRR) 1·60, 95% confidence interval (CI) 1·38-1·86]. AD was associated with higher cognitive function (β-coefficient 0·15, 95% CI 0·05-0·24) and higher educational level (RRR 1·29, 95% CI 1·13-1·47). However, adjustment for socioeconomic characteristics of the family of origin attenuated the magnitude of the associations and eliminated the statistical significance (β-coefficient 0·06, 95% CI -0·03 to 0·15; RRR 1·16, 95% CI 1·00-1·35). Swedish men with AD had lower stress resilience in late adolescence but did not have lower cognitive function or poorer educational attainment. The lower stress resilience associated with AD is consistent with an increased risk of possible long-term adverse health outcomes.

Gut Microbiome in Survivors of Childhood Acute Lymphoblastic Leukemia

PurposeAcute lymphoblastic leukemia (ALL) is the most common cancer in childhood and has a high treatment success rate. However, survivors of childhood ALL have a high prevalence of chronic medical illnesses, such as metabolic syndrome. Dysbiosis in the gut microbiome is associated with metabolic derangement and disease risk. Chemotherapy and antibiotics increase gut microbiome dysbiosis. We tested the hypothesis that ALL treatment can cause alterations in the gut microbiome that persist in survivorship.MethodStool samples were collected on fecal occult blood test cards from 38 survivors between 2-18 years of age who were >1 year off therapy for ALL. 16 stool samples from healthy siblings age 2-18 years were collected from 14 families as controls. Clinical data including anthropometrics, antibiotic use, and probiotic use were collected. DNA was extracted and sequenced using a modified Illumina 16S Metagenomics Sequencing Library Preparation protocol for analysis of hypervariable region V4. A single rarefaction was performed at 4,897 removing 2 samples with low mapped read counts. Alpha and beta (Bray) diversities were calculated; Wilcoxon rank-sum test was used to compare the alpha diversities between groups, as well as the beta diversities within and between groups. Wilcoxon signed-rank test was used to compare the alpha diversity between survivors and their matched siblings. Finally, read counts for each Operational Taxonomic Unit (OTU) was normalized and tested for differential abundance using edgeR, assuming a negative binomial model.ResultsSignificant differences in the abundance of taxa were found, with the most notable being the depletion of Faecalibacterium in survivors (FDR= 0.0004). Figure 1 shows a heatmap with the complete linkage clustering method on the Euclidean distance using the 13 OTUs with statistically significant (FDR<0.05) differences between survivors and siblings (Table 1). When compared to their respective siblings, survivors exhibited decreased alpha diversity using four metrics (Observed, Shannon, Simpson, Fisher), but these results did not meet statistical significance. Significant differences were not observed in alpha diversity within survivors between different clinical categories (antibiotic usage, probiotic usage, disease risk, age at diagnosis and time off treatment). Stool microbiome was more similar within a family than between families (P = 0.00079).ConclusionDifferences in the relative abundance of certain taxa were found between survivors and siblings. Specifically, Fecalibacterium was depleted in survivors, which has also been previously observed in older populations of childhood ALL survivors. This study shows that these microbiome changes are present in ALL survivors during childhood, and should be evaluated longitudinally for association with the chronic medical illnesses seen in ALL survivors in adulthood. Early interventions to restore the gut microbiome in ALL patients may potentially ameliorate the risk of long-term adverse health outcomes. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Long-term adverse health outcomes of physical workplace violence: a 7-year population-based follow-up study

ABSTRACTThe aim of the present study was to analyse whether physical workplace violence increases the risk of long-term adverse health outcomes (i.e., high number of visits to the general practitioner, outpatient treatment, hospital admittance, antidepressant use, and/or having a mental disorder). The study was based on representative survey data from 2006 and 2010 (entitled “How are you?”) merged with register data for a 7-year follow-up period (N = 30,812). To examine if physical workplace violence was a predictor of adverse health outcomes, logistic regression models were conducted for the total follow-up period and for each follow-up year with the different outcome measures as the dependent variables. In the follow-up period, individuals who were exposed to physical workplace violence had a higher number of visits to the general practitioner, had more often received outpatient treatment, and had more often been admitted to hospital than their non-exposed counterparts. Moreover, exposed individuals had higher odds of using antidepressants in the last three follow-up years than did non-exposed individuals. The findings call for heightened attention to securing preventive as well as rehabilitative strategies to help victims of physical workplace violence with the aim of avoiding adverse long-term health consequences.

Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans.

Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.

Effects of Respiratory Syncytial Virus Infection in Infancy on Asthma and Respiratory Allergy in 6-Year-Old Children.

The purpose of this study was to examine the association between respiratory syncytial virus (RSV) infection in early infancy and health conditions such as asthma and respiratory allergies at 6 years of age in a cohort of US children born at term with no medical issues at birth. Data (1542 records) from the Infant Feeding Practices Study II and the Year Six Follow-Up study were used in the analysis. Descriptive statistics and logistic regression were conducted to estimate the magnitude and direction of potential associations between children's health conditions such as asthma, hay fever, or respiratory allergy, and RSV infection during infancy. A substantial proportion of children with RSV infection in infancy were reported to have developed asthma (10.3%) and hay fever or respiratory allergy (9.4%) by 6 years of age. Analyses revealed that children with RSV infection in infancy were more likely to develop asthma (odds ratio 1.99, 95% confidence interval 1.06-3.74), and hay fever or respiratory allergy (odds ratio 2.13, 95% confidence interval 1.28-3.57) by 6 years of age. In addition, the risk of developing asthma and hay fever or respiratory allergy by 6 years of age increased considerably with a family history of these conditions. Our findings support the need for understanding and monitoring the long-term health outcomes of RSV infection in infancy. Appropriate prevention and treatment measures for RSV infection during infancy may reduce the incidence of associated long-term adverse health outcomes. Knowledge of the long-term complications of RSV infection in infancy, such as asthma, hay fever, or respiratory allergy, can aid in the prevention and better management of these health conditions.

Long-Term Adverse Health Outcomes of Physical Violence at Work

Long-Term Adverse Health Outcomes of Physical Violence at Work

Long-Term Adverse Health Outcomes of Physical Violence at Work

Long-Term Adverse Health Outcomes of Physical Violence at Work

Nutrition and Fetal Origins of Diseases in Adults

Accumulating evidence suggests that the early-life environment has lasting effects on health and disease into adulthood. The current concept of developmental origins of adulthood disease has expanded beyond the original observation by Barker and colleagues correlating low birth weight with adulthood cardiovascular and metabolic disorders. Notably, the fetal-neonatal nutritional environment has a significant role in influencing an individual’s wellness in adulthood. During critical periods of fetal and neonatal development, tissues and organ systems are most vulnerable to nutrient deficiencies. Through fetal programming mechanisms such as epigenetic modification, a biochemical process that regulates gene expression without altering the genetic code, developing tissues adapt to nutrient-poor environments to preserve normal development of critical organ systems, including the brain. However, these programmed adaptations can have negative long-term health consequences if the postnatal environment does not match the fetal-neonatal environment in which the programming occurred. These long-term adverse health outcomes constitute the true cost to society, in both increased medical costs and the indirect cost of lost productivity. Here we review the effects of nutrient deficiencies on fetal programming and subsequent health outcomes, as well as the potential mechanisms that underlie fetal programming. This review contains 3 Figures, 2 Tables and 115 references Key words: critical period, epigenetics, fetal programming, iron, long-chain polyunsaturated fatty acids, neurodevelopment, nutrient deficiency, protein-energy, vitamins, zinc

Late adverse outcomes after treatment of testicular cancer

Modern oncological treatment has rendered testicular cancer (TC) a curative malignant disease but there is a risk of decreasing survival and reduced health-related quality of life (HR-QoL) related to long-term adverse health outcomes (AHOs). To provide an overview on AHOs after oncological treatment of TC. Summary of published studies and previous reviews. Relative survival rates decrease among TC survivors 25 years after diagnosis, mainly due to treatment-related second cancer and/or cardiovascular disease, the latter mediated by components of the metabolic syndrome. With increasing age cisplatin-induced ototoxicity becomes a clinical problem in patients, whereas reported peripheral neurotoxicity only exceptionally achieves major clinical relevance. Anxiety but not depression represents the dominating psychological problem. In most patients HR-QoL is good, but working ability may be reduced by very intensive treatment. Awareness of long-term AHOs among TC survivors and health professionals can contribute to reduce long-term morbidity and mortality and to improve QoL by initiating early preventive and therapeutic measures. Radiotherapy should be avoided as much as possible during risk-adapted treatment of TC. Existing data indicate premature aging among strongly treated TC survivors but larger studies and longer follow-up in longitudinal studies are required to confirm these preliminary observations.

The DIAMOND trial \u2013 DIfferent Approaches to MOderate & late preterm Nutrition: Determinants of feed tolerance, body composition and development: protocol of a randomised trial

BackgroundBabies born at moderate-late preterm gestations account for > 80% of all preterm births. Although survival is excellent, these babies are at increased risk of adverse neurodevelopmental outcomes. They also are at increased risk of adverse long-term health outcomes, such as cardiovascular disease, obesity and diabetes. There is little evidence guiding optimal nutritional practices in these babies; practice, therefore, varies widely. This factorial design clinical trial will address the role of parenteral nutrition, milk supplementation and exposure of the preterm infant to taste and smell with each feed on time to tolerance of full feeds, adiposity, and neurodevelopment at 2 years.Methods/designThe DIAMOND trial is a multi-centre, factorial, randomised, controlled clinical trial. A total of 528 babies born between 32+ 0 and 35+ 6 weeks’ gestation receiving intravenous fluids and whose mothers intend to breastfeed will be randomised to one of eight treatment conditions that include a combination of each of the three interventions: (i) intravenous amino acid solution vs. intravenous dextrose solution until full milk feeds established; (ii) milk supplement vs. exclusive breastmilk, and (iii) taste/smell given or not given before gastric tube feeds. Babies will be excluded if a particular mode of nutrition is clinically indicated or there is a congenital abnormality.Primary study outcome: For parenteral nutrition and milk supplement interventions, body composition at 4 months’ corrected age. For taste/smell intervention, time to full enteral feeds defined as 150 ml.kg− 1.day− 1 or exclusive breastfeeding. Secondary outcomes: Days to full sucking feeds; days in hospital; body composition at discharge; growth to 2 years’ corrected age; development at 2 years’ corrected age; breastfeeding rates.DiscussionThis trial will provide the first direct evidence to inform feeding practices in moderate- to late-preterm infants that will optimise their growth, metabolic and developmental outcomes.Trial registrationAustralian New Zealand Clinical Trials Registry - ACTRN12616001199404. This trial is endorsed by the IMPACT clinical trials network (https://impact.psanz.com.au).

【論文摘要】Effects of Early Intervention for Preterm Infants: Outcomes of Motor Function, Lung Function and Health-Related Quality of Life during School Age

Background and Purpose: Infants born preterm are at risk for neurodevelopmental disorders and adverse long-term health outcomes. Previous studies have shown short-term and mid-term effects of early intervention for preterm children. However, very limited research has investigated the long-term effects. Our research team previously conducted a randomized control trial to examine the effects of two comprehensive early intervention programs: clinicalbased intervention program (CBIP) and home-based intervention program (HBIP) compared to usual care program (UCP) on very low birth weight (VLBW) preterm infants. The purpose of the present study was to examine the long-term effects of these early interventions programs on preterm children’s motor function, lung function and health-related quality of life (HRQoL) during school age. Methods: Thirty-nine preterm children (10 UCP, 14 CBIP, 15 HBIP) and 13 full-term children who participated in our previous intervention study were recruited at 10-11 years of age. Children’s motor function was examined using Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Lung function was measured by pulmonary function test with a computerized spirometer. HRQoL was measured by parental reports of Pediatric Quality of Life Inventory. One-way analysis of variance and Kruskal-Wallis test were conducted for normally distributed and non-normally distributed outcomes, respectively, to investigate the differences among 4 groups of children. Results: Compared to full-term peers, preterm children in the UCP group demonstrated significantly poorer motor function, indicated by lower scores of upper limb coordination (p = 0.002), body coordination (p = 0.04) and total motor composite (p = 0.04). They also showed lower forced expiratory volume (p = 0.008) and lower forced vital capacity (p = 0.04). While preterm children in the HBIP group showed comparable outcomes with term children, children in the CBIP group had significantly poorer performance in upper limb coordination (p = 0.002) than full-term peers did. All children were reported to have comparable HRQoL. Conclusion: Our study shows positive effects of early intervention on motor function and lung function of preterm children during school age. Furthermore, home-based early intervention appears to be more beneficial than clinical-based program for the long-term outcomes of preterm children. Clinical Relevance: Early intervention programs for preterm infants should be provided with comprehensive child-, parent-, and dyad-focused services to enhance long-term outcomes.

Using a trauma-informed policy approach to create a resilient urban food system.

Food insecurity is associated with toxic stress and adverse long-term physical and mental health outcomes. It can be experienced chronically and also triggered or exacerbated by natural and human-made hazards that destabilize the food system. The Baltimore Food System Resilience Advisory Report was created to strengthen the resilience of the city's food system and improve short- and long-term food security. Recognizing food insecurity as a form of trauma, the report was developed using the principles of trauma-informed social policy. In the present paper, we examine how the report applied trauma-informed principles to policy development, discuss the challenges and benefits of using a trauma-informed approach, and provide recommendations for others seeking to create trauma-informed food policy. Report recommendations were developed based on: semi-structured interviews with food system stakeholders; input from community members at outreach events; a literature review; Geographic Information System mapping; and other analyses. The present paper explores findings from the stakeholder interviews. Baltimore, Maryland, USA. Baltimore food system stakeholders stratified by two informant categories: organizations focused on promoting food access (n 13) and community leaders (n 12). Stakeholder interviews informed the recommendations included in the report and supported the idea that chronic and acute food insecurity are experienced as trauma in the Baltimore community. Applying a trauma-informed approach to the development of the Baltimore Food System Resilience Advisory Report contributed to policy recommendations that were community-informed and designed to lessen the traumatic impact of food insecurity.

Associations of Stress Exposures and Social Support With Long-Term Mental Health Outcomes Among U.S. Iraq War Veterans

The long-term mental health effects of war-zone deployment in the Iraq and Afghanistan wars on military personnel are a significant public health concern. Using data collected prospectively at three distinct assessments during 2003–2014 as part of the Neurocognition Deployment Health Study and VA Cooperative Studies Program Study #566, we explored how stress exposures prior, during, and after return from deployment influence the long-term mental health outcomes of posttraumatic stress disorder (PTSD), depression, anxiety disorders, and problem drinking. Longer-term mental health outcomes were assessed in 375 service members and military veterans an average of 7.5 years (standard deviation = 1.0 year) after the initial (i.e., “index”) Iraq deployment following their predeployment assessment. Anxiety disorder was the most commonly observed long-term mental health outcome (36.0%), followed by depression (24.5%), PTSD (24.3%), and problem drinking (21.0%). Multivariable regression models showed that greater postdeployment stressors, as measured by the Post-Deployment Life Events scale, were associated with greater risk of depression, anxiety disorders, and problem drinking. Anxiety disorder was the only outcome affected by predeployment stress concerns. In addition, greater postdeployment social support was associated with lower risk of all outcomes except problem drinking. These findings highlight the importance of assessing postdeployment stress exposures, such as stressful or traumatic life events, given the potential impact of these stressors on long-term mental health outcomes. This study also highlights the importance of postdeployment social support as a modifiable protective factor that can be used to help mitigate risk of long-term adverse mental health outcomes following war-zone exposure.

Estrogen-based hormone therapy in women with primary ovarian insufficiency: a systematic review.

Sex hormones play a role in bone density, cardiovascular health, and wellbeing throughout reproductive lifespan. Women with primary ovarian insufficiency (POI) have lower estrogen levels requiring hormone therapy (HT) to manage symptoms and to protect against adverse long-term health outcomes. Yet, the effectiveness of HT in preventing adverse outcomes has not been systematically assessed. We summarize the evidence regarding effects of HT on bone and cardiovascular health in women with POI. A comprehensive search of the electronic databases MEDLINE, EMBASE, and Scopus was conducted by a medical reference librarian from database inception to January 2016. Randomized trials and observational cohort studies with an estrogen-based HT intervention in women with POI under the age of 40 were included. Reviewers worked independently and in duplicate to assess eligibility and risk of bias, and extract data of interest from each study. The search identified 1670 articles; 12 met inclusion criteria. Four randomized clinical trials and eight cohort studies at high risk of bias enrolled 806 women with POI. The most common HT formulations were transdermal estradiol and oral conjugated equine estrogen combined with medroxyprogesterone acetate. Bone mineral density was the most frequent outcome, with three out of eight studies showing HT associated increase benefits. Only one study reported effects on fractures or vasomotor symptoms and none on cardiovascular mortality. Results regarding lipid profiles were inconsistent. Evidence supporting bone and cardiovascular benefits of HT in women with POI is limited by high risk of bias, reliance on surrogate outcomes, and heterogeneity of trials regarding the formulation, dose, route of administration, and regimen of HT. Further research addressing patient important outcomes such as fractures, stroke, and cardiovascular mortality are crucial to optimize benefits of this therapy.

Binding and neutralizing anti-cytomegalovirus activities in immune globulin products

Congenital infection as well as infection of immunocompromised individuals by cytomegalovirus (CMV) can be associated with significant morbidity, mortality, and long-term adverse health outcomes. Assessment of anti-viral activity using appropriate assays is essential for ensuring safe and efficacious use of therapeutic CMV immune globulin (IG) products. In this study, we used commercial ELISA kits to compare anti-CMV antibody binding activity and avidity for lots of CMV-specific and normal IG products available in the US market. Additionally, neutralizing activity of IG products was measured against CMV strains (AD169wt131 or TB40E-GFP) in MRC-5 human fibroblasts and ARPE-19 human epithelial cells. Our data revealed that, regardless of the method, anti-CMV activity was higher in CMV IG lots we tested compared with normal IG lots; CMV binding activity was at least 4-fold higher, and neutralizing activity at least 2- and 3-fold higher for epithelial and fibroblast cells, respectively, in CMV IG lots compared with normal IG lots. Furthermore, anti-CMV activity values from all three methods (ELISA, neutralization in MRC-5 cells, and neutralization in ARPE-19 cells) were highly correlated, whereas avidity, although higher in CMV IG lots, did not correlate well with either binding or neutralizing activities.

Maternal Systemic Interleukin-6 During Pregnancy Is Associated With Newborn Amygdala Phenotypes and Subsequent Behavior at 2 Years of Age

BackgroundMaternal inflammation during pregnancy increases the risk for offspring psychiatric disorders and other adverse long-term health outcomes. The influence of inflammation on the developing fetal brain is hypothesized as one potential mechanism but has not been examined in humans. MethodsParticipants were adult women (N = 86) who were recruited during early pregnancy and whose offspring were born after 34 weeks’ gestation. A biological indicator of maternal inflammation (interleukin-6) that has been shown to influence fetal brain development in animal models was quantified serially in early, mid-, and late pregnancy. Structural and functional brain magnetic resonance imaging scans were acquired in neonates shortly after birth. Infants’ amygdalae were individually segmented for measures of volume and as seeds for resting state functional connectivity. At 24 months of age, children completed a snack delay task to assess impulse control. ResultsHigher average maternal interleukin-6 concentration during pregnancy was prospectively associated with larger right amygdala volume and stronger bilateral amygdala connectivity to brain regions involved in sensory processing and integration (fusiform, somatosensory cortex, and thalamus), salience detection (anterior insula), and learning and memory (caudate and parahippocampal gyrus). Larger newborn right amygdala volume and stronger left amygdala connectivity were in turn associated with lower impulse control at 24 months of age, and mediated the association between higher maternal interleukin-6 concentrations and lower impulse control. ConclusionsThese findings provide new evidence in humans linking maternal inflammation during pregnancy with newborn brain and emerging behavioral phenotypes relevant for psychiatric disorders. A better understanding of intrauterine conditions that influence offspring disease susceptibility is warranted to inform targeted early intervention and prevention efforts.

Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005-2015.

Anterior cruciate ligament (ACL) injuries in children and adolescents have been the focus of recent media attention and parental concern, given their potential for adverse long-term health outcomes and healthcare costs. However, there is limited formal evidence on trends in the incidence of ACL injuries in children. This study utilizes the Victorian Admitted Episodes Dataset (VAED) to characterize epidemiologic trends of hospital-admitted ACL injuries in those aged 5 to 14 years over a period of 10 years from 2005 to 2015. There was a total of 320 cases and the overall annual rate of ACL injuries increased by 147.8% from 2.74 per 100,000 population in 2005/2006 to 6.79 per 100,000 in 2014/2015. The majority (96.9%) of these injuries were in 10- to 14-year-olds. The main in-hospital procedure provided to over 80% of the hospitalized cases involved ACL reconstruction. Sporting activities accounted for 56.6% of ACL injuries. For females, over half (52.4%) of ACL injuries occurred whilst playing ball sports, compared to 35.4% of males. The large increase in ACL injuries in 5- to 14-year-olds in the state of Victoria, Australia over a 10-year period indicates they are a significant and emerging health burden. Population-wide ACL prevention policies are required to halt these trends. Cost effective prevention programs that involve neuromuscular training must be implemented in schools and junior sports teams.

Abstract P179: Comparison of Earlier versus Later Orthostatic Hypotension Assessment Times in Middle-Age Adults of the Atherosclerosis Risk in Communities Study (ARIC)

Background: Guidelines recommend assessing orthostatic hypotension (OH) 3 minutes after rising from supine to standing positions. Hypothesis: Measurements performed immediately after standing will be as informative as measurements performed closer to 3 minutes after standing with regards to symptoms of dizziness or risk of adverse outcomes. Methods: OH, defined as a drop in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, was measured up to five times at 25 seconds intervals in middle-aged (range 44 to 66 years) ARIC participants (1987-1989). Associations between each measurement and history of dizziness upon standing were examined via logistic regression. We used Cox models to examine the association between each of five measurements with risk of fall, fracture, syncope, and all-cause mortality over a median follow-up of 23 years. Results: In 11,449 participants (mean age 54 years, 54% women, 26% black) 10% reported a history of dizziness upon standing. OH assessed at measurement 1 (performed at a mean of 28 seconds after standing) was associated with risk of fall ( P = 0.03), fracture ( P = 0.05), syncope ( P &lt;0.001), and mortality ( P &lt; 0.001) ( Table ). Furthermore, measurement 1 was the only measurement associated with higher odds of dizziness upon standing (OR: 1.5; P = 0.001). Measurement 2 (performed on average 53 seconds after standing) was associated with all long-term outcomes. Measurements 4 and 5 (mean 100 and 116 seconds after standing) were generally less informative with regards to prospective outcomes than earlier measurements and were not statistically associated with history of dizziness. Conclusions: OH measurements obtained, on average, within the first 30 seconds of standing were predictive of long-term adverse health outcomes and were the most strongly related to symptoms of dizziness compared to later measurements. These findings suggest that BP measurements for determining orthostatic hypotension should be performed immediately after standing.