Gender-matched Reference Population Research Articles

Occupational exposures to particulate matter and PM2.5-associated polycyclic aromatic hydrocarbons at the Agbogbloshie waste recycling site in Ghana

Electronic waste (e-waste) disposal and recycling activities such as burning and smelting can emit particulate matter (PM), polycyclic aromatic hydrocarbons (PAHs), and other pollutants that expose workers and nearby communities. At informal e-waste recycling facilities, both emission controls and protective measures for workers are absent. This study characterizes personal exposures (breathing zone) of PM and PAHs of e-waste workers at the large Agbogbloshie e-waste site in Accra, Ghana. We collected gravimetric and optical measurements of PM2.5 and PM10 using shift samples for workers and for an age- and gender-matched reference population. PM2.5 filters were analyzed for 26 PAHs using gas chromatography/mass spectroscopy. Among e-waste workers, PM2.5 and PM10 concentrations were 99 ± 56 and 218 ± 158 µg/m3 (median ± interquartile range, optical measurements), respectively; these levels were 78 and 57% higher, respectively, than levels measured at a fixed site that was centrally located at the waste site. In the reference community, breathing zone PM2.5 and PM10 levels were lower, 49 ± 20 and 131 ± 108 µg/m3, respectively, and the fraction of coarse PM was larger. We detected all 26 target PAHs, of which naphthalene and phenanthrene were the most abundant. PAH concentrations were weakly correlated to PM levels, but PAH abundances, representing the fraction of PAH mass to the total PM2.5 mass collected, were strongly and inversely correlated to PM levels, suggesting multiple and different sources of PAHs and PM that affected exposures. Both PM and PAH levels were elevated for workers performing burning and dismantling, and both exceeded standards or risk-based guidelines, e.g., lifetime excess cancer risks for several PAHs were in the 10−4 to 10−6 range, indicating the need to reduce emissions as well as provide respiratory protection. The study emphasizes the importance of using personal and shift samples to accurately characterize worker exposure.

P11.06 Health-related quality of life and emotional wellbeing connected to glioblastoma; a longitudinal follow-up of patients and relatives

Abstract BACKGROUND Glioblastoma is the most common malignant brain tumor in adults and also the most aggressive one. At present, there is only palliative treatment available. The aim of this study is to investigate the HRQoL and emotional well-being of patients with glioblastoma by surveying them and their relatives from a time point before surgery until 2 years later. MATERIAL AND METHODS Patients and their relatives answered the validated questionnaires SF-36 and HADS at several time points: preoperatively, at 3 weeks postoperatively, at 12 weeks postoperatively, at 6 months postoperatively, at 1 year postoperatively, at 1.5 years postoperatively, and at 2 years postoperatively. At baseline, the paired patients and their relatives came to consist of 63 patients and 63 relatives. Descriptive statistics and the Wilcoxon signed-rank test were used. RESULTS Relatives scored more symptoms of anxiety than patients on all occasions except at 1.5 years postoperatively, with the largest significance preoperatively with p<0.001 and at 3 weeks postoperatively with p<0.001. 50% or more of the relatives reported the presence of symptoms of anxiety on all measured occasions. Furthermore, relatives scored worse for the SF-36 mental component summary (MCS) on all occasions except at 1.5 years postoperatively. Patients scored the SF-36 physical component summary (PCS) worse than the relatives on all measured occasions e.g., preoperatively p<0.001, at 3 weeks postoperatively p<0.001, at 12 weeks postoperatively p<0.001 and at 6 months postoperatively p<0.001. A comparison was also made between patients’ PCS and MCS with an age and gender matched population, patients scored MCS significantly worse than the general population preoperatively p<0.001 with effect size r=0.5, at 3 weeks postoperatively p<0.001with effect size r=0.5 and at 1.5 years postoperatively p=0.013 with effect size r=0.6. CONCLUSION The comparison between the HRQoL and emotional well-being of patients with glioblastoma and their relatives from presurgery to one and a half years postsurgery shows that patients on most occasions scored worse physical HRQoL and that relatives mostly scored worse mental HRQoL and emotional well-being. When comparing the patients in the present study with an age and gender matched reference population, it was found that the patients with glioblastoma scored worse HRQoL than the reference population.

Long term outcome of valve repair for degenerative mitral valve disease in Iceland

Degenerative mitral valve disease is the most common indication for mitral valve repair in the Western world. The aim of this study was to study the long term outcome of mitral valve repair for degenerative mitral valve regurgitation in Iceland. A retrospective study of 101 consecutive mitral valve repair patients (average age 57.7 years, 80.2% male) operated in Iceland 2004-2018 for degenerative mitral valve regurgitation. Long term survival and MACCE (major adverse cardiac and cerebrovascular event) free survival was estimated using the Kaplan-Meier method and compared to age and gender matched reference population. Median follow-up time was 83 months. On average there were 6,7 (range 1-14) mitral valve repairs performed annually with 99% of the patients receiving ring annuloplasty. A total of 82 (82,2%) underwent resection of the posterior leaflet and 64.4% recieved Gore-Tex®-chordae. Major early complications occured in 28.7% of cases, most commonly perioperative myocardial infarction (11.9%) and reoperation for bleeding (8.9%). Mortality within 30 days was 2%, the median duration of intensive care unit stay was one day and the median hospital length of stay was 8 days. One patient needed reoperation later for recurrent mitral regurgitation. Five and ten year MACCE-free survival was 91.1% (95%-CI: 85.3-97.2) and 81.0 (95%-CI: 71.6-91.6), respectively. Five year survival was 93.5% (95-CI: 88.6-98.7) and 10 year survival 85.3% (95%-CI: 76.6-94.9), which was not different from an age and gender matched reference population (p=0.135, log-rank test). Outcomes of mitral valve repair due to degenerative mitral regurgitation is good in Iceland and results are comparable to larger institutions overseas. Long term prognosis is generally good although early postoperative complications often occur.

Health-related quality of life in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden: a nation-wide, cross-sectional study

PurposeTo examine health-related quality of life (HRQoL) in refugee minors resettled in Sweden and compare results to a European reference population, while exploring associations between sociodemographic factors and HRQoL dimensions.MethodsA cross-sectional, nation-wide study was conducted with a stratified sample of refugee minors ages 12–15 and 16–18 from Afghanistan, Iraq and Syria, resettled in Sweden between 2014 and 2018. HRQoL was measured using KIDSCREEN-27. HRQoL dimension scores of the sample were compared to mean scores of European age and gender-matched reference population. Associations between sociodemographic factors and HRQoL dimensions were investigated with independent t tests and ANOVA. A multivariable regression analysis was performed to identify the sociodemographic factors associated with HRQoL.ResultsThe questionnaire was sent to 10,000 potential respondents. The response rate was 26%, yielding n = 2559 refugee minors (boys 55%, girls 45%) in the study sample. Compared to European references, minors in the present study had significantly lower scores of HRQoL within psychological wellbeing and peers and social support, whereas levels for autonomy and parent/guardian relations and school environment were higher. Several sociodemographic factors were significantly associated with all HRQoL dimensions, with those 16–18 years old, having average or poor family economy, and living with an unrelated adult or family reporting lower levels of HRQoL. Minors from Afghanistan had significantly lower scores of HRQoL for all dimensions compared to those from Iraq and Syria.ConclusionRefugee minors had significantly lower levels of HRQoL for psychological wellbeing and peers and social support compared to European references. Future research should further investigate this potential HRQoL gap further.

Tibial plateau fractures are associated with a long-term increased risk of mortality: a matched cohort study of 7950 patients.

Disregarding proximal femoral fractures, the current literature includes only limited information regarding mortality following lower extremity fractures. Information regarding risk of mortality related to specific fracture patterns is essential when planning treatment modalities. The primary aim of this study was to report the long-term cumulative survival rate in patients with a tibial plateau fracture compared to an age- and gender-matched reference population. Patients who sustained a tibial plateau fracture in Denmark between 1996 and 2000 were included in the study. Survival status was monitored until 2015. We compared the mortality rate with a tenfold reference population matched on age and gender without a prior tibial plateau fracture. The study was based on register data from the Danish National Patient Register. The study included 7950 patients sustaining 8065 tibial plateau fractures. The cohort had a mean follow-up period of 13.9years. Patients with a tibial plateau fracture had a 1.52 (95% CI 1.46-1.58) times higher hazard ratio (HR) of death compared to the age- and gender-matched reference population. The 30-day, 6-month and 1-year mortality rates were 1.2%, 3.3% and 4.9%, respectively. Patients with a proximal tibial plateau fracture have a higher cumulative risk of death during the mean 13.9-year observational period compared to an age- and gender-matched reference population.

SUN-260 REFERENCE RANGES FOR LEAN AND FAT TISSUE INDEX(LTI, FTI) IN A LARGE ASIAN POPULATION

Bioimpedance analysis has become a widely used technology to assess body composition in health and disease. While most devices on the market use a single frequency, multifrequency devices have advantages in extremes of body composition. The BCM-Body Composition Monitor combines spectroscopy with the Chamney 3-compartment model (Chamney et al, AJCN 2007) to determine body composition independent of fluid status, and is thereby the only device suitable in patients with altered hydration status. While reference ranges for lean and fat tissue index (LTI, FTI) have been long available for Caucasians, no such data has yet been collected in a large and diverse Asian population. Aim of this study was to determine LTI and FTI reference ranges for a healthy Asian population and compare ranges with a Caucasian reference. Data was collected in N=1305 healthy subjects from 4 different Asian countries/region (China, Korea, Taiwan and Vietnam), covering an age range from 2 to 98 years. LTI and FTI were determined and clustered within 5-year age groups. Each age group consists of at least 40 males and females each. 10th and 90th percentiles were calculated in each age group for both genders. The resulting ranges were compared between Asians and Caucasians. Table 1 gives an overview of number of subjects, age, LTI and FTI in the different countries and Caucasian’s as reference. Asian percentile ranges for LTI and FTI differed significantly between Asians and Caucasians (Figure 1) in most age groups. While Asians tended to have lower LTI over age, FTI was more comparable with Caucasians. Table 1LTI and FTI (mean+-SD) for different Asian countries, and Caucasian adults for comparison.Country/region#subjectsAge [yrs]LTI [kg/m2]FTI [kg/m2]femalemalefemaleMaleChina34547.5 +- 20.413.1 +- 1.916.9 +- 2.49.7 +- 3.57.3 +- 3.2Korea28346.8 +- 19.811.9 +- 1.516.2 +- 1.911.2 +- 3.68.3 +- 3.0Taiwan34650.0 +- 21.912.6 +- 1.614.8 +- 3.210.0 +- 3.68.7 +- 4.2Vietnam33148.6 +- 19.413.5 +- 1.817.2 +- 2.27.7 +- 2.85.2 +- 2.7Caucasian ref.113243.0 +- 18.113.6 +- 2.118.1 +- 2.711.1 +- 5.87.7 +- 4.6 Open table in a new tab Figure 1: Lean and Fat tissue index in males and females over age. Circles: Asian population. Solid lines: Caucasian reference range for 10th and 90th percentiles averaged over 5-yr-age groups. Crosses: 10th and 90th percentiles for Asian population. This work establishes new reference ranges for a large population of healthy Asian subjects. The 10th and 90th percentiles allow individual comparison with an age- and gender-matched reference population, assessment of nutritional status and detection of potential malnutrition.

Multi-collector ICP-mass spectrometry reveals changes in the serum Mg isotopic composition in diabetes type I patients

Serum Mg shows a lighter isotopic composition in diabetes type-1 patients than in an age- and gender-matched reference population.

Health-related quality of life after general surgical intensive care.

Impaired mental and physical health are common complications after intensive care that could influence the patient's health-related quality of life (HRQoL). Earlier research has mainly focused on HRQoL in mixed surgical and medical ICU populations. This study aimed to describe and analyze factors associated with HROoL after discharge from a general surgical ICU. A prospective cohort study was conducted in a general surgical ICU in Sweden between 2005 and 2012. Adult patients (≥18years) with an ICU length of stay ≥96hours were included. HRQoL was measured at 3, 6, and 12months after discharge from the ICU using a questionnaire (SF-36). A linear mixed model was used to analyze changes over time and Wilcoxon Signed Rank Tests were used to compare the 12-months results to an age and gender matched reference population in Sweden. Linear regression analyses were performed to explore the impact on HRQoL from background variables. Of 447 patients eligible for the study, 276 patients (62%) answered SF-36 at least once at 3, 6 or 12months after ICU care and were included in the study. HRQoL improved over time but was still significantly lower at 12months compared to the reference population. Female gender, age <75years, living single, and ICU-stay of more than 14days were associated with lower HRQoL. General surgical ICU patients reports low HRQoL 1year after ICU stay. The impaired HRQoL could be a long-lasting problem with major consequences for the individual, family, and society.

The use of psychoactive prescription drugs among DUI suspects

BackgroundThe study seeks to increase understanding of the use of psychoactive prescription drugs among persons suspected of driving under the influence (DUI). We studied whether the use of prescribed psychoactive medication was associated with DUI, and examined the difference in the use of prescription drugs between DUI recidivists and those arrested only once. MethodsIn this register-based study, persons suspected of DUI (n=29470) were drawn from the Register of DUI suspects, and an age- and gender-matched reference population (n=30043) was drawn from the Finnish general population. Data on prescription drug use was obtained by linkage to the National Prescription Register. The associations of DUI arrest and use of psychoactive prescription drugs in different DUI groups (findings for alcohol only, prescription drugs, prescription drugs and alcohol, illicit drugs) were estimated by using mixed-effect logistic regression. ResultsThe use of psychoactive prescription drugs and DUI appeared to be strongly associated, with DUI suspects significantly more likely to use psychoactive prescription drugs compared to the reference population. Gender differences existed, with the use of benzodiazepines being more common among female DUI suspects. Moreover, DUI recidivists were more likely to use psychoactive prescription drugs compared to those arrested only once. ConclusionsIn addition to alcohol and/or illicit drug use, a significant proportion of DUI suspects were using psychoactive prescription drugs. When prescribing psychoactive medication, especially benzodiazepines, physicians are challenged to screen for possible substance use problems and also to monitor for patients’ alcohol or illicit drug use while being medicated.

Low bone mineral density and fat-free mass in younger patients with a femoral neck fracture.

Reduced bone mineral density (BMD) together with muscle wasting and dysfunction, that is sarcopenia, emerges as a risk factor for hip fracture. The aim of this study was to examine body composition and BMD and their relationship with trauma mechanisms in young and middle-aged patients with femoral neck fracture. Altogether, 185 patients with femoral neck fracture aged 20-69 were included. BMD, body composition and fat-free mass index (FFMI) were determined by dual-X-ray absorptiometry (DXA), and trauma mechanisms were registered. Ninety per cent of the whole study population had a femoral neck BMD below the mean for age. In the young patients (< 50 years), 27% had a Z-score of BMD ≤ -2 SD. More than half of the middle-aged patients (50-69 years) had osteopenia, that is T-score -1 to -2.5, and 35% had osteoporosis, that is T-score < -2.5, at the femoral neck. Patients with low-energy trauma, sport injury or high-energy trauma had a median standardised BMD of 0.702, 0.740 vs. 0.803 g/cm(2) (P = 0.03), and a median FFMI of 15.9, 17.7 vs. 17.5 kg/m(2) (P < 0.001), respectively. FFMI < 10th percentile of an age- and gender-matched reference population was observed in one-third. A majority had low BMD at the femoral neck, and one-third had reduced FFMI (i.e. sarcopenia). Patients with fracture following low-energy trauma had significantly lower femoral neck BMD and FFMI than patients with other trauma mechanisms. DXA examination of both BMD and body composition could be of value especially in those with low-energy trauma.

Health-related quality of life in young adults with congenital central hypoventilation syndrome due to PHOX2B mutations: a cross-sectional study.

BackgroundCongenital central hypoventilation syndrome (CCHS) is a rare genetic disease due to PHOX2B mutations. CCHS patients suffer from many autonomic disorders, dominated clinically by defective ventilatory automatisms. From birth, the life of CCHS patients depends on ventilatory support during sleep, involving a high burden of care. Whether or not this impairs the quality of life of these patients during adulthood remains unknown.MethodsWe applied the medical outcome study short form-36 (SF-36) to 12 CCHS patients aged 15–33 (9 women) at the time of their passage from pediatric to adult care. Scores for the SF-36 dimensions were compared to the age- and gender-matched French reference population after transformation into standardized Z-scores. The SF-36 physical component summary score (PCS) and mental component summary score (MCS) were compared to American reference values.ResultsMedian Z-scores were significantly different from zero for PF (physical functioning, p = 0.020) and GH (general health perception, p = 0.0342) and for PCS (p = 0.020). The other physical dimensions (RP, role limitation due to physical function; BP, bodily pain) and the mental dimensions (VT, vitality; SF, social functioning; RE, role limitation due to emotional function; MH, mental health) and MCS were not altered.ConclusionsWe conclude that, despite the physical constraints imposed by CCHS and its anxiogenic nature, this disease is associated with an impairment of health-related quality of life in young adults that remains moderate. Whatever the underlying explanations, these results convey hope to parents with a child diagnosed with CCHS and for patients themselves.

PCN171 - Comparison of expected Health impacts for Major Cancers:Integration of incidence rate and loss of quality-adjusted Life Expectancy

A B S T R A C T Purpose: The study aims to quantify the expected impacts of different cancers through multiplying the incidence rate by loss-of-QALE (quality-adjusted life expectancy), with QALY (quality-adjusted life year) as the common unit, to aid prevention policy decisions. Methods: 464,722 patients with pathologically verified cancer registered in the Taiwan Cancer Registry during 1998–2009 were used to estimate lifetime survival through Kaplan–Meier estimation combined with a semi-parametric method. A convenience sample for measuring the utility value with EQ-5D was conducted with 11,453 cancer patients, with the results then multiplied by the survival functions to estimate QALE. The loss-of-QALE was calculated by subtracting the QALE of each cancer cohort from the life expectancy of the corresponding age- and gender-matched reference population. The cumulative incidence rates from age 20 to 79 (CIR20–79) were calculated to estimate the lifetime risk of cancer for each organ-system. Results: Liver and lung cancer were found the highest expected lifetime health impacts in males and females, or expected lifetime losses of 0.97 and 0.41 QALYs that could be averted, respectively. While the priority changes for prevention based on expected health impacts were slightly different for females based on standardized mortality rates, those of males involve a broader spectrum, including oral, colorectal, esophageal and stomach cancer. Conclusion: The integration of incidence rate with loss-of-QALE could be used to represent the expected losses that could be averted by prevention, which may be useful in prioritizing strategies for cancer control.

Improvements in physical performance and health-related quality of life one year after radical operation for lung cancer

Abstract Micro abstract This study assessed physical performance and health-related quality of life one year after lung cancer surgery and investigated the potential association between both outcomes. We found that the walked distance was associated with the subjective perception of the physical functioning. Patients improved health-related quality of life, reaching values similar to a healthy reference population. Background Resuming an acceptable level of lifestyle and health-related quality of life after lung cancer surgery has become an important issue. We aimed to evaluate the course of recovery of physical performance and health-related quality of life following pulmonary resection for lung cancer, as well as examine the potential association between these outcomes. Methods In an observational design, we assessed 78 individuals radically operated for lung cancer. We measured health-related quality of life (SF-36), six-minute walk test (6MWT) and lung function (spirometry) three weeks (baseline), four and twelve months after surgery. SF-36 values were compared to an age- and gender-matched reference population. Results The mean age was 65 years (SD9), 59% were males. Thoracotomy was performed in 77% of the cases. Compared to baseline values, we found significant improvements after one year in SF-36 physical and mental component summary components of large effect size (0.8 and 0.9 respectively). Values for both SF-36 summary components were comparable to those of the reference population. The improvement in 6MWT was of moderate effect size (0.6). We found a positive association between 6MWT and the SF-36 domain for physical functioning (β=0.05, 95% CI [0.00;0.09], p=0.03) one year after surgery. Conclusion Individuals who were radically operated for lung cancer improved health-related quality of life one year after surgery, reaching values similar to a healthy reference population. The walked distance was positively associated with the subjective perception of physical functioning. The clinical significance of these findings deserves further investigation.

Comparison of expected health impacts for major cancers: Integration of incidence rate and loss of quality-adjusted life expectancy

PurposeThe study aims to quantify the expected impacts of different cancers through multiplying the incidence rate by loss-of-QALE (quality-adjusted life expectancy), with QALY (quality-adjusted life year) as the common unit, to aid prevention policy decisions. Methods464,722 patients with pathologically verified cancer registered in the Taiwan Cancer Registry during 1998–2009 were used to estimate lifetime survival through Kaplan–Meier estimation combined with a semi-parametric method. A convenience sample for measuring the utility value with EQ-5D was conducted with 11,453 cancer patients, with the results then multiplied by the survival functions to estimate QALE. The loss-of-QALE was calculated by subtracting the QALE of each cancer cohort from the life expectancy of the corresponding age- and gender-matched reference population. The cumulative incidence rates from age 20 to 79 (CIR20–79) were calculated to estimate the lifetime risk of cancer for each organ-system. ResultsLiver and lung cancer were found the highest expected lifetime health impacts in males and females, or expected lifetime losses of 0.97 and 0.41 QALYs that could be averted, respectively. While the priority changes for prevention based on expected health impacts were slightly different for females based on standardized mortality rates, those of males involve a broader spectrum, including oral, colorectal, esophageal and stomach cancer. ConclusionThe integration of incidence rate with loss-of-QALE could be used to represent the expected losses that could be averted by prevention, which may be useful in prioritizing strategies for cancer control.

The arrest of drivers under the influence as a predictor of subsequent social disadvantage and death

BackgroundThe association between DUI (driving under the influence) and disadvantaged social background has been shown in cross-sectional studies, but less is known about the processes behind this phenomenon. We aimed to examine the effect of DUI arrest on subsequent social disadvantage in Finland during 1993–2006 to provide more understanding about the dynamics of DUI and marginalization and to study DUI arrest as a potential point of intervention. MethodsIn this longitudinal, register-based study the Register of DUI suspects (n=68894) was linked with the Employment Register. An age- and gender-matched reference population (n=67740) was drawn from the general Finnish population. A multi-state model was used to estimate the transition intensities between three different states (advantaged social status/disadvantaged social status/death) among three different DUI groups (alcohol only, prescription drugs, illicit drugs). ResultsCompared to references, the movement of DUI suspects between different social states was more dynamic in that they were more likely to either move to a disadvantaged social state or to an improved status (except DUI suspects using prescription drugs). A DUI's relative risk of death compared to references was high, especially if currently in advantaged social status. The effect of DUI did not diminish over time. ConclusionsDriving under the influence is associated with an increased long-term risk for social disadvantage. DUI arrest could serve as an opportunity for intervention in the marginalization process.

Cardiovascular morbidity and mortality in surgically treated hyperthyroidism – a nation‐wide cohort study with a long‐term follow‐up

Previous studies suggest that patients with hyperthyroidism remain at an increased risk of cardiovascular morbidity even after restoring euthyroidism. The mechanisms of the increased risk and its dependency on the different treatment modalities of hyperthyroidism remain unclear. The aim of this long-term follow-up study was to compare the rate of hospitalizations for cardiovascular causes and the mortality in hyperthyroid patients treated surgically with an age- and gender-matched reference population. A population-based cohort study was conducted among 4334 hyperthyroid patients (median age 46 years) treated with thyroidectomy in 1986-2007 in Finland and among 12,991 reference subjects. Firstly, the hospitalizations due to cardiovascular diseases (CVD) were analysed until thyroidectomy. Secondly, the hazard ratios for any new hospitalization due to CVDs after the thyroidectomy were calculated in Cox regression analysis adjusted with the prevalent CVDs at the time of thyroidectomy. The risk of hospitalization due to all CVDs started to increase already 5 years before the thyroidectomy, and by the time of the operation, it was 50% higher in the hyperthyroid patients compared to the controls (P < 0·001). After the thyroidectomy, the hospitalizations due to all CVDs (HR 1·15), hypertension (HR 1·23), heart failure (HR 1·17) and valvular diseases or cardiomyopathies (HR 1·55) remained more frequent among the patients than among the controls for 20 years after thyroidectomy. The increased morbidity was not clearly related to the aetiology of hyperthyroidism. Despite the increased CVD morbidity among the patients, there was no difference in cardiovascular mortality. The present study shows that hyperthyroidism increases the risk of hospitalization due to CVDs and the risk is sustained up to two decades after effective surgical treatment. However, there was no excess CVD mortality in the middle-aged patient cohort studied.

Long-term treatment with supraphysiological doses of thyroid hormone in affective disorders — effects on bone mineral density

To investigate the long-term effects of supraphysiological, TSH suppressive doses of levothyroxine (TSDL) on bone mineral density (BMD) in patients with affective disorders during an average treatment duration of 69 months. In 22 patients, BMD of the spine (lumbar vertebrae L1-4) and femur (femoral neck) was measured by dual energy X-ray absorptiometry (DXA). Forty (40) measurements from the prior study and 48 new follow-up measurements were included. BMD was expressed as Z-scores as a population standard reference. We used a linear mixed model to investigate the duration of TSDL as an explanatory factor for change in BMD compared to an age and gender matched reference population. We found no significant differences in bone loss between the study and the reference population. The estimated non-significant decrease in Z-score compared to the reference population found was: a) lumbar spine (L1-4): -0.00069/month (p=0.9759) b) neck region of femur: -0.01405/month (p=0.4436). We did not find the factors age, thyroxine-dose or postmenopausal state as predictors for a decline in BMD. Small sample size, no bone density assessment prior to treatment with TSDL, no patient control group with mood disorders who did not receive TSDL, variable bone density follow-up intervals. This study did not demonstrate evidence that long-term treatment of affectively ill patients with TSDL accelerates loss of BMD compared to an age- and gender-matched reference population.

Long-term health-related quality of life following surgery for lung cancer

The aim of the study was to examine the long-term health-related quality of life following surgery for lung cancer. We performed a prospective population-based cohort study to explore health-related quality of life after lung surgery. We used a validated quality-of-life instrument (Short Form-36 (SF-36)) to gather information on health-related quality of life at baseline, 6 months, and 2 years after surgery. The main outcome measures were the SF-36 physical component summary (PCS) and mental component summary (MCS) scores. Between 2006 and 2008, 249 patients were included. The response rate at 6 months was 85% and, at 2 years of follow-up, was 95%. The study population consisted of 166 patients who completed all three SF-36 questionnaires. The PCS score decreased from baseline to 6 months (47.4 vs 41.1; p < 0.001) and remained unchanged at the 2-year follow-up (41.1 vs 41.4). The MCS score increased from baseline to 6 months (40.5 vs 44.6; p = 0.001), with a further improvement at 2 years (44.6 vs 46.9; p = 0.005). At 2-year follow-up, both the PCS score and the MCS score of the study population were lower than that of an age- and gender-matched reference population (41.4 vs 44.0; p = 0.013 and 46.9 vs 50.6; p = 0.01). We found that patients undergoing surgery for lung cancer had an early decrease in the physical aspect of health-related quality of life at 6 months after surgery, which was still present at 2 years of follow-up. A moderate clinically relevant improvement was noted in the mental aspect at 6 months and further improvement was reported at 2 years of follow-up.

Association between gastrointestinal symptoms and health-related quality of life after heart transplantation

Heart transplantation (HTx) ameliorates the self-perceived health-related quality of life (HRQoL) of patients with terminal heart disease; gastrointestinal (GI) symptoms, due to obligatory immunosuppression, may contribute to impaired HRQoL post-HTx. In this cross-sectional, exploratory study we aimed to investigate association between GI symptoms and HRQoL. The study consisted of 167 patients who had undergone HTx between 1985 and 2006 in Finland. Short-Form 36 (SF-36) Quality of Life and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires were sent to the patients at the end of 2006 for capturing data on the HRQoL of HTx recipients. Higher or equal SF-36 scores describing the HRQoL dimensions compared with the Finnish age- and gender-matched reference population were as follows: physical functioning, 60.5%; role-physical, 67.5%; bodily pain, 62.6%; general health, 64.0%; vitality, 68.1%; social functioning, 68.1%; role-emotional, 70.0%; and mental health, 70.4%. The prevalence of troublesome GI symptoms (GSRS score >1) per GSRS dimension was 53.9% for diarrhea, 91.0% for indigestion, 60.6% for constipation, 73.4% for abdominal pain, 46.4% for reflux and 95.8% for any GI symptom. Diabetes contributed to the presence of diarrhea (odds ratio [OR]: 3.00; 95% confidence interval [CI]: 1.12 to 8.00), use of prednisolone to indigestion (OR: 3.21; 95% CI: 1.05 to 9.79) and increased age to constipation (OR: 1.04; 95% CI: 1.02 to 1.07). HRQoL after HTx is relatively good and comparable to the age- and gender-matched reference population. HRQoL is vulnerable to side-effects caused by the obligatory post-HTx immunosuppressive regimen, where GI symptoms play a major but clearly an underestimated role.

Peutz-Jeghers syndrome: a study of long-term surgical morbidity and causes of mortality

Patients with Peutz-Jeghers syndrome (PJS) require lifelong multidisciplinary care for gastrointestinal polyposis and increased risk of cancer. Their long-term morbidities and causes of mortality are unknown. Patients with a definitive diagnosis of PJS (n = 54) were retrospectively reviewed for disease course and outcome. Operative details, pathology and complications were noted for those treated surgically (n = 33). Median follow-up was 7.0 years (interquartile range: 2-20). Two malignancies were found intra-operatively (duodenal and rectal adenocarcinoma). In the long-term, 42% underwent additional operations; 1 patient developed short bowel syndrome, while another, chronic partial bowel obstruction and pain. Twenty-one additional cancers were treated in 19 patients: gynecologic (11), lung (3), and prostate (2) being the most common. 16 patients (30%) were deceased, at a median age of 51 years. The cause of death was unknown in 4 patients, but was due exclusively to malignancies in all other patients, most commonly due to metastatic gynecologic cancer (5). The overall survival of PJS patients was significantly shorter than the expected survival of an age-and gender-matched reference population (P < 0.001). Given the morbidities associated with repeated operations and the risk for cancer-related mortality in the long-term, efforts should focus on minimizing the need for surgical intervention and optimizing cancer detection, treatment and prevention.