General Population-based Studies Research Articles

The relationship between serum HDL-cholesterol, cardiovascular disease and mortality in community-based people with type 2 diabetes: the Fremantle Diabetes Study phase 2

BackgroundOlder general population-based studies found an inverse association between serum HDL-cholesterol and both cardiovascular disease (CVD) events and mortality, but more recent data have suggested a U-shaped relationship. Whether this applies to type 2 diabetes is uncertain. The aim of this study was to assess the prognostic significance of serum HDL-cholesterol concentrations in representative, community-based participants from the Fremantle Diabetes Study Phase II (FDS2).MethodsWe followed 1,479 FDS2 participants with confirmed type 2 diabetes (713 females, mean age 65.6 years; 763 males, mean age 65.9 years) from entry (2008–2011) to death/end-2021. Major adverse cardiovascular events (non-fatal myocardial infarction (MI), non-fatal stroke, cardiovascular death; 3-point MACE), and all-cause mortality were ascertained from prospectively collected data and validated administrative databases. Independent associates of 3-point MACE by sex, excluding participants with prior MI/stroke, were assessed using Cox and competing risk models with sex-specific quintiles of HDL-cholesterol added to the most parsimonious models. Predictors of all-cause mortality were identified using Cox proportional hazards modelling.ResultsIn females, with baseline serum HDL-cholesterol quintile 2 (1.04–1.22 mmol/L) as reference, both quintiles 1 (< 1.04 mmol/L) and 5 (> 1.59 mmol/L) were significant independent predictors of 3-point MACE (P < 0.027) and all-cause death (P < 0.019) after adjustment for a full range of demographic, clinical and laboratory variables. In males, serum HDL-cholesterol quintile did not add to the most parsimonious model for 3-point MACE, but quintile 1 (< 0.90 mmol/L) was a significant predictor of death (P = 0.026 versus quintile 4 (1.15–1.31 mmol/L) as reference) after adjustment. Competing risk analyses for 3-point MACE showed similar results to the Cox models for both sexes.ConclusionThere was a significant U-shaped relationship between serum HDL-cholesterol and both 3-point MACE and all-cause death in females with type 2 diabetes after adjustment for confounders. There was no such relationship for 3-point MACE in males but a low HDL-cholesterol was associated with all-cause mortality. These data have sex-specific implications for assessment of serum lipid profiles in the clinical management of type 2 diabetes.

232. EPIDEMIOLOGY OF EOSINOPHILIC ESOPHAGITIS IN JAPAN: A POPULATION-BASED STUDY

Abstract Backgrounds Eosinophilic esophagitis (EoE) has been increasingly diagnosed in Western countries whilst there have been few general population-based studies in Asia. In addition, risk factors for EoE have not been examined completely. The aim of the study was to investigate the epidemiology and risk factors of EoE in Japanese general population. Methods We analyzed an employer-based health insurance claim database from January 2005 to September 2022. EoE cases were identified based on the International Classification of Diseases-tenth Revision code, K20.0. We calculated the incidence and prevalence of EoE using Poisson regression and binomial distribution with exact methods respectively. Using 10 times more matched controls for EoE cases, a nested case-control study identified potential risk factors for adult EoE. Results Of 15,200,895 individuals, 1,010 EoE cases were identified. The incidence and prevalence of EoE were 2.82 (95% CI 2.44–3.26) per 100,000 person-years and 10.68 (95% CI 10.01–11.37) per 100,000 people in 2022. Both rates had dramatically increased since 2017. smoking was associated with a 59% risk reduction of EoE whereas constant alcohol consumption was associated with a 63% increase in the risk of EoE. EoE was not associated with either body mass index or health-related diseases such as hypertension, diabetes mellitus, hyperuricemia, and dyslipidemia. Conclusion The incidence and prevalence of EoE in Japan has steadily increased over the past two decades. Nevertheless, EoE remains less common in Japan compared to Western countries. Factors contributing to the epidemiology of EoE on a global basis may improve our understanding of the contribution of genetic and environmental risk factors. In light of potential risk factors, further study is warranted to investigate whether lifestyle intervention can improve the management of EoE.

Burden of risk factors in women and men with unrecognised myocardial infarction: a systematic review and meta-analysis.

Unrecognised myocardial infarction (MI) is a MI that remains undetected in the acute phase and is associated with an unfavourable prognosis. With this systematic review and meta-analysis, we evaluated the burden of cardiovascular risk factors in individuals with unrecognised MI. We searched general population-based cohort studies diagnosing unrecognised MI by electrocardiogram or myocardial imaging up to 24 November 2023. Pooled mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI) were determined, and random-effects meta-analyses were performed. Fourteen cohort studies were included involving 200,450 individuals (mean age 62.8±9.9 years, 56.0% women), among which 4,322 (2.2%) experienced unrecognised MI (mean age 66.3±8.2 years, 47.8% women) and 4,653 (2.1%) recognised MI (mean age 68.5±7.3 years, 33.8% women). Compared to individuals without MI, those with unrecognised MI had higher body mass index (MD 0.27, 95% CI 0.16-0.39) and systolic blood pressure (MD 4.48, 95% CI 2.81-6.15), and higher prevalence of hypertension (RR 1.27, 95% CI 1.06-1.51) and diabetes mellitus (RR 1.67, 95% CI 1.36-2.06). Furthermore, individuals with unrecognised MI had lower prevalence of hypertension (RR 0.92, 95% CI 0.88-0.97) and diabetes mellitus (RR 0.80, 95% CI 0.70-0.92). Individuals with unrecognised MI are characterised by a substantial burden of metabolic risk factors. Our findings suggest insufficient recognition and management of cardiovascular risk factors among individuals with unrecognised MI.

Epidemiology and Risk Factors of Eosinophilic Esophagitis in Japan: A Population-Based Study

Background and AimsEosinophilic esophagitis (EoE) has been increasingly diagnosed globally. However, there have been few general population-based studies in Asia. The aim of this study was to investigate EoE epidemiology in the Japanese general population. MethodsWe analyzed an employer-based health insurance claim database from January 2005 to September 2022. EoE cases were identified based on the International Classification of Diseases-tenth Revision code, K20.0. We calculated the incidence and prevalence of EoE using Poisson regression and binomial distribution, respectively. Using 10 matched controls for each EoE case, a nested case-control study was performed to identify potential risk factors for EoE. ResultsOf 15,200,895 individuals, 1,010 EoE cases were identified. The incidence and prevalence of EoE were 2.82 (95% CI 2.44–3.26) per 100,000 person-years and 10.68 (95% CI 10.01–11.37) per 100,000 people in 2022, nearly three and eight times as high as those in 2017, respectively. Smoking was associated with decreased risk of EoE (OR 0.45 (0.36 to 0.56), p<0.001) whereas alcohol consumption (OR 1.51 (1.21 to 1.88), p<0.001) were associated with increased risk of EoE along with several allergic conditions and psychiatric disorders. EoE was not related to either body mass index or lifestyle-related diseases such as hypertension, diabetes mellitus, hyperuricemia, and dyslipidemia. ConclusionThe incidence and prevalence of EoE in Japan have steadily increased over the past two decades. Nevertheless, EoE remains less common in Japan compared to the United States and Western Europe. Factors contributing to the epidemiology of EoE on a global basis may improve our understanding of the contribution of genetic and environmental risk factors.

Risks of alopecia areata in long COVID: Binational population-based cohort studies from South Korea and Japan.

Previous studies have proposed alopecia areata (AA) as a potential outcome of COVID-19 infection among autoimmune diseases, yet the findings might be inconclusive and difficult to generalize due to limited sample sizes and evidence levels. Thus, we aimed to investigate in detail the long-term risk of AA following SARS-CoV-2 infection based on large, binational, general population-based cohort studies. Our study investigated the long-term AA risk after SARS-CoV-2 infection by analyzing bi-national, claim-based cohorts in South Korea and Japan: a Korean nationwide cohort (K-COV-N cohort; discovery cohort; total n = 10 027 506) and a Japanese claims-based cohort (JMDC cohort; validation cohort; total n = 12 218 680). AA was identified based on the international classification of diseases 10th revision code (L63) requiring at least three claims within 1 year. After exposure-driven propensity score matching, SARS-CoV-2 infection was associated with an increased risk of incident AA (aHR, 1.66; 95% CI, 1.38-1.99). This increased risk was observed and persisted for up to 6 months. A similar pattern was observed in the validation cohort. As modifiable factors, severe COVID-19 increased the risk of AA, whereas receiving two or more doses of the COVID-19 vaccine before infection decreased the risk of AA. Through a bi-national cohort study in South Korea and Japan, SARS-CoV-2 infection was associated with an elevated risk for incident AA in the aspect of long COVID.

Hand eczema-related presenteeism and sickness absence: A cross-sectional population-based study.

To date, hand eczema (HE)-related presenteeism has never been assessed within the general population, and general population-based studies on HE-related sickness absence are limited. To assess the prevalence of HE-related presenteeism and sickness absence, and factors associated with HE-related presenteeism, within the Dutch general population. Within the Lifelines Cohort Study, participants with HE in the last year (aged 18-65 in 2020), were identified by a questionnaire including questions regarding HE-related presenteeism and sickness absence. Socio-demographic factors were collected from 2006 to 2020. Out of the 3.703 included participants with HE, 2.7% (n = 100) reported HE-related presenteeism, with 19.8% (n = 57) among those with severe-to-very-severe HE. HE-related sickness absence was reported by 0.5% (n = 20) and 5.9% (n = 17), respectively. Logistic regression analyses, adjusted for age and sex, showed negative associations between HE-related presenteeism and higher educational attainment, higher income (>€2500) and higher occupational skill level, and positive associations for high-risk occupations, chronic HE, moderate and severe-to-very-severe HE (compared to almost clear), atopic dermatitis and occupational wet exposure. A high prevalence of HE-related presenteeism was found among participants with severe-to-very-severe HE. Future studies should focus on longitudinal associations with the clinical course of HE, as HE-related presenteeism might aggravate symptoms of HE.

Prevalence of traditional cardiovascular risk factors in subjects with unrecognized myocardial infarction: a systematic review and meta-analysis

Abstract Background Unrecognized myocardial infarction (UMI) is defined as myocardial ischemia (MI) that was not recognized as such during the acute phase, but later identified by pathological Q waves on an electrocardiogram (ECG), myocardial imaging evidence, or pathological findings on autopsy. Previous studies found that UMI accounts for up to 50% of all MIs, especially in women and the elderly. UMI is associated with increased risk of adverse cardiovascular outcomes and mortality, similar to subjects with recognized myocardial infarction (RMI). However, associated risk factors of UMI remain understudied. Purpose We aimed to summarize and combine the evidence on the associations between traditional cardiovascular risk factors and UMI in the general population. We also sought to assess sex differences in these risk factors. Methods A systematic search of general population-based cohort studies investigating UMI and reporting traditional cardiovascular risk factors of subjects with UMI and subjects without MI was performed through Embase, Medline, and Google Scholar up to 7 February 2023. Study selection, data extraction and risk of bias were assessed independently by 2 authors. Pooled standardized mean differences (SMD) or odds ratios (ORs) with 95% confidence intervals (CI) of traditional cardiovascular risk factors were determined, comparing UMI to subjects without MI. Random-effects meta-analyses were performed. If data allowed, analyses were repeated stratified by sex. Results A total of 17 studies were included involving 216,858 individuals, among which 4,717 experienced UMI (mean age 66.1±8.3 year, 49% women). UMI was diagnosed through ECG in 14 studies and MRI in 3 studies. All studies established diagnosis of UMI and risk factors in a cross-sectional manner. Compared to subjects without MI, individuals with UMI demonstrated significantly larger values of BMI (SMD 0.05, 95% CI 0.03-0.08) and SBP (SMD 0.25, 95% CI 0.12-0.39), and higher prevalence of hypertension (OR 1.71, 95% CI 1.07-2.72) and diabetes mellitus (DM) (OR 1.81, 95% CI 1.40-2.34). Risk factors were reported stratified by sex in 3 studies. The relation between hypertension and UMI was stronger in women than in men. In contrast, the association of DM with UMI was weaker in women. However, these differences were statistically non-significant. Conclusion BMI, SBP, hypertension and diabetes mellitus are associated with an increased risk of UMI, similar to RMI. Limited evidence from studies stratified for sex indicate a differential impact of traditional risk factors on UMI in women and men.

Global incidence and prevalence of autoimmune hepatitis, 1970–2022: a systematic review and meta-analysis

Autoimmune hepatitis (AIH) varies significantly in incidence and prevalence across countries and regions. We aimed to examine global, regional, and national trends in incidence and prevalence of AIH from 1970 to2022. We conducted a thorough search of the PubMed/MEDLINE, Embase, CINAHL, Google Scholar, and Cochrane databases from database inception to August 9, 2023, using the search term "autoimmune hepatitis" in combination with "incidence," "prevalence," or "trend." Only general population-based observational studies with larger samples sizes were considered for inclusion. Studies that recruited convenience samples, and those with fewer than 50 participants were excluded. Summary data were extracted from published reports. A random effects model was used and pooled estimates with 95% CI were used to calculate the incidence and prevalence of AIH. Heterogeneity was evaluated using the I2 statistic. The study protocol was registered with PROSPERO, CRD42023430138. A total of 37 eligible studies, encompassing more than 239 million participants and 55,839 patients with AIH from 18 countries across five continents, were included in the analysis. Global pooled incidence and prevalence of AIH were found to be 1.28 cases per 100,000 inhabitant-years (95% CI, 1.01-1.63, I2=99·51%; number of studies, 33; sample population, 220,673,674) and 15.65 cases per 100,000 inhabitants (95% CI, 13.42-18.24, I2=99·75%; number of studies, 26; sample population, 217,178,684), respectively. The incidence of AIH was greater in countries with high Human Development Index (>0.92), in North America and Oceania (compared with Asia), among females, adults (compared with children), and high latitude (>45°). Similar patterns in AIH prevalence were observed. Pooled AIH prevalence increased gradually from 1970 to 2019 (1970-1999; 9.95 [4.77-15.13], I2=95·58% versus 2015-2022; 27.91 [24.86-30.96], I2=99·32%; cases per 100,000 inhabitants). The overall incidence and prevalence of AIH, as well as some subgroup analyses of the studies, displayed asymmetry in the funnel plots, suggesting potential evidence of publication bias. AIH incidence and prevalence have increased significantly and exhibit substantial variation across regions worldwide. Further research is required to assess the incidence and prevalence of AIH, specifically in South America and Africa. National Research Foundation of Korea.

Analysis of dengue fever disease in West Africa.

Dengue fever disease (DFD) which is caused by four antigenically distinct dengue viruses (DENV) presents a global health threat, with tropical and subtropical regions at a greater risk. The paucity of epidemiological data on dengue in West African subregion endangers efforts geared toward disease control and prevention. A systematic search of DFD prevalence, incidence, and DENV-infected Aedes in West Africa was conducted in PubMed, Scopus, African Index Medicus, and Google Scholar in line with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. A total of 58 human prevalence studies involving 35,748 people from 8 countries were identified. Two incidence and six DENV-infected studies were also reviewed. Nigeria and Burkina Faso contributed the majority of the prevalence studies which spanned between 1968 and 2018, with a considerable variation in coverage among the countries reviewed in this study. An average prevalence of 20.97% was observed across both general prevalence and acute DENV infection study categories, ranging between 0.02% and 93%. The majority of these studies were conducted in acute febrile patients with a prevalence range of 0.02-93% while 19% (n = 11) of all studies were general population-based studies and reported a prevalence range of 17.2-75.8%. DENV-infected Aedes aegypti were reported in four out of the five countries with published reports; with DENV-2 found circulating in Cape Verde, Senegal, and Burkina Faso while DENV-3 and DENV-4 were also reported in Senegal and Cape Verde, respectively. High prevalence of DFD in human populations and the occurrence of DENV-infected A. aegypti have been reported in West Africa, even though weaknesses in study design were identified. Epidemiological data from most countries and population in the subregion were scarce or non-existent. This study highlights the epidemic risk of DFD in West Africa, and the need for research and surveillance to be prioritized to fill the data gap required to enact effective control measures.

Development of a quantitative North and Central European job exposure matrix for wood dust.

Wood dust is an established carcinogen also linked to several non malignant respiratory disorders. A major limitation in research on wood dust and its health effects is the lack of (historical) quantitative estimates of occupational exposure for use in general population-based case-control or cohort studies. The present study aimed to develop a multinational quantitative Job Exposure Matrix (JEM) for wood dust exposure using exposure data from several Northern and Central European countries. For this, an occupational exposure database containing 12653 personal wood dust measurements collected between 1978 and 2007 in Denmark, Finland, France, The Netherlands, Norway, and the United Kingdom (UK) was established. Measurement data were adjusted for differences in inhalable dust sampling efficiency resulting from the use of different dust samplers and analysed using linear mixed effect regression with job codes (ISCO-88) and country treated as random effects. Fixed effects were the year of measurement, the expert assessment of exposure intensity (no, low, and high exposure) for every ISCO-88 job code from an existing wood dust JEM and sampling duration. The results of the models suggest that wood dust exposure has declined annually by approximately 8%. Substantial differences in exposure levels between countries were observed with the highest levels in the United Kingdom and the lowest in Denmark and Norway, albeit with similar job rankings across countries. The jobs with the highest predicted exposure are floor layers and tile setters, wood-products machine operators, and building construction labourers with geometric mean levels for the year 1997 between 1.7 and 1.9 mg/m3. The predicted exposure estimates by the model are compared with the results of wood dust measurement data reported in the literature. The model predicted estimates for full-shift exposures were used to develop a time-dependent quantitative JEM for exposure to wood dust that can be used to estimate exposure for participants of general population studies in Northern European countries on the health effects from occupational exposure to wood dust.

Gestational age at birth and body size from infancy through adolescence: An individual participant data meta-analysis on 253,810 singletons in 16 birth cohort studies.

Preterm birth is the leading cause of perinatal morbidity and mortality and is associated with adverse developmental and long-term health outcomes, including several cardiometabolic risk factors and outcomes. However, evidence about the association of preterm birth with later body size derives mainly from studies using birth weight as a proxy of prematurity rather than an actual length of gestation. We investigated the association of gestational age (GA) at birth with body size from infancy through adolescence. We conducted a two-stage individual participant data (IPD) meta-analysis using data from 253,810 mother-child dyads from 16 general population-based cohort studies in Europe (Denmark, Finland, France, Italy, Norway, Portugal, Spain, the Netherlands, United Kingdom), North America (Canada), and Australasia (Australia) to estimate the association of GA with body mass index (BMI) and overweight (including obesity) adjusted for the following maternal characteristics as potential confounders: education, height, prepregnancy BMI, ethnic background, parity, smoking during pregnancy, age at child's birth, gestational diabetes and hypertension, and preeclampsia. Pregnancy and birth cohort studies from the LifeCycle and the EUCAN-Connect projects were invited and were eligible for inclusion if they had information on GA and minimum one measurement of BMI between infancy and adolescence. Using a federated analytical tool (DataSHIELD), we fitted linear and logistic regression models in each cohort separately with a complete-case approach and combined the regression estimates and standard errors through random-effects study-level meta-analysis providing an overall effect estimate at early infancy (>0.0 to 0.5 years), late infancy (>0.5 to 2.0 years), early childhood (>2.0 to 5.0 years), mid-childhood (>5.0 to 9.0 years), late childhood (>9.0 to 14.0 years), and adolescence (>14.0 to 19.0 years). GA was positively associated with BMI in the first decade of life, with the greatest increase in mean BMI z-score during early infancy (0.02, 95% confidence interval (CI): 0.00; 0.05, p < 0.05) per week of increase in GA, while in adolescence, preterm individuals reached similar levels of BMI (0.00, 95% CI: -0.01; 0.01, p 0.9) as term counterparts. The association between GA and overweight revealed a similar pattern of association with an increase in odds ratio (OR) of overweight from late infancy through mid-childhood (OR 1.01 to 1.02) per week increase in GA. By adolescence, however, GA was slightly negatively associated with the risk of overweight (OR 0.98 [95% CI: 0.97; 1.00], p 0.1) per week of increase in GA. Although based on only four cohorts (n = 32,089) that reached the age of adolescence, data suggest that individuals born very preterm may be at increased odds of overweight (OR 1.46 [95% CI: 1.03; 2.08], p < 0.05) compared with term counterparts. Findings were consistent across cohorts and sensitivity analyses despite considerable heterogeneity in cohort characteristics. However, residual confounding may be a limitation in this study, while findings may be less generalisable to settings in low- and middle-income countries. This study based on data from infancy through adolescence from 16 cohort studies found that GA may be important for body size in infancy, but the strength of association attenuates consistently with age. By adolescence, preterm individuals have on average a similar mean BMI to peers born at term.

Frailty and risk of hospitalization from COVID-19 infection among older adults: evidence from the Dutch Lifelines COVID-19 Cohort study

BackgroundFrailty is associated with COVID-19 severity in clinical settings. No general population-based studies on the association between actual frailty status and COVID-19 hospitalization are available.AimsTo investigate the association between frailty and the risk of COVID-19 hospitalization once infected.Methods440 older adults who participated in the Lifelines COVID-19 Cohort study in the Northern Netherlands and reported positive COVID-19 testing results (54.2% women, age 70 ± 4 years in 2021) were included in the analyses. COVID-19 hospitalization status was self-reported. The Groningen Frailty Indicator (GFI) was derived from 15 self-reported questionnaire items related to daily activities, health problems, and psychosocial functioning, with a score ≥ 4 indicating frailty. Both frailty and COVID-19 hospitalization were assessed in the same period. Poisson regression models with robust standard errors were used to analyze the associations between frailty and COVID-19 hospitalization.ResultsOf 440 older adults included, 42 were hospitalized because of COVID-19 infection. After adjusting for sociodemographic and lifestyle factors, a higher risk of COVID-19 hospitalization was observed for frail individuals (risk ratio (RR) [95% CI] 1.97 [1.06–3.67]) compared to those classified as non-frail.DiscussionFrailty was positively associated with COVID-19 hospitalization once infected, independent of sociodemographic and lifestyle factors. Future research on frailty and COVID-19 should consider biomarkers of aging and frailty to understand the pathophysiological mechanisms and manifestations between frailty and COVID-19 outcomes.ConclusionsFrailty was positively associated with the risk of hospitalization among older adults that were infected with COVID-19. Public health strategies for frailty prevention in older adults need to be advocated, as it is helpful to reduce the burden of the healthcare system, particularly during a pandemic like COVID-19.

Methylated DNA markers discriminate between endometrial cancer and benign endometrium in women with Lynch syndrome (222)

Methylated DNA markers discriminate between endometrial cancer and benign endometrium in women with Lynch syndrome (222)

Reliability of self-reported questionnaire for epidemiological investigation of Helicobacter pylori eradication in a population-based cohort study

General population-based cohort studies provide solid evidence on mass Helicobacter pylori (HP) eradication effects. Self-reported questionnaires are occasionally used in such studies to ascertain the HP eradication history. However, reports on the reliability of these questionnaires are lacking. This general population-based cohort study included 899 individuals with HP infection at the baseline survey who were reported to have eradicated it at the 5-year follow-up survey. Of these, the medical records of 280 patients were available for investigation, and the HP eradication status of 93 individuals was ascertained. Their medical records were reviewed, and the reliability of the self-reported questionnaire responses was assessed. Of the 91 individuals who successfully eradicated HP based on the medical records, 90 (98.9%) answered the self-reported questionnaire correctly, with an unweighted kappa value of 0.661 (p < 0.001). The difference between the self-reported and medical records age at eradication was within a 1-year range in most participants (86.8%). Similarly, the HP eradication procedure and the outcomes were reasonably matched. In conclusion, the responses to the self-reported HP eradication questionnaire were almost consistent with the medical records. Thus, HP eradication history assessment by a self-reported questionnaire is reliable for an epidemiological study in the general population.

Changes in lipidomic profile by anti-retroviral treatment regimen: An ACTG 5257 ancillary study.

High cardiovascular disease risk in people living with HIV is partly attributed to antiretroviral therapy (ART). Lipid response to ART has been extensively studied, yet, little is known how small molecule lipids respond to Integrase inhibitor-based (INSTI-based) compared to Protease inhibitor-based (PI-based) ART regimens.Ancillary study to a phase 3, randomized, open-label trial [AIDS Clinical Trial Group A5257 Study] in treatment-naive HIV-infected patients randomized in a 1:1:1 ratio to receive ritonavir-boosted atazanavir (ATV/r), ritonavir-boosted darunavir (DRV/r) (both PI-based), or raltegravir with Tenofovir Disoproxil Fumarate-TDF plus emtricitabine (RAL, INSTI-based).We examined small molecule lipid response in a subcohort of 75 participants. Lipidomic assays of plasma samples collected pre- and post-ART treatment (48 weeks) were conducted using ultra-performance liquid chromatography coupled to time-of-flight mass spectrometry. The effect of ART regimens was regressed on lipid species response adjusting for the baseline covariates (lipids, age, sex, race, CD4 level, BMI, and smoking). Results were validated in the Centers for AIDS Research Network of Integrated Clinical Systems study (N = 16).Out of 417 annotated lipids, glycerophospholipids (P = .007) and sphingolipids (P = .028) had a higher response to ATV/r and DRV/r compared to RAL. The lysophosphatidylcholine (LPCs(16:1),(17:1),(20:3)) and phosphophatidylcholine species (PCs(40:7),(38:4)) had an opposite response to RAL versus ATV/r in the discovery and validation cohort. The INSTI-based regimen had an opposite response of ceramide species ((d38:1), (d42:2)), PCs((35:2), (38:4)), phosphatidylethanolamines (PEs(38:4), (38:6)), and sphingomyelin(SMd38:1) species compared with the PI-based regimens. There were no differences observed between 2 PI-based regimens.We observed differences in response of small molecule lipid species by ART regimens in treatment-naive people living with HIV.

Being Yourself and Mental Health: Goal Motives, Positive Affect and Self-Acceptance Protect People with HIV from Depressive Symptoms

Depression is a major problem for many people living with HIV. In general population-based studies, it was found that characteristics of personal goals, positive affect, and self-acceptance were associated negatively with depression, but almost no studies have investigated their role in HIV infection-related depression. This study examines a prospective model where autonomy and perceived progress in personal goals are positively associated with self-acceptance and positive affect, and these variables, over time, are negatively associated with depressive symptoms. Participants (N = 70) responded first to measures of autonomy, progress in personal goals, perceptions of self-acceptance, and positive affect, and 4 months later, they completed measures of depression. Personal goals variables were observed to be differentially associated with well-being variables: whereas personal goals autonomy was directly associated with both well-being variables, progress in personal goals was directly associated with positive affect and indirectly with self-acceptance, through its association with positive affect. Longitudinally, both self-acceptance and positive affect were associated with depression, the former directly, and the latter indirectly, through its association with self-acceptance. Self-acceptance is revealed as an important predictor of depression in PLWH. Results are discussed in terms of the contributions of hedonic and eudaimonic well-being to the relief of depressive symptoms.

Cytokines, Oxidative Stress and Cellular Markers of Inflammation in Schizophrenia.

In this article, we review current evidence linking immune dysfunction in schizophrenia and related psychotic disorders focusing particularly on circulating cytokines, oxidative stress and cellular markers of inflammation in various stages on illness from drug-naïve first episode psychosis to chronic schizophrenia. Acute psychotic episode is associated with low-grade systemic inflammation in some patients, as reflected by increased concentrations of cytokines and other inflammatory markers in peripheral blood. Evidence from general population-based longitudinal cohort studies reporting an association between elevated inflammatory markers in childhood/adolescence and risk of schizophrenia and related psychosis subsequently in adulthood suggest that inflammation could be a causal risk factor for psychosis rather than simply be a consequence of illness. Mendelian randomization studies also suggest that associations between IL-6, CRP and schizophrenia are likely to be causal. In addition, we discuss evidence for disruptions in oxidative stress markers and CSF cytokine levels in schizophrenia, and potential reasons for reported trans-diagnostic associations for inflammatory cytokines including role of early-life adversity/maltreatment. We argue that low-grade inflammation is a clinically useful feature, because it is associated with poor response to antipsychotic medication in first episode psychosis. We discuss clinical implications for immunological understanding of schizophrenia including scope for clinical trials of anti-inflammatory agents and notable gaps in current knowledge, and offer suggestions for future research.

Elder mistreatment in South Asian communities: a review of the literature

PurposeThe purpose of this paper is to perform a review of the literature of empirical studies on elder mistreatment (EM) in South Asians, and to discuss key implications for policy, practice and research.Design/methodology/approachFor this review, multiple electronic databases in the international health and social science were searched and supplemented by grey literature and cross-references. Quality of papers was assessed by two authors against the standard checklists.FindingsIn total, 16 studies met the inclusion criteria of this review, of which 11 were cross-sectional design, and only six of them used standard instruments to measure EM. The prevalence estimates of overall EM retrieved from general population-based studies ranged from 9.3 per cent in India to 49.1 per cent in Nepal. Age, gender, residential settings, socioeconomic status, health, education, and social structures and processes were key risk factors for EM in South Asian communities. Reporting and action taking were culturally rooted.Originality/valueWhile the review is not systematic, there are limitations associated with the paper in covering the diverse range of databases and studies. However, this review provides a valuable synthesis of the empirical papers on the incidence, culturally specific risk factors and reporting trends of EM in South Asians. Additionally, the review presents the papers evaluated for a quality to ensure the validity of empirical data. Finally, the review includes several implications for policy, practice and future research on EM which may ultimately contribute in improving the health and wellbeing of elder South Asians.

Global epidemiology and holistic prevention of pancreatitis.

Knowledge of pancreatitis in the 20th century was shaped predominantly by animal data and clinical trials. Several large general population-based cohort studies and comprehensive systematic literature reviews in the 21st century have had a major effect on our understanding of pancreatitis and its sequelae. This Review provides precise and up-to-date data on the burden ofacute pancreatitis, chronic pancreatitis and post-pancreatitis diabetes mellitus. Exocrine pancreatic insufficiency and altered bone metabolism following pancreatitis are also discussed. Furthermore, the article introduces a framework for the holistic prevention of pancreatitis with a view to providing guidance on strategies and intervention objectives at primary, secondary and tertiary levels. Concerted efforts by not only gastroenterologists and surgeons but also primary care physicians, endocrinologists, radiologists, pain specialists, dietitians, epidemiologists and public health specialists will be required to reduce meaningfully the burden of pancreatitis and its sequelae over the ensuing decades.

Frequency and risk factors for liver disease following pancreatitis: A population-based cohort study

Background & aimsBoth liver disease (LD) and pancreatitis pose substantial burdens. There have been no general population-based studies on frequency of LD after an episode of pancreatitis. The aim of this study was to investigate the occurrence of LD in a population-based cohort of patients following pancreatitis. MethodsNationwide data on the general population of nearly 3 million people were used to identify retrospectively diagnoses of acute pancreatitis, chronic pancreatitis (CP), LD and cirrhosis from 1998 to 2016. Acute pancreatitis was categorised as first (FAP) or recurrent (RAP) episode. Number of pancreatitis recurrences prior to LD diagnosis was determined. ResultsA total of 20,931 pancreatitis patients were included, of which 874 developed LD following pancreatitis. The incidence of LD in FAP was 115.59 (95% confidence interval 102.19–128.98), in RAP – 217.63 (95% confidence interval 173.31–261.94), and in CP – 539.43 (95% confidence interval 494.72–584.13) patients per 100,000 pancreatitis patients per year. There was a significant increase in the probability of LD with increasing number of pancreatitis recurrences and, for the same number of pancreatitis recurrences, LD was significantly more frequent after CP than RAP (hazard ratio 1.666 (95% confidence interval 1.322–2.098; p = <0.001)). ConclusionsThe frequency of LD increases from FAP to RAP to CP. While number of pancreatitis recurrences is a significant risk factor for development of LD, there is a higher probability of LD following CP than RAP even for the same number of recurrences. Interventions preventing pancreatitis and its progression may lower the burden of LD.