General Population Comparison Group Research Articles

Treatment and Mortality Following Cancer Diagnosis Among People With Non-affective Psychotic Disorders in Ontario, Canada: A Retrospective Cohort Study.

People with psychotic disorders have a higher risk of mortality following cancer diagnosis, compared to people without psychosis. The extent to which this disparity is influenced by differences in cancer-related treatment is currently unknown. We hypothesized that, following a cancer diagnosis, people with psychotic disorders were less likely to receive treatment and were at higher risk of death than those without psychosis. We constructed a retrospective cohort of cases of non-affective psychotic disorder (NAPD) and a general population comparison group, using Ontario Health (OH) administrative data. We identified cases of all cancers diagnosed between 1995 and 2019 and obtained information on cancer-related treatment and mortality. Cox proportional hazards models were used to compare the probability of having a consultation with an oncologist and receiving cancer-related treatment, adjusting for tumor site and stage. We also compared the rate of all-cause and cancer-related mortality between the two groups, adjusting for tumor site. Our analytic sample included 24944 people diagnosed with any cancer. People with NAPD were less likely to receive treatment than people without psychosis (HR = 0.87, 95% CI = 0.82, 0.91). In addition, people with NAPD had a greater risk of death from any cause (HR = 1.68, 95% CI = 1.60, 1.76), compared to people without NAPD. The lower likelihood of receiving cancer treatment reflects disparities in accessing cancer care for people with psychotic disorders, which may partially explain the higher mortality risk following cancer diagnosis. Future research should explore mediating factors in this relationship to identify targets for reducing health disparities.

Kumanu Tāngata: the aftermatch study – protocol to examine the health outcomes of high-level male rugby union players using linked administrative data

There is increasing interest in the potential long-term outcomes of participation in contact and collision sports, driven by evidence of higher rates of neurodegenerative diseases among former athletes. Recent research...

Burden of influenza A (H1N1)pdm09 infection among tuberculosis patients: a prospective cohort study

BackgroundInfluenza and tuberculosis both cause significant morbidity and mortality worldwide. Therefore, this study aimed to estimate the burden of influenza A (H1N1)pdm09 virus infection among human tuberculosis patients and the general population.MethodsA prospective cohort study was conducted among a cohort group (TB positive patients) as exposed and a comparison group (general population) as non-exposed. A total of 304 participants were recruited in both groups and followed for a period of 12 weeks. Of the 304 concurrently enrolled individuals, 152 were TB-positive patients (cohort group) and 152 were from the general population (comparison group).To calculate the sample size, the power of study was kept at 80% for detecting a difference at 5% alpha level assuming the 25% prevalence of respiratory viruses in cohort group compared to 12.5% in general population. An oropharyngeal swab was taken from a participant with symptoms of influenza-like illness (ILI). Samples were tested by conventional reverse transcription polymerase chain reaction (RT-PCR) for the detection of influenza A (H1N1)pdm09. All statistical analyses were conducted using R software.ResultsA total of 95 participants developed influenza-like illness (ILI) symptoms. Among these, 64 tested positive for influenza A(H1N1)pdm09, of which 39 were from the exposed group and 25 were from the non-exposed group. During the 12-week period of follow-up, the influenza A (H1N1)pdm09 incidence rate was 20 per 1000 people. The risk of testing positive for influenza A (H1N1)pdm09 was 1.66 times higher in the exposed group compared to the non-exposed group. The cumulative incidence indicated that 25% of the TB cohort and 16% of the comparison group were at risk of getting influenza A (H1N1)pdm09 during the 12 weeks of follow-up.ConclusionParticipants from the TB cohort had a higher incidence of influenza A (H1N1)pdm09 than the general population suggesting that they should be prioritized for influenza vaccination.

Epidemiology and clinical outcomes of light-chain amyloidosis in Sweden: A nationwide population-based study.

This study evaluated data from six Swedish national registries to fill current evidence gaps on the epidemiology, clinical burden, and overall survival (OS) associated with light-chain (AL) amyloidosis. Patients newly diagnosed with AL amyloidosis were identified using six linked Swedish nationwide population-based registers. For each case, individuals from the general population were selected and matched with a maximum ratio of 1:5 based on age, sex, calendar year, and county. 846 patients newly diagnosed with AL amyloidosis and 4227 demographically matched individuals were identified. From 2011 to 2019, annual AL amyloidosis incidence increased from 10.5 to 15.1 cases per million. At baseline, patients with AL amyloidosis had a significantly higher disease burden including higher rates of cardiac and renal failure relative to the comparison group. Among patients with AL amyloidosis, 21.5% had incident heart failure and 17.1% had incident renal failure after initial diagnosis. Median OS for patients with AL amyloidosis was 56 months versus not reached in the matched general population comparison group. The incidence of newly diagnosed AL amyloidosis in Sweden increased over time with AL amyloidosis being associated with a higher risk of cardiac/renal failure and all-cause mortality compared with the general population.

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

Sex differences in the course of autistic and co-occurring psychopathological symptoms in adolescents with and without autism spectrum disorder.

There is an ongoing debate as to whether autism spectrum disorder (ASD) is expressed differently in women than men. Studies on sex differences in autistic symptoms and symptoms of other psychiatric problems present in individuals with autism generally do not include a general population comparison group, making it unclear whether differences are specific to autism or merely reflecting development in the general population. In this study, we compared sex differences in the course of autistic and at the same time present symptoms of other psychiatric problems in adolescents with milder forms of ASD to those in a group of the general population with an equal intelligence quotient (IQ) and socioeconomic status. Data of five assessment moments from ages 11 to 22 years were analyzed using a statistic procedure that allowed us to determine which factors affect the course of symptoms over time. We found that in adolescence, sex differences in the course of psychopathological symptoms specific for autism are confined to the repetitive stereotyped domains. Males had higher scores on the sensory/stereotypic and resistance to change domains, the latter difference disappeared during the course of adolescence due to an increase of these problems in autistic females. Other sex differences, among which an increase over time in mood and anxiety problems in females was the most outstanding, were also observed in females without autism. These sex-specific differences have relevance in the clinical care of autistic men and women, although they are subtle compared to differences between individuals with and without autism.

Light-Chain Amyloidosis in Sweden (2011-2019): Incidence, Disease Burden, and Clinical Outcomes in Real-World Patients

Introduction: Light-chain (AL) amyloidosis is a rare plasma cell disorder characterized by organ damage caused by deposits of light-chain amyloid fibrils. While prior research indicates that outcomes for AL patients have improved with the adoption of novel anti-plasma cell combination therapies as standard of care, there are limited population-based data characterizing outcomes in contemporary real-world patients with AL. In the present study, Swedish registry data were used to characterize AL incidence trends, patient clinical characteristics, and outcomes in real-world patients newly diagnosed with AL. Methods: Data came from six nationwide population-based registers provided by the National Board of Health and Welfare in Sweden and Statistics Sweden and linked by unique personal identity number. Patients ≥18 years of age and newly diagnosed with AL were identified on the basis of having ≥2 diagnosis codes for amyloidosis (ICD-10-SE codes E85.4x, E.85.8x, E85.9) from 1/1/2011 to 12/31/2019 plus ≥1 of the following: (1) receipt of anti-plasma cell therapy, (2) an amyloidosis diagnosis made in a hematology/oncology clinic, and/or (3) a diagnosis code specific to AL (E85.8A). Patients with a prior history of amyloidosis or specific diagnosis codes or treatments consistent with non-AL amyloidosis etiologies were excluded. For each newly diagnosed AL case, individuals from the general population without any type of amyloidosis were randomly selected and matched with a maximum ratio of 1:5 based on age, sex, calendar year, and county. Key measures of interest included AL incidence and prevalence, baseline patient characteristics, burden of and interventional procedures for cardiac and renal complications, and OS overall and by major organ involvement. Risks of incident cardiac and renal failure and OS were quantified with the Kaplan-Meier (KM) estimator; log-rank tests were used to evaluate the differences in survival and Cox regression was used to provide an estimate of the hazard ratio (HR). Patients were followed until date of death or the database cut-off date (12/31/2019), whichever occurred first. Results: 846 Swedish patients newly diagnosed with AL (median age 70yr, 41% female) and 4,227 demographically matched controls were identified. During the study period, there was an increase in the incidence of AL from 10.5 cases per million in 2011 to 15.1 cases per million in 2019 (test for trend: p<0.001; Figure 1A). At initial diagnosis, 48%, 33%, and 18% of AL patients had evidence of cardiac, renal, and neurologic involvement, respectively; 10% had a history of multiple myeloma. Relative to the non-AL controls, at baseline AL patients had a significantly higher mean Charlson Comorbidity Score (1.7 vs 0.4; p<0.001) and higher rates of cardiac failure (30% vs 5%; p<0.001) and renal failure (12% vs 2%; p<0.001). In AL patients, the KM estimated risks of incident cardiac and renal failure at 5 years following initial diagnosis were 38% and 28%, respectively. Median OS for AL patients was 4.7 years vs. not reached in non-AL controls (HR: 5.8, 95% CI [5.0, 6.7]; Figure 1B). Conclusions: In this contemporary cohort of real-world Swedish patients newly diagnosed with AL, the risks of cardiac failure, renal failure, and all-cause mortality were higher relative to the demographically-matched general population comparison group. In addition, a trend toward an increased incidence of AL was observed during the study period (2011-2019). This trend may reflect greater awareness of AL and an increased likelihood of it being diagnosed and treated in the last years of this time-period. Compared to the median OS of 1.7 years previously reported for Swedish patients newly diagnosed with AL in 1995-2013 (Weiss et al, Am Soc of Hematology, 2015), the median OS of 4.7 years observed for patients newly diagnosed with AL in the present study represents a meaningful improvement. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Adults with autism spectrum disorder and the criminal justice system: An investigation of prevalence of contact with the criminal justice system, risk factors and sex differences in a specialist assessment service.

The behavioural and cognitive difficulties of some adults with autism spectrum disorder (ASD) may increase their risk of contact with the criminal justice system (CJS) as a potential suspect. There has been limited investigation of ASD and offending and available evidence is mixed. A retrospective review was completed of medical records of 1570 adults (17–75 years old) who were referred for an ASD assessment over a 17-year period (April 2003 to February 2020). Of the adults diagnosed with ASD, 23% had previous contact with the CJS. Being male or diagnosed with co-occurring attention-deficit hyperactivity disorder (ADHD) and/or psychotic disorder were risk factors for CJS contact. However, the rates of contact with the CJS or for specific offences in the ASD group were never higher than adults referred to our service but not diagnosed with ASD. We did not include a general population comparison group, therefore cannot say how rates of CJS contact in ASD compare with the general population. Further health services research for adults with ASD is warranted, as modifying the treatable risk factors (i.e. ADHD) could reduce contact with the CJS. In addition, joint working between CJS and mental health services could reduce the risk of adults with ASD having CJS contact.Lay abstractThere has been growing interest in offending and contact with the criminal justice system (CJS) by people with autism spectrum disorder (ASD). However, it is not clear whether people with ASD offend more than those without ASD. Studies have started to look at whether there are particular offences people with ASD are more likely to commit and whether there are any factors that can affect whether someone comes into contact with the CJS as a potential suspect. This study looked at the patients who attended an ASD diagnostic service over a 17-year period to see the rate of contact with the CJS of those who were diagnosed with ASD and whether there were any particular factors that might increase the risk of CJS contact. Nearly a quarter of the ASD group had some contact with the CJS as a potential suspect. Factors that seemed to increase whether someone with ASD was more likely to have contact with the CJS were being male, being diagnosed with ADHD, and being diagnosed with psychosis. This study is one of the largest studies to investigate the rate of CJS contact as a potential suspect in a sample of adults with ASD in an attempt to give a clearer picture of what might influence someone with ASD to engage in offending behaviour in order to try to see what mental health services can offer to reduce the likelihood of someone with ASD coming into contact with the CJS, for example, treatment for another condition or support.

Individuals with lived experience of homelessness and their COVID-19 outcomes in Wales: a data linkage study

BackgroundHomelessness as a complex and persistent public health challenge is an extreme form of social exclusion. Our understanding on the health of homeless populations is largely informed by research on the more visible street homelessness, highlighting ill health, substance dependencies, and reduced life expectancy. These estimates are likely to underestimate individual's health-care needs, alongside barriers to accessing care. We aimed to adopt a broad definition of homelessness to understand COVID-19-related health outcomes for this population. MethodsOur definition includes street homelessness and precarious or insecure housing, thus including those known as hidden homeless who are not in government homelessness statistics. We generated an e-cohort of individuals with recorded lived experience of homelessness in Wales, by combining information across four routine health-care datasets (primary care, inpatient care, emergency department, and substance misuse service. A population comparison group was randomly selected from the Welsh Demographic Service database. We linked the e-cohort and comparison group with COVID-19 NHS Wales Test Trace and Protect, annual district death extract, and the patient episode database to examine the COVID-19 outcomes. This study is exempt from consent due to the anonymised nature of the databank. The independent Information Governance Review Panel approved this study. FindingsThe e-cohort includes 15 472 individuals aged 16 years and older who visited the four health-care services in Wales since Jan 1, 2014, until July 31, 2020, including 1717 currently homeless during the pandemic in 2020 (69·2% were male and 42·0% were younger than 35 years). Of those people currently homeless during COVID-19, 54 (3·2%; 95% CI 2·4–4·1) tested positive for the virus, 16 (0·9%; 0·5–1·5) had COVID-19-related hospital admissions, and five (0·3%; 0·1–0·7) died, involving COVID-19. Compared with the general population comparison group (n=15 472), where 340 (2·20%; 1·97–2·44) tested positive, 11 (0·07%; 0·04–0·13) had COVID-19 related hospital admissions, and nine (0·06%; 0·03–0·11) died, involving COVID-19 (mentioned on death certificate). InterpretationThese findings suggest that COVID-19-related outcomes were worse for individuals who were homeless during the pandemic compared with the general population. The complex health needs and pre-existing vulnerabilities people who are homeless warrant further exploration. This study is likely to underestimate the population size and health needs due to relying on people seeking health care and disclosing their homeless or housing status, to which there are recognised barriers. Accurate and standardised coding of housing status in practise is an area that needs urgent improvement. FundingPublic Health Wales.

Assessment of contact tracing for COVID-19 among people experiencing homelessness, Salt Lake County Health Department, March–May 2020

PurposeContact tracing is intended to reduce the spread of coronavirus disease 2019 (COVID-19), but it is difficult to conduct among people who live in congregate settings, including people experiencing homelessness (PEH). This analysis compares person-based contact tracing among two populations in Salt Lake County, Utah, from March–May 2020. MethodsAll laboratory-confirmed positive cases among PEH (n = 169) and documented in Utah's surveillance system were included in this analysis. The general population comparison group (n = 163) were systematically selected from all laboratory-confirmed cases identified during the same period. ResultsNinety-three PEH cases (55%) were interviewed compared to 163 (100%) cases among the general population (P < .0001). PEH were more likely to be lost to follow-up at end of isolation (14.2%) versus the general population (0%; P-value < .0001) and provided fewer contacts per case (0.3) than the general population (4.7) (P-value < .0001). Contacts of PEH were more often unreachable (13.0% vs. 7.1%; P-value < .0001). ConclusionsThese findings suggest that contact tracing among PEH should include a location-based approach, along with a person-based approach when resources allow, due to challenges in identifying, locating, and reaching cases among PEH and their contacts through person-based contact tracing efforts alone.

School outcomes of adolescents with cerebral palsy in Sweden.

AimTo study school outcomes of adolescents with cerebral palsy (CP) compared with a matched comparison group from the general population, and to observe to what extent sociodemographic and disability‐specific factors are associated with school outcomes.MethodThis was a register study of persons with CP in Sweden, born between 1990 and 1999, with a matched comparison group. Logistic regressions were used to estimate the associations between CP and disability‐specific factors and school outcomes (receiving final grades, grade scores, fulfilling the requirements for progressing to secondary school/university, and attending secondary school).ResultsChildren with CP had substantially lower school achievement compared with a general population sample. Much of the difference can be attributed to intellectual disability; however, CP remained strongly negatively associated with school outcomes. Ability to communicate in an effective manner explained most of the variation in children with CP, whereas motor function played a smaller role.InterpretationThe results suggest that school achievements might be improved if the communication barrier could be reduced, for example by ascertaining access to appropriate communication devices and by educators being aware that communicative difficulties do not necessarily imply intellectual disability. This might enhance the school experience and create an environment where children with CP can reach their full potential.What this study adds There are reduced educational outcomes associated with cerebral palsy.Negative outcomes are mainly driven by reduced communicative and intellectual ability.Gross motor function is associated with outcomes, but plays a smaller part.

Patterns of Primary Care Use Prior to a First Diagnosis of Nonaffective Psychotic Disorder in Ontario, Canada: Modèles d'utilisation des soins de première ligne avant un premier diagnostic de trouble psychotique non affectif en Ontario, Canada.

Many people experience early signs and symptoms before the onset of psychotic disorder, suggesting that there may be help-seeking prior to first diagnosis. The family physician has been found to play a key role in pathways to care. This study examined patterns of primary care use preceding a first diagnosis of psychotic disorder. We used health administrative data from Ontario (Canada) to construct a population-based retrospective cohort. We investigated patterns of primary care use, including frequency and timing of contacts, in the 6 years prior to a first diagnosis of psychosis, relative to a general population comparison group matched on age, sex, geographic area, and index date. We used latent class growth modeling to identify distinct trajectories of primary care service use, and associated factors, preceding the first diagnosis. People with early psychosis contacted primary care over twice as frequently in the 6 years preceding first diagnosis (RR = 2.22; 95% CI, = 2.19 to 2.25), relative to the general population, with a sharp increase in contacts 10 months prior to diagnosis. They had higher contact frequency across nearly all diagnostic codes, including mental health, physical health, and preventative health. We identified 3 distinct service use trajectories: low-, medium-, and high-increasing usage. We found elevated patterns of primary care service use prior to first diagnosis of psychotic disorder, suggesting that initiatives to support family physicians in their role on the pathway to care are warranted. Earlier intervention has implications for improved social, educational, and professional development in young people with first-episode psychosis.

Trajectories of prosociality from early to middle childhood in children at risk of Developmental Language Disorder

Longitudinal research into the development of prosociality during childhood contributes to our understanding of individual differences in social and emotional outcomes. There is a dearth of literature on the development of prosociality in children with Developmental Language Disorder (DLD). Data from the UK based Millennium Cohort Study was used to investigate prosociality from age 5 to 11 years in 738 children at risk of Developmental Language Disorder (r-DLD) and 12,972 children in a general population (GP) comparison group. Multilevel mixed effects regression models were run to investigate the mean change in prosociality and latent class growth analysis was used to identify heterogeneous groups of children who shared similar patterns of development. Overall, children at risk of DLD were less prosocial at age 5 and, although they did become more prosocial by the age of 11, they did not reach the same levels of prosociality as those in the GP group. Subsequent sub group analysis revealed four distinct developmental trajectories: stable high (19 %), stable slightly low (36 %), decreasing to slightly low (5 %), and increasing to high (40 %). Children at risk of DLD were less likely than those in the GP group to be in the stable high class and more likely to be in the stable slightly low class. For children at risk of DLD, being prosocial was protective against concurrent social and emotional difficulties. But being prosocial in early childhood was not protective against later social and emotional difficulties nor did the absence of prosociality in early childhood make social and emotional difficulties in middle childhood inevitable. Rather, the presence of prosociality in middle childhood was the key protective factor, regardless of prosociality in early childhood. Prosociality is not a key area of concern for children at risk of DLD. Instead, it is an area of relative strength, which can be nurtured to mitigate social and emotional difficulties in children at risk of DLD, particularly in middle childhood.

Chronic oral anticoagluation and risk of prostate cancer: Evidence of detection bias.

Warfarin treatment has been associated with lower risks of prostate cancer, without a specified biological mechanism. Our study tested the hypothesis that reluctance to perform prostate biopsies in men who are anticoagulated results in lower rates of diagnosed prostate cancer, leading to an apparent protective effect. Rates of prostate biopsies have decreased from 2000 to 2015, allowing calendar time to be used as the intervention. In a national population-based sample of elderly men, our study compared trends in prostate cancer incidence between 17,815 men treated with chronic oral anticoagulation for prosthetic heart valve thromboprophylaxis and a general population comparison group of 356,300 men. Cancer events were based on administrative claims. Among men enrolled in 2000-2001 and followed through 2015, prostate cancer incidence was substantially lower in the anticoagulation group (adjusted incidence rate ratio [IRR] 0.70; 95% confidence interval [CI] 0.62-0.80). Incidence decreased over time in the general population group to approach that of the anticoagulation group among men enrolled in 2008-2010 (IRR 0.86; 95% CI 0.71-1.04). Rates of prostate biopsies also decreased over time in the general population group to match the rate in the anticoagulation group. These results indicate that the apparent protective effect of warfarin treatment on the risk of prostate cancer is likely the result of detection bias from lower rates of biopsies among men who are anticoagulated.

Educational outcomes of children in contact with social care in England: a systematic review

BackgroundIn England, the state intervenes in the lives of children through Children’s Social Care (CSC) services with the aim of supporting and maintaining their welfare. It is known from government cross-sectional data that children who experience these CSC interventions (such as state care) have consistently poorer educational outcomes than the general population. However, these data are limited in providing crude estimates of association and in ignoring longitudinal histories. This systematic review aimed to appraise the extant research evidence from longitudinal studies and answer the question: how do educational outcomes differ between children in contact with CSC and the general population in the UK?MethodsAccording to a pre-defined protocol, we searched 16 health, social care, education and legal databases for population-level quantitative studies conducted on UK children with exposure to CSC, a general population comparison group and an educational outcome. We also conducted snowball searches and searches of Google Scholar and grey literature. Data on whether each study met inclusion criteria were extracted, and findings of included studies were synthesised narratively. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.ResultsIn total, 5482 sources were screened which resulted in seven studies being included in the narrative synthesis. Only three were published in peer-reviewed journals. All but one used administrative education data and five used administrative data from CSC services. In all studies, exposure to CSC interventions was measured crudely, ignoring heterogeneity in the experiences of children. All agreed that children in contact with CSC services perform worse than their peers on all outcomes (variously: exam results, absences, exclusions, school moves, being missing from school, higher education aspirations and quality of school).ConclusionsDespite employing a search across 16 databases supplemented with additional searches of other online sources, we found only seven studies that met our inclusion criteria. This review throws into sharp relief the urgent need to conduct more population-level research into the educational prospects of children in contact with CSC services.Systematic review registrationPROSPERO CRD42018089755

The educational aspirations and psychological well-being of adopted young people in the UK

Much is hypothesised but little is known about the effects of early adversity on school experience, academic attainment and career aspiration for children and young people adopted from care. Drawing on data from Wave 1 of the Youth (10‒15 years old) Questionnaire (n = 4899) from the United Kingdom Household Longitudinal Survey (UKHLS), also known as Understanding Society, this study explored differences between young people adopted (n = 22) and a matched comparison group (n = 110) on measures of educational and occupational aspirations and psychological well-being. Adopted young people reported higher externalising and total difficulties scores (based on the SDQ, Goodman, 1997 ) than the general population comparison group, but equivalent internalising symptoms. Adopted children were more likely to show an intention to seek full-time work at the end of compulsory schooling. These findings align with previous research regarding the psychological well-being of adopted children, contribute new knowledge about the aspirations of young people adopted from care and highlight methodological issues when utilising large-scale panel survey data for narrowly defined sub-groups.

Network Analysis of Anxiety in the Autism Realm.

The anxiety and autism realms are each complicated and heterogeneous, and relationships between the two areas are especially complex. Network analysis offers a promising approach to the phenotypic complexities of typical and atypical human behavior. The Revised Children's Anxiety and Depression Scale (RCADS) was used to assess anxiety in 126 high-functioning 9-13 year-olds with ASDs. Network graphs of Autism Diagnostic Observation Schedule items and RCADS anxiety total score, social, generalized, panic and separation anxiety subscores consistently found the anxiety node (score) to be highly peripheral. Also, the networks of RCADS anxiety items themselves were similar for the ASDs group and a general population comparison group (n = 2017). The results suggest anxiety is not a central part of autism and that anxiety is dynamically similar (aspects of anxiety relate to one another in a similar manner) in high-functioning autism and the general population.

Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general population: a cross-sectional study

ObjectivesTo determine the prevalence of knee pain, radiographic knee osteoarthritis (RKOA), total knee replacement (TKR) and associated risk factors in male ex-professional footballers compared with men in the general population...

Comorbidities treated in primary care in children with chronic fatigue syndrome / myalgic encephalomyelitis: A nationwide registry linkage study from Norway.

BackgroundChronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a complex condition. Causal factors are not established, although underlying psychological or immunological susceptibility has been proposed. We studied primary care diagnoses for children with CFS/ME, with children with another hospital diagnosis (type 1 diabetes mellitus [T1DM]) and the general child population as comparison groups.MethodsAll Norwegian children born 1992–2012 constituted the study sample. Children with CFS/ME (n = 1670) or T1DM (n = 4937) were identified in the Norwegian Patient Register (NPR) (2008-2014). Children without either diagnosis constituted the general child population comparison group (n = 1337508). We obtained information on primary care diagnoses from the Norwegian Directorate of Health. For each primary care diagnosis, the proportion and 99 % confidence interval (CI) within the three groups was calculated, adjusted for sex and age by direct standardization.ResultsChildren with CFS/ME were more often registered with a primary care diagnosis of weakness/general tiredness (89.9 % [99 % CI 88.0 to 91.8 %]) than children in either comparison group (T1DM: 14.5 % [99 % CI: 13.1 to 16.0 %], general child population: 11.1 % [99 % CI: 11.0 to 11.2 %]). Also, depressive disorder and anxiety disorder were more common in the CFS/ME group, as were migraine, muscle pain, and infections. In the 2 year period prior to the diagnoses, infectious mononucleosis was registered for 11.1 % (99 % CI 9.1 to 13.1 %) of children with CFS/ME and for 0.5 % (99 % CI (0.2 to 0.8 %) of children with T1DM. Of children with CFS/ME, 74.6 % (1292/1670) were registered with a prior primary care diagnosis of weakness / general tiredness. The time span from the first primary care diagnosis of weakness / general tiredness to the specialist health care diagnosis of CFS/ME was 1 year or longer for 47.8 %.ConclusionsThis large nationwide registry linkage study confirms that the clinical picture in CFS/ME is complex. Children with CFS/ME were frequently diagnosed with infections, supporting the hypothesis that infections may be involved in the causal pathway. The long time span often observed from the first diagnosis of weakness / general tiredness to the diagnosis of CFS/ME might indicate that the treatment of these patients is sometimes not optimal.

Employment and social benefits up to 10 years after breast cancer diagnosis: a population-based study.

Background:Little is known about employment outcomes after breast cancer (BC) beyond the first years after treatment.Methods:Employment outcomes were compared with a general population comparison group (N=91 593) up to 10 years after BC for 26 120 patients, diagnosed before age 55 between 2000–2005, with income and social benefits data from Statistics Netherlands. Treatment effects were studied in 14 916 patients, with information on BC recurrences and new cancer events.Results:BC survivors experienced higher risk of losing paid employment (Hazard Ratio (HR): 1.6, 95% Confidence Interval (95% CI) 1.4–1.8) or any work-related event up to 5–7 years (HR 1.5, 95% CI 1.3–1.6) and of receiving disability benefits up to 10 years after diagnosis (HR 2.0, 95% CI 1.6–2.5), with higher risks for younger patients. Axillary lymph node dissection increased risk of disability benefits (HR 1.5, 95% CI 1.4–1.7) or losing paid employment (HR 1.3, 95% CI 1.2–1.5) during the first 5 years of follow-up. Risk of disability benefits was increased among patients receiving mastectomy and radiotherapy (HR 1.2; 95% CI 1.1–1.3) and after chemotherapy (HR 1.7; 95% CI 1.5–1.9) during the first 5 years after diagnosis.Conclusions:BC treatment at least partly explains the increased risk of adverse employment outcomes up to 10 years after BC.