General Population Control Research Articles

Survival After Shunt Therapy in Normal-Pressure Hydrocephalus: A Meta-Analysis of 1614 Patients.

Ventriculoperitoneal (VP) shunt therapy is a crucial intervention for normal-pressure hydrocephalus (NPH). This meta-analysis delves into survival time and the impact of baseline symptom burden on survival after VP shunt therapy for NPH, employing reconstructed pooled survival curves and a one-stage meta-analysis. IPD regarding overall survival (OS) were acquired from published Kaplan-Meier charts, utilizing the R package IPDfromKM in R (Version 4.3.1, the R Foundation for Statistical Computing). Reconstructed Kaplan-Meier charts were then generated from the pooled IPD data. Both one-stage and two-stage meta-analyses were executed, with hazard ratios (HRs) employed as metrics to evaluate effectiveness. From the initial screening of 216 records, five articles encompassing 1614 patients met the eligibility criteria for inclusion. In two of the five included studies, overall survival was stratified by gait score (1-4 vs. ≥4) in 1043 patients, continence score (1-3 vs. ≥4) in 1022 patients, and mRS (0-2 vs. ≥3) in 956 patients. Patients with good gait demonstrated a mean survival of 8.24 years, while those with poor gait had a mean survival of 6.19 years (log-rank test: p < 0.001). The HR for gait was 2.25 (95% CI: 1.81-2.81, p < 0.001). Continence score stratification revealed a significant difference in survival time (log-rank test: p < 0.001), with an HR of 1.66 (95% CI: 1.33-2.06, p < 0.001). Similarly, mRS stratification demonstrated a significant survival difference (log-rank test: p < 0.001), with an HR of 2.21 (95% CI: 1. 74-2.80, p < 0.001). The reconstructed survival curves for all NPH patients treated with VP shunt therapy, pooling data from five studies, revealed a median survival time of 8.82 years (95% CI: 8.23-9.40). Survival rates at 1, 3, 5, 7, 9, 11, and 13 years were 95.7%, 83.8%, 70.5%, 59.5%, 48.7%, 35.8%, and 25.4%, respectively. Comparison with a general control population showed an HR of 1.79 (95% CI: 1.62-1.98, p < 0.001). This comprehensive meta-analysis underscores the influence of baseline symptom burden on survival after VP shunt therapy in NPH. Therapy in the early stages for those without significant comorbidities may enhance survival.

Birth Weight, Gestational Age, and Risk of Pediatric-Onset MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease worldwide and is increasingly being diagnosed at younger ages, affecting more than one-third of young people with obesity. To evaluate associations between perinatal conditions and risk of MASLD and associated progressive liver disease. This nationwide, population-based case-control study included all biopsy-confirmed cases of MASLD in Sweden. Individuals aged 25 years or younger (hereafter, young individuals) with biopsy-proven MASLD between January 1, 1992, and December 31, 2016, were matched to up to 5 general population control individuals. Granular data on maternal and perinatal characteristics were retrieved from the Swedish Medical Birth Register. Data were analyzed from June 2023 to June 2024. Birth weight (low [<2500 g], reference [2500 to <4000 g], or high [≥4000 g]), gestational age (GA), and birth weight for GA (small for GA [SGA; <10th percentile], appropriate for GA [10th-90th percentile], or large for GA [LGA; >90th percentile]), compared between patients and matched controls. The main outcome was odds of biopsy-proven MASLD and MASLD-associated progressive liver disease (ie, liver fibrosis or cirrhosis) according to birth weight, GA, and birth weight for GA, adjusted for matching factors. In total, 165 young individuals with biopsy-proven MASLD (median age at diagnosis: 12.0 years [IQR, 4.4-16.9 years]; 100 [60.6%] male) were matched with 717 controls. There was an association between low birth weight and future development of MASLD (adjusted odds ratio [AOR], 4.05; 95% CI, 1.85-8.88) but no association between high birth weight and odds of MASLD (AOR, 0.64; 95% CI, 0.38-1.08) compared with the reference birth weight. An association was seen for SGA (AOR, 3.36; 95% CI, 2.00-5.64) compared with appropriate size for GA (reference category) but not for LGA (AOR, 0.57; 95% CI, 0.27-1.20). Progressive liver disease was more common in individuals born with low birth weight (AOR, 6.03; 95% CI, 1.66-21.87) or SGA (AOR, 4.90; 95% CI, 2.15-11.14). In this nationwide study of young individuals with biopsy-proven MASLD, low birth weight and SGA were associated with development of MASLD and progressive liver disease, suggesting a need for structured screening measures to diagnose these conditions early in high-risk individuals.

Low Levels of Cortisol are Associated with HIV Infection in Older People: A Hormonal Substudy in the OVER50 Cohort.

People with the human immunodeficiency virus (PWH) who were diagnosed long ago are more prone to age-related conditions and comorbidities than the general population. We hypothesized that older PWH have endocrine abnormalities that may influence the patient's health status. Mean hormonal values across the thyrotropic, somatotropic, corticotropic, and gonadal axis, and percentage of subjects with abnormal values, were compared between PWH aged ≥50 years (n=30) and people without HIV (n=30) (Over50 cohort). Clinical factors were also analyzed as independent variables. PWH had a higher prevalence of comorbidities (36.67% PWH and 20.69% controls had ≥3 comorbidities). Male PWH exhibited lower estradiol levels than male controls (29.75±7.68 pg/mL vs. 35.45 ± 10.04 pg/mL; p = 0.0041). Abnormal concentrations of testosterone were found in 35% of male PWH compared to 55% of male controls (mostly above reference values). Cortisol levels were significantly lower among PWH (9.97 ± 4.33 μg/dL vs. 13.56 ± 3.39 μg/dL; p = 0.002); 16.6% of PWH exhibited abnormally low levels (<5 μg/dL), compared to 0% of controls, and 3 PWH met criteria for a definitive diagnosis of adrenal insufficiency (<3.6 μg/dL). For the somatotropic axis, growth hormone (GH) levels were significantly lower in male PWH than in controls (p = 0.0394). No significant differences were found in relation to the thyroid axis. Hormones are generally similar between the chronic PWH who are receiving ART treatment and the general control population, except for cortisol in both sexes and testosterone and estradiol in men. Some special attention should be given to cortisol in PWH due to a presumably higher risk of adrenal complications.

Estimation of the Age of the Kashubian-Specific Pathogenic NPHS2 Variant Responsible for Hereditary Steroid-Resistant Nephrotic Syndrome Points to Its Recent Local Origin

Steroid-resistant nephrotic syndrome (SRNS) is a highly heterogenic kidney disorder resulting from genetic abnormalities or immune system dysfunction affecting the establishment and maintenance of the glomerular filtration barrier. The most common cause of genetic SRNS is biallelic pathogenic variants in NPHS2 gene, especially in individuals with an infantile or childhood onset. The type of the NPHS2 defect implies the course of the disease and the stage of its onset and differs across populations. In a cohort of Polish patients with SRNS, a unique profile of the disease-related NPHS2 variants was identified in patients from northern Poland inhabited by Kashubs, a minority West-Slavic ethnic group known for a local increase of the frequency of several pathogenic variants. Among Kashubian families, the compound heterozygotes c.686G&gt;A/c.1032delT and a single c.1032delT homozygote were the only underlying cause of SRNS. The restricted, Kashubian-only pattern of c.1032delT occurrence, suggesting the founder effect, prompted us to conduct a detailed analysis of its haplotype background to estimate the age of the c.1032delT origin. Eight Kashubian SRNS families were genotyped using the Infinium Global Screening Array-24. The haplotype background analysis was performed using an in-house pipeline designed to solve the phase of the heterozygous genotype data. The age of the c.1032delT mutation was calculated using the gamma method based on the genetic length of ancestral haplotypes shared between two or more individuals carrying this variant. The results of our study indicated a very recent origin of the c.1032delT mutation (~240 years). Genetic screening performed in the general Polish population control corroborates the assumption that the mutation occurred on the specific Kashubian haplotype background. The identification of ancestry-specific Kashubian pathogenic variant can help to develop effective screening and diagnostic strategies as a part of personalized medicine approach in the region.

Anterior knee pain patients without structural knee abnormalities and normal lower limb skeletal alignment have a higher prevalence of cam-femoroacetabular impingement syndrome than the general population

ObjectivesThis study aimed to ascertain the prevalence of cam femoroacetabular impingement syndrome (cam-FAIS) in anterior knee pain (AKP) patients devoid of both structural patellofemoral joint abnormalities and lower limb skeletal malalignment. A secondary objective was to examine pain and disability differences between AKP patients with and without cam-FAIS. MethodsA total of 209 AKP patients were screened for eligibility. Inclusion criteria were normal imaging studies and normal lower limb alignment, and exclusion criteria were previous knee surgery and knee and/or hip osteoarthritis. Of those, 49 (23.4%) were eligible and this number matched a previous power analysis to detect statistically significant differences in prevalence of cam-FAIS in a population of AKP patients. The first step in the study sequence was to ask the patient whether they had groin pain. If so, the impingement test was done. Then, the femoral cam morphology defined by an alpha angle greater than or equal to 55° in a 45° Dunn axial view of the hip was ruled out. Additionally, patients completed Kujala and International Knee Documentation Committee (IKDC) functional knee scores for disability assessment. General population control group was obtained from literature. ResultsThe study included 9 males and 40 females, with an average age of 36 (20–50, ±SD 8.03) years. Groin pain and positive impingement test were found in 26/49 patients (53%). An alpha angle ≥55° was observed in 35/49 patients (71%). A combination of groin pain, positive impingement test and an alpha angle ≥55° was seen in 18/49 patients (37%). The AKP patients with groin pain, a positive impingement test and an alpha angle ≥55° exhibited statistically similar pain and disability levels as AKP patients without cam-FAIS. ConclusionThe results of this study suggest that AKP patients without structural abnormalities in the patellofemoral joint and without lower limbs malalignment have a statistically significantly higher prevalence of cam-FAIS than the general population. Moreover, AKP patients with cam-FAIS have a statistically similar degree of pain and disability than AKP patients without it. Study designCross-sectional study. Level of EvidenceIV.

Psychiatric comorbidity in Danish patients with narcolepsy type 1, narcolepsy type 2, and idiopathic hypersomnia: a case-control study.

To examine the difference in psychiatric comorbidity of Danish patients with Narcolepsy type 1 (NT1), Narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH). Polysomnography (PSG), Multiple Sleep Latency Test (MSLT), and lumbar puncture were performed on 505 patients referred to a sleep clinic for diagnostic evaluation of hypersomnia. Diagnosis, clinical characteristics, electrophysiologic data, and cerebrospinal fluid hypocretin-1 (Csf-Hcrt-1) results were retrieved. Subsequently, the patients were identified in the Danish national health registers to collect information on psychiatric diagnoses and psychotropic medication use 10 years before the sleep disorder diagnosis. The prevalence of psychiatric comorbidities per hypersomnia group was compared to a 1:4 general population control group matched on age, gender, and educational level. A diagnosis of NT2 and IH was significantly associated with total psychiatric comorbidity compared to the matched controls but not NT1 (NT1: OR = 1.5; NT2: OR = 6.1; IH: OR = 5.2). NT1 was not significantly associated with any psychiatric disorder. NT2 was significantly associated with schizophrenia spectrum disorders (OR = 8.5), mood disorders (OR = 6.7), neurotic disorders (OR = 3.8), personality disorders (OR = 3.1), and behavioral and emotional disorders (OR = 4.3). IH was significantly associated with schizophrenia spectrum disorders (OR = 3.3), mood disorders (OR = 5.9), neurotic disorders (OR = 3.0), and behavioral and emotional disorders (OR = 4.0). NT2 and IH had a close relationship to psychiatric disorders before diagnosis of their sleep disorder, while NT1 did not. This supports previous studies finding higher rates of psychiatric illness in patients with hypersomnia; however, it highlights the similarity between NT2 and IH. We believe this link to psychiatric disorders could play a role in the pathophysiology. Future studies evaluating the relation between hypersomnias of central origin and psychiatric diseases should include hypersomnia subclassifications to further the understanding of the differences in these disorders.

Risk of congestive heart failure and mortality following lymphovenous anastomosis: a nationwide population-based retrospective cohort study.

Lymphovenous anastomosis (LVA) enables lymphatic fluid to drain into the venous system. However, no study has investigated the association between LVA and heart failure (HF) caused by fluid overload in the blood circulating system. The purpose of our study was to determine whether LVA increases the risk of HF and mortality. This nationwide retrospective study evaluated a total of 1400 lymphedema patients who underwent LVA and two control cohorts with 28000 lymphedema who did not undergo LVA and 70000 age-matched and sex-matched participants from the Korean National Health Insurance database were included. Blood pressure, body mass index (BMI), glucose and cholesterol levels, smoking history, and comorbidities were obtained during National Health Insurance Service - Health Screening (NHIS-HealS). The incidence, adjusted risk for HF, and mortality were evaluated. Adjusted HRs for HF were 1.20 (confidence interval [CI], 1.03-1.40) and 1.30 (CI, 1.12-1.50), referenced by the general population control cohort and patients with lymphedema without LVA, respectively. In age, sex, BMI, and smoking status-stratified analyses, heightened risk of HF was evident across all sexes, spanning both young and old age groups, encompassing individuals with various smoking statuses, and those with a BMI of 18.5 or higher. Among these groups, the risk was notably greater in males compared to females, higher in younger individuals as opposed to older ones, and further elevated within the BMI range of 18.5-25. LVA is associated with an increased HF risk, independent of cardiovascular risk factors and associated comorbidities. This association is prominent in participants aged <50 years, in males, and in the normal-to-obese (BMI ≥18.5kg/m 2 ) group. Among patients with lymphedema, LVA did not significantly affect mortality.

Psychometric properties and observational data for COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) for post-COVID-19 syndrome.

The recently developed modified COVID-19 (coronavirus of 2019) Yorkshire Rehabilitation Scale (C19-YRSm) captures comprehensive biopsychosocial components of WHO's International Classification of Functioning, Disability, and Health related to the Long Covid or post-COVID syndrome. The scale response categories on C19-YRSm were done post hoc on data collected from the original version of C19-YRS. To evaluate the C19-YRSm scale using reliability and validity measures. Prospective, observational study. The study includes 369 patients (clinical group) and 426 subjects of the general population (control group) and captures their post-COVID-19 symptoms. In addition, the reliability of C19-YRSm was estimated by Cronbach's alpha coefficients of internal consistency and inter-item correlations for subscales ('Symptom severity, Functional disability, and Other symptoms'). Convergent validity was established using correlations between C19-YRSm and Fatigue Severity Scale (FSS). The incremental validity of C19-YRSm was measured by introducing a hierarchical regression model using the C19-YRSm 'Overall health' subscale and FSS as criterion variables. C19-YRSm subscales have excellent internal consistencies (Cronbach's α value 0.81-0.96) and acceptable inter-item correlations (r value 0.23-0.79). Hereafter, the convergent validity of the C19-YRSm is good due to significant correlations between C19-YRSm subscales and FSS and C19-YRSm subscales. Finally, the hierarchical regression analysis supported consistent evidence for the incremental validity of the C19-YRSm subscales. C19-YRSm is a reliable and valid self-assessment scale for the assessment of post-COVID-19 syndrome.

Income and gambling disorder: A longitudinal matched case-control study with registry data from Norway

BackgroundUntangling the association between gambling disorder (GD) and income is complex. Financial strain is often a consequence of GD. At the same time GD is more prevalent in the context of poverty, suggesting income may be a risk marker for GD. AimsThe aim of the present study was to investigate whether income is a risk marker for GD and whether the longitudinal average predicted income for patients with GD between 2008 and 2018 compared to control groups. The study also explored the potential heterogeneity in income trajectories for patients with GD and associated characteristics. MethodsA matched case-control longitudinal study was conducted using two Norwegian registries (i.e., the Norwegian Patient Registry and the Division of Welfare Statistics). A total of 65,771 participants were included, 5131 who were diagnosed with GD (cases), 30,467 diagnosed with any other psychiatric or somatic disorder (control), and 30,164 from the general population (control). Multinomial and ordinary least squares regressions, along with group-based trajectory models were estimated. ResultsIndividuals with GD were more likely to have income levels in the bottom quartile of the nationally reported average income in 2008 compared to the general population. However, this was not observed in the psychiatric/somatic group. Both GD and psychiatric/somatic groups were less likely to have average/above average income compared to the general population. Expected income for patients with GD was below national averages between 2008 and 2018, with significant group differences identified. Estimated trajectories for patients with GD resulted in a seven-group model. Males were more likely to have membership in higher income groups, whereas females and younger GD patients were more likely to belong to trajectory groups with the lowest income. ConclusionThe results suggest income is a risk marker for GD. Heterogeneity present across the income distribution for patients with GD, coupled with identifiable patient characteristics, may help in prediction and screening of GD.

Patient and Public Acceptance of Digital Technologies in Health Care: Protocol for a Discrete Choice Experiment.

Strokes pose a particular challenge to the health care system. Although stroke-related mortality has declined in recent decades, the absolute number of new strokes (incidence), stroke deaths, and survivors of stroke has increased. With the increasing need of neurorehabilitation and the decreasing number of professionals, innovations are needed to ensure adequate care. Digital technologies are increasingly used to meet patients' unfilled needs during their patient journey. Patients must adhere to unfamiliar digital technologies to engage in health interventions. Therefore, the acceptance of the benefits and burdens of digital technologies in health interventions is a key factor in implementing these innovations. This study aims to describe the development of a discrete choice experiment (DCE) to weigh criteria that impact patient and public acceptance. Secondary study objectives are a benefit-burden assessment (estimation of the maximum acceptable burden of technical features and therapy-related characteristics for the patient or individual, eg, no human contact), overall comparison (assessment of the relative importance of attributes for comparing digital technologies), and adherence (identification of key attributes that influence patient adherence). The exploratory objectives include heterogeneity assessment and subgroup analysis. The methodological aims are to investigate the use of DCE. To obtain information on the criteria impacting acceptance, a DCE will be conducted including 7 attributes based on formative qualitative research. Patients with stroke (experimental group) and the general population (control group) are surveyed. The final instrument includes 6 best-best choice tasks in partial design. The experimental design is a fractional-factorial efficient Bayesian design (D-error). A conditional logit regression model and mixed logistic regression models will be used for analysis. To consider the heterogeneity of subgroups, a latent class analysis and an analysis of heteroscedasticity will be performed. The literature review, qualitative preliminary study, survey development, and pretesting were completed. Data collection and analysis will be completed in the last quarter of 2023. Our results will inform decision makers about patients' and publics' acceptance of digital technologies used in innovative interventions. The patient preference information will improve decisions regarding the development, adoption, and pricing of innovative interventions. The behavioral changes in the choice of digital intervention alternatives are observable and can therefore be statistically analyzed. They can be translated into preferences, which define the value. This study will investigate the influences on the acceptance of digital interventions and thus support decisions and future research. DERR1-10.2196/46056.

HEalth And Dementia outcomes following Traumatic Brain Injury (HEAD-TBI): protocol for a retrospective cohort study

BackgroundIt is estimated that by 2050 the global incidence of dementia will have exceeded 152 million. At present, there are no effective therapies for dementia, with a focus in research...

1318-P: Type 2 Diabetes as a Risk Factor for Dementia—An Analysis of Australian National Registries

High dementia prevalence and associated disability have necessitated a focus on the identification of potentially modifiable risk factors. One such example is type 2 diabetes; however, there are not enough large population-based studies that can provide an accurate estimate of the strength of the association. Therefore, we investigated prospective associations between diabetes and dementia using Australian national registries. The study included ~850,000 people with type 2 diabetes (median age=66.2 years, females=45.5%) registered on the National Diabetes Services Scheme (NDSS) during the period 2002-2014 and followed up for at least 1 year (median 7.0 years). Propensity score matching (based on logistic regression with birth year, sex, socio-economic index and medication history as predictors) was then conducted to match (1:1) people with diabetes to a general population control group without diabetes. The latter comprised people with no registration history on NDSS or record of taking glucose lowering drugs on the Pharmaceutical Benefits Scheme (median age=67.3 years, females=43.9%, median follow up=7.5 years). Dementia was defined either by dementia drug use (cholinesterase inhibitors or memantine) or dementia-related death. The association between diabetes and dementia was examined using Cox’s proportional hazard model that treated each individual with diabetes and their matched control as one stratum. Diabetes was associated with an increased risk of dementia-related death (HR 1.19, 95% CI 1.17, 1.22), while no significant association was observed between diabetes and dementia medication use (HR 0.99, 95% CI 0.97, 1.02). When both dementia-related death and dementia drug use were included in the outcome, diabetes was still associated with an increased risk of dementia (HR 1.11, 95% CI 1.09, 1.14). These findings highlight the need for clinicians to be vigilant in identifying and managing diabetes as a potentially modifiable risk factor for cognitive decline and dementia. Disclosure K.Mehta: None. A.Salim: None. J.W.Sacre: None. K.J.Anstey: Speaker's Bureau; Nutricia. D.J.Magliano: None. J.E.Shaw: Advisory Panel; Abbott Diagnostics, Lilly, Zuellig Pharma Holdings Pte. Ltd., Mylan, Research Support; AstraZeneca, Speaker's Bureau; AstraZeneca, Roche Diagnostics, Lilly, Amgen Inc., Sanofi, Zuellig Pharma Holdings Pte. Ltd. Funding Deakin University (to K.M.); Alicia Baker and Eleanor Shaw Gender Equity Fellowship (to D.J.M.); National Health and Medical Research Council (APP1173952 to J.E.S.); Victorian Government’s Operational Infrastructure Support Program

A discussion of early maladaptive schemas in men convicted sexual offenders in Poland.

Aim of the studyThis study aims to explore differences in the prevalence of early maladaptive schemas (EMS) in convicted sexual offenders (CSO’s) as compared to the general male population (control group).Subject or material and methodsThe study included 102 men incarcerated for sexual offences and 167 men from a non-criminal population. The study used the Polish version of Young’s schema questionnaire – YSQ-S3-PL.ResultsThe results demonstrated a higher degree of EMS severity in CSO except in the ‘impaired limits’ domain where non-criminal individuals scored higher. The individuals who have committed sexual offenses displayed more extensive and severe schemas than non-criminal / non-treated males (including more EMS domains).DiscussionThe study revealed nine early maladaptive schemas characterising the specific mind-set of male sex offender convicts. The results seem to illustrate well the genesis of the formation of a disordered personality as described by J. Young within the schema therapy concept. In the context of the cited studies, these structures – in addition to their important role in the development of psychopathology – appear to contribute to sexual offending.ConclusionsThe conclusion emerging from the findings is that EMS are an important problem for Individuals involved in sexual offending. A consideration of these schemas in the psychotherapy of CSO’s would help develop new and effective therapeutic protocols designed to treat that particular population and reduce the rate of repeat offending.

Cognitive Impairment and Self-Reported Dementia in UK Retired Professional Soccer Players: A Cross Sectional Comparative Study

BackgroundPrevious studies based on death certificates have found professional soccer players were more likely to die with neurodegenerative diseases, including dementia. Therefore, this study aimed to investigate whether retired professional male soccer players would perform worse on cognitive tests and be more likely to self-report dementia diagnosis than general population control men.MethodsA cross-sectional comparative study was conducted between August 2020 and October 2021 in the United Kingdom (UK). Professional soccer players were recruited through different soccer clubs in England, and general population control men were recruited from the East Midlands in the UK. We obtained self-reported postal questionnaire data on dementia and other neurodegenerative diseases, comorbidities and risk factors from 468 soccer players and 619 general population controls. Of these, 326 soccer players and 395 general population controls underwent telephone assessment for cognitive function.ResultsRetired soccer players were approximately twice as likely to score below established dementia screening cut-off scores on the Hopkins Verbal Learning Test (OR 2.06, 95%CI 1.11–3.83) and Verbal Fluency (OR 1.78, 95% CI 1.18–2.68), but not the Test Your Memory, modified Telephone Interview for Cognitive Status, and Instrumental Activities of Daily Living. Analyses were adjusted for age, education, hearing loss, body mass index, stroke, circulatory problems in the legs and concussion. While retired soccer players were younger, had fewer cardiovascular diseases and other morbidities and reported healthier lifestyles, 2.8% of retired soccer players reported medically diagnosed dementia and other neurodegenerative disease compared to 0.9% of controls (OR = 3.46, 95% CI 1.25–9.63) after adjustment for age and possible confounders.ConclusionsUK male retired soccer players had a higher risk of performing below established cut-off scores of dementia screening tests and were more likely to self-report medically diagnosed dementia and neurodegenerative diseases, despite having better overall physical health and fewer dementia risk factors. Further study is needed to determine specific soccer-related risk factors.

Evaluation of Birth by Cesarean Delivery and Development of Early-Onset Colorectal Cancer

The incidence of early-onset colorectal cancer (CRC), diagnosed younger than 50 years of age, has increased worldwide. Gut dysbiosis throughout the life course is hypothesized as a leading mechanism, yet epidemiologic data are limited. To prospectively examine the association between birth by cesarean delivery and early-onset CRC among offspring. In this population-based, nationwide case-control study in Sweden, adults diagnosed with CRC between 18 and 49 years of age from 1991 to 2017 were identified through the Epidemiology Strengthened by Histopathology Reports in Sweden (ESPRESSO) cohort. Up to 5 general population control individuals without CRC were matched with each case on age, sex, calendar year, and county of residence. Pathology-confirmed end points were linked with the Swedish Medical Birth Register and other national registers. Analyses were conducted from March 2022 through March 2023. Birth by cesarean delivery. The primary outcome was development of early-onset CRC in the overall population and by sex. We identified 564 case patients with incident early-onset CRC (mean [SD] age, 32.9 [6.2] years; 284 [50.4%] male) and 2180 matched controls (mean [SD] age, 32.7 [6.3] years; 1104 [50.6%] male). Compared with vaginal delivery, birth by cesarean delivery was not associated with early-onset CRC in the overall population (adjusted odds ratio [aOR], 1.28; 95% CI, 0.91-1.79) after multivariable adjustment for matching and maternal and pregnancy-related factors. A positive association was found for females (aOR, 1.62; 95% CI, 1.01-2.60), but there was no association for males (aOR, 1.05; 95% CI, 0.64-1.72). In this nationwide, population-based case-control study, birth by cesarean delivery was not associated with early-onset CRC compared with birth by vaginal delivery in the overall population in Sweden. However, females born by cesarean delivery had greater odds of early-onset CRC compared with individuals born through vaginal delivery. This finding suggests that early-life gut dysbiosis may contribute to early-onset CRC in females.

Abstract WMP100: Association Of Clonal Hematopoiesis Of Indeterminate Potential With Clinical Features And Outcome Of Patients With Acute Ischemic Stroke

Introduction: Clonal hematopoiesis of indeterminate potential (CHIP) has been linked with incident cardiovascular disease and its outcome. However, the association between CHIP and acute ischemic stroke is not yet fully elucidated. Methods: This retrospective, observational cohort study included 366 acute ischemic stroke patients from a single center prospective stroke registry and 4,628 general population control (age over 40 years old). We compared the prevalence of CHIP between stroke patients and control groups. A multivariable linear or logistic regression model was used to assess the association between CHIP and initial stroke severity, hemorrhagic transformation and functional disability at 90-day (modified Rankin scale score &gt;1) after stroke. The contribution of individual CHIP driving genes was also evaluated. Results: When comparing the acute ischemic stroke patients (N=366) and the general population (N=4,628), the prevalence of CHIP was significantly higher in stroke patients than in the general population (32.0% vs. 13.9% with variant allele frequencies of 1.5%, p&lt;0.001). Most mutated genes in CHIP of stroke patients were DNMT3A, TET2, and PP1MD, in order. In the stroke patients group, the presence of CHIP was significantly associated with initial stroke severity (β=1.4350, p=0.0453). Furthermore, after adjusting covariates, presence of CHIP independently predicted the occurrence of hemorrhagic transformation (adjusted odds ratio [aOR]=7.261, 95% confidence interval [CI] 4.183-12.968, p&lt;0.001) and functional disability after stroke (aOR=2.214, 95% CI 1.237-3.984, p=0.008). PP1MD was most strongly associated with the incident ischemic stroke, while DNMT3A was most highly related with a functional disability after stroke. Conclusion: CHIP was obviously increased in ischemic stroke patients. Furthermore, CHIP was significantly associated with stroke severity, hemorrhagic transformation, and functional disability at 90 days.

Rezistentna arterijska hipertenzija i modaliteti lečenja

Hypertension is one of the most common diseases in the general population. Despite the new generation of antihypertensive drugs and improved guidelines, there is still a poor number of patients with well-controlled hypertension. The particular group is patients with resistant hypertension. It is highly prevalent in the general hypertensive population and good control of those patients remains a great challenge. Renal sympathetic hyperactivity is a response mechanism of resistant hypertension. One of the options for those patients is transcatheter renal sympathetic denervation. Recent studies show promising results and it has become a possible therapeutic alternative to treat this group of patients.

Influencing factors of cancer prevention and control among urban and rural adults in Fujian, China: A cross-sectional survey.

Cancer burden can be reduced when the population's knowledge of cancer prevention and control measures is increased. However, current epidemiological research investigating cancer prevention and control knowledge in China is limited. This study aimed to examine the core knowledge levels of cancer prevention and control measures as well as its influencing factors among adults in Fujian, China. A cross-sectional study. From September to December 2021, a total of 2,440 Chinese urban and rural adults from Fujian Province, located in Southeastern China, were randomly selected for this cross-sectional study. The probability proportionate approach to sampling was used. A 38-item questionnaire that covered demographics and basic knowledge of cancer, including concepts, screening, therapy, and rehabilitation-related key points was used to measure knowledge levels of cancer prevention and control measures among 2,074 participants. The level of each participants' core knowledge of cancer prevention and control measures was defined as a rate calculated by the number of correct answers divided by the total number of questions. The binary logistic regression model was used to determine if influencing factors were associated with core knowledge awareness. In total, 1,290 participants (62.2%) were in the low knowledge group and 784 (37.8%) were in the high knowledge group. The average knowledge rate of cancer prevention and control measures among all participants was 56.01%. Participants from urban areas, who held white-collar jobs, were married, had a bachelor's degree or above, had a family history of cancer, or self-rated their health level as good or average were associated with higher rates of cancer prevention and control core knowledge (overall p < 0.05). These findings may assist healthcare providers and/or researchers in designing effective primary preventive interventions to enhance the general population's cancer prevention and control knowledge, and subsequently decrease the cancer burden in China.

Health-Related Quality of Life in Migraine: EQ-5D-5L-Based Study in Routine Clinical Practice.

Migraine leads to moderate to severe disabilities and disrupts family life, interpersonal relationships, and professional life, and is the second leading cause of disability worldwide. Many people with migraine suffer prolonged headaches and frequent migraine attacks, transition to having chronic migraine, and have the highest number of disability-adjusted life-years. The aim of this study is to measure the quality of life in migraineurs based on the EQ-5D-5L questionnaire. We assessed 100 consecutive patients diagnosed with migraine: 70 with episodic migraine and 30 with chronic migraine. Migraineurs were asked to complete the EQ-5D-5L. The control group (n = 100), matched for sex and age group, was created based on the results of the population norms study for the EQ-5D-5L in the general population of Poland. Patients with migraine had worse HRQoL than the matched general population control group for all three primary endpoints of the EQ-5D-5L questionnaire: dimensions, EQ-5D-5L Index and EQ VAS. Migraine is a disease that disrupts daily function, and as a lifelong disease, plays a role in every aspect of it. Proving a negative impact on many aspects helps to make decisions about treatment, especially in the context of the design and reimbursement of drugs.

Prevalence of Ocular Comorbidities in Elderly Patients with Multiple Myeloma in the US: An Analysis of 100% Medicare Sample Data during 2007-2020

Background Multiple myeloma (MM) predominantly affects older patients (median age at diagnosis 69 years [Padala SA, Barsouk A, Barsouk A, Rawla P, Vakiti A, Kolhe R, Kota V, Ajebo GH. Epidemiology, staging, and management of multiple myeloma. Medical Sciences. 2021 Jan 20;9(1):3]) in whom comorbidities are prevalent. Some anti-MM therapies can be associated with ocular toxicities and require careful attention when used among patients with pre-existing ocular comorbidities (OCs). A study found that 39% of adult (>18 years of age) MM patients had pre-existing OCs (e.g., disorders of lens, glaucoma) and the prevalence increased with age. Given the potential implication of comorbid OCs on MM treatment decisions, this study aimed to describe the annual prevalence of OCs among Medicare beneficiaries with MM during 2007-2020 in the US. Methods Using a 100% sample of Medicare claims data, beneficiaries ≥65 years with newly diagnosed MM (NDMM; defined as the first MM diagnosis after a 1-year clean period) who received up to 4 lines of systemic therapies (LOT) for MM during 2007-2020 were selected. The following cohorts were identified: NDMM patients, NDMM patients who received 1L treatment, relapsed/refractory MM (RRMM) patients who initiated 2L, 3L or 4L treatment. The index date was the date of NDMM diagnosis or LOT initiation date. Patients were required to have ≥12 months of continuous Medicare enrollment before the index date. LOT was defined based on a clinically validated adaptation of published algorithms. A non-MM general population control cohort was also selected by matching to the 1L initiator cohort by age group (i.e., 65-74, 75-84, and ≥85), sex, and race, with a randomly selected medical claim date as the index date. Patients were considered to have an OC if they had a claim with any OC ICD-9/10 diagnosis codes in the 12 months prior to index date. OCs (e.g., disorders of conjunctiva, lens, choroid, retina, glaucoma) were considered potentially MM-related disease manifestations or MM treatment-related toxicity based on published literature and clinical expert opinion. The prevalence of OCs, defined by the percent of patients with ≥1 OC among all eligible patients in a cohort, was reported by age group, sex, race, and index year. Results The median age for NDMM was 76.5 years (N=122,991). Among patients who received treatment, the median age was 75.8, 76.4, 77.0, and 77.5 years at 1L, 2L, 3L, and 4L initiation. About half of patients (49.1-51.3% across groups) were women, and 79.9-84.4% were White. The mean modified Charlson Comorbidity Index (excluding malignancy conditions) was 2.1 among NDMM and 1.9 among treated patients. Proteasome inhibitors and immunomodulatory drugs were the most used treatments in all LOTs and monoclonal antibody therapies were more commonly used in later LOTs (3.2% in 1L vs. 30.8% in 4L). The prevalence of OCs among NDMM was 60.0% (Table 1). Among treated patients, the prevalence of OCs was 58.7% at 1L initiation, compared to 55.8% in the matched general population, and even higher in RRMM patients (61.7%, 63.3%, and 64.8% prior to 2L, 3L, and 4L initiation, respectively). This trend was observed across all OC categories, among MM-related OCs, and across all age groups. The most prevalent OCs were disorders of lens (32.9% in NDMM, 33.4% in 1L initiators, and 32.3% in general population) and disorders of choroid and retina (22.9% in NDMM, 21.6% in 1L initiators, and 19.6% in general population). The prevalence of disorders of eyelid, lacrimal system, and orbit had the greatest increase from 1L (17.0%) to 4L (23.9%), followed by disorders of lens (from 33.4% in 1L to 36.8% in 4L). Women and White patients had a higher prevalence of OCs than men and minorities, respectively, in all LOTs and the prevalence increased with age. The prevalence of OCs by LOT was stable over the years (Figure 1). Conclusions Sixty percent of newly diagnosed multiple myeloma patients among US Medicare beneficiaries have an existing ocular comorbidity at diagnosis. Prevalence of OCs, especially MM and MM treatment-related OCs, is higher among patients who are treated than the general population and the prevalence increases with advancing lines of therapy. Ocular comorbidities are more prevalent among White than among African American, Asian and Hispanic patients and among women than men. Given the magnitude, ocular comorbidities should be factored into the treatment decisions for the elderly patients with MM. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal