General Population Estimates Research Articles

Migraine Prevalence and Academic Impact on Medical Students at Alfaisal University.

Migraine is highly prevalent among medical students but has been understudied in Saudi Arabia. This study aimed to determine migraine prevalence, characteristics, academic impacts, and coping strategies in medical students. A cross-sectional survey was conducted among 352 medical students. Migraine was identified using ID-Migraine (38.8% prevalence) and International Classification of Headache Disorders 3rd edition (ICHD-3) criteria (36.8% prevalence). Analyses focused on the 130 students meeting ICHD-3 criteria. The mean monthly migraine frequency was 3.5 days. Average pain severity was moderate at 6.4/10. Mean duration was 9.3h. Exams triggered migraines for 66% and increased headache frequency/severity for most students. Headaches limited productivity ≥1 day for 86% and caused missed exams and grade point average (GPA) declines. Rest (77.7%), trigger avoidance (57.7%), and medications (56.9%) were the most common coping strategies. Migraine prevalence exceeded general population estimates, frequently disrupted academics, and was exacerbated by exam stressors. Support services and education on coping strategies tailored to academically triggered migraines could better equip students to manage headaches.

The prevalence of hepatitis B virus, human T-lymphotropic virus and human immunodeficiency virus in patients receiving blood transfusions in South Africa.

South Africa has a high prevalence of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) and to a lesser extent human T-lymphotropic virus (HTLV). Each of these agents is transfusion-transmissible (TT)but deciding whether to implement preventive screening depends upon knowledge of background prevalence in transfused patients. We determined the prevalence of HIV, HBV and HTLV I/II among blood transfusion recipients in South African hospitals. We obtained identity-unlinked samples used for blood cross-matching at 634 South African hospitals served by the South African National Blood Service (SANBS). The ABBOTT Alinity S® Immunochemiluminescent system measured HIV, HBV and HTLV I/II antibodies. Repeatedly reactive samples were confirmed using the Roche Cobas® 8000. Logistic regression was performed to investigate the determinants of associations for HIV, HBV and HTLV infections. The overall prevalences of HIV, HBV and HTLV were 37.8%, 7.4% and 0.6%, respectively. The HIV prevalence in blood recipients was twice as high as general population estimates. Public hospital patients had a significantly higher prevalence compared with private hospital patients for HIV and HBV. HIV prevalence was significantly higher in females, and HBV prevalence was significantly higher in males, excluding the unknown gender results. Patients receiving blood transfusions in South Africa have high rates of HIV and HBV infection that should be taken into consideration when determining donor screening strategies for other viral infections. Measurable prevalence of HTLV indicates endemicity of this infection in South Africa.

Adjusting mobile phone data to account for children's travel and the impact on measles dynamics in Zambia.

Models of measles transmission can be used to identify areas of high risk to tailor immunization strategies. Estimates of spatial connectivity can be derived from data such as mobile phone records, however it is not clear how this maps to the movement of children who are more likely to be infected. Using travel surveys across two districts in Zambia and national mobile phone data, we compared estimates of out-of-district travel for the population captured in the mobile phone data and child-specific travel from travel surveys. We then evaluated the impact of unadjusted and adjusted connectivity measures on simulated measles virus introduction events across Zambia. The number of trips made by children from the travel survey was three to five times lower than the general population estimates from mobile phone data. This decreased the percentage of districts with measles virus introduction events from 78% when using unadjusted data to 51% - 64% following adjustment. Failure to account for age-specific heterogeneities in travel estimated from mobile phone data resulted in overestimating subnational areas at high risk of introduction events, which could divert mitigation efforts to districts that are at lower risk.

Heart involvement in systemic sclerosis: emerging concepts.

Systemic sclerosis (SSc)-associated heart involvement (SHI) is a significant cause of both morbidity and mortality in individuals with SSc. SHI can take many different forms, and likely is a spectrum of fibroinflammatory cardiac disease. Presenting features include arrhythmia, ventricular systolic or diastolic dysfunction, pericardial disease, and exercise intolerance. Risk of sudden cardiac death in SSc is likely 10-30-fold greater than general population estimates. In this review, we explore what is known about the pathogenesis of SHI, its prevention and management, and discuss available strategies for screening for SHI in light of new recommendations for the routine screening of SHI in all SSc patients. We describe the spectrum, clinical features, and pathogenesis of SHI. Furthermore, we review the new recommendations for screening for SHI in individuals with SSc. There is a large, under-recognized burden of SHI in people living with SSc, which likely contributes to the significant increase in sudden cardiac death observed in SSc. However, a broad-based screening approach, including asymptomatic, low-risk patients should be viewed with caution given the lack of evidence-based treatments and interventions for SHI particularly in this group.

The cost of providing care by family and friends (informal care) in the last year of life: A population observational study

Introduction: Little is known about replacement costs of care provided by informal carers during the last year of life for people dying of cancer and non-cancer diseases. Aim: To estimate informal caregiving costs and explore the relationship with carer and decedent characteristics. Design: National observational study of bereaved carers. Questions included informal end-of-life caregiving into the 2017 Health Survey for England including estimated recalled frequency, duration and intensity of care provision. We estimated replacement costs for a decedent’s last year of life valuing time at the price of a substitutable activity. Spearman rank correlations and multivariable linear regression were used to explore relationships with last year of life costs. Setting/participants: Adult national survey respondents – England. Results: A total of 7997 adults were interviewed from 5767/9612 (60%) of invited households. Estimated replacement costs of personal care and other help were £27,072 and £13,697 per carer and a national cost of £13.2 billion and £15.5 billion respectively. Longer care duration and intensity, older age, death at home (lived together), non-cancer cause of death and greater deprivation were associated with increased costs. Female sex, and not accessing ‘other care services’ were related to higher costs for other help only. Conclusion: We provide a first adult general population estimate for replacement informal care costs in the last year of life of £41,000 per carer per decedent and highlight characteristics associated with greater costs. This presents a major challenge for future universal care coverage as the pool of people providing informal care diminish with an ageing population.

Survival From Birth Until Young Adulthood Among Individuals With Congenital Heart Defects: CH STRONG.

Limited population-based information is available on long-term survival of US individuals with congenital heart defects (CHDs). Therefore, we assessed patterns in survival from birth until young adulthood (ie, 35 years of age) and associated factors among a population-based sample of US individuals with CHDs. Individuals born between 1980 and 1997 with CHDs identified in 3 US birth defect surveillance systems were linked to death records through 2015 to identify those deceased and the year of their death. Kaplan-Meier survival curves, adjusted risk ratios (aRRs) for infant mortality (ie, death during the first year of life), and Cox proportional hazard ratios for survival after the first year of life (aHRs) were used to estimate the probability of survival and associated factors. Standardized mortality ratios compared infant mortality, >1-year mortality, >10-year mortality, and >20-year mortality among individuals with CHDs with general population estimates. Among 11 695 individuals with CHDs, the probability of survival to 35 years of age was 81.4% overall, 86.5% among those without co-occurring noncardiac anomalies, and 92.8% among those who survived the first year of life. Characteristics associated with both infant mortality and reduced survival after the first year of life, respectively, included severe CHDs (aRR=4.08; aHR=3.18), genetic syndromes (aRR=1.83; aHR=3.06) or other noncardiac anomalies (aRR=1.54; aHR=2.53), low birth weight (aRR=1.70; aHR=1.29), and Hispanic (aRR=1.27; aHR=1.42) or non-Hispanic Black (aRR=1.43; aHR=1.80) maternal race and ethnicity. Individuals with CHDs had higher infant mortality (standardized mortality ratio=10.17), >1-year mortality (standardized mortality ratio=3.29), and >10-year and >20-year mortality (both standardized mortality ratios ≈1.5) than the general population; however, after excluding those with noncardiac anomalies, >1-year mortality for those with nonsevere CHDs and >10-year and >20-year mortality for those with any CHD were similar to the general population. Eight in 10 individuals with CHDs born between1980 and 1997 survived to 35 years of age, with disparities by CHD severity, noncardiac anomalies, birth weight, and maternal race and ethnicity. Among individuals without noncardiac anomalies, those with nonsevere CHDs experienced similar mortality between 1 and 35 years of age as in the general population, and those with any CHD experienced similar mortality between 10 and 35 years of age as in the general population.

#5300 HUMANISTIC BURDEN OF RARE KIDNEY DISEASES: UNDERSTANDING THE IMPACT OF IGAN AND FSGS ON PATIENTS AND CARE-PARTNERS STUDY (HONUS): A US IGAN RESULTS UPDATE

Abstract Background and Aims While immunoglobulin A nephropathy (IgAN) has been shown to be associated with clinical and economic burden, the humanistic burden associated with IgAN is less understood. HONUS is a multi-national, cross-sectional survey study to evaluate the humanistic burden associated with rare kidney diseases, including IgAN, from the patient and caregiver perspectives in the US and Europe. Method The study recruited adult patients (≥18 years old) with their care-partners and parents/care-partners of youth (8-17 years old) with IgAN or focal segmental glomerulosclerosis (FSGS). Participants completed an online survey with questions on demographic and clinical characteristics, health-related quality of life (HRQoL) (ie, 12-Item Short Form Survey [SF-12]), anxiety and depression (ie, Generalized Anxiety Disorder Assessment [GAD-7], Patient Health Questionnaire [PHQ-9]), most burdensome symptoms, fear and uncertainty for the future, and disease impact on work productivity (ie, Work Productivity and Activity Impairment [WPAI]). The current analysis is based on information from adults with IgAN and their care-partners in the US before September 2022. Descriptive analyses were conducted, with continuous variables summarized using means, medians, and standard deviations (SD), and categorical variables summarized using frequency counts and percentages. Results A total of 96 pairs of adults with IgAN and their care-partners in the US were included in the analysis. The mean age of adult patients was 37.5 and the majority were Caucasian (86.5%) and female (53.1%). Median time since diagnosis was 5.6 years. More than half of patients (59.4%) were in chronic kidney disease stage 3 or 4, while 5.2% were in end-stage renal disease and had received a kidney transplant. Hypertension (31.3%), anemia (25.0%), and depression (18.8%) were the most common comorbidities. In terms of HRQoL, patient's mean (SD) SF-12 physical and mental component scores (PCS, MCS) were reported at 46.9 (7.4) and 41.1 (9.1), respectively, reflecting worse HRQoL (lower score) than previously published US general population scores (PCS and MCS of 50 [10]). Moderate and severe anxiety was reported by 28.1% and 1.0% of patients, respectively; moderate, moderately severe, and severe depression was reported by 51.0%, 2.1% and 1.0% of patients, respectively. The most burdensome symptoms reported by patients were constipation (82.3%), lower back pain (79.2%), and bone or joint pain (77.1%). Based on a 4-week recall period, 25.0% of adult patients reported being ‘very much bothered’ or ‘extremely bothered’ by bone or joint pain (22.9% for lower back pain, 10.4% for constipation). Most patients (96.9%) reported feeling fear and uncertainty for the future due to their disease, of which 52.1% reported the frequency of fear and uncertainty to be ‘often’. Among employed patients (72.9%), percent absenteeism was reported in 6.9%, presenteeism in 27.1%, overall work productivity loss in 31.4%, and activity impairment in 36.2% because of IgAN-related reasons. Most paired care-partners (87.5%) were partners of patients, with a mean age of 39.5 years. The mean SF-12 PCS and MCS of care-partners were 50.4 and 43.6, respectively. Moderate anxiety was reported in 13.5% of care-partners, with none reporting severe anxiety; moderate and moderately severe depression was reported in 35.4% and 5.2% of care-partners, respectively. Almost all care-partners (99.0%) reported feeling fear and uncertainty for the future due to the disease of their cared ones, of which 39.6% reported the frequency of this worry to be ‘often’. Among employed care-partners (93.8%), 9.8% reported absenteeism, 27.3% reported presenteeism, 33.2% reported overall work productivity loss, and 31.9% reported activity impairment due to IgAN-related reasons. Conclusion Patients with IgAN experience impaired HRQoL, depression, anxiety, and poor productivity, compared to previously reported US general population estimates. This also impacts the HRQoL, in terms of mental components, and productivity of care-partners. Both patients with IgAN and their care-partners also report widespread fear and uncertainty for the future.

All-cause and cause-specific mortality in patients with depression in Scotland

IntroductionPremature mortality in people with depression is well established. A better understanding of the causes of death and the relative risks of death from each cause may help identify factors that contribute to the health inequalities between people with and without depression.ObjectivesTo describe all-cause and cause-specific mortality of people with a hospital admission record for depression in Scotland, relative to the general population.MethodsWe used a linked population-based dataset of all psychiatric hospital admissions in Scotland to the national death dataset to identify 28,837 adults ≥18 years of age who had a hospital admission record of depression between 2000 and 2019. We obtained general population estimates and mortality data from the National Records of Scotland and quantified the relative difference in mortality by calculating the standardised mortality ratio (SMR), using indirect standardisation and stratifying by sex.ResultsDuring a median follow-up of 8.1 years, 7,931(27.5%) people who were hospitalised for depression died. Circulatory system diseases were the most common causes of death. Standardised all-cause mortality was more than three times higher than would be expected based on death rates in the general Scottish population. SMRs were similar in men and women for all-cause mortality and, in general, for cause-specific death (Table 1). The SMR for the suicide category was markedly higher in women than men, partly explained by the higher suicide mortality in males than females in the general population.Table 1All-cause and cause-specific mortality of people hospitalised for depression in Scotland 2000-19Observed deaths, n(All)Expected deaths, n(All)SMR (95% CI)(All)Observed deaths, n(Male)Expected deaths, n(Male)SMR (95% CI)(Male)Observed deaths, n(Female)Expected deaths, n(FemaleSMR (95% CI)(Female) All-cause7,93124273.3(3.2-3.3)361710523.4(3.3-3.5)431413753.1(3.0-3.2)Circulatory system diseases2,0208062.5(2.4-2.6)8863432.6(2.4-2.7)1,1344632.4(2.3-2.6)Neoplasms1,1536821.7(1.6-1.8)5343061.7(1.6-1.9)6193761.6(1.5-1.8)Respiratory system diseases1,1062923.8(3.6-4.0)4531124.0(3.7-4.4)6531803.6(3.3-3.9)Mental & behavioural disorders8351316.4(5.9-6.8)333526.4(5.7-7.2)502796.3(5.8-6.9)Accidents395695.7(5.2-6.3)224385.9(5.1-6.7)171315.5(4.7-6.3)Suicide, self-harm & injuries of undetermined Intent8055315.2(14.1-16.2)4853912.4(11.3-13.5)3201422.9(20.3-25.4)Other external cause2864.7(2.9-6.4)1635.3 (2.7- 7.9)1234.0(1.7-6.3)Other natural diseases1,5893884.1(3.9-4.3)6861594.3 (4.0-4.6)9032293.9(3.7-4.2)CI: Confidence interval; SMR: Standardised mortality ratioConclusionsPeople hospitalised for depression continue to have higher all-cause mortality than the general population in Scotland, with relative mortality varying by cause of death.Disclosure of InterestNone Declared

Mental health and wellbeing of further and higher education students returning to face-to-face learning after Covid-19 restrictions.

This study aimed to examine the mental health and wellbeing of further and higher education students and the associating factors after returning to face-to-face (in-person) learning after Covid-19 restrictions. A cross-sectional study informed by student consultations was conducted using a survey design. Mental health and wellbeing were assessed using self-report items on the Depression, Anxiety and Stress Scale (DASS-21) and the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Descriptive statistics and stepwise multiple linear regression analyses were conducted on data collected between December 2021 and June 2022. N = 1160 students participated; 69.6% between 16 and 25 years, 67.9% studying in the UK, 66.5% studying away from home, 60.2% identified as she/her, 59.8% studying at the undergraduate degree level, 42.5% belonging to non-White ethnic backgrounds, 29.6% identifying as having additional needs and 22.8% as sexual minority. Moderate anxiety (M = 13.67, SD = 9.92) and depression (M = 17.04, SD = 11.56) scores were mainly reported. Wellbeing scores (M = 20.31, SD = 3.93) were lower than the estimate for the pre-pandemic general population. Gender expression, sexuality, age, ethnicity, having additional needs, and level and location of study was associated with mental health or wellbeing. Individual coping styles, levels of self-efficacy and physical activity were also associated with mental health or wellbeing. Many students returning to further and higher education after Covid-19 restrictions experienced reduced mental health and wellbeing, and some students were at greater risk. Providing student-centred interventions focusing on self-efficacy, coping styles and physical activity may help improve the mental health and wellbeing of students.

Sleep health among people with severe mental ill health during the COVID-19 pandemic: Results from a linked UK population cohort study.

ObjectivesSleep problems are a transdiagnostic feature of nearly all psychiatric conditions, and a strong risk factor for initial and recurrent episodes. However, people with severe mental ill health (SMI) are often excluded from general population surveys, and as such the extent and associates of poor sleep in this population are less well understood. This study explores sleep health in an SMI sample during the COVID-19 pandemic, using multiple regression to identify risk factors, including daily routine, wellbeing and demographics.MethodsAn existing cohort of people with an SMI diagnosis were sampled. Participants were invited to complete a self-report survey about their health and the impacts of COVID-19 and associated public health measures. Sleep duration, efficiency, and quality were measured using items from the Pittsburgh Sleep Quality Index (PSQI).ResultsTwo hundred forty-nine adults (aged 21–84 years) completed the survey. Mean sleep duration and efficiency were similar to general population estimates, at 7 h 19 min and 78%, respectively. However, 43% reported “bad” sleep quality that was associated with being younger in age as well as disturbed routine and declined wellbeing. Indeed, 37% reported a disturbed routine during the pandemic.ConclusionsHigh estimates of perceived poor sleep quality in the SMI population align with previous findings. Supporting people with SMI to maintain routine regularity may work to protect sleep quality and wellbeing. Future research should more closely examine sleep health in people with SMI, using accessible and scalable measures of objective and subjective sleep, examining longitudinal trends.

The impact of anger and self-concealment on post-traumatic stress and psychiatric comorbid symptoms in Chinese prisoners: A longitudinal study.

Research reported prevalence of post-traumatic stress disorder (PTSD) among prisoners varies between countries, with most studies based on Western samples. The trajectory of symptoms has also been controversial. Trauma can affect prisoners' emotions and their emotional regulation tends to be maladaptive. To examine changes in PTSD and psychiatric comorbidity among prisoners in China over time and to determine whether anger and self-concealment predicts later distress. In a longitudinal, prospective study, sentenced men in one prison in China were asked to complete a demographic page and several self-rating scales: the Post-traumatic Stress Diagnostic Scale, the General Health Questionnaire-28, the Clinical Anger Scale and the Self-Concealment Scale at baseline and at 6 and 12months after the initial assessment. More than half of the 496 participating men were diagnosed with PTSD. For those completing the scales at each evaluation, PTSD-DS scores were significantly lower at baseline than at the 6-month and 1-year assessments. No significant differences were found between the two follow-up scores. There was no significant difference in psychiatric comorbidity between the three phases. At the cross-sectional level, after controlling for age and education level, PTSD, anger and self-concealment were associated with psychiatric comorbidity. At the prospective level, anger predicted PTSD 6months and 1year later. Self-concealment predicted psychiatric comorbidity over time. Among these prisoners the prevalence of chronic PTSD was far higher than in general population estimates. Early identification of aspects of coping styles is likely to help predict disorder trajectory and inform interventions. Early signs of anger were indicative of the chronic severity of trauma reactions, while the intention to hide distress was related to other later mental health problems.

Myeloma precursor disease (MGUS) among rescue and recovery workers exposed to the World Trade Center disaster

An elevated risk of myeloma precursor disease, monoclonal gammopathy of undetermined significance (MGUS), was identified among Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed firefighters. Further investigation was needed to determine if these findings were reproducible in a more heterogeneous WTC-exposed rescue/recovery workers cohort, the Stony Brook University-General Responder Cohort GRC (SBU-GRC). MGUS risk was compared between the cohorts and to published general population estimates from Olmsted County, MN, USA. In this observational seroprevalence study, odds ratios (OR) and age-standardized risk ratios (RR) of MGUS (M-spike and light-chain-MGUS combined), M-spike, and light-chain-MGUS were estimated using logistic regression. Age-standardized prevalences were calculated for white males aged 50–79; RRs were estimated by comparing risk in the WTC-exposed cohort with the Olmsted County screened cohort. SBU-GRC had elevated odds of MGUS compared with FDNY (OR = 1.38; 95%CI = 1.00–1.89). The age-standardized prevalence of MGUS was 9.0/100 persons (95%CI = 7.5–10.6), over two-fold higher than the general population (RR = 2.08; 95%CI = 1.72–2.51); the age-standardized prevalence of light-chain-MGUS was 3.5-fold higher (RR = 3.54; 95%CI = 2.52–4.97). This study adds to mounting evidence supporting an association between WTC/environmental exposures and MGUS among rescue/recovery workers. Access to MGUS screenings for the entire WTC-exposed cohort could allow for treatment interventions that improve survival.

Clinical Characteristics and Outcomes of COVID-19 in Pediatric and Early Adolescent and Young Adult Hematopoietic Stem Cell Transplant Recipients: A Cohort Study

Adult hematopoietic stem cell transplantation (HSCT) recipients are at a high risk of adverse outcomes after COVID-19. Although children have had better outcomes after COVID-19 compared to adults, data on risk factors and outcomes of COVID-19 among pediatric HSCT recipients are lacking. We describe outcomes of HSCT recipients who were ≤21 years of age at COVID-19 diagnosis and were reported to the Center for International Blood and Marrow Transplant Research between March 27, 2020, and May 7, 2021. The primary outcome was overall survival after COVID-19 diagnosis. We determined risk factors of COVID-19 as a secondary outcome in a subset of allogeneic HSCT recipients. A total of 167 pediatric HSCT recipients (135 allogeneic; 32 autologous HSCT recipients) were included. Median time from HSCT to COVID-19 was 15 months (interquartile range [IQR] 7-45) for allogeneic HSCT recipients and 16 months (IQR 6-59) for autologous HSCT recipients. Median follow-up from COVID-19 diagnosis was 53 days (range 1-270) and 37 days (1-179) for allogeneic and autologous HSCT recipients, respectively. Although COVID-19 was mild in 87% (n = 146/167), 10% (n = 16/167) of patients required supplemental oxygen or mechanical ventilation. The 45-day overall survival was 95% (95% confidence interval [CI], 90-99) and 90% (74-99) for allogeneic and autologous HSCT recipients, respectively. Cox regression analysis showed that patients with a hematopoietic cell transplant comorbidity index (HCT-CI) score of 1-2 were more likely to be diagnosed with COVID-19 (hazard ratio 1.95; 95% CI, 1.03-3.69, P = .042) compared to those with an HCT-CI of 0. Pediatric and early adolescent and young adult HSCT recipients with pre-HSCT comorbidities were more likely to be diagnosed with COVID-19. Overall mortality, albeit higher than the reported general population estimates, was lower when compared with previously published data focusing on adult HSCT recipients.

P135 NEOPLASTIC DISEASE LONG AFTER ACUTE CORONARY SYNDROME. THE ABC–4* STUDY ON HEARTDISEASE

Abstract Background Non cardiac outcomes after ACS are seldom reported specially on the long term. In the literature, aspects of parallelism between the atherosclerotic, inflammatory, and neoplastic process have been observed. However, there is a lack of prospective studies looking for potential association between ACS and future neoplasia. Aim To describe the presence, incidence of malignant neoplasia long after ACS. Comparison with the general population registries incidence rate worldwide and in Italy was also considered. Methods This prospective study included 541 patients who were discharged alive after index hospitalization with ACS in three hospitals and followed for 22 years. Results All but 3 patients completed the follow–up or were followed until death. Pre–existing malignancy was noted in 15 patients, whereas 106 patients developed cancer during the follow–up period, which represented 6232 person–years. The most common sites were the lungs (22%), colorectal (19%), and prostate (15%), as well as the pancreas (5%), breast (5%), and leukaemia (5%). A total of 99 (18%) patients died due to malignancy (Figure 1). The risk of malignancy after ACS in the present study, appears higher than that of general population; as we observed a cancer incidence rate approximating 17.8 case per 1000 person–year, while in general population estimates carried out globally, in Europe, Italy and in Veneto Region, the age standardized cancer incidence rate was reported to be 3.27, 4.64, 4.73 and 4.70 cases per 1000 person–years, respectively [according to GLOBOCAN 2020]. Conclusions In this prospective, long–term study, we observed an increase in the risk of malignant neoplasia in patients who survived ACS, notably higher than the risk observed in the general population globally, in Europe, in Italy and in Veneto region. Further understanding of the delicate interaction between CV disease and cancer may lead to better prevention, earlier detection, and safer treatment strategies.

The Prevalence of Cardiometabolic Health Risk Factors among Airline Pilots: A Systematic Review.

Background: The occupational demands of professional airline pilots such as shift work, work schedule irregularities, sleep disruption, fatigue, physical inactivity, and psychological stress may promote adverse outcomes to cardiometabolic health. This review investigates the prevalence of cardiometabolic health risk factors for airline pilots. Methods: An electronic search was conducted utilizing PubMed, MEDLINE (via OvidSP), CINAHL, PsycINFO, SPORTDiscus, CENTRAL, and Web of Science for publications between 1990 and February 2022. The methodological quality of included studies was assessed using two quality assessment tools for cross-sectional and clinical trial studies. The prevalence of physiological, behavioral, and psychological risk factors was reported using descriptive analysis. Results: A total of 48 studies derived from 20 different countries, reviewing a total pooled sample of 36,958 airline pilots. Compared with general population estimates, pilots had a similar prevalence for health risk factors, yet higher sleep duration, lower smoking and obesity rates, less physical activity, and a higher overall rate of body mass index >25. Conclusions: The research reported substantial prevalence >50% for overweight and obesity, insufficient physical activity, elevated fatigue, and regular alcohol intake among pilots. However, the heterogeneity in methodology and the lack of quality and quantity in the current literature limit the strength of conclusions that can be established. Enhanced monitoring and future research are essential to inform aviation health practices and policies (Systematic Review Registration: PROSPERO CRD42022308287).

Clinical outcomes in transient epileptic amnesia: A 10-year follow-up cohort study of 47 cases.

ObjectiveTransient epileptic amnesia (TEA) is a form of adult‐onset epilepsy where presenting features are well described, but little is known regarding prognosis. This study aimed to elucidate the long‐term prognosis of TEA regarding seizure control, memory, medical comorbidities, and life expectancy.MethodsUp‐to‐date clinical information was collected for 47 people diagnosed with TEA who had joined the The Impairment of Memory in Epilepsy (TIME) study 10 years earlier. At entry to the study, information about comorbid conditions was systematically collected. Details regarding subsequent diagnoses, seizure activity, changes to treatment, or reports of cognitive impairment were obtained through the family doctor. The variables of interest were compared with UK population data.ResultsMortality in the cohort was 21 of 47 (45%), with an average age at death of 82.5 years. Seizures remained well controlled for the majority but medications required adjustments in dose and type for some (28%). A small number (three cases) remained seizure‐free without medication. History of cardiovascular disorders was frequent (78.7%), typically involving hypertension (55.3%). Autoimmune disorders (25.5%), cancer (23.4%), and depression (21.3%) were also commonly reported. Although persisting memory problems were often noted, dementia was diagnosed in seven cases (14.9%). Life expectancy and comorbidities in TEA did not differ from available population norms.SignificanceResults suggest that life expectancy is not reduced in TEA. Although TEA does not appear to be a self‐limiting form of epilepsy, seizures are typically well controlled via medication. Because adjustments to medication may be required, even after long periods of stability, ongoing medical monitoring is recommended. Comorbid vascular disorders are frequent but appear similar to general population estimates. Monitoring mood may be important, given that people with chronic conditions are often vulnerable to depression. Because of persisting memory difficulties, the development of effective memory interventions for people with TEA is warranted.

Risk of cancer following primary care presentation with fatigue: a population-based cohort study of a quarter of a million patients

BackgroundThe management of adults presenting with fatigue presents a diagnostic challenge, particularly regarding possible underlying cancer.MethodsUsing electronic health records, we examined cancer risk in patients presenting to primary care with new-onset fatigue in England during 2007–2013, compared to general population estimates. We examined variation by age, sex, deprivation, and time following presentation.FindingsOf 250,606 patients presenting with fatigue, 12-month cancer risk exceeded 3% in men aged 65 and over and women aged 80 and over, and 6% in men aged 80 and over. Nearly half (47%) of cancers were diagnosed within 3 months from first fatigue presentation. Site-specific cancer risk was higher than the general population for most cancers studied, with greatest relative increases for leukaemia, pancreatic and brain cancers.ConclusionsIn older patients, new-onset fatigue is associated with cancer risk exceeding current thresholds for urgent specialist referral. Future research should consider how risk is modified by the presence or absence of other signs and symptoms. Excess cancer risk wanes rapidly after 3 months, which could inform the duration of a ‘safety-netting’ period. Fatigue presentation is not strongly predictive of any single cancer, although certain cancers are over-represented; this knowledge can help prioritise diagnostic strategies.

Prevalence, Incidence and Associates of Pulmonary Hypertension Complicating Type 2 Diabetes: Insights from the Fremantle Diabetes Study Phase 2 and National Echocardiographic Database of Australia.

There is a paucity of epidemiologic data examining the relationship between pulmonary hypertension (PH) and diabetes. The aim of this study was to determine prevalence, incidence and associates of PH complicating type 2 diabetes. Data from 1430 participants (mean age 65.5 years, 51.5% males) in the Fremantle Diabetes Study Phase 2 (FDS2) were linked with the National Echocardiographic Database of Australia (NEDA) to ascertain the prevalence and incidence of PH (estimated right ventricular systolic pressure (eRVSP) >30 mmHg as a new suggested threshold or the conventional >40 mmHg) over a 12-year period. PH prevalence in FDS2 was compared with that in NEDA overall and a geographically close sub-population. Multivariable analyses identified associates of prevalent/incident PH in the FDS2 cohort. Of 275 FDS2 patients (19.2%) with pre-entry echocardiography, 90 had eRVSP >30 mmHg and 35 had eRVSP >40 mmHg (prevalences 32.7% (95% CI 27.3–38.7%) and 12.7% (9.1–17.4%), respectively), rates that are 35–50% greater than national/local NEDA general population estimates. Moreover, 70 (5.0%) and 123 (9.2%) FDS2 participants were identified with incident PH at the respective eRVSP thresholds (incidence (95% CI) 7.6 (6.0–9.7) and 14.2 (11.8–17.0)/1000 person-years), paralleling data from recognised high-risk conditions such as systemic sclerosis. The baseline plasma N-terminal pro-brain natriuretic peptide concentration was the strongest independent associate of prevalent/incident PH. Approximately 1 in 8 people with type 2 diabetes have PH using the eRVSP >40 mmHg threshold. Its presence should be considered as part of regular clinical assessment of individuals with type 2 diabetes.

Comparison of Cancer Prevalence in Patients With Neurofibromatosis Type 1 at an Academic Cancer Center vs in the General Population From 1985 to 2020

Neurofibromatosis type 1 (NF1) is a complex genetic disorder that is associated with not only neurofibromas, but also an increased susceptibility to other neoplasms. To evaluate the prevalence of neoplasia and outcomes among patients with NF1. This cohort study was conducted among patients with NF1 at a single academic cancer center from 1985 to 2020 with median (range) follow-up of 2.9 years (36 days to 30.5 years). Of 2427 patients evaluated for NF1, 1607 patients who met the National Institutes of Health consensus criteria for NF1 were included. This group was compared with estimates from Surveillance, Epidemiology, and End Results (SEER) Cancer Statistics Review 1975 to 2015 and SEER participants database unless otherwise specified. Data were analyzed from August 2018 to March 2020. Disease-specific survival (DSS) was measured from diagnosis date to date of neoplasm-specific death or censorship and calculated using the Kaplan-Meier method. Survival curves were compared using the log-rank test. Deaths from disease were considered a DSS end point; other deaths were considered censored observations. Secondary outcome measures were comparisons of (1) overall survival of patients with NF1 with neurofibroma neoplasms vs those without nonneurofibroma neoplasms, (2) neoplasm prevalence in the NF1 group vs general population estimates, and (3) age at diagnosis in the NF1 group vs general population estimates for the most common neoplasms in the NF1 group. Among 1607 patients with NF1, the median (range) age at initial visit was 19 years (1 month to 83 years) and 840 (52.3%) were female patients. Among 666 patients who developed other neoplasms in addition to neurofibromas (41.4%), 295 patients (18.4%) developed glioma and 243 patients (15.1%) developed malignant peripheral nerve sheath tumor (MPNST), the most common neoplasms. Patients with NF1, compared with the general population, developed several neoplasms at a younger mean (SD) age (low-grade glioma: 12.98 [11.09] years vs 37.76 [24.53] years; P < .0001; high-grade glioma [HGG]: 27.31 [15.59] years vs 58.42 [19.09] years; P < .0001; MPNST: 33.88 [14.80] years vs 47.06 [20.76] years; P < .0001; breast cancer: 46.61 [9.94] years vs 61.71 [13.85] years; P < .0001). Patients with NF1 developed neoplasms more frequently compared with the general population (odds ratio, 9.5; 95% CI, 8.5-10.5; P < .0001). Among patients with NF1, significantly lower 5-year DSS rates were found among those with undifferentiated pleomorphic sarcoma (1 of 5 patients [20.0%]), HGG (8 of 34 patients [23.1%]), MPNST (72 of 228 patients [31.6%]), ovarian carcinoma (4 of 7 patients [57.1%]), and melanoma (8 of 12 patients [66.7%]) compared with those who had neoplasms classified as other (110 of 119 patients [92.4%]) (all P < .001) . This cohort study found that among patients with NF1, those who developed undifferentiated pleomorphic sarcoma, HGG, MPNST, ovarian carcinoma, or melanoma had significantly lower DSS rates compared with those who developed other neoplasms. This study also found that patients with NF1 developed some neoplasms more frequently and at a younger age compared with individuals without NF1. HGGs and MPNST were noteworthy causes of death among patients NF1. This information may be useful for NF1 patient counseling and follow-up.

Cohort profile: South Australian Aboriginal Birth Cohort (SAABC)—a prospective longitudinal birth cohort

PurposeThe South Australian Aboriginal Birth Cohort (SAABC) is a prospective, longitudinal birth cohort established to: (1) estimate Aboriginal child dental disease compared with population estimates; (2) determine the efficacy of...