General Population Of Same Age Research Articles

Carney complex predisposes to breast cancer: prospective study of 50 women.

Carney complex (CNC) is a rare genetic syndrome, mostly due to germline loss-of-function pathogenic variants in PRKAR1A. Carney complex includes pigmented skin lesions, cardiac myxomas, primary pigmented nodular adrenocortical dysplasia, and various breast benign tumors. The present study was designed to describe the characteristics of breast lesions in CNC patients and their association with other manifestations of CNC and PRKAR1A genotype. A 3-year follow-up multicenter French prospective study of CNC patients included 50 women who were analyzed for CNC manifestations and particularly breast lesions, with breast imaging, genotyping, and hormonal settings. Among the 38 women with breast imaging, 14 (39%) had breast lesions, half of them bilateral. Ten women (26%) presented with benign lesions and six with breast carcinomas (16%): one had ductal carcinoma in situ at 54, and five had invasive cancer before 50 years old, whom one with contralateral breast cancer during follow-up. The occurrence of breast cancer was more frequent in women with PRKAR1A pathogenic variant odds ratio = 6.34 (1.63-17.91) than in general population of same age. The mean age at breast cancer diagnosis was 44.7 years old: 17 years younger than in the general population. Breast cancer patients had good prognosis factors. All breast carcinomas occurred in individuals with familial CNC and PRKAR1A pathogenic variants. Loss of heterozygosity at the PRKAR1A locus in the 2 invasive breast carcinomas analyzed suggested a driver role of this tumor suppressor gene. As CNC could predispose to breast carcinoma, an adequate screening strategy and follow-up should be discussed in affected women. ClinicalTrial.gov NCT00668291.

The association between mental disorders and subsequent years of working life: a Danish population-based cohort study

Mental disorders can affect workforce participation via a range of mechanisms. In this study, we aimed to estimate the association between different types of mental disorders and working years lost, defined as the number of years not actively working or enrolled in an educational programme. In this population-based cohort study, we included all people aged 18-65 years (mean 38·0 [SD 13·9]) in the Danish Civil Registration System from Jan 1, 1995 to Dec 31, 2016. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and information on labour market characteristics was obtained from administrative registers. Follow-up started at age 18 years, immigration to Denmark, or on Jan 1, 1995, whichever came later; and it ended at age 65 years, death, emigration from Denmark, disability pension, voluntary early retirement, or Dec 31, 2016 (whichever came earlier). As the main outcome, we estimated working years lost for those diagnosed with any mental disorder and 24 types of mental disorders, as well as for the general population of same age and sex. We decomposed total working years lost into periods of unemployment or sick leave, disability pension, voluntary early retirement, or death. Data on ethnicity were not available through administrative registers. A total of 5 163 321 individuals, 2 642 383 men and 2 520 938 women, were followed up for 65·4 million person-years. Overall, 488 775 (9·47%) individuals were diagnosed with a mental disorder. On average, individuals with mental disorders lost an additional 10·52 (95% CI 10·48-10·57) years of working life compared with the general Danish population. Receiving a disability pension (7·54 [7·49-7·59] years) and longer periods of unemployment (2·24 [2·21-2·27] years) accounted for most of this difference. Our findings foreground the substantial impact of mental disorders on workforce participation. There is a need to invest in programmes that reduce the burden of working years lost and assist people with mental disorders in returning to the workforce. Lundbeck Foundation and Danish National Research Foundation.

Intravenous drug users in Iceland: Use of emergency departments, hospital admissions and mortality

Drug abuse is a significant contributor to premature disease and mortality. Drug users are less likely to attend traditional Primary Health Care and more likely to present to Emergency Departments with their problems. Drug users often present late for treatment and find difficult ot engage and follow through treatment in standard models of health services. The study is retrospective. 108 intravenous drug users were identified upon admission to one of three intpatient addiction treatment centres in Iceland in the years 2012-2013. Case notes for the two years leading to admission were examined. The study group had significantyl more contacts with Emergency Departments than a matched sample from the community (p<0.001). Mean number of visits for the study group per year was 4.8 (median 3.5) and 43% had four or more visits in a year. Majority of visits were for pshychiatric symptoms with a third considered serious. The two main medical reasons were infections from injecting and accidents/violence. There was no significant difference in study parameters between those who mainly use methylphenidate vs other substances. Mortality rate for the study group compared to the general population of same age was 26.4 (CI 16.7-41.5, (p<0.01)). Intravenous drug users are a vulnerable group with high level of psychiatric and medical problems and high mortality. It is important that this group has good access to evicence based addiction treatment, but also to medical and psychiatric services that are adapted to their needs.

O7.4. CHANGES IN DIFFERENTIAL MORTALITY GAP IN THOSE WITH MENTAL DISORDERS BETWEEN 1995 AND 2015 IN DENMARK. A NATIONWIDE, REGISTER-BASED COHORT STUDY BASED ON 7.4 MILLION INDIVIDUALS

BackgroundPeople with mental disorders have increased mortality rates and reduced life expectancies. We recently found that, compared to the general population, men and women with any mental disorder experienced 10 and 7 years, respectively, of life-years lost (LYLs), a new metric to estimate reduced life expectancy that takes into account the age of onset of the disorder. Our aim is to examine changes in mortality rate ratios (MRRs) and LYLs for both external and natural causes over twenty years for a comprehensive range of mental disorders, including schizophrenia spectrum disorder.MethodsWe conducted a cohort study comprising all 7,369,926 people living in Denmark in 1995–2015. Information on mental disorders and mortality was obtained from national registers. We looked at all mental disorders combined and specific groups of diagnoses as defined by the ICD-10 F-subchapters (substance use disorders, schizophrenia spectrum disorder, mood disorders, neurotic disorders, etc.) and classified causes of death into natural and external causes. We estimated MRRs using Poisson regression models, adjusting for sex and age and including an interaction term with calendar time. Differences in remaining life expectancy after disease diagnosis were estimated as excess LYLs (divided into LYLs due to natural and external causes of death) between those with each disorder and the general Danish population (matched on sex and age) for specific periods separately (1995–1999, 2000–2004, 2005–2009, 2010–2015).ResultsOver the period of observation, mortality rates decreased for those with any diagnosed mental disorder, as well as for those without a diagnosis. Despite these improvements, the MRRs between the two groups increased from 2.38 (95% CI: 2.32–2.44) in 1995 to 2.60 (95% CI: 2.55–2.65) in 2015. For external causes of death, MRRs decreased from 6.64 (95% CI: 6.15–7.17) to 5.27 (95% CI: 4.87–5.70), while MRRs for natural causes increased from 2.19 (95% CI: 2.14–2.25) to 2.52 (95% CI: 2.47–2.56). Remaining life expectancy after disease diagnosis increased 4.6 years from 32.0 to 36.6 years; however, remaining life expectancy increased also in the matched general population of same age and sex by 3.2 years (from 41.7 to 44.9 years). The life expectancy gap between the two periods was therefore shortened by 1.4 years; excess LYLs were 9.7 years in 1995–1999 (5.8/3.8 years due to natural/external causes) and 8.3 years in 2010–2015 (6.6/1.7 years due to natural/external causes). When looking at specific mental disorders, the life expectancy gap was reduced for mood disorders (0.8 years), neurotic disorders (1.7 years), and personality disorders (0.9 years); remained similar for schizophrenia spectrum disorder and substance use disorders; and increased for organic disorders (1.1 years).DiscussionMortality rates for people experiencing mental disorders decreased from 1995 to 2015. However, for natural causes of death, those with mental disorders did not reflect the benefits seen in the general population. Consequently, life lost due to natural causes increased. Overall, life expectancy increased an additional 1.4 years for those with mental disorders compared with the general population, thus reducing the gap. Nevertheless, for some disorders e.g. schizophrenia spectrum disorder and substance use disorders, life expectancy gap did not change. These findings support the hypothesis that service improvements have reduced mortality due to suicide and accidents, but similar benefits are not apparent in natural causes of death, which suggests that interventions related to promoting a healthier lifestyle and optimizing the general medical care of those with mental disorders warrants added investment.

Anti-HCV, HBsAg Positive Incidences Among Patients Aged 40 Years and Over Diagnosed with B- Non-Hodgkin’s Lymphoma: A Comparison with General Population of Same Age

Objectives: There are several risk factors contribute to the development of the B-cell Non-Hodgkin’s lymphoma (B-NHL) among which hepatitis B, hepatitis C virus (HBV, HCV) infection, as well as old age, are known to have a signi cant effect. Previous studies examining the relationship between HBV, HCV infection and B-NHL show inconsistent results in different endemic areas. Methods: We compared the hepatitis B surface antigen (HBsAg) and antibody against the HCV (anti-HCV) positive incidences among aged 40 years or older patients who have been newly diagnosed with B-NHL, between 2015 and 2018, to prevalence of hepatitis B and C virus infection in the general population of Mongolia in the same age by data of the general population in hepatitis screening and the results of previous studies on the Mongolian population. Results: A total of 187 patients, newly diagnosed with B-NHL ≥40years of age took part in our study. In case of these two groups, the prevalence of HBsAg in the B-NHL population was close to the general population while anti-HCV positive was signi cantly higher in the B-NHL group (p&lt;.00001). Conclusion: Further studies are needed to clarify the reasons and contributing factors which result situations where the HBV prevalence among B-NHL patients and the general population are not signi cantly different.

Long-Term Survivors After Pediatric Liver Transplatation Are at Increased Risk for Development of Cardiovascular Disease Events: Analysis of 30 Cases

BackgroundLiver transplantation (LT) in adult patients is associated with a higher incidence of cardiovascular risk factors (CVRF), chronic kidney disease (CKD), and cardiovascular disease mortality than the general population. Available information about these problems in adult patients with LT from a pediatric age is limited. The aim of this study was to analyze the incidence of CVRF, risk of developing CKD, and risk of 10-year coronary event in adult patients who received LT in childhood. MethodsThirty adult patients (11 female, 19 male; mean age, 29.3 years) who underwent LT in childhood were analyzed, and CVRF, estimated glomerular filtration rate, and current immunosuppressive regimen were recordered. The risk of 10-year coronary event was calculated with the use of validated equations (Framingham and Regicor) and compared with the estimated risk in the general population. ResultsNone of the patients had CVRF before LT, except 1 patient who received a transplant because of familial hypercholesterolemia. Median age of patients at the time of study was 28.6 years (range, 19.3–43.1 y), and mean follow-up after LT was 17.83 ± 5.21 years. Twenty-nine patients (96.7%) were receiving a calcineurin inhibitor (69% tacrolimus, 31% cyclosporine), along with steroids in 13 of them. The average CVRF per patient was 2, and 11 patients (43.33%) had ≥3. Thirteen patients (43.33%) had CKD. The estimated risk of developing a coronary event at 10 years according to the Framingham score was 3%, higher than expected in the general population of same age and sex. With the use of the Regicor equation, adapted to the Spanish population, the estimated cardiovascular risk was 1.6%, corresponding to Spanish men without CVRF aged 50–55 years. None of the patients had cardiovascular events during the follow-up. ConclusionsOur data show a high incidence of CVRF and CKD in young adults who received LT in childhood, resulting in an increased risk of cardiovascular disease.

FOSTER CHILDREN AND MENTAL HEALTH

Foster children are highly vulnerable social group, mainly beca­use they are often exposed to the various types of violence. Literature is emphasizing higher prevalence of mental health diagnosis among the children from the child protection system, especially foster children, in comparison to general population of same age. Author stresses the different manners in which the […]

All-cause and liver-related mortality in HIV positive subjects compared to the general population: Differences by HCV co-infection

We aimed at comparing overall and liver-related mortality rates, observed in HIV positive subjects followed-up in the Cohorts of Spanish Network on HIV/AIDS Research stratified by HCV co-infection status, with the expected mortality of the general population of same age and sex in Spain, for the period 1997 - 2008. We estimated standardized mortality ratio (SMR) and excess mortality, comparing death rates from our cohort (globally and by HCV co-infection) with death rates from the general population standardized by sex in 5 year-age bands. Overall, 5914 HIV positive subjects were included, 37.3% of which were co-infected with HCV; 231 deaths occurred, 10.4% of which were liver-related. SMR for all causes mortality for the HIV positive subjects was 5.6 (CI 95% 4.9-6.4), 2.4 (1.9-3.1) for HCV negative subjects and 11.5 (9.9-13.4) for HCV positive ones. Having HCV co-infection and AIDS yielded an SMR of 20.8 (16.5-26.1) and having AIDS and being HCV negative had an SMR of 4.8 (3.5-6.7). SMR for liver-related mortality was 1.8 (0.6-5.7) for HCV negative subjects vs. 22.4 (14.6-34.3) for HCV positive ones. Overall, both mortality rates as SMR and excess mortality rates were higher for injecting drug users (IDUs) than men having sex with men (MSM) and heterosexuals, patients with AIDS, with and without cART and for subjects included between 1997 and 2003. There was an excess of all-cause and liver-related mortality in our cohorts compared with the general population. Furthermore, HCV co-infection in HIV positive patients increased the risk of death for both all causes and liver-related causes.

Long-term mortality in nonalcoholic fatty liver disease: Is liver histology of any prognostic significance?

Over the last decade, a wealth of data has emerged illustrating both the rather benign clinical course of nonalcoholic fatty liver disease (NAFLD) in many individuals, and the unfavorable prognosis of this condition in others. Several studies on long-term mortality of patients suffering from NAFLD confirmed by imaging and/or liver biopsy have been reported. Studies with an average follow-up of at least 5 years are summarized in Table 1 [1-10]. Compared to the general population of same age and sex, NAFLD is associated with a significantly higher overall mortality [1,2,4] and liver-related mortality [1,2]. The long-term prognosis of patients with NAFLD, however, varies across the disease stage. Although the terms simple steatosis and NASH are often used in studies on long-term prognosis to classify patient risk, differing definitions have been used across the studies. Despite that, however, some conclusions can be derived from pooling data from these studies together (Table 1). Within the first 15 years of follow-up, the prevalence of cirrhosis development is significantly higher in patients with NASH as compared to patients with simple steatosis (10.8% vs. 0.7%, respectively, x2 = 23.3, p<0.001). Consequently, the liver-related mortality is also significantly higher in patients with NASH as compared to simple steatosis (7.3% vs. 0.9%, respectively, x2 = 16.7, p<0.001). The overall mortality between these two groups, however, is not significantly different, although there is a trend towards a higher overall mortality in the NASH group (40.5% vs. 32.5%, respectively, x2=3.61, p<0.1).

Obesity and Nonalcoholic Fatty Liver Disease

With the increasing prevalence of obesity and type 2 diabetes mellitus in the general population, nonalcoholic fatty liver disease (NAFLD) has become a common diagnosis in clinical practice. Insulin resistance and oxidative stress play an important role in NAFLD development and progression. NAFLD affects one in three adults and one in 10 children/adolescents in the United States. Mortality in patients with NAFLD is significantly higher than in the general population of same age and gender with liver-related complications. Lifestyle intervention may improve NAFLD, but medications that increase insulin sensitivity and the antioxidant defenses in the liver deserve evaluation in carefully controlled trials.

GI Epidemiology: nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a common diagnosis in clinical practice. Insulin resistance and oxidative stress play an important role in NAFLD development and progression. To review the data available on the epidemiology and natural history of NAFLD as well as the risk factors for its development and the areas where future research is necessary. RESULTS /CONCLUSIONS: NAFLD may affect individuals of any age range and race/ethnicity. NAFLD affects one in three adults and one in ten children/adolescents in the United States. Mortality in patients with NAFLD is significantly higher than in the general population of same age and gender with liver-related complications being a common cause of death. Liver-related morbidity and mortality in NAFLD occurs when the disease has progressed to advanced fibrosis and cirrhosis. Further studies are necessary to determine the impact of NAFLD on health-related quality of life and resources utilization, and to the extent to which preventing the development of the metabolic syndrome would prevent NAFLD development and reduce liver-related morbidity and mortality. Lifestyle intervention may improve NAFLD, but medications that increase insulin sensitivity and the antioxidant defenses in the liver deserve evaluation in carefully controlled trials.

A 25-year follow-up of a population screened with faecal occult blood test in Finland

The aim of the study was to assess the feasibility of and possible selection to attend in colorectal cancer screening. Materials and Methods. During the years 1979–1980, 1 785 men and women (born in 1917–1929) were invited to a pilot screening project for colorectal cancer. The screening method used was a guaiac-based faecal occult blood test repeated once if the initial test was positive. Results. Compliance was 69% and the test was positive in 19% of those attending. In a record linkage with the Finnish Cancer Registry, 47 colorectal cancer cases and 24 deaths from colorectal cancer were observed by the end of 2004. In all, the particular test method was not regarded specific enough for population screening. There was, however, no difference in cancer incidence between those who complied and those who did not when compared to the general population of same age and gender. Conclusion. Compliance was found high enough to make screening feasible and there was no self selection of persons with low cancer risk to attend screening.

This Month in Gastroenterology

This Month in Gastroenterology

Prevalencia de los factores de riesgo cardiovascular clásicos en una población laboral mediterránea de 4.996 varones

To report a cross-sectional study on the incidence of cardiovascular risk factors among 4,996 male workers (mean age = 47 years) at an automobile factory in the Spanish mediterranean region. The following parameters were obtained by means of standardized forms, medical visits and laboratory exams: obesity indexes, smoking habits, family history of atherosclerosis, physical activity, blood pressure at rest, abnormal electrocardiogram, total cholesterol, plasma triglycerides, lipidemia, and fasting glucose. The results are presented by age groups and labor categories (manual work or managing activities). Family history was positive in 27.2% of individuals; 43.7% were smokers. A body mass index > or = 30 was presented in 19% of the population, while in 29% blood pressure readings were > or = 140/90 mmHg. Plasma values of triglycerides > or = 200 mg/dl, total cholesterol > or = 220 mg/dl and fasting glucose > or = 110 mg/dl appeared in 16.5%; 35.8% and 8.1% respectively. An abnormal electrocardiogram was presented in 3.1% of the patients. A hundred and twenty individuals (2.4%) presented the triad high blood pressure-smoking-hypercholesterolemia. a) There is a high level of overweight and obesity; b) high blood pressure has similar prevalence to the general population of same age, and almost doubly prevalent among managers than manual workers; c) smoking and sedentarism were less prevalent than in general population, smoking being more frequent in manual workers; d) lipid levels are very similar to those of Mediterranean populations of same age.

Annealing of damage in Se +-implanted indium phosphide : J. D. Woodhouse, J. P. Donnelly, P. M. Nitishin, E. B. Owens and J. L. Ryan. Solid-St. Electron.27, 677 (1984)

Liver transplantation (LT) in adult patients is associated with a higher incidence of cardiovascular risk factors (CVRF), chronic kidney disease (CKD), and cardiovascular disease mortality than the general population. Available information about these problems in adult patients with LT from a pediatric age is limited. The aim of this study was to analyze the incidence of CVRF, risk of developing CKD, and risk of 10-year coronary event in adult patients who received LT in childhood.Thirty adult patients (11 female, 19 male; mean age, 29.3 years) who underwent LT in childhood were analyzed, and CVRF, estimated glomerular filtration rate, and current immunosuppressive regimen were recordered. The risk of 10-year coronary event was calculated with the use of validated equations (Framingham and Regicor) and compared with the estimated risk in the general population.None of the patients had CVRF before LT, except 1 patient who received a transplant because of familial hypercholesterolemia. Median age of patients at the time of study was 28.6 years (range, 19.3–43.1 y), and mean follow-up after LT was 17.83 ± 5.21 years. Twenty-nine patients (96.7%) were receiving a calcineurin inhibitor (69% tacrolimus, 31% cyclosporine), along with steroids in 13 of them. The average CVRF per patient was 2, and 11 patients (43.33%) had ≥3. Thirteen patients (43.33%) had CKD. The estimated risk of developing a coronary event at 10 years according to the Framingham score was 3%, higher than expected in the general population of same age and sex. With the use of the Regicor equation, adapted to the Spanish population, the estimated cardiovascular risk was 1.6%, corresponding to Spanish men without CVRF aged 50–55 years. None of the patients had cardiovascular events during the follow-up.Our data show a high incidence of CVRF and CKD in young adults who received LT in childhood, resulting in an increased risk of cardiovascular disease.