Higher Proportion Of Females Research Articles

P654 Clinical outcomes in familial versus sporadic inflammatory bowel disease diagnosed in the era of biological therapies. Prospective data from the ENEIDA registry

Abstract Background It has been reported that familial aggregation occurs in 10–20% of inflammatory bowel disease (IBD) patients1. Familial IBD has been associated with disease anticipation2 and with an increased need for immunosuppressants3 and surgery4. However, most studies were performed before the widespread use of biological agents and this may impact on the need for surgery. We aimed to compare the clinical outcomes of IBD (by means of the need for biological therapy and abdominal surgery) between familial and sporadic forms of IBD in the era of biological therapies. Methods Data were extracted from the ENEIDA registry by GETECCU, a Spanish, prospectively-maintained, IBD database in which more than 80 centers are participating. Only adult patients diagnosed with IBD since 2005 and prospectively followed in the registry since diagnosis were included. Familial IBD was defined as those cases with at least one first-degree relative diagnosed with IBD. Sporadic IBD was defined as those cases with no familial relative (of any degree) with IBD. Kaplan-Meier survival curves were performed to evaluate the cumulative probabilities of remaining biologic-free and surgery-free. Log-rank test was performed to compare them between familial and sporadic IBD forms. Chi-square test was performed for the rest of variables. Results A total of 5,263 patients (2,627 Crohn’s disease [CD]; 2,636 ulcerative colitis [UC]) were included. Of them, 507 (10%) were familial cases (274 CD, 233 UC; P=0.05). The median follow-up was 38,4 and 35.5 months, respectively (P=0.086). Familial cases were younger (P=0.022) and had a higher proportion of females among UC cases (P=0.048). No differences were observed in the need for biological therapy in both CD and UC between familial and sporadic IBD. Regarding surgery, no differences were observed in the cumulative probabilities of a first intestinal resection for CD and colectomy for UC. Similar results were obtained when all the analyses were restricted to those subgroups at high-risk for surgery (i.e. CD with ileal involvement and extensive UC). Conclusion In patients diagnosed with IBD in the era of biological therapies, familial forms have the same requirements for biological agents and resectional surgery as sporadic forms. Therefore, familial aggregation does not seem to be a factor for a more aggressive disease.

P113 Defining the Safety of Early Ileostomy Closure After IPAA

Abstract Background Patients undergoing ileal pouch-anal anastomosis commonly wish to have their ileostomy reversed as quickly as possible. The safety of ileostomy reversal (DLI-R) within 8 weeks of surgery has not been established. Our hypothesis is early closure before 8 weeks is associated with negative outcomes. Methods Patients who underwent primary IPAA with DLI from 2000 – 2021 from our Pouch Registry were retrospectively reviewed and stratified into groups based on timing of ileostomy closure: very early, routine (< 8 weeks, 56–116 days, respectively). Reasons for early closure were reported. Our primary outcome was overall complication rates according to timing of closure. Univariate analysis was used to compare categorical variables between groups. Results 2,000 patients underwent DLI-R following IPAA at a very early or routine timepoint: 3-stage 62%, 2-stage 38%; median age 39.2. DLI-R was performed very early in 92 patients and early routine in 1,908. Median time to closure in the very early group is 49 days and in the early routine group was 93 days. There were no differences between the two groups in age or BMI, but the very early group had a higher proportion of females (62% vs 41.5% p<0.001) and a higher proportion of patients with ASA 1–2 (65.2% vs 51.9% p<0.02). Reasons for DLI-R in the very early group were stoma related problems in 39 patients (43.3%) with scheduled closure in 51 patients (56.7%). Complications following DLI-R occurred in 11.3% of patients overall. The complication rate in the very early group was 17.4% compared to 11% in the routine group (p=0.09) and are shown in Table 1. When the patients in the very early group were stratified according to reason for DLI-R those reversed early for stoma related problems had a complication rate of 25.6% compared to 11% in the early routine group (p=0.03). Patients undergoing scheduled DLI-R in the very early group did not have higher complication rates than the routine group (11.8% vs 11% respectively, p=1.0). Conclusion DLI-R at <8 weeks following IPAA does not appear to be associated with a statistically higher rate of complications compared to closure in a standard time frame. However, when patients were reversed early due to complications associated with their stoma they had worse outcomes.

Evaluation of Prevalence of PCOS and Associated Depression, Nutrition, and Family History: A Questionnaire-based Assessment.

Context:Polycystic ovarian syndrome (PCOS) is a common condition affecting women in the prime of reproductive age. The symptoms include infertility, amenorrhea, hirsutism, obesity, and androgenic alopecia. It is a socially stigmatizing condition and is often associated with depression, poor mental health, and quality of life.Settings and Design:We carried out a questionnaire based cross sectional study that assessed the prevalence of PCOS, collected information on the nutritional and life style related factors. A questionnaire was used to collect information with an intention to assess the prevalence of PCOS and to understand the contribution of life style/nutrition to the risk of PCOS. Student’s t test and Z proportion test were used to assess significance and a ‘p’ value of ≤ 0.05 was considered significant.Results:A total of 972 females completed the questionnaire (mean age:24.37±8.37 years). Majority were from Telangana (n=823;84.67%) and students (690;70.98%). The mean weight was 60.58±13.03 kg and height was 1.78±2.56 m. Sizeable proportion reported irregular menstrual cycle (n=289;29.73%), that they get easily depressed: 283/972 (29.11%), low self-esteem:242/972 (24.90%), insomnia:223/972 (22.94%). A higher proportion of females were diabetic (8/243;3.29%Vs.10/706;1.42%;p=0.02) and non-vegetarian (69/243;28.40%Vs.119/706;16.86%;p=0.0002). No difference in the consumption of processed/fast food, carbonated drinks and lifestyle were noted. A significantly (p=0.0001) higher proportion of females had a positive family history (32/243;13.17%Vs.26/706;3.68%).Conclusion:Higher prevalence of PCOS was noted in young female population. Identifying at-risk individuals and imparting life style, nutrition-based modifications would be beneficial. Furthermore, regular counseling sessions might help tackle depression leading to a better overall physical and mental health.

A comparison of the circadian rhythm of intraocular pressure in patients with primary glaucoma and normal individuals

Purpose The aim of this study was to evaluate the 24-h intraocular pressure (IOP) fluctuations in patients with glaucoma and to compare them with normal persons.Patients and methods This is a cross-sectional comparative study of the circadian rhythm of IOP that was conducted on 30 patients diagnosed with primary glaucoma on medical or surgical treatment and 30 normal individuals with no signs of glaucoma. There were three cases of primary angle closure glaucoma, and so they were excluded from the analysis.Results The mean age of all participants was 60.25±12.15 years. The mean age of the normal individuals was 58.60±12.33 years compared with 62.22±11.66 years in patients with primary open angle glaucoma (POAG), with no statistically significant difference (P=0.486). A higher proportion of females (63%) were found in the glaucoma group, though not statistically significant (P=0.138). The mean IOP was higher among the glaucoma group (19.92±6.18 mmHg) than in the normal individuals (14.83±1.75 mmHg), with a statistically significant difference (P=0.001). The mean diurnal variation of IOP in the right eye among the normal individuals (3.6±1.1 mmHg) was significantly lower than in the POAG group (7.11±4.8 mmHg) (P=0.001). Similarly, in the left eye, the mean diurnal variation was significantly higher in the POAG group (6.07±2.25 mmHg) compared with the normal individuals (3.52±1.25 mmHg) (P=0.00). The average peak of IOP among normal individuals and patients with POAG was 19.75±2.0 and 37.56.9 mmHg, respectively, in the right eye (P=0.01) and 20.00 ± 1.6 mmHg and 26.25 ± 2.2 in normal individuals and patients with POAG, respectively, in the left eye (P=0.001). The peak IOP among the POAG group was seen at 6 p.m. and 6 a.m., mostly outside office hours.Conclusion The diurnal variation of IOP was more among patients with glaucoma than normal individuals. The average peak of the IOP was seen only after office hours (9 a.m.–5 p.m.), thus emphasizing the need for 24-h monitoring of IOP. The 24-h measurement would help recognize the IOP spikes and help decide the time of instillation of antiglaucoma medication to avoid further glaucoma progression.

Characteristics and long-term prognosis of patients with reduced, mid-range, and preserved ejection fraction: A systemic review and meta-analysis.

AimsPatients with heart failure (HF) have a poor prognosis and are categorized by ejection fraction. We performed a meta‐analysis to compare baseline characteristics and long‐term outcomes of patients with heart failure with reduced (HFrEF), mid‐range (HFmrEF), and preserved ejection fraction (HFpEF).Methods and ResultsA total of 27 prospective studies were included. Patients with HFpEF were older and had a higher proportion of females, hypertension, diabetes, and insufficient neuroendocrine antagonist treatments, while patients with HFrEF and HFmrEF had a higher prevalence of coronary heart disease and chronic kidney disease. After more than 1‐year of follow‐up, all‐cause mortality was significantly lower in patients with HFmrEF 9388/25 042 (37.49%) than those with HFrEF 39 333/90 023 (43.69%) and HFpEF 24 828/52 492 (47.30%) (p < .001). Cardiovascular mortality was lowest in patients with HFpEF 1130/9904 (11.41%), highest in patients with HFrEF 3419/16 277 (21.07%) mainly coming from HF death and sudden cardiac death, and middle in patients with HFmrEF 699/5171 (13.52%) and the non‐cardiovascular mortality was on the contrary. Subgroup analysis showed that in high‐risk patients with atrial fibrillation, the all‐cause mortality of HFpEF was significantly higher than both HFrEF and HFmrEF (p < .001). HF hospitalization was lowest in patients with HFmrEF 1822/5285 (34.47%), highest in patients with HFrEF 12 607/28 590 (44.10%) and middle in patients with HFpEF 8686/22 763 (38.16%) and the composite of all‐cause mortality and HF hospitalization was also observed similar results.ConclusionsIn summary, patients with HFmrEF had the lowest incidence of all‐cause mortality and HF hospitalization, while the highest all‐cause mortality and HF hospitalization rates were HFpEF and HFrEF patients, respectively.

Effects of Mindfulness Meditation Intervention on Depressive Symptoms in Emerging Adults: A Systematic Review and Meta-Analysis.

Introduction: Depression in emerging adults (20-29 years of age), a transition from adolescence to adulthood, is a mental health problem globally. Antidepressants and psychotherapy have limited effectiveness and might not be available worldwide. Alternative and complementary treatments, such as mindfulness meditation, are growing. Objective: We examined the effects of mindfulness interventions on depression in emerging adults and explored the moderating effects of participants, methods, and intervention characteristics. Design: Systematic review and meta-analysis. Subjects: Emerging adults. Interventions: Mindfulness meditation interventions versus control groups. Outcomes measures: depressive symptoms. Results: Forty-five studies resulted in 49 comparisons, including 3479 participants (23.0-2.7 years old); 1826 participants practiced mindfulness and 1653 served as controls. Overall, mindfulness interventions showed significant reduction in depression compared with controls (g = 0.44, 95% confidence interval: 0.33-0.55). Mindfulness interventions conducted in Asian countries had a greater decrease in depression (g = 0.69) than studies conducted in North America (g = 0.44) or Europe (g = 0.23). Mindfulness interventions showed greater reductions in depression in studies with higher proportion of females (Slope = 0.010, τ2 = 0.07, Qbetween = 7.10, p = 0.008). Mindfulness interventions conducted in emerging adults with depressive disorders reduced depression more (g = 1.12) than in emerging adults without (g = 0.40). Providing mindfulness intervention in a group setting had a greater reduction of depression (g = 0.54) than on an individual basis (g = 0.30). More minutes of unstructured mindfulness practice per session showed a greater reduction in depressive symptoms (Slope = 0.016, Qbetween = 1.34, p = 0.035). Using intention-to-treat analyses showed a lower ES (g = 0.14) than not using it (g = 0.55). Other quality indicators were not significant moderators. Primary researchers did not report the adverse effects of mindfulness interventions. Conclusion: Mindfulness interventions somewhat improved depression in emerging adults. Because primary researchers did not report the adverse effects, mindfulness interventions should be used with caution. Future researchers might study the adverse effects of mindfulness interventions as well as the long-term effects.

Using electronic medical record data to establish and monitor the distribution of refractive errors,

ObjectiveTo establish the baseline distribution of refractive errors and associated factors amongst a population that attended primary care optometry clinics. DesignRetrospective cross sectional cohort study of electronic medical records (EMR). MethodsElectronic medical record data was extracted from forty optometry clinics, representing a mix of urban and rural areas in Ireland. The analysis was confined to demographic and clinical data gathered over a sixty-month period between 2015 and 2019. Distribution rates were calculated using the absolute and relative frequencies of refractive error in the dataset, stratified for age and gender using the following definitions: high myopia ≤ -6.00 D, myopia ≤ -0.50 D, hyperopia ≥ +0.50 D, astigmatism ≤ -0.75 DC and anisometropia ≥ 1.00 D. Visual acuity data was used to explore vision impairment rates in the population. Further analysis was carried out on a gender and age-adjusted subset of the EMR data, to match the proportion of patients in each age grouping to the population distribution in the most recent (2016) Irish census. Results153,598 clinic records were eligible for analysis. Refractive errors ranged from -26.00 to +18.50 D. Myopia was present in 32.7%, of which high myopia represented 2.4%, hyperopia in 40.1%, astigmatism in 38.3% and anisometropia in 13.4% of participants. The clinic distribution of hyperopia, astigmatism and anisometropia peaked in older age groups, whilst the myopia burden was highest amongst people in their twenties. A higher proportion of females were myopic, whilst a higher proportion of males were hyperopic and astigmatic. Vision impairment (LogMAR > 0.3) was present in 2.4% of participants. In the gender and age- adjusted distribution model, myopia was the most common refractive state, affecting 38.8% of patients. ConclusionAlthough EMR data is not representative of the population as a whole, it is likely to provide a reasonable representation of the distribution of clinically significant (symptomatic) refractive errors. In the absence of any ongoing traditional epidemiological studies of refractive error in Ireland, this study establishes, for the first time, the distribution of refractive errors observed in clinical practice settings. This will serve as a baseline for future temporal trend analysis of the changing pattern of the distribution of refractive error in EMR data. This methodology could be deployed as a useful epidemiological resource in similar settings where primary eyecare coverage for the management of refractive error is well established.

Association between occupational testicular radiation exposure and lower male sex ratio of offspring among orthopedic surgeons.

Exposure to occupational radiation can lower the male sex ratio. However, specific radiation exposure to the testes has not been evaluated. This study aimed to examine the association between testicular radiation exposure and lower male sex ratio in children. A comprehensive questionnaire survey was administered to 62 full-time male doctors with children aged < 10 years at 5 hospitals. Based on the possibility of testicular radiation exposure 1 year before the child's birth, participants were assigned to 3 groups as follows: RT (orthopedic surgery), RNT (cardiology/neurosurgery), and N (others). Intergroup differences in the proportion of female children were ascertained, and the female sex ratio (number of female/total number) of each group was compared against the standard value of 0.486. Multivariate logistic regression analysis with a generalized estimating equation was used to model the effects on the probability of female birth while controlling for the correlation among the same fathers. The study population included 62 fathers and 109 children, 49 were female: 19/27, 11/30, and 19/52 in the RT, RNT, and N group, respectively; the RT group had the highest proportion of females (p = 0.009). The p values for comparisons with the standard sex ratio (0.486) were 0.02, 0.19, and 0.08 for the RT, RNT, and N groups, respectively. Based on the N group, the adjusted odds ratios for the child to be female were 4.40 (95% confidence interval 1.60-2.48) and 1.03 (0.40-2.61) for the RT and RNT groups, respectively. Our results imply an association between testicular radiation exposure and low male sex ratio of offspring. Confirmatory evidence is needed from larger studies which measure the pre-conceptional doses accumulated in various temporal periods, separating out spermatogonial and spermatid effects.

Comparison of Mortality Rates between Italian and Foreign-born Patients with Alcohol Use Disorders

ABSTRACT In Italy, although the number of foreign-born residents has grown exponentially, there are no data on mortality risk among migrants who have alcohol use disorders (AUDs). We examined the mortality risk and causes of death for natives and non-natives in a cohort of individuals treated for AUDs in Northern Italy in the period from 01/01/1975 to 31/12/2016. We highlight important characteristics of non-natives compared to Italians: 1) a younger age and a higher proportion of females; 2) a better health status; 3) a better social capital 4) a lower risk of death. We found differences in mortality between the various areas of origin, with a higher risk among participants born in Asia and African countries other than Mediterranean. The excess mortality compared to the reference population (SMRs) was at least three times for Italians and two times for migrants. While the non-native patients with AUDs have in general better health than Italians with AUDs, our results highlighted higher percentage of dropouts from treatment and lower access to Mental Health Services, suggesting that barriers to the access and completion of therapeutic programs still exist.

Estimating Contributions of Social and Behavioral Factors to Cardiovascular Disease, Cancer, COPD, and Unintentional-Injury Mortality Disparities by Psychological Distress in the United States: A Blinder-Oaxaca Decomposition Analysis of the 1997-2014 NHIS-NDI Record Linkage Study

Background: Previous research has shown a significant association between psychological distress (PD) and cause-specific mortality, but contributions of sociodemographic and behavioral characteristics to mortality differences by PD are not fully explored. Methods: The Blinder-Oaxaca decomposition analysis was used to quantify the contributions of individual sociodemographic and behavioral characteristics to the observed cardiovascular disease (CVD), cancer, chronic obstructive pulmonary disease (COPD), and unintentional-injury mortality disparities between United States (US) adults with no PD and those with serious psychological distress (SPD), using the pooled 1997-2014 data from the National Health Interview Survey prospectively linked to the National Death Index (N=263,825). Results: Lower levels of education and household income, and higher proportions of current smokers, former drinkers, non-married adults, US-born, and renters contributed to higher mortality for adults with SPD. The relative percentage of mortality explained by sociodemographic and behavioral factors was highest for cancer mortality (71.25%) and lowest for unintentional-injury mortality (20.19%). Enhancing education level among adults with SPD would decrease approximately 30% of cancer or CVD mortality disparity, and around 10% of COPD and unintentional-injury mortality disparities. Half of the cancer mortality disparity (47.4%) could be attributed to a single factor, smoking. Increasing income level will decrease 7 to 13% of the disparity in cause-specific mortality. Higher proportions of renters explained higher CVD and COPD mortality among adults with SPD by 7% and 3%, respectively. Higher proportions of former drinkers explained higher CVD, cancer, and COPD mortality among adults with SPD by 6%, 7%, and 3%, respectively. Younger age, higher proportion of females, and higher BMI among adults with SPD mitigated the mortality disparities. Conclusions and Implications for Translational Research: Improved education and income levels, and reduced smoking among US adults with SPD would eliminate around 90% of the cancer mortality disparity by SPD, and half of the CVD mortality disparity. Copyright © 2021 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Novel use of tau imaging to enrich for pathological homogeneity within the PERISCOPE‐ALZ study of zagotenemab

AbstractBackgroundZagotenemab (LY3303560), a humanized monoclonal antibody targeting extracellular aggregated tau, is currently in development as a potential disease modifying treatment for early symptomatic Alzheimer’s disease (AD). The PERISCOPE‐ALZ study (Phase 2, NCT03518073) of zagotenemab implements tau PET for classifying AD pathological stage based on the NIA‐AA guidelines (Jack CR, Jr., Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, et al. NIA‐AA Research Framework: Toward a biological definition of Alzheimer's disease. Alzheimers Dement. 2018;14(4):535‐62) and serves as a key eligibility criterion. Here we summarize the study’s screening and baseline characteristics.MethodScreening procedures were performed at 60 sites in the United States, Canada, and Japan. Key eligibility criteria include age of 60‐85 years, Mini‐Mental State Exam (MMSE) score of 20‐28, and pre‐defined baseline tau load as assessed by flortaucipir F18 PET. This eligibility strategy was intended to exclude participants with minimal tau burden whose pathology may not be consistent with AD in absence of amyloid pathology confirmation and who are expected to have slower clinical progression. Participants with high tau levels, hypothesized to be less likely to respond to therapy, were also excluded.ResultThe most common reasons for screen failure were out of range baseline tau levels and cognitive screener score. Of screened participants who underwent a flortaucipir scan, 58% did not meet scan eligibility criteria. Seventy‐nine percent of the flortaucipir scans not meeting eligibility criteria were below pre‐defined tau levels required for inclusion. A higher proportion of females than males who were ineligible based on the tau scan harbored too high of tau levels for eligibility (27% v. 14%, chi‐square p=0.0004). The enrolled cohort had an average age at baseline of 75 years and 53% were female. Average MMSE score at baseline of the enrolled cohort was 23.7.ConclusionPERISCOPE‐ALZ successfully implemented flortaucipir PET imaging as the key inclusion criterion to enroll a pathological homogeneous cohort based on level of tau accumulation. As tau‐targeted therapies for AD advance into clinical research, staged tau pathology as eligibility criterion may be useful in phase 2 proof‐of‐concept trials to test disease modifying therapies. Topline trial results are anticipated in late 2021.

A year in perspective: The impact of the COVID-19 pandemic on engagement with Jigsaw youth mental health services.

AimThe COVID‐19 pandemic has presented significant challenges for young people and youth mental health services. To address a gap in knowledge about the impact of the pandemic and associated restrictions on youth mental health services, this paper examined the nature of young people's engagement with Jigsaw's brief intervention service during the pandemic.MethodData gathered from young people engaging with Jigsaw's brief intervention service in the 12 months after the official declaration of the COVID‐19 pandemic (n = 6161), and 12 months prior (n = 8665) were examined.ResultsThere were less referrals to Jigsaw during the pandemic, especially during lockdown periods, but this rebounded when public health restrictions were eased. A higher proportion of females (p < .001) and 12–17 year olds (p < .001) were referred during the pandemic period. There was an increase in the proportion of young people who presented with anxiety (p < .001) and sleep changes (p < .001). Although 12–16 year olds reported significantly higher levels of distress during the pandemic (p < .05), the effect size was small. Young people reported high levels of satisfaction with the new phone/video modes of support offered by Jigsaw, and the overall attendance rate improved during the pandemic period.ConclusionsThe impact of COVID‐19 on young people's mental health needs to be considered as a priority. This paper is helpful for services considering the long‐term mental health needs of young people, and the best way of meeting those needs.

Prevalence of Individuals at Clinical High-Risk of Psychosis in the General Population and Clinical Samples: Systematic Review and Meta-Analysis.

(1) The consistency and magnitude of the prevalence of Clinical High-Risk for Psychosis (CHR-P) individuals are undetermined, limiting efficient detection of cases. We aimed to evaluate the prevalence of CHR-P individuals systematically assessed in the general population or clinical samples. (2) PRISMA/MOOSE-compliant (PROSPERO: CRD42020168672) meta-analysis of multiple databases until 21/01/21: a random-effects model meta-analysis, heterogeneity analysis, publication bias and quality assessment, sensitivity analysis—according to the gold-standard CHR-P and pre-screening instruments—leave-one-study-out analyses, and meta-regressions were conducted. (3) 35 studies were included, with 37,135 individuals tested and 1554 CHR-P individuals identified (median age = 19.3 years, Interquartile range (IQR) = 15.8–22.1; 52.2% females, IQR = 38.7–64.4). In the general population (k = 13, n = 26,835 individuals evaluated), the prevalence of the CHR-P state was 1.7% (95% Confidence Interval (CI) = 1.0–2.9%). In clinical samples (k = 22, n = 10,300 individuals evaluated), the prevalence of the CHR-P state was 19.2% (95% CI = 12.9–27.7%). Using a pre-screening instrument was associated with false negatives (5.6%, 95% CI = 2.2–13.3%) and a lower CHR-P prevalence (11.5%, 95% CI = 6.2–20.5%) compared to using CHR-P instruments only (28.5%, 95% CI = 23.0–34.7%, p = 0.003). (4) The prevalence of the CHR-P state is low in the general population and ten times higher in clinical samples. The prevalence of CHR-P may increase with a higher proportion of females in the general population and with a younger population in clinical samples. The CHR-P state may be unrecognized in routine clinical practice. These findings can refine detection and preventive strategies.

130 PREDICTORS OF DRIVING STATUS IN OLDER IRISH ADULTS ATTENDING A GERIATRIC OUTPATIENT SERVICE

Abstract Background The main mode of transportation in Ireland remains travel by car. Transport mobility is important for older adults in accessing shops, healthcare, services, community and in maintaining relationships. Cessation of driving is associated with negative effects on mental health, loneliness and physical health. We aimed to explore factors associated with driving status in older adults living in an urban environment. Methods Study included adults aged greater than 65 years attending a geriatric outpatient service in an urban environment and recruited as part of the TUDA (Trinity Ulster, Department of Agriculture) study. We excluded those with a MMSE (Mini-Mental State Exam) less than 24 as we aimed to include only non-dementia patients. Physical frailty was measured with the Timed Up and Go (TUG) and depression with the Center for Epidemiological Studies Depression scale (CES-D). Factors associated with driving status were explored in multinomial regression models. Results 1978 adults, mean age 77.7 ± 7.1 years, 76.0% were female. 35.5% were current drivers but this differed by age category 45.9% (65–75 years), 25% (75–85 years) and 12.5% (85+ years). 28.1% were past drivers. Positive independent predictors of current driving were younger age (P &amp;lt; 0.001), male gender (P &amp;lt; 0.001), married status (P = 0.01), higher socioeconomic status (P &amp;lt; 0.0001) while negative predictors included physical frailty (TUG, P &amp;lt; 0.001), visual impairment (P = 0.01), stroke (P &amp;lt; 0.001), depression (P &amp;lt; 0.001) and self reported loneliness (P = 0.01). Conclusion One third of patients attending a geriatric outpatients in an urban environment were currently driving which is much lower than in the general older Irish population. However, our study included frail adults living in more deprived socioeconomic areas and had a high proportion of females who had never learned to drive. Furthermore, access to urban public transport may be a factor. Non-drivers were more likely to have depression and report loneliness independent of other factors highlighting its negative impact.

Validity and reliability of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale in patients undergoing bariatric surgery in Sweden: a prospective psychometric evaluation study

ObjectivesThe aim was to psychometrically test and evaluate the Swedish functional health literacy scale and the Swedish communicative and critical health literacy scale in patients undergoing bariatric surgery.DesignA prospective cross-sectional...

Comparison of household income in in-hospital outcomes after implantation of left ventricular assist device.

Due to the inability to keep up with the demand for heart transplantation, there is an increased utilization of left ventricular assist devices (LVAD). However, paucity of data exists regarding the association of household income with in-hospital outcomes after LVAD implantation. Retrospective cohort study using the NIS to identify all patients ⩾18 years who underwent LVAD implantation from 2011 to 2017. Statistical analysis was performed comparing low household income (⩽50th percentile) and high income (>50th percentile). A total of 25,503 patients underwent LVAD implantation. The low-income group represented 53% and the high-income group corresponded to 47% of the entire cohort. The low-income group was found to be younger (mean age 55 ± 14 vs 58 ± 14 years), higher proportion of females (24% vs 22%), and higher proportion of blacks (32% vs 16%, p < 0.001 for all). The low-income group was found to have higher prevalence of hypertension, chronic pulmonary disease, smoking, dyslipidemia, obesity, and pulmonary hypertension (p < 0.001 for all). However, the high-income cohort had higher rate of atrial tachyarrhythmias and end-stage renal disease (p < 0.001). During hospitalization, patients in the high-income group had increased rates of ischemic stroke, acute kidney injury, acute coronary syndrome, bleeding, and need of extracorporeal membrane oxygenation (p < 0.001 for all). We found that the unadjusted mortality had an OR 1.30 (CI 1.21-1.41, p < 0.001) and adjusted mortality of OR 1.14 (CI 1.05-1.23, p = 0.002). In patients undergoing LVAD implantation nationwide, low-income was associated with increased comorbidity burden, younger age, and fewer in-hospital complications and all-cause mortality.

EGFR testing patterns and detection of EGFR exon 20 insertions among patients with NSCLC in the US

Abstract Introduction/Objective Epidermal growth factor receptor (EGFR) mutations are common in non-small cell lung cancer (NSCLC). EGFR exon 20 insertions (EGFRex20ins), a rare subset of EGFR mutations, are refractory to tyrosine kinase inhibitors. With the development of targeted therapies for EGFRex20ins, such as mobocertinib, molecular testing is required to optimize treatment. A better understanding of real-world EGFR detection patterns is needed to maximize patient outcomes. Methods/Case Report This retrospective study describes EGFR testing and EGFRex20ins detection patterns in patients with NSCLC in the United States. The Flatiron Health electronic health record database was used to identify patients ≥18 years, with advanced NSCLC, and with ≥2 clinic visits between 01/01/2011 and 12/31/2020. Baseline demographics, clinical characteristics, EGFR testing, and EGFRex20ins detection rates by sex, race, and smoking history were summarized. Results (if a Case Study enter NA) A total of 67,281 patients with NSCLC were identified. EGFR testing increased from 44% in 2011 to 77% in 2020. Of all patients, 44,926 (66.8%) were tested: 50.8% female; 3.3% Asian; 16.0% never-smokers. Of all patients, 22,355 (33.2%) were not tested: 41.4% female; 1.2% Asian; 7.5% never-smokers. Of those tested, 6,245 (13.9%) patients had EGFR mutations: 65.9% female; 11.8% Asian; 48.4% never-smokers. EGFRex20ins detection rates changed from 0.6% in 2011 to 1.0% in 2019 and 0.7% in 2020. Of those tested, 304 patients had EGFRex20ins: 58.2% female; 8.2% Asian; 50.3% never-smokers. EGFR testing was higher in females (71.2%) than males (62.8%), never-smokers (84.5%) than those with a smoking history (64.6%), and Asian patients (84.2%) than White (66.6%), Black (65.4%), or other patients (69.5%). Of those tested, EGFRex20ins mutations were detected in 0.8% of females (males: 0.6%), 2.2% of never-smokers (with smoking history: 0.4%), and 1.7% of Asians (White: 0.6%, Black: 0.6%, other patients: 0.7%) had EGFRex20ins. A similar trend was observed for EGFR mutations with higher proportions of females, never-smokers, and Asian patients affected. Conclusion EGFR testing and EGFRex20ins detection rates have increased. However, not all patient subgroups were tested at the same rate and undertesting occurred in all subgroups. Further education of specialists diagnosing NSCLC is warranted to ensure all patients receive biomarker testing and benefit from emerging EGFRex20ins- targeted therapies.

Post-COVID-19 syndrome: prospective evaluation of clinical and functional outcomes

IntroductionCoronavirus disease 2019 (COVID-19) is a highly pathogenic coronavirus characterized by by systemic inflammatory response with endothelial damage and a dysregulated coagulation system. Despite most patients survive the acute setting of COVID-19, their long-term clinical sequelae are highly unclear. We have sought to identify the impact of post-COVID-19 syndrome on mid-term follow-up and gain some additional insights about the potential explanation for persistence of dyspnea.MethodsThis is a 3-month prospective cohort study of previously hospitalised COVID-19 patients recruited from a single Spanish center, a small outpatient group without prior hospitalisation was also evaluated. Patients underwent serial testing with cardio-pulmonary exercise test (CPET), transthoracic echocardiogram, pulmonary lung test, six-minute walking test, serum biomarker analysis and quality of life questionaries. They were classify according to the presence of persistent dyspnea. Primary study outcome was predicted peak oxygen consumption (V02) according to CPET and predicted carbon monoxide diffusion capacity.ResultsOur study included 41 (58.6%) patients with dyspnea and 29 (41.4%) asymptomatic. Symptomatic patients had a higher proportion of females (73.2% vs. 51.7%), but comparable age and prevalence of cardiovascular risk factors. We did not observe differences among the assessed variables in transthoracic echocardiogram and pulmonary function test. Patients who referred dyspnea had smaller predicted peak O2 consumption (77.8 [64–92.5] vs. 99 [88–105]: p<0.001), total distance in the 6-minute walking test (535 [467–600] vs. 611 [550–650] meters; p=0.001), and quality of life (KCCQ-23 60.1±18.6 vs. 82.8±11.3; p<0.001). Additionally, abnormalities in CPET were suggestive of a ventilation/perfusion misthmach or hyperventilatory syndrome characterized by impaired ventilatory efficiency with a greater VE/VCO2 slope (32 [28.1–37.4] vs. 29.4 [26.9–31.4]; p=0.022) and low PETCO2 (34 [32–39] vs. 38 [36–40]; p=0.025).InterpretationIn this study >50% of COVID-19 survivors present a symptomatic functional impairment irrespective of age or prior hospitalization. Compared to asymptomatic patients, among those who referred dyspnea our findings suggest potential ventilatory inefficiency.Funding AcknowledgementType of funding sources: Public grant(s) – National budget only. Main funding source(s): Gerencia Regional de Salud de Castilla y Leόn; Grant from the Spanish Society of Cardiology Tabla de resultados

Lack of Salivary Long Non-Coding RNA XIST Expression Is Associated with Increased Risk of Oral Squamous Cell Carcinoma: A Cross-Sectional Study.

Studies have shown that there is a disparity between males and females in south-east Asia with regard to oral cancer morbidity. A previous study found that oral cancer tissue showed loss of heterozygosity of the X-linked lncRNA XIST gene. We suggest that XIST may play an important role in oral cancer morbidity when associated with sex. Saliva contains proteins and RNAs that are potential biomarkers for the diagnosis of diseases. This study investigated salivary XIST expression and the correlation to clinical–pathological data among oral squamous cell carcinoma patients. Salivary XIST expression was only observed in females, and a high proportion of females with OSCC lack salivary lncRNA XIST expression (88%). The expression showed no correlation with alcohol consumption, betel quid chewing, or cigarette smoking habits. People lacking salivary lncRNA XIST expression had a significantly increased odds ratio of suffering from OSCC (OR = 19.556, p < 0.001), particularly females (OR = 33.733, p < 0.001). The ROC curve showed that salivary lncRNA XIST expression has acceptable discrimination accuracy to predict the risk of OSCC (AUC = 0.73, p < 0.01). Lack of salivary lncRNA XIST expression was associated with an increased risk of OSCC. We provided an insight into the role of salivary lncRNA XIST as a biomarker to predict the morbidity of OSCC.

A retrospective cohort study describing characteristics of those repeatedly detained under Section 136 of the Mental Health Act over a 5-year period and the association with past abuse.

Individuals repeatedly detained under Section 136 (S136) of the Mental Health Act account for a significant proportion of all detentions. This study provides a detailed analysis of those repeatedly detained ('repeat attenders') to a London Mental Health Trust, identifying key demographic profiles when compared to non-repeat attenders, describing core clinical characteristics and determining to what degree a past history of abuse might be associated with these.All detentions to the S136 suite at South West London and St George's Mental Health NHS Trust over a 5-year period (2015-2020) were examined. Data were collected retrospectively from electronic records. A total of 1767 patients had been detained, with 81 patients identified as being a 'repeat attenders' (having had > = 3 detentions to the S136 suite during the study period). Repeat attenders accounted for 400 detentions, 17.7% of all detentions.Repeat attenders included a higher proportion of females (49.4%, p = 0.0001), compared to non-repeat attenders, and a higher proportion of them were of white ethnicity (85.2%, p = 0.001). 52 (64%) patients reported being a victim of past abuse or trauma. Of repeat attenders who reported past abuse or trauma, a high proportion had diagnoses of personality disorders, with deliberate self-harm as the most common reason for detention. They were more commonly discharged home with community support, rather than considered for hospital admission. In light of these findings, this paper discusses support potential strategies for those most vulnerable to repeated S136 detention, thereby minimising the ever-growing number of S136 detentions in the UK.