Long-term Health Outcomes Research Articles

HIV Outcomes Among Women Living With HIV Who Experienced Early Sexual Violence Across Four Sub-Saharan African Countries.

Early experiences of sexual violence may influence HIV care and treatment outcomes among women living with HIV (WLHIV). We examined whether self-report by WLHIV of being forced into their first sexual experience was associated with awareness of HIV-positive status, being on antiretroviral therapy (ART) and being virologically suppressed. We conducted a secondary analysis using nationally representative, cross-sectional Population-based HIV Impact Assessment surveys from Lesotho, Malawi, Zambia, and Zimbabwe conducted from 2015 through 2017. Adjusted logistic regression models with survey weights and Taylor series linearization were used to measure the association between forced first sex and 3 HIV outcomes: (1) knowledge of HIV status among all WLHIV, (2) being on ART among WLHIV with known status, and (3) virological suppression among WLHIV on ART. Among WLHIV, 13.9% reported forced first sex. Odds of knowledge of HIV status were not different for WLHIV with forced first sex compared with those without (adjusted odds ratio [aOR], 1.17; 95% CI: 0.95 to 1.45). Women living with HIV with forced first sex had significantly lower odds of being on ART (aOR 0.74, 95% CI: 0.57 to 0.96) but did not have lower odds of virological suppression (aOR 1.06, 95% CI: 0.80 to 1.42) compared with WLHIV without forced first sex. While high proportions of WLHIV were on ART, report of nonconsensual first sex was associated with a lower likelihood of being on ART which may suggest that early life trauma could influence long-term health outcomes.

The critical role of quality-of-life data in managing patients with central nervous system disorders

Quality of life (QoL) is an essential metric in evaluating the overall well-being of patients with central nervous system (CNS) disorders. Understanding QoL data is crucial for tailoring treatment approaches, enhancing patient outcomes, and assessing the effectiveness of therapeutic interventions. This paper discusses the importance of QoL assessments in CNS disorders, including the impact on treatment decisions, patient satisfaction, and long-term health outcomes. It also explores the challenges and methodologies for collecting and analyzing QoL data, emphasizing the need for integrating these metrics into clinical practice. Ultimately, enhancing QoL is paramount in the comprehensive management of CNS disorders.

What long-term health outcomes can we anticipate for children who have been in social care?

Abstract The concept of cumulative disadvantage suggests that setbacks in one area of life not only lead to further challenges within that domain but also increase vulnerability to adversities across different domains, as highlighted in life course studies. In the context of children with a history of childhood social care (CSC) experience, research consistently shows poorer long-term health outcomes compared to peers without such experiences. This disparity persists into middle age and can affect subsequent generations, underscoring the enduring impact of early-life adversity. Dr Viviane S. Straatmann, a social epidemiologist based in Sweden and enriched by her experience in studying the health and social life of vulnerable children in diverse international settings, will offer insights from life-course and intergenerational epidemiological studies. She will explore the intricate web of disadvantages preceding children’s entry into social care, shedding light on the complex interplay between early-life adversity, cumulative disadvantage, and long-term health outcomes. Participants will engage in reflective dialogue on pertinent questions, such as how cumulative disadvantage informs interventions for children with CSC backgrounds, the potential mechanisms underlying the contribution of early-life adversities to long-term health disparities, and the ways intergenerational studies can inform strategies for breaking the cycle of disadvantage.

Developmental Timing of Associations Among Parenting, Brain Architecture, and Mental Health.

Parenting is associated with brain development and long-term health outcomes, although whether these associations depend on the developmental timing of exposure remains understudied. Identifying these sensitive periods can inform when and how parenting is associated with neurodevelopment and risk for mental illness. To characterize how harsh and warm parenting during early, middle, and late childhood are associated with brain architecture during adolescence and, in turn, psychiatric symptoms in early adulthood during the COVID-19 pandemic. This population-based, 21-year observational, longitudinal birth cohort study of low-income youths and families from Detroit, Michigan; Toledo, Ohio; and Chicago, Illinois, used data from the Future of Families and Child Well-being Study. Data were collected from February 1998 to June 2021. Analyses were conducted from May to October 2023. Parent-reported harsh parenting (psychological aggression or physical aggression) and observer-rated warm parenting (responsiveness) at ages 3, 5, and 9 years. The primary outcomes were brainwide (segregation, integration, and small-worldness), circuit (prefrontal cortex [PFC]-amygdala connectivity), and regional (betweenness centrality of amygdala and PFC) architecture at age 15 years, determined using functional magnetic resonance imaging, and youth-reported anxiety and depression symptoms at age 21 years. The structured life-course modeling approach was used to disentangle timing-dependent from cumulative associations between parenting and brain architecture. A total of 173 youths (mean [SD] age, 15.88 [0.53] years; 95 female [55%]) were included. Parental psychological aggression during early childhood was positively associated with brainwide segregation (β = 0.30; 95% CI, 0.14 to 0.45) and small-worldness (β = 0.17; 95% CI, 0.03 to 0.28), whereas parental psychological aggression during late childhood was negatively associated with PFC-amygdala connectivity (β = -0.37; 95% CI, -0.55 to -0.12). Warm parenting during middle childhood was positively associated with amygdala centrality (β = 0.23; 95% CI, 0.06 to 0.38) and negatively associated with PFC centrality (β = -0.18; 95% CI, -0.31 to -0.03). Warmer parenting during middle childhood was associated with reduced anxiety (β = -0.05; 95% CI -0.10 to -0.01) and depression (β = -0.05; 95% CI -0.10 to -0.003) during early adulthood via greater adolescent amygdala centrality. Neural associations with harsh parenting were widespread across the brain in early childhood but localized in late childhood. Neural associations with warm parenting were localized in middle childhood and, in turn, were associated with mental health during future stress. These developmentally contingent associations can inform the type and timing of interventions.

Relationships among intensive blood pressure control, morning blood pressure surge and 24-hour blood pressure variability

Abstract Objectives This study aimed to investigate the relationships between cardiovascular outcomes and blood pressure (BP) reduction, 24-hour BP variability (BPV), morning BP surge (MBPS), and visit-to-visit BPV. Methods This study involved 897 participants from the Systolic Blood Pressure International Trial (SPRINT), for whom biochemical and demographic data, medication history, and various blood profile information were collected. Univariate and multivariate linear regression models were used to assess the impact of intensive BP management on 24-hour BPV and the MBPS. Results Among the 897 participants (average age 71.48 ± 9.42 years; 640 males), 453 received intensive treatment. Those in the intensive group were more likely to be on ACE inhibitors, CCBs, or diuretics. This group showed significant reductions in 24-hour systolic and diastolic BP, as well as in both short-term and long-term BPVs, such as average real variability (ARV) and MBPS. The analysis demonstrated strong associations between intensive BP management and improvements in various BPV measures, including systolic ARV, diastolic BP ARV, and cumulative BP loads. A significant correlation was also found between intensive BP lowering and the primary composite outcome of the SPRINT study. Conclusions This study highlighted the significant associations between intensive BP management and reductions in the MBPS and 24-hour BPV, which affect both short-term and long-term health outcomes. The primary benefits of intensive BP control appear to stem from direct BP reduction rather than changes in BPV. However, further extensive randomized controlled trials are needed to confirm these findings.

Free fatty acids and mortality among adults in the United States: a report from US National Health and Nutrition Examination Survey (NHANES)

Abstract Introduction Free fatty acids (FFAs) serve as vital energy sources in multiple body tissues and they have been associated with elevated cardiovascular disease risk and mortality. There is a scarcity of prospective studies examining the associations between specific FFAs and long-term health outcomes. Purpose To examine the correlation between different FFAs types and all-cause or cardiovascular mortality in a large, nationally representative sample of adults in the United States (US), and examine how different concentrations and types of FFAs may mediate this association. Methods This cohort study included 3719 and 3900 participants in the unsaturated fatty acids (USFAs) and saturated fatty acids (SFAs) populations, respectively, who participated in the US National Health and Nutrition Examination Survey (NHANES) from 2011-2014. Multiple model calibration was performed using univariate and multivariate cox regression analysis to explore the associations between circulating FFAs and all-cause or cardiovascular mortality. Results The UFAs (myristoleic acid (14:1 n-5), palmitoleic acid (16:1 n-7), cis-vaccenic acid (18:1 n-7), nervonic acid (24:1 n-9), eicosatrienoic acid (20:3 n-9), docosatetraenoic acid (22:4 n-6), and docosapentaenoic acid (22:5 n-6)) were associated with an elevated risk of all-cause mortality ((hazard ratio (HR) 1.02 [1.006-1.034]; P=0.004), (HR 1.001 [1.001–1.002]; P＜ 0.001), (HR 1.006 [1.003–1.009]; P＜ 0.001), (HR 1.007 [1.002–1.012]; P = 0.003), (HR 1.027 [1.009–1.046]; P= 0.003), (HR 1.024 [1.012–1.036]; P＜ 0.001) and (HR 1.019 [1.006–1.032]; P = 0.005), respectively), whereas docosahexaenoic acid (22:6 n-3) was linked to a lower risk (HR 0.998 [0.996–0.999]; P = 0.007). Among SFAs, palmitic acid 16:0 was associated with a higher all-cause risk (HR 1.00 [1.00–1.00]; P = 0.022), while tricosanoic acid (23:0) and lignoceric acid (24:0) were associated with lower risks (HR 0.975 [0.959–0.991]; P = 0.002) and (HR 0.992 [0.984–0.999]; P = 0.036). Kaplan–Meier survival curves according to FFAs quartiles shown the highest risk for all-cause mortality was observed in the group with the highest concentration, except serum 23:0. The association between FFAs concentration and cardiovascular mortality in the multivariate analysis indicated that only 22:6 n-3 (HR 0.997 [0.994-1.000]; P=0.035) had a lower risk of cardiovascular mortality in the USFAs group, while none of the SFAs was found to be associated with cardiovascular mortality. While, the relationship between 22:6 n-3, and cardiovascular mortality was characterized by neither a linear nor nonlinear association (P-linear = 0.215; P-nonlinear = 0.260). Conclusion In this cohort of US adults, the types and concentrations of FFAs exhibited significant associations with risk of all-cause mortality. Achieving optimal concentrations of specific FFAs effectively lowered this risk of all-cause mortality, but this benefit was not observed in regards to cardiovascular mortality.FFA and all-cause mortality

Health disparities among in multicultural and non-multicultural families in South Korea

Abstract South Korea has experienced significant immigrant growth, with international marriages playing a key role in this demographic change. In 2019, international marriages accounted for 10.3% of all marriages, increasing the number of multicultural households. Multicultural families in Korea faced controversies over accepting new members in a society traditionally considered racially and ethnically homogenous. In rural areas, where patriarchal and conservative values prevail, there is greater discrimination and negative perception towards foreigners compared to urban areas, impacting access to healthcare. This potentially adversely affects the health of married immigrants. However, research on this issue is limited. This study aims to examine the differences in health behaviors, access to care, and health status between multicultural and non-multicultural families in rural and urban areas. Using a cross-sectional study design based on the 2023 Community Health Survey, the sample included 228,216 adults from non-multicultural families and 3,373 adults from multicultural families. Adjusted differences in outcome were estimated using regression models, including linear probability and logistic models. Overall, there were minimal or no differences in health behaviors and health status between adults from multicultural and non-multicultural families. However, significant differences were observed in access to care, such as annual health check-ups (0.72 [0.64, 0.81]) and vaccinations (0.84 [0.76, 0.94]). Non-multicultural families showed regional differences in all outcomes, whereas multicultural families exhibited minimal or no regional differences. These findings suggest that multicultural families may face barriers beyond regional environments, limiting their access to care and potentially leading to long-term negative health outcomes. Targeted policy development for multicultural families in Korea is necessary to address this issue. Key messages • Access to health care may vary for individual and local factors, especially for people with different ethnicities or cultures. • Multicultural families may encounter greater barriers than individual and regional characteristics, requiring the development of tailored policies for immigrants and multicultural families.

Outcomes of Radiation Dose Reduction Protocol in Electrophysiologic and Cardiac Device Procedures

Background: Exposure to radiation has been demonstrated to be associated with adverse short- and long-term health outcomes. Objective: To presented outcomes before and after the implementation of a radiation dose reduction protocol in electrophysiologic (EP) and cardiac device procedures. Materials and Methods: The present study was a retrospective comparative study, conducted at Chiang Mai University Hospital in Thailand using 2017 and 2019 data, including all patients who underwent EP and cardiac implantable electronic device (CIED) procedures. Exclusion criteria involved patients with incomplete radiation dose records. The authors compared fluoroscopic time, radiation exposure, and complication rates before and after the protocol. Results: Among the 458 cases, with 214 Eps and 244 devices, the mean age was 58 years. For device implantation procedures, there was no significant change in fluoroscopic time as median (P₂₅, P₇₅) before and after protocol implementation were 3.1 (0.4, 5.8) versus 4.4 (1.2,7.6) minutes, respectively (p=0.117). However, there was a decreasing trend in dose area product (DAP) at 242.0 (119.2, 766.0) versus 197.9 (71.5, 494.5) cGy.cm² (p=0.073). The reduction in DAP was more pronounced in cardiac resynchronization therapy (CRT) implantation when comparing 2017 to 2019 were 1,933.6 (1,039.4, 7,683.8) versus 1,074.6 (427.2, 2,890.7) cGy.cm² (p=0.020). In EP procedures, fluoroscopic time significantly decreased from 8.1 (3.0, 14.3) minutes in 2017 to 1.0 (0.0, 3.6) minute in 2019 (p<0.001), accompanied by a significant reduction in exposure dose of 45.0 (10.8, 153.3) versus 1.7 (0.0, 31.6) mGy (p<0.001) and DAP of 1,022.9 (247.2, 2,660.3) versus 38.5 (0.0, 566.9) cGy.cm² (p<0.001). There was no difference in the complication rate between the two periods. Conclusion: The implementation of the radiation dose reduction protocol resulted in a significant decrease in radiation exposure during EP procedures and showed a trend towards reduction in CIED procedures.

Current State of Connected Sensor Technologies Used During Rehabilitation Care: Protocol for a Scoping Review.

Connected sensor technologies can capture raw data and analyze them using advanced statistical methods such as machine learning or artificial intelligence to generate interpretable behavioral or physiological outcomes. Previous research conducted on connected sensor technologies has focused on design, development, and validation. Published review studies have either summarized general technological solutions to address specific behaviors such as physical activity or focused on remote monitoring solutions in specific patient populations. This study aimed to map research that focused on using connected sensor technologies to augment rehabilitation services by informing care decisions. The Population, Concept, and Context framework will be used to define inclusion criteria. Relevant articles published between 2008 to the present will be included if (1) the study enrolled adults (population), (2) the intervention used at least one connected sensor technology and involved data transfer to a clinician so that the data could be used to inform the intervention (concept), and (3) the intervention was within the scope of rehabilitation (context). An initial search strategy will be built in Embase; peer reviewed; and then translated to Ovid MEDLINE ALL, Web of Science Core Collection, and CINAHL. Duplicates will be removed prior to screening articles for inclusion. Two independent reviewers will screen articles in 2 stages: title/abstract and full text. Discrepancies will be resolved through group discussion. Data from eligible articles relevant to population, concept, and context will be extracted. Descriptive statistics will be used to report findings, and relevant outcomes will include the type and frequency of connected sensor used and method of data sharing. Additional details will be narratively summarized and displayed in tables and figures. Key partners will review results to enhance interpretation and trustworthiness. We conducted initial searches to refine the search strategy in February 2024. The results of this scoping review are expected in October 2024. Results from the scoping review will identify critical areas of inquiry to advance the field of technology-augmented rehabilitation. Results will also support the development of a longitudinal model to support long-term health outcomes. Open Science Framework jys53; https://osf.io/jys53. DERR1-10.2196/60496.

Causal inference in multi-cohort studies using the target trial framework to identify and minimize sources of bias.

Longitudinal cohort studies, which follow a group of individuals over time, provide the opportunity to examine causal effects of complex exposures on long-term health outcomes. Utilizing data from multiple cohorts has the potential to add further benefit by improving precision of estimates through data pooling and by allowing examination of effect heterogeneity through replication of analyses across cohorts. However, the interpretation of findings can be complicated by biases that may be compounded when pooling data, or, contribute to discrepant findings when analyses are replicated. The "target trial" is a powerful tool for guiding causal inference in single-cohort studies. Here we extend this conceptual framework to address the specific challenges that can arise in the multi-cohort setting. By representing a clear definition of the target estimand, the target trial provides a central point of reference against which biases arising in each cohort and from data pooling can be systematically assessed. Consequently, analyses can be designed to reduce these biases and the resulting findings appropriately interpreted in light of potential remaining biases. We use a case study to demonstrate the framework and its potential to strengthen causal inference in multi-cohort studies through improved analysis design and clarity in the interpretation of findings. Special Collection: N/A.

Reviewing the Impact of Maternal Opioid Use Disorder on Fetal Development and Long-Term Pediatric Health Outcomes

Reviewing the Impact of Maternal Opioid Use Disorder on Fetal Development and Long-Term Pediatric Health Outcomes

18 Past and current care practices for neonates with complex medical needs: A scoping review to support clinical program evaluation

Abstract Background Neonates with complex medical needs (NCMN) are a rapidly growing patient population internationally. Although NCMN are a relatively small proportion of all Neonatal Intensive Care Unit (NICU) admissions, they are high healthcare utilizers. Since 2018, a dedicated Neonatal Complex Care Team (NCCT) has cared for NCMN at a large quaternary care center. The NCCT cares for NCMN in a dedicated, single-family room, patient area within the NICU. This model of care has yet to be evaluated for its potential impact on healthcare outcomes. Objectives The objective of the scoping review is to determine the breadth of available literature on the care practices for the management of NCMN and to collate the available evidence to define outcome measures to be used in a formal program evaluation. Design/Methods The review followed the PRISMA extension for scoping reviews and utilized resources from the Joanna Briggs Institute. The two databases that were utilized include Medline via OVID and CINAHL. The dates for included publications are January 1st 1993, until July 15th 2023. Only studies published in English and primary research were included. Two independent reviewers performed the initial title and abstract screening, and the full text review. The data extraction was completed by one independent reviewer. Results 102 articles were included in the title and abstract screen, and 12 were considered for full text review. Four articles were included. Interventions discussed in the included articles ranged from discharge conferences with patient’s caregivers, to the implementation of an entirely new model of care. Multidisciplinary health care teams appear to be integral to the in-hospital care and smooth discharge of NCMN. We identified that caregiver involvement and satisfaction are important to the discharge process as they are primarily responsible for their infant’s care after discharge, and so it is important that the specifics of care are communicated and taught effectively. The outcomes of interest identified as most useful for clinical program evaluation were length of stay and readmission rate. Additionally there was limited data reported on long-term health outcomes of this patient population. Conclusion This scoping review identified few articles that reported new models of care, a lack of consistent outcomes used in evaluating existing care models and overall a gap in research in this rapidly growing patient population. There is more work to be done to improve care of NCMN and our findings will be used in designing future studies that evaluate care models.

Social Aspects of Food and Nutrition: An Overview

This article explores the multifaceted social aspects of food and nutrition, examining how cultural, economic, and social factors influence dietary habits and health outcomes. It discusses sociological perspectives, including structural functionalism, conflict theory, and symbolic interactionism, highlighting their relevance to food and nutrition. The article also addresses food as a social problem, focusing on issues such as food safety, biotechnology, and dietary disorders, and the role of public health policies in managing these concerns. Cultural influences on food and nutrition are analyzed with examples from various societies, illustrating how traditional foods, religious beliefs, and globalization shape dietary practices. Social influences on eating behavior, including family, peer, and societal norms, are explored, emphasizing their implications for nutritional interventions. The article delves into socio-economic inequalities in nutrition, discussing barriers to healthy eating faced by low-income populations and proposing strategies to address these disparities. Finally, the emerging field of nutritional epigenetics is examined, considering its social and biological implications for long-term health outcomes.

Lesbian, Gay, Bisexual, Transgender and Queer People's Experiences of Stigma Across the Spectrum of Inpatient Psychiatric Care: A Systematic Review.

Lesbian, gay, bisexual, transgender, queer and other diverse sexual orientations and gender identity groups (LGBTQ+) face high rates of poor mental health. In the most severe and emergent of instances, inpatient psychiatric care may be required. LGBTQ+ people report experiences of mistreatment in healthcare settings broadly, such as denial of healthcare services and harassment from healthcare providers and other patients. However, little is known about the experiences of LGBTQ+ people in inpatient psychiatric care settings, specifically. The purpose of this review was to assess the existing literature for descriptions of LGBTQ+ people's experiences within inpatient psychiatric care. We searched multiple databases (i.e., PubMed, PsychINFO, CINAHL, Web of Science and Google Scholar) for peer-reviewed articles that described the experiences of LGBTQ+ people within inpatient psychiatric care that were published in English. The included articles (N = 14) were analysed using a conceptual model of stigma and organised within those strata (structural, interpersonal and individual stigma) across the inpatient experience, (admission, inpatient unit, and discharge). Themes identified included: noninclusive intake tools and pervasive misgendering during the admission process; lack of healthcare infrastructure, inadequate training and lack of cultural humility, pervasive discrimination and victimization, silencing of LGBTQ+ patients, and feelings of fear and shame while on inpatient units, and lack of community resources during the discharge process. Clinicians should consider the perspectives and experiences of LGBTQ+ people to enact identity-affirming care practices that may increase mental healthcare engagement and improve long-term mental health outcomes.

Overcoming the Challenges of Increasing Urbanisation in Respiratory Health

IN THIS year’s European Respiratory Society (ERS) Congress, a session focused on the current challenges related to the impact of urbanisation on respiratory health. This discussion among experts highlighted the role of environmental factors, including air quality, green spaces, and indoor microbiomes, in shaping longterm health outcomes.

A cost-effectiveness analysis of sentinel lymph node biopsy compared with lymphadenectomy in intermediate- and high-risk endometrial carcinoma

BackgroundSentinel lymph node biopsy (SLN) is increasingly used for surgical staging of endometrial carcinoma.ObjectiveTo estimate the effect and cost-effectiveness of the implementation of an SLN algorithm for surgical staging in...

The role of maternal obesity in macrosomia and childhood obesity: a comprehensive review of current evidence and mechanisms

ABSTRACT In recent decades, global rates of overweight and obesity have surged, posing significant health challenges, Maternal obesity is particularly concerning because of its potential adverse effects on women, foetuses, and children. The intrauterine environment plays a crucial role in shaping long-term health outcomes, with maternal factors significantly influencing childhood obesity and related health markers. This review synthesises current evidence on the associations between macrosomia, maternal weight, pregnancy weight gain, and offspring obesity risk. It explores how maternal weight status during pregnancy may impact a child’s susceptibility to obesity later in life, examining potential underlying mechanisms. By consolidating these findings, the review aims to deepen our understanding of the complex relationships between maternal health, prenatal factors, and childhood obesity. This knowledge can inform future research and public health strategies aimed at addressing this global health issue effectively.

Long-Term Mental Health Outcomes of Bronchopulmonary Dysplasia in Neonates: An 18-Year National Cohort Study.

To evaluate the association between neonatal bronchopulmonary dysplasia and the subsequent development of mental health conditions in children and adolescents. This was a retrospective cohort study, utilizing data from individuals born in South Korea between 2002 and 2005 and followed up until 2021, using the National Health Insurance Database. The cohort included 1,893,314 participants born during that period, with 927 diagnosed with bronchopulmonary dysplasia during the neonatal period (the exposed cohort). They were matched 1:10 with 9,270 unexposed individuals (the unexposed cohort) based on key demographic factors. The median age at the first mental health disorder diagnosis was 9 years (interquartile range, 5-15 years), with 5,698 individuals (55.9%) being male. During an average follow-up of 15.2 years, the incidence rate was 481/10,000 person-years in the exposed and 138/10,000 person-years in the unexposed cohort. By the age of 18 years, the cumulative incidence in the exposed cohort was 54% (95% confidence interval [CI]; 50%-57%), with an adjusted hazard ratio of 3.18 (95% CI; 2.81-3.60) compared with the unexposed cohort, and adjusted hazard ratios for early- and late-onset mental health disorders of 4.48 (95% CI; 3.84-5.22) and 1.89 (95% CI; 1.61-2.22), respectively. Sensitivity analyses confirmed these findings, and a subgroup analysis revealed a higher risk among individuals with bronchopulmonary dysplasia who required prolonged respiratory support or oxygen. Half of children with bronchopulmonary dysplasia in our cohort developed mental health disorders by the age of 18 years, emphasizing the need for interventions and support for such individuals.

A nationwide longitudinal investigation on the role of prenatal exposure to infectious diseases on the onset of chronic conditions in children and adolescents in Brazil.

In utero exposure to infections might set the stage for a chain of events leading to a wide spectrum of long-term health outcomes observed in children and adolescents. This proposal aims to investigate whether syphilis, zika, dengue and chikungunya during pregnancy can increase the risk of the offspring developing a non-infectious chronic condition during childhood and adolescence. 1) Estimate the risk of non-infectious chronic conditions associated to syphilis, zika, dengue and chikungunya during pregnancy and when appropriate, explore if the risk varies by timing during pregnancy when the infection is acquired (first, second or third trimester) and severity (such as severe or mild dengue); 2) Investigate whether in uterus exposure to maternal infection affects the growth pattern of children and adolescents; 3) Examine the extent to which the relationship between maternal infection and non-infectious chronic outcomes are mediated by intrauterine growth restriction and preterm birth. We will compare health outcomes and growth trajectories of children and adolescents born to mothers with and without specific infections during pregnancy using conventional multivariable regression in the whole study population, in a within sibship design, using the subgroup of offspring with at least one sibling who is not exposed to the infection, and negative control outcome. Then we will decompose the direct and mediated effects (by preterm birth and small for gestational age) of maternal infection on chronic disorders. The results from this study will advance our understanding of the relationship between infections during pregnancy and chronic disorders, with widespread implications enabling targeting of critical points along the path from in utero exposure to outcomes to avoid or mitigate illness and disability over the life course.

Perspectives on Long-Term Follow-Up Among Living Kidney Donors

Background: The long-term follow-up of living kidney donors is highly variable in Canada. Methods: We surveyed perspectives on post-donation follow-up among 685 living donors in the two largest transplant programs in Canada (43% survey response rate). The anonymous survey was informed by semi-structured interviews with 12 living kidney donors. The survey was developed based on themes identified in the semi-structured interviews, guidance from the research and clinical teams, and feedback from pilot testing with six previous donors. Results: Most (73%) respondents received follow-up after the first donation year from a primary care provider, and 70% reported annual follow-up visits including blood and urine tests. Most (71%) received a follow-up reminder from their transplant center, and follow-up was higher (86% versus 68%) among those receiving reminders. Donors wanted specialist involvement if new health or kidney-related events occurred. Most (70%) were satisfied with their follow-up, and 66% endorsed annual life-long follow-up. Donors wanted more information about lifestyle and living donor outcomes and wanted to contribute to research to increase understanding of long-term donor health outcomes. Conclusions: Donors wanted annual lifelong follow-up including clinical assessment and laboratory tests and more information about their post-donation health. A transplant center led, primary care provider administered model of long-term follow-up may best meet the care and information needs of most donors.