Population-based Longitudinal Study Research Articles

Risk factors for shoulder pain and stiffness in adults aged 44 and older: an 11-year longitudinal population-based study

Objective We conducted a longitudinal observational study over 11 years to identify the risk factors for developing shoulder pain, stiffness, or both. Method The study population (n = 1645) was identified from Health 2000 Survey, a nationally representative sample of Finns aged ≥ 44 years, without shoulder pain and stiffness at the start of the study based on a questionnaire. The independent variables included age, sex, body mass index (BMI), education level, diabetes, physical work exposures, and Beck’s depression score. We used multinomial logistic regression models to estimate relative risk ratios and 95% confidence intervals for three outcomes: shoulder pain, shoulder stiffness, and both combined. Results We found that excess body mass and depressive symptoms were shared statistically significant risk factors for all three outcomes. However, we also observed distinct risk factor profiles: older age was associated with lower risk of shoulder pain but higher risk for shoulder stiffness with or without pain, while females had a lower risk of shoulder stiffness with or without pain. Participants with diabetes had higher risk of shoulder stiffness only. Physical workload factors predicted an increased risk of the combination of shoulder pain and stiffness. Conclusions Our study identified increased BMI and depressive symptoms as consistent risk factors for shoulder pain, stiffness, or both. Older age increased the risk of shoulder stiffness but lowered the risk of pain alone, while females had a lower risk of stiffness. Diabetes was specifically linked to shoulder stiffness, and physical workload increased the risk of combined pain and stiffness.

Burden of Respiratory Syncytial Virus Infection in Children and Older Patients Hospitalized with Asthma: A Seven-Year Longitudinal Population-Based Study in Spain

(1) Background: To describe hospitalizations due to respiratory syncytial virus (RSV) infection among children and elderly patients with asthma. (2) Methods: We used a nationwide discharge database to select patients with asthma aged 0 to 15 years and ≥65 years admitted to Spanish hospitals from 2016 to 2022. (3) Results: We identified 49,086 children and 471,947 elderly patients hospitalized with asthma (3.52% and 0.51%, respectively, with RSV). The proportion of RSV increased over time in children with asthma (from 1.44% to 7.4%, p < 0.001) and in elderly individuals (from 0.17% to 1.01%, p < 0.001). Among children with RSV infection, the presence of influenza (OR 3.65; 95% CI 1.46–9.1) and pneumonia (OR 1.85; 95% CI 1.02–3.55) increased the risk of poor outcome. The presence of RSV was associated with severity in these patients, defined by use of mechanical ventilation and/or admission to the intensive care unit (OR 1.44; 95% CI 1.11–1.86). In elderly patients with RSV infection, older age, congestive heart failure, COVID-19, and pneumonia increased the risk of in-hospital mortality (IHM). However, RSV infection was not associated with IHM (OR 0.88; 95% CI 0.68–1.15) in these patients. (4) Conclusion: Our results highlight the impact of RSV infection in children and elderly patients hospitalized with asthma. Strategies to improve surveillance, prophylaxis, and management of RSV infection should be evaluated.

Home Mechanical Ventilation and Risk of Hospitalization in Obesity Hypoventilation Syndrome - The Population-based DISCOVERY Study.

Patients with obesity hypoventilation syndrome (OHS) have high risk of hospitalization, which might be decreased by home mechanical ventilation (HMV). To evaluate annualized hospitalization rate (AHR) and change in AHR in patients with OHS starting home mechanical ventilation (HMV), and explore if there were any difference in AHR by starting HMV acutely or electively. Population-based longitudinal study of patients with OHS starting HMV in the Swedish DISCOVERY cohort between 1996 and 2018, cross-linked with the National Patient Registry for national data on hospital admissions. AHR was calculated for each patient for three years before (Year -3, -2, -1) and three years after (Year 1, 2, 3) the year of starting HMV (Year 0; start date ± 6 months). Differences in AHR were analyzed using Wilcoxon signed-rank test (between years) and Mann-Whitney U test (between acute/elective). Proportion of patients hospitalized in each year was analyzed and comparison between years was done with McNemar´s test. Factors associated with change in AHR were identified using multivariate linear regression models. In total, 2,445 patients were included: 47% females, mean age 62.3 ± 12.2 years, and 1,418 (58%) started HMV electively. Overall, AHR decreased with 0.88 (95%CI 0.74-1.02) hospitalization/year after start of HMV and starting treatment acutely was associated with greater decrease in AHR. There was no statistically significant difference in AHR in Year 1 between acute and elective start (P=0.199). The year after start of HMV, proportion of patients hospitalized decreased from 84% to 54% (P<0.05). Initiation of HMV was associated with reduced hospitalization rate in patients with OHS, irrespective of acute or elective start. Majority of patients with OHS are hospitalized in the year of HMV initiation.

Maternal Immune Activation and Child Brain Development: A Longitudinal Population-based Multimodal Neuroimaging study

Maternal Immune Activation (MIA) has been hypothesized to have an adverse effect on child neurodevelopment, but only a few neuroimaging studies have been performed to date, mostly in neonates. In this population-based cohort study, we investigated the association between MIA and multiple neuroimaging modalities depicting brain development from childhood to adolescence. We used data of mother-child pairs from the Generation R Study. To define our exposure, we measured IL-1β, IL-6, IL-17a, IL-23 and IFN-γ, and CRP at two time points during pregnancy. Given that levels of these 5 cytokines were highly correlated, we were able to compute a Cytokine index. We used multiple brain imaging modalities as outcomes, encompassing global and regional measures of brain morphology (structural MRI, volume, n=3,295), white matter microstructure (diffusion MRI, FA and MD, n=3,267), and functional connectivity (functional MRI, graph theory measures and network-level connectivity, n=2,914) at child mean ages 10 and 14 years. We performed mixed-effects models using the child's age as continuous time variable. We found no significant association or time interaction between MIA and any neuroimaging outcomes in children over time. These associations were similar for the Cytokine index, CRP, and individual cytokines. We observed no evidence for differential effects of timing of prenatal MIA or child sex after multiple testing correction. This longitudinal population-based study reports no evidence for an association between MIA and child brain development in the general population. Our findings differ from prior research in neonates showing structural and functional brain abnormalities after MIA.

Associations and mediating factors between adverse childhood experiences and substance use behaviours in early adulthood: A population-based longitudinal study

BackgroundResearch has demonstrated positive associations between adverse childhood experiences (ACEs) and substance use behaviours in young adults. However, many of these are based on cross-sectional data. The pathway between ACEs and substance misuse among emerging adults is also not fully understood and few studies have investigated potential mediating factors. MethodsWe analysed data from the Child Cohort of the Growing Up in Ireland study, a nationally representative longitudinal sample of children recruited at 9 years of age (n = 4,729). Logistic regression was used to examine individual and cumulative ACE exposure relationships with substance use at age 20 years. Mediation analyses were used to assess whether parental and peer relationships and school engagement mediate ACE history associations with substance use behaviours. ResultsACE exposure relationships with current cannabis use, other illicit drug use and problematic drug use were observed. In particular, young adults who had experienced 2 ACEs or 3 + ACEs had an approximate two-fold (OR=1.80, 95 % CI: 1.29, 2.51) and approximate three-fold (OR=2.94, 95 % CI: 2.06, 4.19) increased odds of problematic drug use, respectively, when compared to participants who had experienced no ACEs during the study period. Mediation analyses suggested that parent and peer attachment and liking school partially mediate relationships between ACEs and substance use behaviours. ConclusionsChildren who have experienced ACEs are at higher risk of future substance use and problematic drug use. In supporting these children, identified mediators such as interpersonal relationships and school engagement may help guide selection of prevention interventions.

Endocrine disorders in Rett syndrome: a systematic review of the literature

BackgroundRett syndrome (RTT) is an X-linked progressive neurodevelopmental disorder that involves mainly girls and is the second most frequent cause of genetic intellectual disability. RTT leads to neurological regression between 6 and 18 months of life and could be associated with a variable neurological impairment. However, RTT affects not only neurological function but also wide aspects of non-neurological organs. Recent data showed that the endocrine system is often involved in RTT patients, including disorders of growth, bone health, thyroid, puberty onset, and weight abnormalities However, systematic data on endocrinopathies in RTT are scarce and limited.ObjectiveThis review aims to analyze the prevalence and type of endocrine comorbidities in RTT population, to allow a precocious diagnosis and appropriate endocrinological management.MethodsSystematic research was carried out from January 2000 to March 2024 through MEDLINE via PubMed, Scopus, and the Cochrane Library.ResultsAfter the selection phase, a total of 22 studies (1090 screened) met the inclusion criteria and were reported in the present review. Five studies were observational-retrospective, four were cross-sectional and case report or series, three were survey, prospective, and case-control, and finally one study for descriptive-transversal and longitudinal population-based study. The sample population consisted of multiethnic groups or single ethnic groups. The main endocrinopathies reported were malnutrition, bone alterations, and alterations of puberty onset.ConclusionsOur analysis shows that endocrinopathies are not rare in RTT patients. Therefore, in the context of a multidisciplinary approach, accurate screening and monitoring for endocrinopathies should be recommended in all RTT patients, to improve clinical practice, healthcare management, and, finally, patients’ quality of life.

Examining the complex dynamics influencing acute malnutrition in Turkana and Samburu counties: Study protocol.

Acute malnutrition in children under 5 years is persistent in Eastern Africa's arid and semiarid lands. This study aimed to identify the drivers of acute malnutrition in Turkana and Samburu counties, Kenya. This was a population-based longitudinal mixed-methods observational study. Qualitative and quantitative data were collected at Wave 1, but only quantitative data were collected during follow-up. Participants were a representative sample of children and their primary caregivers from households with children under 3 years at Wave 1. Anthropometric measurements of all children under 5 years in the sampled households were taken at Wave 1 (May to July 2021), and one child under 3 years was randomly selected for follow-up about every 4 months over 2 years for six data collection waves. The study also collected data on sociodemographics; child feeding practices and morbidity; household water and food insecurity; shocks; coping strategies, social safety nets and economic safeguards; water, sanitation and hygiene; women's decision-making and food consumption. Qualitative data were collected through community dialogues, focus group discussions, in-depth interviews, photovoice and key informant interviews with mothers and fathers with children under 5 years, community leaders, county officials and staff of nongovernmental organisations. Data collection is complete and analysis is ongoing. The analysis includes thematic analysis of qualitative data and descriptive and multi-variable regression analyses of quantitative data.

Association of childhood obesity or weight change with early-onset follicular occlusion triad among children.

The effects of childhood obesity or weight gain on the development of early-onset follicular occlusion triad (FOT) among children, which includes hidradenitis suppurativa (HS), acne conglobata (AC), and dissecting cellulitis of the scalp (DCS), remain unknown. To investigate the association between body mass index (BMI) or its changes and early-onset FOT development. This nationwide population-based longitudinal cohort study included a cohort of 2,012,928 Korean children who underwent two consecutive health examinations at 30-36 months and 42-48 months of age between 2009 and 2020. The BMI and its changes derived during health screenings at 30-36 and 42-48 months. We performed multivariate Cox proportional hazards regression analyses to estimate the risk of early-onset FOT, including HS, AC, and DCS. During the follow-up, 1,283 FOT, including 143 HS, 1,068 AC, and 72 DCS, events were identified. Children with obesity were at an elevated risk of early-onset FOT compared to those with a normal weight (FOT: adjusted hazard ratio [aHR] 1.49, 95% confidence interval [CI] 1.21-1.84; HS: aHR 2.30, 95% CI 1.39-3.82; AC: aHR 1.36, 95% CI 1.07-1.73). BMI gain was correlated with an elevated risk of early-onset FOT, particularly HS, whereas BMI loss was linked to a decreased risk of early-onset FOT, especially HS. Children who became obese had an increased early-onset FOT risk (aHR 1.51, 95% CI 1.07-2.14) compared to those who maintained a normal weight. Children who reduced from obese to normal weight exhibited a decreased risk of early-onset FOT (FOT: aHR 0.41, 95% CI 0.17-0.96, P for trend=0.02; HS: P for trend=0.05) compared to obese children who retained their weight. Childhood obesity was associated with an elevated risk of early-onset FOT, including HS and AC. Weight gain was correlated with an increased risk of early-onset FOT, especially HS, while weight loss was associated with a decreased risk of early-onset FOT, particularly HS. Implementing purposeful weight-reduction strategies may be helpful in preventing early-onset FOT development.

Health-related quality of life and supportive care needs in young adult cancer survivors-a longitudinal population-based study.

To examine health-related quality of life (HRQoL) and supportive care needs among young adult (YA) cancer survivors up to 3years post-diagnosis. A national cohort of individuals diagnosed at 18-39years with breast, cervical, ovarian, or testicular cancer, lymphoma or brain tumor was approached with surveys at 1.5 (n = 1010, response rate 67%) and 3 (n = 722) years post-diagnosis. HRQoL was measured using the EORTC QLQ-C30. Scores were dichotomized using cut-off scores to predict supportive care needs in the Supportive Care Needs Survey-Long Form 59 (SCNS-LF59). Swedish cancer quality registers provided clinical data. Factors predicting need of support at 1.5 and 3years post-diagnosis were identified using logistic regression. HRQoL improvements over time were trivial to small. At both time points, a majority of respondents rated HRQoL levels indicating supportive care needs. At 1.5years post-diagnosis, the risk of having support needs was lower among survivors with testicular cancer (compared to lymphoma) or university-level education, and higher among those on treatment (predominantly endocrine therapy). At 3years post-diagnosis, when controlling for previous HRQoL scores, most correlations persisted, and poor self-rated household economy and chronic health conditions were additionally associated with supportive care needs. A majority of YAs diagnosed with cancer rate HRQoL at levels indicating support needs up to 3years post-diagnosis. Testicular cancer survivors are at lower risk of having support needs. Concurrent health conditions and poor finances are linked to lower HRQoL. More efforts are needed to provide adequate, age-appropriate support to YA cancer survivors.

Sex-specific dementia risk in known or suspected obstructive sleep apnea: A 10-year longitudinal population-based study

Abstract Study Objective To evaluate sex-specific associations between known or suspected OSA and dementia risk over 10-years among older women and men. Methods This study included 18,815 women and men age 50+ years (dementia-free at baseline) who participated in the Health and Retirement Study (HRS), a nationally representative cohort of US adults. Presence of OSA was defined by self-reported diagnosis or key HRS items that correspond to elements of a validated OSA screening tool (STOP-Bang). Incident dementia cases were identified using a validated, HRS-based algorithm derived from objective cognitive assessments. Survey-weighted regression models based on pseudo-values were utilized to estimate sex- and age-specific differences in cumulative incidence of dementia by OSA status. Results Data from 18,815 adults were analyzed, of which 9% of women and 8% of men (weighted proportions) met criteria for incident dementia. Known/suspected OSA was more prevalent in men than in women (weighted proportions 68% vs. 31%). Unadjusted sex-stratified analyses showed that known/suspected OSA was associated with higher cumulative incidence of dementia across ages 60–84 years for women and men. By age 80, relative to adults without known/suspected OSA, the cumulative incidence of dementia was 4.7% higher (CI 2.8%,6.7%) for women with known/suspected OSA, and 2.5% (CI 0.5%,4.5%) for men with known/suspected OSA, respectively. Adjusted associations between age-specific OSA and cumulative incidence of dementia attenuated for both women and men but remained statistically significant. Discussion OSA contributes to dementia risk in older adults, particularly women. This study illuminates the impact of a potentially modifiable yet frequently overlooked risk factor for dementia onset.

Associations between body height and cardiovascular risk factors in women and men: a population-based longitudinal study based on The Tromsø Study 1979–2016

ObjectivesInvestigate associations between body height and cardiovascular disease risk factors at several time points in women and men across educational levels in Norway.DesignPopulation-based longitudinal study.SettingThe Tromsø Study, a population-based study...

Association between husband's participation in household work and the onset of depressive symptoms in married women: A population-based longitudinal study in South Korea

An unequal distribution of household work by gender is prevalent. This study explored the association between husbands' participation in household work and the onset of depressive symptoms among married Korean women. A nationwide sample of 7024 married women was repeatedly followed up at 2-year intervals from 2014 to 2022 (20,343 observations). The daily household work hours of both the participants and their husbands were self-reported. Satisfaction with husbands' participation in household work was classified as satisfactory, neutral, or dissatisfactory. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiologic Studies Depression. A generalized estimating equation was employed to determine how household work participation was associated with the onset of depressive symptoms in married women at the 2-year follow-up. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. The mean daily hours spent on household work were 2.62 h for married women and 0.35 h for husbands. A 1-h increase in the husbands' daily time spent on household work was negatively associated with the risk of onset of depressive symptoms in married women (RR: 0.88, 95% CI: 0.80–0.98). Compared with individuals with neutral responses, those satisfied with their husband's household work had a lower risk of depressive symptom onset (RR: 0.82, 95% CI: 0.74–0.90), whereas dissatisfaction was linked to increased risk (RR: 1.15, 95% CI: 1.04–1.27). Husbands' participation in household work was associated with a reduced risk of depressive symptom onset among married women. Achieving gender equality in the division of household work is important for women's mental health.

Hidradenitis Suppurativa and Maternal and Offspring Outcomes

Hidradenitis suppurativa (HS) is associated with morbidity in persons of reproductive age, but the effect on maternal and offspring outcomes is understudied. To determine the association of HS with pregnancy outcomes and maternal and child morbidity in the long term. This population-based longitudinal cohort study with up to 16 years of follow-up took place between 2006 and 2022 in Quebec, Canada. . Maternal HS. Outcomes included hypertensive disorders of pregnancy, gestational diabetes, and other birth outcomes as well as the long-term risk of hospitalization up to 16 years after delivery. The study used adjusted log-binomial and Cox proportional hazards regression models to estimate the association between maternal HS and pregnancy outcomes or hospitalization following pregnancy. Outcomes in both mothers and offspring were assessed. There were 1 324 488 deliveries during the study, including 1332 (0.1%) among mothers with HS. Compared with patients without HS, patients with HS had a greater risk of hypertensive disorders of pregnancy (risk ratio [RR], 1.55 [95% CI, 1.29-1.87]), gestational diabetes (RR, 1.61 [95% CI, 1.40-1.85]), and severe maternal morbidity (RR, 1.38 [95% CI, 1.03-1.84]). In neonates, maternal HS was associated with risk of preterm birth (RR, 1.28 [95% CI, 1.07-1.53]) and birth defects (RR, 1.29 [95% CI, 1.07-1.56]). In the long term, HS was associated with 2.29 times the risk of maternal hospitalization (95% CI, 2.07-2.55) and 1.31 times the risk of childhood hospitalization (95% CI, 1.18-1.45), including hospitalization for respiratory, metabolic, psychiatric, and immune-related morbidity over time. This cohort study found that HS is associated with adverse maternal and offspring outcomes in the peripartum period and in the long term. Early detection and management of HS may help mitigate these outcomes.

Racial/ethnic differences in the association of incident stroke with late onset epilepsy: The Northern Manhattan Study.

Little is known about the incidence of late onset epilepsy (LOE) across different racial/ethnic groups in the USA, particularly in the Hispanic population. Stroke, a strong predictor of LOE, is more common in non-Hispanic Blacks (NHBs) and Hispanics than in non-Hispanic Whites (NHWs). We assessed the incidence of LOE across racial/ethnic groups and examined whether the associations of stroke with LOE risk differ by race/ethnicity. The Northern Manhattan Study is a population-based longitudinal study of older adults enrolled between 1993 and 2001. Participants free of history of stroke or epilepsy at baseline (n = 3419) were followed prospectively for incidence of LOE. We estimated LOE incidence per 1000 person-years in each racial/ethnic group. We used Cox proportional hazards regression to assess the association of race/ethnicity with LOE and multiplicative interactions of race/ethnicity with incident stroke in relation to LOE, adjusting for demographics and comorbid diagnoses. During 51 176 person-years of follow-up, 183 individuals developed LOE. Incidence of LOE was significantly higher in NHBs (6.2 per 1000 person-years) than in NHWs (3.3 per 1000 person-years, p = .004). There was no significant difference in LOE incidence between NHWs (3.3 per 1000 person-years) and Hispanics (2.6 per 1000 person-years, p = .875). However, following incident stroke, the risk of LOE differed across racial/ethnic groups. Incident stroke was associated with 2.55 times the risk of LOE among NHWs (95% confidence interval [CI] = .88-7.35), 8.53 times the risk of LOE among Hispanics (95% CI = 5.36-13.57, p = .04 for stronger association than that in NHWs), and 6.46 times the risk of LOE among NHBs (95% CI = 3.79-11.01, p = .12 for stronger association than that in NHWs). We found a stronger association of incident stroke with LOE risk in Hispanics and NHBs than in NHWs, offering some insight into the racial/ethnic disparities of LOE incidence.

External validation of dementia prediction models in Black or African American and White older adults: A longitudinal population-based study in the United States.

Identifying people at high risk of Alzheimer's disease (AD) dementia allows for timely intervention, which, if successful, will result in preventing or delaying the onset of the disease. Utilizing data from the Chicago Health and Aging Project (CHAP; n=2130), we externally evaluated four risk-prediction models for AD dementia, including Cardiovascular Risk Factors, Aging, and Dementia (CAIDE), Australian National University Alzheimer's Disease Risk Index (ANU-ADRI), Brief Dementia Screening Indicator (BDSI), and Dementia Risk Score (DRS), in Black or African American and White adults. BDSI had the highest discriminate abilities for AD dementia (c-statistics of 0.79 in Black and 0.77 in White adults), followed by ANU-ADRI, within the age range and follow-up period of the original development cohort. CAIDE had the lowest discriminating power (c-statistic≤0.55). With increasing follow-up periods (i.e., 10-15 years), the discrimination abilities for all models declined. Because of racial disparities in AD dementia and longer preclinical and prodromal stages of disease development, race-specific models are needed to predict AD risk over 10 years. Utilizing risk-prediction models to identify individuals at higher risk of Alzheimer's disease (AD) dementia could benefit clinicians, patients, and policymakers. Clinicians could enroll high-risk individuals in clinical trials to test new risk-modifiable treatments or initiate lifestyle modifications, which, if successful, would slow cognitive decline and delay the onset of the disease. Current risk-prediction models had good discriminative power during the first 6 years of follow-up but decreased with longer follow-up time. Acknowledging the longer preclinical phase of AD dementia development and racial differences in dementia risk, there is a need to develop race-specific risk-prediction models that can predict 10 or 20 years of risk for AD and related dementias.

Population dynamics of HIV drug resistance during treatment scale-up in Uganda: a population-based longitudinal study.

Clinical studies have reported rising pre-treatment HIV drug resistance during antiretroviral treatment (ART) scale-up in Africa, but representative data are limited. We estimated population-level drug resistance trends during ART expansion in Uganda. We analyzed data from the population-based open Rakai Community Cohort Study conducted at agrarian, trading, and fishing communities in southern Uganda between 2012 and 2019. Consenting participants aged 15-49 were HIV tested and completed questionnaires. Persons living with HIV (PLHIV) provided samples for viral load quantification and virus deep-sequencing. Sequence data were used to predict resistance. Population prevalence of class-specific resistance and resistance-conferring substitutions were estimated using robust log-Poisson regression. Data from 93,622 participant-visits, including 4,702 deep-sequencing measurements, showed that the prevalence of NNRTI resistance among pre-treatment viremic PLHIV doubled between 2012 and 2017 (PR:1.98, 95%CI:1.34-2.91), rising to 9.61% (7.27-12.7%). The overall population prevalence of pre-treatment viremic NNRTI and NRTI resistance among all participants decreased during the same period, reaching 0.25% (0.18% - 0.33%) and 0.05% (0.02% - 0.10%), respectively ( p- values for trend = 0.00015, 0.002), coincident with increasing treatment coverage and viral suppression. By the final survey, population prevalence of resistance contributed by treatment-experienced PLHIV exceeded that from pre-treatment PLHIV, with NNRTI resistance at 0.54% (0.44%-0.66%) and NRTI resistance at 0.42% (0.33% - 0.53%). Overall, NNRTI and NRTI resistance was predominantly attributable to rtK103N and rtM184V. While 10.52% (7.97%-13.87%) and 9.95% (6.41%-15.43%) of viremic pre-treatment and treatment-experienced PLHIV harbored the inT97A mutation, no major dolutegravir resistance mutations were observed. Despite rising NNRTI resistance among pre-treatment PLHIV, overall population prevalence of pre-treatment resistance decreased due to treatment uptake. Most NNRTI and NRTI resistance is now contributed by treatment-experienced PLHIV. The high prevalence of mutations conferring resistance to components of current first-line ART regimens among PLHIV with viremia is potentially concerning. National Institutes of Health and the Gates Foundation. Evidence before the study: We searched PubMed for studies matching the keywords "hiv" "resistance" "longitudinal" "cohort" "population" published since 2004 (the beginning of antiretroviral therapy (ART) availability in sub-Saharan Africa) and identified 50 studies. We excluded 34 studies not based in sub-Saharan Africa, five studies primarily concerned with infection with other pathogens (e.g. HBV, M. tuberculosis ), two studies concerned with insulin resistance, one sequencing-methods paper, and one paper concerned with host susceptibility to HIV infection. The remaining seven studies were not population-based meaning that the study population was not all persons but e.g. people living with HIV enrolled in care at a given clinic. Population-based cohort are essential for monitoring HIV drug resistance in both treated and untreated individuals, including those people who may go undetected in clinical settings, capturing evolutionary dynamics of resistance in real-world conditions. Added value of this study: We estimated the prevalence of drug resistance over five consecutive survey rounds of a population-based open-cohort study in southern Uganda between 2012 and 2019 during a period of intense treatment scale-up. We show that among the entire population regardless of HIV status, 0.8% and 0.5% of individuals harbor viremic resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside-reverse transcriptase inhibitors (NRTIs), respectively, of which the majority is dual-class NNRTI/NRTI resistance. Despite a two-fold increase in the prevalence of NNRTI resistance among pre-treatment viremic PLHIV, the overall prevalence of pre-treatment viremic resistance in the entire population decreased by more than 50% due to increased treatment initiation and population viral load suppression. The majority of resistance in recent survey rounds was contributed by treatment-experienced PLHIV. Among treatment-experienced viremic PLHIV, we observe a substantial burden of mutations that confer resistance to the NNRTI and NRTI components of dolutegravir and cabotegravir based regimens e.g. rtM184V (34%) rtY181C (15%), rtG190A (12%), rtK65R (12%), and rtK101E (9.5%). The integrase strand transfer inhibitor (INSTI) resistance mutation inT97A was observed in about a tenth of viremic PLHIV.These results provide the first longitudinal population-based estimates of temporal trends in the prevalence of drug resistance during ART program expansion in a high-burden setting. Further, they provide critical insight into the landscape of prevalent drug resistance substitutions circulating in this population.Implications of all the available evidence: Scale-up of HIV treatment has increased the prevalence of drug resistance mutations among viremic people living with HIV in sub-Saharan Africa. The relatively high prevalence of NNRTI resistance has prompted a recent shift to first-line regimens including dolutegravir (an INSTI) in combination with NRTIs. The high prevalence of mutations conferring resistance to components of current first-line regimens in our population warrants continued monitoring of treatment failures and the prevalence of drug resistance in high burden settings.

Genome-wide association study of subfoveal choroidal thickness in a longitudinal cohort of older adults

To identify genetic influences on subfoveal choroidal thickness of older adults using a genome-wide association study (GWAS). We recruited 300 participants from the population-based Korean Longitudinal Study on Health and Aging (KLoSHA) and Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) cohort studies and 500 participants from the Bundang age-related macular degeneration (AMD) cohort study dataset. We conducted a GWAS on older adult populations in the KLoSHA and KLOSCAD cohorts. Single nucleotide polymorphisms (SNPs) associated with choroidal thickness were identified with P values < 1.0 × 10−4 in both the right and left eyes, followed by validation using the Bundang AMD cohort dataset. This association was further confirmed by a functional in vitro study using human umbilical vein endothelial cells (HUVECs). The ages of the cohort participants in the discovery and validation datasets were 73.5 ± 3.3 and 71.3 ± 7.9 years, respectively. In the discovery dataset, three SNPs (rs1916762, rs7587019, and rs13320098) were significantly associated with choroidal thickness in both eyes. This association was confirmed for rs1916762 (genotypes GG, GA, and AA) and rs7587019 (genotypes GG, GA, and AA), but not for rs13320098. The mean choroidal thickness decreased by 56.7 μm (AA, 73.8%) and 31.1 μm (GA, 85.6%) compared with that of the GG genotype of rs1916762, and by 55.4 μm (AA, 74.2%) and 28.2 μm (GA, 86.7%) compared with that of the GG genotype of rs7587019. The SNPs rs1916762 and rs7587019 were located close to the FAM124B gene near its cis-regulatory region. Moreover, FAM124B was highly expressed in vascular endothelial cells. In vitro HUVEC experiments showed that the inhibition of FAM124B was associated with decreased vascular endothelial proliferation, suggesting a potential mechanism of choroidal thinning. FAM124B was identified as a susceptibility gene affecting subfoveal choroidal thickness in older adults. This gene may be involved in mechanisms underlying retinal diseases associated with altered choroidal thickness, such as age-related macular degeneration.

Adverse childhood experiences, economic challenges and suicide risk under COVID-19 pandemic: results from U-CORONA study

Purpose The purpose of this study is to examine the synergistic effect of adverse childhood experiences (ACEs) and economic challenges on suicide risk, under the coronavirus disease 2019 (COVID-19) pandemic, using a prospective population-based cohort study. Design/methodology/approach Participants included 435 adults (aged from 18 to 92 years, mean = 53.8) from the Utsunomiya COVID-19 seROprevalence Neighborhood Association (U-CORONA) study, a population-based longitudinal study in Utsunomiya city, Japan. The baseline survey was conducted in June 2020, between the first and the second wave of the COVID-19 pandemic in Japan. ACEs were assessed using 13 items, and economic challenges due to the COVID-19 were assessed using one item. In the follow-up study, conducted in October 2020 between the second and the third wave of the COVID-19 pandemic in Japan, suicide risk was assessed using six items from the Mini-International Neuropsychiatric Interview via a self-reported questionnaire. Findings This study found positive independent association between ACEs and economic challenges due to COVID-19 and suicide risk. Synergistic effects were also found: the participants with one ACE and economic challenges and those with 2+ ACEs and economic challenges were more likely to be at higher risk of suicide compared to those without ACEs and economic challenges. Originality/value The findings suggest that adults with a higher number of ACEs, in addition to severe economic challenges, were more likely to be at risk for suicide during the COVID-19 pandemic.

Childhood poverty, social support, immigration background and adolescent health and life satisfaction: A population-based longitudinal study.

This study examined whether poverty (neighborhood and household) was associated with future health or life satisfaction outcomes and whether the association operated through social support (adult support at home, adult support at school, peer belonging), or differed by the immigration background (nonimmigrant family or immigrant family) of the family. This study utilized a retrospective, longitudinal, population-based cohort that included self-reported survey data from the Middle Years Development Instrument (MDI) completed by children at age 9 and age 12, linked to administrative records. Participants included 5906 children in British Columbia, Canada. Neighborhood and household poverty were observed at age 8. Social support from adults and peers was self-reported at age 9. Outcomes (overall health; life satisfaction) were self-reported at age 12. Adjusted multi-level multiple linear regression analyses and parallel mediation analyses were utilized. The interaction between poverty exposure and immigration background was also examined. Exposure to either poverty type was associated with lower levels of life satisfaction and overall health at age 12, though household poverty appeared to be associated with lower outcomes in comparison to neighborhood poverty. The indirect effects of poverty on outcomes appeared to operate primarily through adult support at home and peer belonging. Children in immigrant families had a larger negative association between neighborhood poverty and life satisfaction. Household poverty had a larger negative association to outcomes in comparison to neighborhood poverty. The association of poverty to outcomes differed by immigration background and operated partially through adult support at home and peer belonging.

Association between dynapenic obesity and risk of cardiovascular disease: The Hisayama study.

Dynapenic obesity is a condition characterized by high adiposity levels combined with muscle dysfunction. Although high adiposity and muscle loss/dysfunction are thought to synergistically increase the risk of cardiovascular disease (CVD), few studies have addressed the association between dynapenic and sarcopenic obesity and CVD. We aimed to investigate the association of dynapenic obesity with incident CVD events using the data from a population-based prospective longitudinal study in Japan. A total of 2490 community-dwelling Japanese aged 40-79years (42.5% males, mean age 57.7±10.6years) without a history of CVD were followed up for a median of 24years. Handgrip strength was classified as low, medium, or high by age- and sex-specific tertiles. Body mass index (BMI) levels were categorized as lean (<18.5kg/m2), normal (18.5-24.9kg/m2), or obese (≥25.0kg/m2). Dynapenic obesity was defined as having both low handgrip strength and obesity. The outcomes were defined as the first-ever development of CVD (defined as stroke or coronary heart disease). The hazard ratios (HRs) and their 95% confidence intervals (CIs) for the development of CVD were estimated using a Cox proportional hazards model, in which participants with high handgrip strength and normal BMI were used as a reference group. Mediation analyses used serum high-sensitivity C-reactive protein (hs-CRP) and homeostatic model assessment for insulin resistance (HOMA-IR) as mediators. During the follow-up period, 482 participants developed CVD events (324 cases of stroke and 209 of coronary heart disease). The multivariable-adjusted risk of CVD increased significantly among participants with dynapenic obesity compared with the reference group (HR 1.49, 95% CI 1.03-2.17). An analysis by age groups showed a further increase in the risk of CVD among participants with dynapenic obesity aged less than 65years (HR 1.66, 95% CI 1.04-2.65). In mediation analyses for participants aged less than 65years, serum hs-CRP was shown to be a significant mediator explaining 13.8% of the association between dynapenic obesity and the development of CVD, while HOMA-IR explained 12.2% of this relationship. Dynapenic obesity was a significant risk factor for the development of CVD in a general Japanese population. This association was more pronounced among those aged <65years. Inflammation, and possibly glucose metabolism, might partly mediate this association. Our findings suggest that preventing muscle dysfunction as well as appropriate weight control, especially in middle-age, are important for preventing the development of CVD.