One-year Prospective Follow-up Study Research Articles

Childhood trauma and treatment resistance in first-episode psychosis: Investigating the role of premorbid adjustment and duration of untreated psychosis

BackgroundEarly identification of treatment non-response in first-episode psychosis (FEP) is essential to outcome. Despite indications that exposure to childhood trauma (CT) can have adverse effects on illness severity, its impact on treatment non-response and the interplay with other pre-treatment characteristics is sparsely investigated. We use a lack of clinical recovery as an early indicator of treatment resistance to investigate the relationship between CT and treatment resistance status at one-year follow-up and the potential mediation of this effect by other pre-treatment characteristics. MethodsThis prospective one-year follow-up study involved 141 participants recruited in their first year of treatment for a schizophrenia-spectrum disorder. We investigated clinical status, childhood trauma (CT), premorbid adjustment (PA), and duration of untreated psychosis (DUP) at baseline and clinical status at one-year follow-up. Ordinal regression analyses were conducted to investigate how PA and DUP affected the relationship between CT and one-year outcome in FEP. Results45 % of the FEP sample reported moderate to severe CT, with significantly higher levels of CT in the early treatment resistant group compared to participants with full or partial early recovery. Ordinal regression analysis showed that CT was a significant predictor of being in a more severe outcome group (OR = 4.59). There was a partial mediation effect of PA and a full mediation effect of DUP on the effect of CT on outcome group membership. DiscussionOur findings indicate that reducing treatment delays may mitigate the adverse effects of CT on clinical outcomes and support the inclusion of broad trauma assessment in FEP services.

The role of functioning in predicting nursing home placement or death among older home care patients

Objective There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. Design A prospective one-year follow-up study. Settings and subjects Persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293). Main outcome measures Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). Results Of the 293 patients (mean age 82.6 years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350 days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62–0.86), IADL (0.75, 0.65–0.87) MMSE (0.92, 0.87–0.96), and TUG (1.02, 1.01–1.03). NHP alone was predicted by BADL (0.62, 0.50–0.78), IADL (0.57, 0.45–0.73), and MMSE (0.88, 0.82–0.94) and mortality by TUG (1.02, 1.01–1.03). Conclusion Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year.

Incidence of and Risk Factors for Missing Events Due to Wandering in Community-Dwelling Older Adults with Dementia

The burden of missing incidents due to wandering with dementia is not only on the patient but also on their family, neighbors, and community. In this study, we conducted a non-randomized prospective one-year followup cohort study based on symptom registration with missing cases due to wandering with dementia as the endpoint. The incidence and recurrence rates of missing events were calculated. Furthermore, analysis of variance and logistic regression analysis were performed to clarify the risk factors associated with the missing event. Among the 236 patients with dementia enrolled, 65 (27.5%) had a previous missing event at baseline. Of the 65 patients with dementia who had a previous missing event at baseline, 28 had a missing event during the oneyear follow-up period (recurrence rate of 43.1%). Of the 171 who did not have a previous missing event at baseline, 23 had a missing event during the one-year follow-up period (incidence rate of 13.5%). Prevention of missing events requires focused attention on changes in the Mini-Mental State Examination, Dementia Behavior Disturbance Scale, Alzheimer's Disease Assessment Scale scores, and the development of a social environment for supporting family caregivers.

Wellness of patients with chronic pain is not only about pain intensity.

Attaining good outcomes in the management of chronic pain remains a clinical challenge. This study aimed to investigate the relationships between - and the contribution of - pain and related conditions to the wellness of these patients. A secondary analysis of database of patients with chronic pain treated with medical cannabis (MC) to carry out a one-year prospective follow-up study was conducted. Questionnaires were completed before (T0 ), six (T6 ), and twelve (T12 ) months after MC initiation. Data included patients' demographics and questionnaires related to three latent factors: pain intensity measures, related conditions (catastrophizing, sleep disturbance, anxiety, and depression), and wellness parameters (quality-of-life, disability, subjective-health-state). Weighted average of the observed variables (WOBs) were calculated for each latent factor. Longitudinal structural equation modeling (SEM) and mediation analyses were performed to identify predictors and interrelations between the WOBs, respectively. Participants included 510 patients. All variables were significantly improved from T0 to T6 and T12 . SEM revealed that related conditions, and to a lesser extent pain, predicted wellness at T0 , T6 , and T12 (related conditions: β0 =0.55, p < 0.001; β6 =0.54, p < 0.001; and β12 =0.51, p < 0.001; pain: β0 =0.42, p < 0.001; β6 =0.18, p < 0.001; and β12 =0.25, p < 0.001). Mediation analyses demonstrated that the effect of WOB-related conditions was greater than WOB-pain on wellness. Wellness of patients with chronic pain can be determined not only by pain itself but even more so by the severity of related conditions. Thus, considering a broad spectrum of pain measures and related conditions seems relevant for improving the wellness of patients with chronic pain.

Adolescents with substance use problems in outpatient treatment: a one-year prospective follow-up study focusing on mental health and gender differences

BackgroundAlthough several studies have found a high incidence of coexisting mental health problems among adolescents with substance use problems, follow-up studies addressing how these conditions change over time are rare. The study will describe and analyze indications of mental health problems and how various risk factors predict outcomes 1 year after initial treatment contact. In addition, gender-specific risk factors are explored.MethodsA clinical sample of 455 adolescents (29% girls, median age 17 years) answered a structural interview at baseline and were followed up using official records 1 year after initiated treatment. Bivariate associations and logistic regressions were conducted to analyse the links between risk factors at the individual, social, and structural levels as well as links between various mental illness symptoms at treatment start and indications of mental health problems 1 year later were analysed.ResultsThe results show that mental health problems among adolescents largely persisted 1 year after start of outpatient care for substance use problems. Forty-two per cent of the sample displayed indications of mental health problems at follow-up, and registrations for both outpatient treatment and psychiatric medication were more common among the girls. Girls also reported more mental illness symptoms at treatment start than boys did, especially anxiety. Depression and suicidal thoughts had predictive values regarding indications of mental health problems and small cumulative effects were found for 6–10 co-occurring risk factors.ConclusionsAdolescents with depression and suicidal thoughts at treatment start should yield attention among clinicians as these general risk factors could predict indication of mental health problems at 1 year follow-up effectively. Also, patients with more than six co-occurring risk factors seem more vulnerable for continued mental health problems. Generally, girls displayed a greater mental health and psychosocial burden at treatment initiation and were more likely to show indication of mental health problems at follow-up. These results suggests that girls are more likely to get psychiatric out-treatment parallel to, or after, substance abuse treatment. We recommend further investigation of gender differences and gender-specific needs in substance use treatment.

Pretreatment Immune Status, Predicts Response to Definite Chemo Radiotherapy in Advanced Stages of Cervical Cancer Patients.

To evaluate the prognostic role of pretreatment CD4 + , CD8 + T lymphocytes in predicting response to definite chemo radiotherapy in advanced cervical cancer. Design: A hospital-based prospective one-year follow-up study. This observational study was conducted on 74 patients with advanced cervical cancer. Pretreatment CD4 + and CD8 + levels in cervical cancer tissue and peripheral blood was noted and quantitatively assessed in patients with complete remission or persistent disease after one year of follow-up. There was a statistically significant association of tumour volume with the remission or persistence of disease. In peripheral blood, mean CD4 + score and CD4 + /CD8 + ratio were significantly higher while mean CD8 + score is significantly lower in patients with remission. Similar results were seen in tumour tissue as well. On Receiver Operating Curve analysis, the cut-off value of CD4 + , CD8 + and CD4 + /CD8 + ratio in predicting remission or persistent disease in peripheral blood was 20.09, 18.51 and 0.41 while in tumor tissue was 19.71, 20.99 and 0.20, respectively. The patients with tumor volume < 100cm 2 have much higher chances of remission. The patients with higher CD4 + and CD4 + / CD8 + ratio, both in peripheral blood as well as tumor tissue, have higher chances of remission. The cut-off value of CD4 + , CD8 + and CD4 + /CD8 + ratio in predicting remission or persistent disease in peripheral blood was 20.09, 18.51 and 0.41 while in tumor tissue was 19.71, 20.99 and 0.20, respectively.

Incidence and Predictors of Hypertension Among HIV Patients Receiving ART at Public Health Facilities, Northwest Ethiopia: A One-Year Multicenter Prospective Follow-Up Study.

BackgroundThe introduction of highly active retroviral therapy has dramatically reduced mortality and improved survival among HIV patients. However, there is a possible risk of comorbid complications such as hypertension. Little evidence is available regarding the incidence of hypertension among HIV patients receiving anti-retroviral therapy in Ethiopia.PurposeTo assess the incidence and predictors of hypertension among HIV positive patients receiving ART at Public Health Facilities, Northwest Ethiopia.Patients and MethodsA one-year prospective follow-up study was conducted among a cohort of 302 new adult individuals initiating on a standard anti-retroviral therapy regimen with a median (IQR) age of 35 years (IQR=30–41). A pretested data extraction checklist was used to extract baseline patient records. The collected data were entered into Epi-Data version 3.1 and exported to STATA version 14 for analysis. The incidence rate was calculated, and a Kaplan–Meier survival curve was used to estimate the survival probabilities of developing hypertension. Cox proportional hazards model was fitted to identify the predictors of hypertension.ResultsAbout 40 (13.25) new hypertensive cases were observed during the follow-up period, and the remaining 262 (86.75%) were censored. The overall incidence rate of hypertension was 16.35 per 1000 person-month with 2447 patient-month observations. Male sex (AHR = 2.45, 95% CI: 1.02, 6.14), old age (AHR = 2.83, 95% CI: 1.08, 7.45), high BMI (AHR = 6.54, 95% CI: 2.03, 21.13), diabetic comorbidity (AHR = 2.36, 95% CI: 1.07, 5.22), and patients who were on Zidovudine (AZT)-based ART regimen (AHR =3.47, 95% CI: 1.10, 10.94) were significant predictors for the development of hypertension.ConclusionThe findings of this study revealed that incident hypertension is a common problem among HIV patients receiving ART. Routine monitoring of blood pressure and screening and treating high blood pressure should be an integral part of follow-up for HIV patients in ART clinics.

Adolescents with substance abuse problems in outpatient treatment: A one-year prospective follow-up study.

Aim:There is a lack of knowledge about how adolescents with substance abuse problems manage after taking part in treatment. It is also difficult to perform traditional follow-up studies with this group. This article presents the outcome of a prospective study of 455 adolescents who underwent outpatient treatment, based on data taken from official registers. It aims to describe and analyse indications of continued use of substance (CUS) and how various risk and protective factors predict outcomes after initiated treatment at a Maria clinic in Sweden.Design:The study is based on structured interviews at intake, and the data that indicated CUS were taken from several different national registers. The analyses included descriptive data and bivariate associations, logistic regressions and a CHAID analysis.Results:Almost two thirds of the adolescents have no indication of CUS at one-year follow-up. The ten studied risk factors independently were weak predictors of CUS and it was instead the accumulation of risk factors that were linked to a negative outcome.Conclusion:The majority of adolescents who start outpatient treatment for substance abuse problems return to a lesser extent in registers that may indicate a continued problem with alcohol and drugs one year later. A concentration of more than five risk factors appears to be associated with a registration. The study also provides an example of an alternative method for following up adolescents with alcohol and drug abuse problems.

Factors Affecting Surgical Outcome of Intramedullary Spinal Cord Tumors: A Prospective One-year Follow-Up Study

Background Data: Identification of the prognostic factors of the surgical outcomes of intramedullary spinal cord tumors (IMSCTs) is essential. Many studies have established that early surgical intervention was associated with better outcomes and enhanced survival rates. Purpose: This study investigated the prognostic factors of the one-year surgical outcomes of patients with IMSCTs. Study Design: A prospective clinical case study. Patients and Methods: Twenty patients with IMSCTs, who underwent surgery in our institution and were followed up at our clinic were recruited for this study. Patients were followed up for one year to assess postoperative functional outcomes using the modified McCormick Scale (MMS). The reported parameters included preoperative MMS, use of operative monitoring, use of ultrasonic aspirator, the extent of tumor resection, and postoperative adjuvant therapy. Results: Operatively, 85% of patients underwent laminectomy, 55% reported growth total resection (GTR), 55% intraoperative monitoring, 75% underwent ultrasonic aspiration, 55% had syrinx, and 20% had duraplasty. The preoperative MMS improved from 3.0 to 2.32 and 2.42 postoperatively at six months and one year of follow-up, respectively. Patients with postoperative MMS ≤3 were more likely to undergo GTR with better postoperative MMS than those with preoperative MMS >3 at six-month follow-up (81.8% vs. 25%, respectively; p = 0.013) and at one-year follow-up (84.4 vs. 0%, respectively; p = 0.001). Good preoperative MMS, use of ultrasonic aspirator, and operative monitoring were associated with better MMS. There were no significant associations between MMS at the sixth month and reported parameters including gender, symptoms duration, tumor location, bony work whether laminectomy or laminoplasty, number of segments involved, tumor histopathology, duraplasty, and postoperative adjuvant therapy. Conclusion: The findings of the current study showed that patients with GTR, good preoperative MMS, intraoperative monitoring, and ultrasonic aspirator usage might be associated with better functional outcomes. (2021ESJ229)

ReMind, a smartphone application for psychotic relapse prediction: A longitudinal study protocol.

Psychotic disorders are associated with a high rate of relapse. In addition to medication non-adherence, some psychosocial factors have been found to be predictive of relapse (e.g., poor premorbid adjustment, high expressed emotion and substance misuse). Impairments in cognitive functions including general memory functioning, set shifting, attention, processing speed and working memory have also been indicative of a subsequent psychotic episode. As clinical appointments do not always allow for timely or accurate detection of these early warning signs, the ReMind app is developed to explore potential relapse predictors and enhance the process of relapse monitoring. The ReMind app aims (1) to assess whether verbal or visual working memory predicts psychotic relapse in 1 year and (2) to determine whether social factors such as stressful life events, level of expressed emotion and medication adherence also predict relapse in 1 year. This is a one-year prospective follow-up study involving 176 remitted patients diagnosed with schizophrenia or non-affective psychoses. Monthly relapse predictor assessments will be conducted via ReMind throughout the one-year study duration. These assessments include neurocognitive tasks and psychosocial questionnaires. Recruitment began in August 2017 and is still ongoing. Preliminary user feedback suggested an overall positive experience with the app. The ReMind app presents a step forward to the identification and sensitive detection of reliable psychosis relapse predictors. With its anticipated success, it may offer an alternative means of monitoring relapse for the Chinese-speaking population in the future.

A new laboratory surrogate (Monocyte Chemotactic Protein-1) for Disease Activity Score28: a favourable indicator for remission in rheumatoid arthritis

This prospective one-year follow-up study was conducted from 835 visits in 178 rheumatoid arthritis (RA) patients. Tender-/swollen-joint count, Health Assessment Questionnaire Disability Index (HAQ-DI), Disease Activity Score 28-ESR (DAS28-ESR), DAS28-CRP, Simplified Disease Activity Index (SDAI) and DAS28-monocyte chemotactic protein-1 (DAS28-MCP-1) scores were obtained every 3 months. Radiographs of hands and feet were acquired at baseline and one year. We evaluated the correlation and accuracy of activity scores in predicting remission, HAQ-DI changes and radiographic changes. DAS28-MCP-1 correlated strongly with DAS28-ESR, DAS28-CRP and SDAI scores (0.830, 0.899 and 0.931, respectively, with all P < 0.001). Score changes of DAS28-MCP-1 were comparable to those of DAS28-ESR, DAS28-CRP and SDAI in predicting changes in HAQ-DI and bone erosion. DAS28-MCP-1 (<2.2) was better than DAS28-ESR (<2.6) in indicating modified American Rheumatism Association remission and 2011 American College of Rheumatology/European League Against Rheumatism remission (75.61% vs. 36.99% and 81.71% vs. 49.13%, respectively) with odds ratios of 5.28 and 4.62 (both P < 0.001), respectively. We compared DAS28-MCP-1 with SDAI (≦3.3) in indicating remission with odds ratios of 2.63 (P = 0.002) and 0.98, respectively (and DAS28-MCP-1 with DAS28-CRP < 2.5: 1.33 and 0.92). Therefore, DAS28-MCP-1 is useful as an alternative in assessing RA activity.

Pain Catastrophizing Scale as a predictor of low postoperative satisfaction after hand surgery

BackgroundPsychological measures are used increasingly in outcome studies. The Pain Catastrophizing Scale is a 13-item questionnaire used to measure coping skills and negative feelings of pain. In the existing literature it is suggested that the Pain Catastrophizing Scale could be associated with the outcome following surgery. The aim of this study was to examine the effect of catastrophic thinking on postoperative satisfaction after treatment for hand conditions where pain is not the predominant symptom (Dupuytren's disease, trigger finger and wrist ganglia), and further to estimate cut-points on the Pain Catastrophizing Scale. MethodsA total of 413 patients (53% females) with a mean age of 59 years were included in this one-year prospective follow-up study. The patients were diagnosed with either Dupuytren's disease (N = 133), trigger finger (N = 365), or wrist ganglia (N = 147). Preoperative data included disability (Disability of the Arm, Shoulder and Hand questionnaire (DASH)), quality of life (EuroQol-5D (EQ-5D)), and pain catastrophizing (Pain Catastrophizing Scale (PCS)). One year postoperative, data on DASH score, EQ-5D, and patient satisfaction were collected. We used a classification tree to define the most important cut-points, which could classify patients as low-risk or high-risk of low postoperative satisfaction. These cut-points and the 75th percentile cut-point was then used in logistic regression models with postoperative satisfaction as outcome variable. ResultsThe median DASH score improved from 13.5 to 2.6 (p < 0.01), and the median EQ-5D score improved from 0.82 to 1.00, and 90.3% of patients were satisfied or very satisfied with the surgery.Using the 75th percentile (≤12) we did not find a predictive effect of PCS. However, when using the two cut-points from the classification tree (≤27.5 & ≤2.9) all tested models were statistically significant with odds ratios for risk of low satisfaction ranging from 2.81 to 6.44. Only the model using PCS ≤27.5 adjusted for both demographics and disability was insignificant. ConclusionThis study suggests that PCS can be a valuable tool in predicting postoperative satisfaction in hand conditions where pain is not the predominant symptom, and that ≤27.5 and ≤ 2.9 are the optimal cut-point on the preoperative PCS.

Epithelial Alarmins in Serum and Exhaled Breath in Patients with Idiopathic Pulmonary Fibrosis: A Prospective One-Year Follow-Up Cohort Study.

Background: Recently, epithelial alarmins have been shown to play important roles in non-allergen driven respiratory diseases like idiopathic pulmonary fibrosis (IPF). Little is known about the expression of the epithelial alarmins in IPF. Methods: This study aimed to prospectively examine interleukin (IL)-25, IL-33, and thymic stromal lymphopoietin (TSLP) levels in the serum and exhaled breath condensate (EBC) in patients with IPF before and after one-year of antifibrotic treatment. A total of 82 volunteers, including 52 patients diagnosed with IPF that qualified for antifibrotic therapy as well as 30 controls, were examined. All study participants underwent baseline peripheral blood and EBC sampling. In 35 out of 52 IPF subjects, a follow-up sampling was performed after 12 months of antifibrotic treatment. Concentrations of alarmins in the serum and EBC were evaluated by means of ELISA. Results: Baseline TSLP concentrations were significantly elevated in patients with IPF compared to controls both in the serum (p < 0.05) and EBC (p < 0.0001). Baseline IL-25 and IL-33 serum and EBC levels did not differ significantly between IPF subjects and controls. Prospective analysis of changes in the epithelial alarmin levels showed significantly decreased IL-25 and TSLP EBC concentrations after 12 months of antifibrotic treatment (p < 0.05), which was observed in the subgroup of IPF patients treated with pirfenidone, but not in those treated with nintedanib. In stable patients with IPF over a study period (absolute forced vital capacity (FVC) % of predicted decline/year ≤ 5%, n = 25), a significant decrease in the EBC levels of both IL-25 and TSLP after 12 months of antifibrotic treatment was noted (p < 0.05), whereas, in progressor IPF patients (absolute FVC % of predicted decline/year > 5%, n = 10), a significant decrease was noted in the IL-25 EBC levels only (p < 0.05). Conclusions: Elevated TSLP levels in patients with IPF and their significant decrease in the lung compartment during antifibrotic therapy in stable patients with IPF, but not in progressors, support its significant contribution to pro-fibrotic type 2 immune responses in IPF. Noted changes in the epithelial alarmins concentration in the lung compartment during pirfenidone therapy may suggest its possible interaction with epithelial alarmins pathways in IPF.

Clinical Presentation and Prognosis in Heart Failure Patients with Reduced Ejection Fraction: A Prospective One-Year Follow-Up Study in National Cardiovascular Center Harapan Kita, Indonesia

Background: Systolic heart failure (HFrEF) is characterized by ejection fraction of &lt;40% and causes significant mortality and morbidity rate. We seek to characterize Indonesian patients’ clinical presentation (low to middle income country), oneyear outcome and prognostic factors of HFrEF patients. Methods and Results: Prospective cohort with consecutive sampling method was done in National Cardiovascular Center Harapan Kita (NCCHK), Jakarta from October 2013 to March 2014. NCCHK is a national heart referral center for 34 provinces in Indonesia. Data was obtained from medical records of HFrEF patients enrolled in ASIAN-HF study. Oneyear follow up was done via medical record or phone interview. Data was analyzed using SPSS version 23. Ninety HFrEF subjects (57.3±1.17 years) were obtained. Angina was more commonly seen in higher EF group (21-40%; p=0.016). At one-year, 22.2% died. Lower EF group had higher rate of death (p&gt;0.05). Age, rales and elevated JVP were predictive of death regardless of EF (p&lt;0.05). Conclusions: Angina was more commonly seen in higher EF group. Signs of congestion are associated with poorer prognosis. Low EF (&lt;20% vs 21-40%) had clinically high rate of death (26.7% vs 13.3%, p&gt;0.05).

Longitudinal associations of fundamental movement skills with objectively measured physical activity and sedentariness during school transition from primary to lower secondary school

ObjectivesThis study aimed to investigate cross-lagged associations of leaping skill and throwing–catching skills with objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) during school transition from upper primary (Grade 6) to lower secondary school (Grade 7). DesignThis study is a one-year prospective follow-up study within Finnish school settings. Students’ MVPA, ST, leaping skill and throwing–catching skills were measured at Grade 6 and subsequently at Grade 7. MethodsA sample of 336 students (163 girls, 173 boys; M age=12.0 years, SD=0.4 at Grade 6 participated in the study. Students’ MVPA and ST were measured objectively by hip-worn accelerometers. Leaping skill was measured by 5-leaps test. Throwing and catching skills were measured by throwing–catching combination test. Cross-lagged structural equation modeling was conducted to evaluate the associations between MVPA, ST, leaping skill, and throwing–catching skills at Grade 6 and Grade 7. ResultsResults demonstrated three significant cross-lagged associations among girls: (1) leaping skill measured at Grade 6 was negatively associated with ST at Grade 7; (2) objectively measured MVPA at Grade 6 associated positively with leaping skill at Grade 7; and (3) throwing–catching skills measured at Grade 6 associated positively with leaping skill measured at Grade 7. There were no statistically significant cross-lagged associations between the study variables for the sample of boys. ConclusionsThe results of this study indicated that supporting opportunities for girls’ engagement in both MVPA and leaping skill development activities during their primary school education is strongly recommended.

Do patients after bariatric surgery change their physical activity habits? A prospective one-year follow-up study

Do patients after bariatric surgery change their physical activity habits? A prospective one-year follow-up study

Biomarkers associated with mortality in patients undergoing dialysis.

Survival for patients commencing renal replacement therapy is around 90% in the first year and 83% at two years after starting dialysis. The factors that appear to predict mortality are comorbidity and frailty associated with kidney disease, glomerular filtration rate, age and biochemical factors. To analyse the condition of patients starting renal replacement therapy, based on biomarkers commonly used in clinical practice and their association with mortality, measured 6 and 12 months after initiating replacement therapy. A one-year prospective follow-up study with 189 patients. Sociodemographic variables, aetiology of renal disease, comorbidities, prior nephrology service monitoring, prior renal transplantation and biochemical parameters at the time of initiating replacement therapy were analysed. The overall percentage of death during the one-year follow-up was 6.87%, with 64% of deaths occurring during the first six months. The only variable independently associated with mortality was low albumin levels. Although most patients in this centre are monitored by a nephrologist prior to starting replacement therapy, many nevertheless fail to achieve the biochemical targets recommended. One such parameter is albumin, which proved at the start of replacement therapy to be an independent predictor of mortality. Findings of this study show the need to intervene on certain biochemical parameters during the pre-dialysis stage and at the start of dialysis, in order to improve survival in this group of patients.

Asymmetry in gait pattern following tibial shaft fractures – a prospective one-year follow-up study of 49 patients

IntroductionDespite the high number of studies evaluating the outcomes following tibial shaft fractures, the literature lacks studies including objective assessment of patients’ recovery regarding gait pattern. The purpose of the present study was to evaluate whether gait patterns at 6 and 12 months post-operatively following intramedullary nailing of a tibial shaft fracture are different compared with a healthy reference population. Patients and methodsThe study design was a prospective cohort study. The primary outcome measurement was the gait patterns at 6 and 12 months post-operatively measured with a 6-metre-long pressure-sensitive mat. The mat registers footprints and present gait speed, cadence as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. Results49 patients were included with a mean age of 43.1 years (18–79 years). Forty-three patients completed the 12-month follow-up (88%). Gait speed and cadence were significantly increased between the 6- and 12-month follow-up (P<0.001). At 6-month follow-up, patients showed considerable asymmetry in the injured leg compared with the non-injured leg: single-support time 12.8% shorter, swing-time 12.8% longer, step-length 11.9% shorter, and rotation of the foot increased by 32.3%. At the 12-month follow-up, gait asymmetry become almost normalized compared to a healthy reference group. ConclusionIn patients treated by intramedullary nailing following a tibial shaft fracture, gait asymmetry accompanied with slower speed and cadence are common during the first 6 months and become normalized compared with a healthy reference population between 6 and 12 months post-operatively.

Exploring associations between self-regulatory mechanisms and neuropsychological functioning and driver behaviour after brain injury

ABSTRACTThe objective of this prospective one-year follow-up study was to explore the associations between self-regulatory mechanisms and neuropsychological tests as well as baseline and follow-up ratings of driver behaviour. The participants were a cohort of subjects with stroke and traumatic brain injury (TBI) who were found fit to drive after a multi-disciplinary driver assessment (baseline). Baseline measures included neuropsychological tests and ratings of self-regulatory mechanisms, i.e., executive functions (Behavior Rating Inventory of Executive Function–Adult Version; BRIEF-A) and impulsive personality traits (UPPS Impulsive Behavior Scale). The participants rated pre-injury driving behaviour on the Driver Behaviour Qestionnaire (DBQ) retrospectively at baseline and after one year of post-injury driving (follow-up). Better performance on neuropsychological tests was significantly associated with more post-injury DBQ Violations. The BRIEF-A main indexes were significantly associated with baseline and follow-up ratings of DBQ Mistakes and follow-up DBQ Inattention. UPPS (lack of) Perseverance was significantly associated with baseline DBQ Inattention, whereas UPPS Urgency was significantly associated with baseline DBQ Inexperience and post-injury DBQ Mistakes. There were no significant changes in DBQ ratings from baseline (pre-injury) to follow-up (post-injury). It was concluded that neuropsychological functioning and self-regulatory mechanisms are related to driver behaviour. Some aspects of driver behaviour do not necessarily change after brain injury, reflecting the influence of premorbid driving behaviour or impaired awareness of deficits on post-injury driving behaviour. Further evidence is required to predict the role of self-regulatory mechanisms on driver behaviour and crashes or near misses.

Impact of avolition and cognitive impairment on functional outcome in first-episode schizophrenia-spectrum disorder: a prospective one-year follow-up study

Previous research investigating the relationships between avolition, cognition and functioning in schizophrenia mostly focused on chronic samples and were cross-sectional in design. Impacts of avolition and cognition on longitudinal functional outcome in first-episode patients are under-studied. We assessed 114 Chinese aged 18–55years presenting with first-episode schizophrenia-spectrum disorder aiming to identify baseline predictors of 1-year functional outcome. Results showed that both avolition and global cognition independently predicted functioning, with avolition being the strongest predictor above and beyond cognition and other symptom dimensions. Our findings indicate the central role of in determining longitudinal functional status in the early illness stage.