Physical Morbidity Research Articles

Gendered Re-Traumatization: End-of-Life Care for Abusive and Neglectful Parents (SCI907)

1.Describe re-traumatizing experiences of women providing EOL UCL to parents which mirror experiences of childhood trauma.2.Identify predictive and protective factors for gendered re-traumatization in the context of EOL UCL for parents.3.Examine structures of power in hospice and palliative care which perpetuate gendered re-traumatization. During the last year of life, 57% of Medicare beneficiaries depend on their daughters’ unpaid care labor (UCL) to meet their basic needs. End-of-life (EOL) UCL is associated with increased risks for physical and psychological morbidity, and negative health impacts of UCL are more common among providers with histories of childhood maltreatment. Over 40% of U.S. women report having experienced childhood sexual, physical, emotional abuse and / or neglect, with the majority of cases involving parents, yet the prevalence and impact of childhood trauma is rarely acknowledged in the field of hospice and palliative care. In contrast to the evidence, the assumption that love and reciprocity characterize relationships between daughters and parents to whom they provide care is widespread in research, policy, and practice. The objective of this study was to explore and conceptualize links between the experience of providing EOL UCL to abusive and neglectful parents and women's health. Using feminist poststructuralist narrative methodology, we performed and analyzed dialogic interviews with 21 women who provided EOL UCL to parents who maltreated them in childhood and 15 healthcare professionals who serve EOL UCL providers. EOL UCL represents a re-traumatization for many women, resulting in avoidable injury, illness, and complicated grief, impeding recovery, and increasing vulnerability to victimization. During EOL UCL, participants were subjected to isolation, domination, deprivation, betrayal, and identity assault mirroring their childhood traumas. In childhood and in EOL UCL, structures of power perpetuated patriarchal norms of family and femininity, constraining participants’ capacities for self-expression, self-esteem, and self-direction. Our analysis also uncovered factors which predicted or protected against gendered re-traumatization. The findings of this study challenge taken-for-granted ideologies in hospice and palliative care which harm marginalized women.

Cardiovascular and musculoskeletal health disorders associate with greater decreases in physical capability in older women

BackgroundGood physical capability is an important part of healthy biological ageing. Several factors influencing physical capability have previously been reported. Long-term reports on physical capability and the onset of clinical disorders and chronic diseases are lacking. Decrease in physical capacity has been shown to increase mortality. This study focuses on the prevalence of chronic diseases. The primary objective of the study was to reveal the association between physical capability and morbidity. Secondary objectives included the validity of self-reported physical capability and the association between baseline physical capability and mortality.MethodsThe OSTPRE (Kuopio Osteoporosis Risk Factor and Prevention Study) prospective cohort involved all women aged 47–56 years residing in the Kuopio Province, Finland in 1989. Follow-up questionnaires were mailed at five-year intervals. Physical capability questions were first presented in 1994. From these women, we included only completely physically capable subjects at our baseline, in 1994. Physical capability was evaluated with five scale self-reports at baseline and in 2014 as follows: completely physically capable, able to walk but not run, can walk up to 1000 m, can walk up to 100 m and temporarily severely incapable. The prevalences of selected chronic diseases, with a minimum prevalence of 10% in 2014, were compared with the change in self-reported physical capability. Additionally, associations between long-term mortality and baseline physical capability of the whole 1994 study population sample were examined with logistic regression. The correlation of self-reported physical capability with functional tests was studied cross-sectionally at the baseline for a random subsample.ResultsOur study population consisted of 6219 Finnish women with a mean baseline age of 57.0 years. Self-reported physical capability showed statistically significant correlation with functional tests. Cardiovascular diseases and musculoskeletal disorders show the greatest correlation with decrease of physical capability. Prevalence of hypertension increased from 48.7% in the full physical capability group to 74.5% in the “able to walk up to 100 metres” group (p < 0.001). Rheumatoid arthritis showed a similar increase from 2.1 to 7.4% between these groups. Higher baseline body mass index (BMI) decreases long-term capability (P < 0.001). Women reporting full physical capability at baseline had a mortality rate of 15.1%, in comparison to 48.5% in women within the “able to walk up to 100 m” group (p = 0.357). Mortality increased steadily with worsening baseline physical capability.ConclusionsThe results of this study show that chronic diseases, particularly cardiovascular and musculoskeletal disorders, correlate with faster degradation of physical capability in the elderly. Similar results are shown for increase in BMI. We also demonstrate that the risk of mortality over a 20-year period is higher in individuals with poor baseline physical capability.

Peripheral neuropathy: an important contributor to physical limitation and morbidity in stages 3 and 4 chronic kidney disease.

Impaired physical function drives adverse outcomes in chronic kidney disease (CKD). Peripheral neuropathy is highly prevalent in CKD, though its contribution to physical function in CKD patients is unknown. This study examined the relationships between peripheral neuropathy, walking speed and quality of life (QoL) in stages 3 and 4 CKD. This was a prospective observational study investigating neuropathy in CKD patients with an estimated glomerular filtration rate (eGFR) 15-60 mL/min/1.73 m2. A total of 109 patients were consecutively recruited. The presence and severity of peripheral neuropathy was determined using the total neuropathy score. Walking speed was assessed at both usual and maximal speed, and QoL was assessed using the Short- Form 36 (SF-36) questionnaire. Peripheral neuropathy was highly prevalent: 40% demonstrated mild neuropathy and 37% had moderate-severe neuropathy. Increasing neuropathy severity was the primary predictor of reduced walking speed (R2 = -0.41, P < 0.001) and remained so after multivariable analysis adjustment for diabetes. This association was evident for both usual and maximal walking speeds. Neuropathy correlated significantly with low scores on multiple domains of SF-36 including physical function (r = -0.570, P < 0.001). Subanalysis according to diabetic status revealed a high prevalence of neuropathy both with and without diabetes; relationships to walking speed remained evident in subgroup analysis. However, those with diabetes demonstrated greater severity of neuropathy, slower walking speed and lower scores in QoL. Moderate to severe peripheral neuropathy was common in stages 3 and 4 CKD, associated with reduced walking speed independent of diabetes status and was correlated with patient-reported QoL. This suggests that neuropathy is an important contributor to declining physical function in CKD irrespective of diabetes status. Targeted diagnosis and management of peripheral neuropathy during CKD progression may improve functional outcomes and QoL.

Outcomes following admission to paediatric intensive care: A systematic review.

To describe the long-term health outcomes of children admitted to a paediatric intensive care unit. A systematic review of the literature was performed. Studies of children under 18 years of age admitted to a paediatric intensive care unit were included. Studies focussed on neonatal admissions and investigating specific paediatric intensive care unit interventions or admission diagnoses were excluded. A table was created summarising the study characteristics and main findings. Risk of bias was assessed using the Newcastle Ottawa Quality Assessment Scale for observational studies. Primary outcome was short-, medium- and long-term mortality. Secondary outcomes included measures of neurodevelopment, cognition, physical, behavioural and psychosocial function as well as quality of life. One hundred and eleven studies were included, most were conducted in high-income countries and focussed on short-term outcomes. Mortality during admission ranged from 1.3 to 50%. Mortality in high-income countries reduced over time but this trend was not evident for lower income countries. Higher income countries had lower standardised mortality rates than lower income countries. Children had an ongoing increased risk of death for up to 10 years following intensive care admission as well as increased physical and psychosocial morbidity compared to healthy controls, with associated poorer quality of life. There is limited high-level evidence for the long-term health outcomes of children after intensive care admission, with the burden of related morbidity remaining greater in poorly resourced regions. Further research is recommended to identify risk factors and modifiable factors for poor outcomes, which could be targeted in practice improvement initiatives.

Rehabilitation after kidney transplantation

HintergrundDurch strukturierte (Langzeit‑)Nachsorge nach Nierentransplantation und Nierenlebendspende können Risikofaktoren für Transplantatüberleben und Nierenfunktion und für die physische wie psychische Morbidität unterschiedlichster Genese detektiert und gebessert werden. Neben den klassischen kardiovaskulären Risikofaktoren zählen hierzu eine mangelnde Adhärenz des Patienten, Wissensdefizite im Hinblick auf Verhaltensregeln nach Transplantation und Lebendspende, Bewegungsmangel, mangelnde Coping-Strategien oder auch arbeitsmedizinische und sozialrechtliche Belange.Ziel der ArbeitEs soll dargestellt werden, wie Rehabilitationsmaßnahmen die Nachsorge nach Nierentransplantation und Lebendspende optimieren können, worauf sich der Rehabilitationsbedarf begründet, welche Ziele verfolgt werden und welche multidisziplinären Therapiemodule sich etabliert haben.Material und MethodenHierfür dienen neben einer Literaturrecherche die Erfahrungen einer Rehabilitationsklinik, die seit dem Jahr 2000 Rehabilitationen nach Nierentransplantation und nach Lebendspende anbietet und etwa 600 Patienten pro Jahr behandelt.ErgebnisseSpezialisierte Rehamaßnahmen mit nephrologischem und transplantationsmedizinischem Schwerpunkt können die ambulante Nachsorge nach Nierentransplantation und Nierenlebendspende sinnvoll ergänzen, wenn die Rehabilitationsklinik konzeptionelle, personelle und strukturelle Qualitätsanforderungen erfüllt. Eine enge Kooperation der Rehaklinik mit dem Transplantationszentrum und den behandelnden Nephrologen ist essenziell.DiskussionKontrollierte Studien zur Langzeitnachsorge unter Einbeziehung der stationären Rehabilitation sind anzustreben. Auch Prärehabilitation sollte in diesen Kontext einbezogen werden.

Tolerability and Efficacy of Clindamycin/Tretinoin versus Adapalene/Benzoyl Peroxide in the Treatment of Acne Vulgaris

Acne vulgaris is the most common dermatological disorder worldwide, causing significant physical and psychological morbidity. Topical combination therapy has shown superior efficacy compared to monotherapy, especially when combined with retinoids. Few studies have directly compared combined formulations. This evaluator-blinded pilot study compared the efficacy and tolerability of two marketed topical combination acne gels, clindamycin 1%-tretinoin 0.025% (CT) and benzoyl peroxide 2.5%-adapalene 0.1% (BA) in 20 patients with mild to moderate acne vulgaris. Gels were applied daily on opposite sides of the face for 21 days. The primary outcome was difference in transepidermal water loss (TEWL) at the end of treatment. Secondary endpoints were skin moisture content measurement, Investigators' Global Assessment, subject self-assessments (SSA) of burning/stinging, itching, erythema, and dryness/scaling, and Comparative Participant Satisfaction Questionnaire (CPSQ). Efficacy was assessed by inflammatory and non- inflammatory acne efflorescences counts. TEWL increased significantly for both CT and BA (+57.74%, P=0.002; +58.77%, P<0.001); skin moisture content significantly decreased only for BA (-16.47%, P=0.02). Only BA showed a significant increase in erythema and dryness/scaling (P=0.027 and P=0.014) and in SSA burning/stinging (P=0.04). Patient satisfaction evaluation also reflected the strong BA irritation. Although CT and BA both reduced acne lesions (P<0.001) and more patients preferred to continue with CT, subject perception of acne improvement was higher for BA. These findings suggest that CT and BA have similar efficacy in the treatment of mild to moderate papulopustular acne. However, CT was better tolerated than BA by both medical and subject evaluation. CT is an effective and tolerated treatment option.J Drugs Dermatol.20(3):295-301. doi:10.36849/JDD.2021.5641Clindamycin/Tretinoin, Adapalene/Benzoyl Peroxide, Acne Vulgaris

Flemish healthcare providers’ attitude towards tiredness of life and euthanasia: a survey study

Objectives To explore the legal understanding and attitudes of nurses and physicians in both acute and chronic geriatric care (Flanders, Belgium) regarding euthanasia in the context of tiredness of life in older people. Method Healthcare providers employed in acute care (59 geriatricians and 75 nurses of acute geriatric wards), as well as chronic care (135 general practitioners (GPs) and 76 nurses employed in nursing homes and home care services) were sent a survey with four case vignettes. For each case vignette, respondents were asked the following questions: (1) ‘Does this case fit the due-care criteria of the euthanasia law?’, (2) ‘Do you consider this person to be tired of life?’, (3) ‘Can you comprehend this person’s euthanasia request?’. Results In cases of severe and life-limiting physical suffering, where the patient meets the legal criteria for euthanasia in Belgium, only 50% of physicians and nurses are aware of this legal basis. In case of tiredness of life without underlying pathology, nurses showed more comprehension for the euthanasia request compared to physicians (43.0% vs. 10.8%, p < 0.001). Physicians tend to assess the legal base of an euthanasia-request depending on the severity of physical morbidity, whereas nurses show a greater comprehension towards euthanasia-requests even in absence of severe illness. Geriatricians are more reserved regarding performing euthanasia themselves as compared to GPs, regardless of underlying pathology or reason for the euthanasia-request (p < 0.001). Conclusion The legal understanding and attitude of Flemish physicians and nurses towards tiredness of life and euthanasia in older patients differed to a great extent. This study showed (1) a lack of awareness of the legal basis for euthanasia in the context of ToL among all HCPs, (2) differences in the extent of comprehension between nurses and physicians and (3) differences in willingness to actually perform euthanasia between geriatricians and GPs. So even with the formulation of strict due-care criteria there is still room for interpretation. This creates a gray area and a discussion point between healthcare providers.

Domestic violence during COVID-19 pandemic: The case for Indian women.

Domestic violence is one of the most pernicious gendered ailments of human society. Researchers have confirmed the inevitable consequences of domestic violence (physical, sexual, and emotional) in increased vulnerability to psychopathologies in addition to physical morbidity. Domestic violence cases are vast in India, and the numbers are further aggravated at an alarming rate during the COVID‐19 pandemic. The present study aimed at exploring the cases of domestic violence among Indian women during the COVID‐19 pandemic. Newspapers reporting the incidents of domestic violence during the last 5 years were analysed to explore the issues related to the surge in domestic violence incidents during the COVID‐19 lockdown period. A major increase in domestic violence cases was observed during the COVID‐19 period as compared to the previous years. Also, the cases were higher during the initial phases of the pandemic but gradually decreased as time progressed.The impact of the COVID‐19 pandemic on women was unprecedented and worse than before. Home containment as a measure to protect the health and well‐being of the general public has resulted in increased sufferings for women in terms of both sufferings from diseases and increased domestic violence.

Social support as a moderator of healthcare adherence and distress in long-term hematopoietic cell transplantation survivors.

Treatment with hematopoietic cell transplantation (HCT) has potentially severe effects on physical and psychosocial functioning. Poor social support has been linked with physical morbidity and mortality as well as psychological distress in HCT survivors. This study tested a theory-driven hypothesis that social support buffers adverse effects of health stressors of comorbidities and graft-versus-host disease (cGVHD) on distress and adherence to recommended healthcare among long-term HCT survivors. This cross-sectional study analyzed baseline data from a randomized controlled trial in adult survivors 3-18years post-HCT. Data included medical records and patient-reported outcomes including cancer and treatment distress (CTXD), healthcare adherence (HCA), comorbidity index, cGVHD, ENRICHD Social Support Instrument (ESSI), Social Activity Log, and Health Self-Efficacy. We tested hypothesized models for HCA and CTXD using blocked hierarchical linear regressions. Among the 781 HCT survivors completing baseline assessment, 38% had > 3 comorbidities, 8% had moderate-severe cGVHD, 30% reported low social support, 30% reported elevated distress, and 49% reported low healthcare adherence. Social support and self-efficacy were directly related to both adherence and distress. Regression models supported the hypothesized moderated relationships for distress but not for healthcare adherence. The two tested models confirm that the health stressors of comorbidities and cGVHD are moderated by better social support and self-efficacy in their associations with lower distress but without moderating effects for healthcare adherence. Social support and self-efficacy confer protective benefits on healthcare adherence and psychological distress. Interventions are needed that focus on maintaining social networks or finding new networks if necessary. NCT00799461.

Varying Trends in Geographical Distribution and Patterns of Dermatophytosis and its Antifungal Susceptibility

Background: Dermatophytosis is seen worldwide, causing severe physical, mental, and psychosocial morbidity to the patient. Owing to indiscriminate, inadequate and irregular use of various drugs, cases of anti-fungal resistance have emerged in recent times, leading to ineffective treatment needing multiple drugs over longer treatment durations. Hence, this study was taken up to evaluate the changing geographical trends in the clinico-mycological profile of dermatophytosis and its antifungal susceptibility patterns. Materials and Methods: Two hundred and eleven patients with clinically diagnosed dermatophytosis were evaluated with history, examination followed by a Potassium Hydroxide wet mount. Skin scrapings were also taken for fungal culture and antifungal susceptibility tests against ten commonly used antifungal agents using the Broth Microdilution method as per CLSI M38-A2 guidelines. Results: Tinea incognito was the most common presentation, and Trichophyton rubrum was the predominant dermatophyte isolated. Recurrent dermatophytosis was seen in 11.84% subjects. Terbinafine was the most effective systemic agent, while Luliconazole was the most effective topical agent. Itraconazole and Luliconazole were the most effective systemic and topical agents, respectively, at their lowest minimum inhibitory concentrations inhibiting T. rubrum isolates in vivo. Fluconazole, followed by Griseofulvin, showed the least efficacy. In vitro microbiological resistance to Griseofulvin was found in 15.3% of cases (P &lt; 0.00001). Conclusion: The rapidly evolving geographical trends in clinico-epidemiological profiles of dermatophytosis and its varying antifungal susceptibility patterns highlight the need for updating the knowledge of this disease in the global scenario as well as counseling the rural populations with behavioral and lifestyle modifications.

Potentially preventable hospitalisations for physical health conditions in community mental health service users: a population-wide linkage study.

Mental health (MH) service users have increased prevalence of chronic physical conditions such as cardio-respiratory diseases and diabetes. Potentially Preventable Hospitalisations (PPH) for physical health conditions are an indicator of health service access, integration and effectiveness, and are elevated in long term studies of people with MH conditions. We aimed to examine whether PPH rates were elevated in MH service users over a 12-month follow-up period more suitable for routine health indicator reporting. We also examined whether MH service users had increased PPH rates at a younger age, potentially reflecting the younger onset of chronic physical conditions. A population-wide data linkage in New South Wales (NSW), Australia, population 7.8 million. PPH rates in 178 009 people using community MH services in 2016-2017 were compared to population rates. Primary outcomes were crude and age- and disadvantage-standardised annual PPH episode rate (episodes per 100 000 population), PPH day rate (hospital days per 100 000) and adjusted incidence rate ratios (AIRR). MH service users had higher rates of PPH admission (AIRR 3.6, 95% CI 3.5-3.6) and a larger number of hospital days (AIRR 5.2, 95% CI 5.2-5.3) than other NSW residents due to increased likelihood of admission, more admissions per person and longer length of stay. Increases were greatest for vaccine-preventable conditions (AIRR 4.7, 95% CI 4.5-5.0), and chronic conditions (AIRR 3.7, 95% CI 3.6-3.7). The highest number of admissions and relative risks were for respiratory and metabolic conditions, including chronic obstructive airways disease (AIRR 5.8, 95% CI 5.5-6.0) and diabetic complications (AIRR 5.4, 95% CI 5.1-5.8). One-quarter of excess potentially preventable bed days in MH service users were due to vaccine-related conditions, including vaccine-preventable respiratory illness. Age-related increases in risk occurred earlier in MH service users, particularly for chronic and vaccine-preventable conditions. PPH rates in MH service users aged 20-29 were similar to population rates of people aged 60 and over. These substantial differences were not explained by socio-economic disadvantage. PPHs for physical health conditions are substantially increased in people with MH conditions. Short term (12-month) PPH rates may be a useful lead indicator of increased physical morbidity and less accessible, integrated or effective health care. High hospitalisation rates for vaccine-preventable respiratory infections and hepatitis underline the importance of vaccination in MH service users and suggests potential benefits of prioritising this group for COVID-19 vaccination.

Volatile Organic Compounds in Exhaled Breath as Fingerprints of Lung Cancer, Asthma and COPD.

Lung cancer, chronic obstructive pulmonary disease (COPD) and asthma are inflammatory diseases that have risen worldwide, posing a major public health issue, encompassing not only physical and psychological morbidity and mortality, but also incurring significant societal costs. The leading cause of death worldwide by cancer is that of the lung, which, in large part, is a result of the disease often not being detected until a late stage. Although COPD and asthma are conditions with considerably lower mortality, they are extremely distressful to people and involve high healthcare overheads. Moreover, for these diseases, diagnostic methods are not only costly but are also invasive, thereby adding to people’s stress. It has been appreciated for many decades that the analysis of trace volatile organic compounds (VOCs) in exhaled breath could potentially provide cheaper, rapid, and non-invasive screening procedures to diagnose and monitor the above diseases of the lung. However, after decades of research associated with breath biomarker discovery, no breath VOC tests are clinically available. Reasons for this include the little consensus as to which breath volatiles (or pattern of volatiles) can be used to discriminate people with lung diseases, and our limited understanding of the biological origin of the identified VOCs. Lung disease diagnosis using breath VOCs is challenging. Nevertheless, the numerous studies of breath volatiles and lung disease provide guidance as to what volatiles need further investigation for use in differential diagnosis, highlight the urgent need for non-invasive clinical breath tests, illustrate the way forward for future studies, and provide significant guidance to achieve the goal of developing non-invasive diagnostic tests for lung disease. This review provides an overview of these issues from evaluating key studies that have been undertaken in the years 2010–2019, in order to present objective and comprehensive updated information that presents the progress that has been made in this field. The potential of this approach is highlighted, while strengths, weaknesses, opportunities, and threats are discussed. This review will be of interest to chemists, biologists, medical doctors and researchers involved in the development of analytical instruments for breath diagnosis.

Social Isolation and Loneliness: Develop a More Robust Evidence Base

This paper reviews the evidence base for the health impacts of SIL on older adults, the risk factors, and the potential moderators and mediators of those relationships. Substantial evidence indicates that SIL are associated with physical, cognitive, and psychological morbidity; health-related behaviors; and health-related quality of life. Social isolation in particular is associated with a significantly increased risk of premature mortality from all causes. The evidence base for interventions in the clinical setting is also reviewed. Finally, the report’s specific recommendations are discussed, including the need for basic science research, increased funding, key elements in the design and evaluation of interventions, and gap areas (including trends among current younger adults and approaches for specific understudied groups of at-risk older adults). Part of a symposium sponsored by Loneliness and Social Isolation Interest Group.

High Rate of Fatal Overdose After Release from Prison In BC, Canada: A Data Linkage Study

IntroductionThe province of BC, Canada is in the grips of a sustained overdose epidemic. People released from prison are at increased risk of fatal drug overdose, but the impact of the overdose epidemic on mortality after release from prison in BC is poorly understood. Few studies have been able to examine risk factors for overdose death in this population.&#x0D; Objectives and ApproachWe aimed to (a) measure risk of overdose-related and all-cause death in different time periods after release from prison; and (b) identify risk factors for overdose-related and all-cause death. In a random 20% sample of the population of BC, Canada, we identified those released from prison 2015-2017 and examined linked health and correctional records for this cohort.&#x0D; ResultsOf 6106 persons released from prison 2015-2017, 77 (1.3%) died from any cause and 48 (0.8%) died from overdose 2015-2017. The incidence of all-cause death was 16.1 (95%CI 13.7-18.8) per 1000 person years, and the incidence of overdose death was 11.2 (95%CI 9.2-13.5) per 1000 person years. Risk factors for overdose death included a history of 3 or more incarcerations (HR=3.00, 95%CI 1.67-5.39), co-occurring substance use disorder and mental illness (HR=4.73, 95%CI 2.94-7.62), chronic physical morbidity (HR=3.10, 95%CI 1.97-4.88), and being dispensed benzodiazepines (HR=3.31, 95%CI 2.27-4.84) or opioids for pain (HR=6.77, 95%CI 3.86-11.89). The incidence of fatal overdose was significantly higher in the first two weeks post-release than at any other time during follow-up.&#x0D; ConclusionPeople released from prison in BC are at markedly increased risk of preventable death, mainly due to overdose. As such, people transitioning from prison to the community should be a key target population for overdose prevention efforts. To be maximally effective, these efforts must go beyond provision of methadone and naloxone on release, to consider physical and mental health comorbidities, and psychosocial disadvantage.

EPID-16. INTEGRATION OF EHR AND CANCER REGISTRY DATA TO CONSTRUCT A PEDIATRIC NEURO-ONCOLOGY SURVIVORSHIP COHORT AND IMPROVE LONG-TERM FOLLOW-UP CARE

BACKGROUNDPediatric neuro-oncology (PNO) survivors suffer long-term physical and neurocognitive morbidity. Comprehensive care addressing late effects of brain tumors and treatment in these patients is important. Clinical guidelines offer a framework for evaluating late effects, yet lack of extended follow-up is a significant barrier. The electronic health record (EHR) allows novel and impactful opportunities to construct, maintain, and leverage survivorship cohorts for health care delivery and as a platform for research.METHODSThis survivorship cohort includes all PNO cases ≤18-years-old reported to the state-mandated cancer registry by our institution. Data mining of the EHR for exposures, demographic, and clinical data identified patients with lack of extended follow-up (>1000 days since last visit). Explanatory variables included age, race/ethnicity, and language. Primary outcome included date of last clinic visit.RESULTSBetween January 1, 2013 and December 31, 2018, there were 324 PNO patients reported to our institutional registry with ongoing analysis to identify the specific survivorship cohort. Thirty patients died with an overall mortality of 9.3%. Two-hundred-and-sixteen patients were seen in PNO clinic, of which 18.5%% (n=40) did not receive extended follow-up. Patients without extended follow-up were an average of 3.5 years older up (p<0.01); however, there was no significant difference in preferred language (p=0.97) or race/ethnicity (p=0.57).CONCLUSIONIntegration of EHR and cancer registry data represents a feasible, timely, and novel approach to construct a PNO survivorship cohort to identify and re-engage patients without extended follow-up. Future applications include analysis of exposures and complications during therapy on late effects outcomes.

Physical fitness and cognitive performance in non‐demented elderly subjects

AbstractBackgroundPoor physical fitness is a well‐known risk factor for cognitive impairment. Physical fitness is closely correlated with age and physical morbidity. We studied, whether the correlation between poor physical fitness and cognitive impairment can be ascertained when these variables are controlled.MethodThe data of 135 non‐demented participants of a dementia prevention program, who were aged between 50 and 60 years, were evaluated (mean age: 55.3 years). Physical fitness was examined using the Step Test (ST) for cardiorespiratory fitness and the Chair Stand Test (CST) for motor fitness. We compared subjective memory disorders, cognitive blackouts (checklist for cognitive blackouts, CKB) and objective cognitive performance between people with low and normal physical fitness.ResultThe participants with low cardiorespiratory fitness (ST) were more concerned with their memory and they reported cognitive blackouts more frequently. They also had a lower orientation score and a lower MMSE score. The participants with low motor fitness (CST) also reported memory loss and cognitive blackouts more frequently and had lower scores in orientation, language, praxia as well as in higher cortical functions. Lower cardiorespiratory fitness was found more frequently in men and in participants with a history of high blood pressure. The participants with lower motor fitness had a higher BMI and a larger hip size.ConclusionPoor physical fitness is correlated with subjective memory disorders and cognitive blackouts as well as with minor objective cognitive impairments, even when controlling for age and physical morbidity.

Inguinal lymph node dissection for penile cancer: a contemporary review.

Penile cancer is an uncommon disease associated with significant psychological and physical morbidity. Penile cancer has an expectable pattern of spread in a stepwise fashion, from inguinal to pelvic lymph nodes (PLN) then distant spread. Patients with penile cancer have variable survival, with patients with a low burden of nodal metastatic disease having lasting survival with surgical management, however patients with a large amount of locoregional metastatic disease having a worse prognosis. The current management options for patients with metastatic lymph node disease in penile cancer aims to reduce the morbidity associated with radical inguinal lymph node (ILN) surgery with appropriate risk stratification to optimise oncological control of the disease. This article describes current challenges in managing the inguinal region in patients with penile squamous cell carcinoma (SCC).

Non-HIV chronic disease burden among transgender populations globally: A systematic review and narrative synthesis.

Chronic disease is a growing concern for research, policy and clinical care. While the global burden of HIV for transgender populations has been comprehensively covered in recent systematic reviews, the same is not true for the burden of other chronic disease. The objective of this study was to review the literature on non-HIV chronic disease burden for transgender populations worldwide. A systematic review was conducted of Medline, Embase, CINAHL, PsycINFO and LGBT Life bibliographic databases for peer-reviewed scientific studies with non-HIV chronic disease prevalence data for transgender populations published any date up to February 15, 2019 without restriction on country or study design. A total of 93 studies and 665 datapoints were included in this review, comprising 48 distinct chronic disease outcomes in seven groups (cancer, cerebro/cardiovascular conditions, chronic liver and kidney disease, mental health and substance use conditions, metabolic and endocrine disorders, musculoskeletal and brain disorders, respiratory conditions, and unspecified and other conditions). The empirical literature on chronic disease among global transgender populations focuses on mental health morbidity, demonstrating an evidence gap on chronic physical health morbidity, particularly beyond that of sexual health. This review identified important gaps including in age-related conditions, inflammation-related disease and studies designed explicitly to investigate chronic disease burden among transgender populations. There is a need for high quality evidence in this area, including longitudinal population-based studies with appropriate comparison groups, and consistent measurement of both transgender status and chronic conditions.

Assessment of School Nutrition and Its Impact on Physical Development and Morbidity

Background. The state of health of modern schoolchildren occupies one of the most important positions in the modern world. Improper nutrition with an intensive educational load and low physical activity contribute to the development of “school” diseases. Aim. To assess the actual nutrition of school-age children using the example of third-grade students and to determine its impact on physical development and school morbidity. Materials and methods. The survey was conducted from November 2019 to March 2020. 33 children aged 8–9 years were studied. The nutrition of children was studied using a questionnaire for parents, which included questions about the frequency of eating various foods during the week. Physical development was assessed by height, body weight, and chest circumference. Incidence data were copied from medical records (form 026-y). The statistical analysis included the calculation of the error of relative values. Results . The children›s diet was found to lack protein products (meat, eggs, poultry). On average, 3–4 times a week, 42 ± 1.50 % consume meat, 52 ± 1.51 % poultry, and 45 ± 1.51 % eggs. There was an increased consumption of foods containing a large amount of fat and carbohydrates, so 1–2 times a week 45 ± 1.51 % eat chips, and 55 ± 1.51 % drink sweet carbonated drinks and juices. The assessment of physical development showed an increase in the number of children with disharmonious development (49 ± 1.51 % for the entire sample). Analysis of morbidity revealed the prevalence of diseases of musculoskeletal system: postural disorder – 24 ± 1.29 % of children, flat foot – 15 ± 1.08 %. Body weight indicators were higher or lower than normal in 24 ± 1.29 % of schoolchildren, including a decrease in body weight in 18 ± 1.16 % and an increase – in 6 ± 0.72 % of children. Conclusions. The study noted a lack of protein consumption, which is necessary for the implementation of growth and development, while an excess of carbohydrates inhibits these processes. Thus, nutrition plays a leading role in the health and physical development of schoolchild.

Psychopathology, Body Image and Quality of Life in Female Children and Adolescents With Anorexia Nervosa: A Pilot Study on the Acceptability of a Pilates Program.

Background: Anorexia nervosa (AN) is a psychiatric illness that without early effective treatment becomes chronic with high physical, psychological and social morbidity and high mortality. Pilates exercises can improve quality of life and increase body awareness in different clinical and healthy populations. The aim of this pilot study was to examine the acceptability of a Pilates program in a sample of female children and adolescents with AN by evaluating the psychopathological status, alterations in the perception of body image and health-related quality of life after 10 weeks.Methods: A total of 12 female patients (age: 14.6 ± 1.7 years) completed the 10-week Pilates program. Psychopathology (EDI-3), body image disturbance (CDRS) and quality of life (KIDSCREEN-27) were evaluated before and after the intervention. A satisfaction questionnaire was also provided.Results: Regarding psychopathology, although there were standardized reductions in seven parameters of those that form EDI-3, none of them reached significance. In relation to body image, significant, moderately standardized and substantial decreases were observed in the body dissatisfaction (p = 0.046, Cohen's d = −0.69). There were significant, large standardized and substantial increases in physical well-being (p = 0.008, Cohen's d = 1.37) and significant, moderately standardized and substantial decreases in autonomy and parent relation (p = 0.021, Cohen's d = −0.60). Satisfaction data was positive.Conclusion: A Pilates program could help to improve perceived health outcomes by decreasing body dissatisfaction and increasing physical well-being in female children and adolescents with AN, so Pilates seems to be a beneficial complementary treatment in children and adolescents with AN. These findings from our pilot study are encouraging for future research with a substantially larger sample size, representing the first phase of a longer process.