8-year Prospective Cohort Study Research Articles

Elevated cobalt levels in metal-on-polyethylene knee megaprostheses: a prospective 1-year cohort study of 56 patients with hip and knee megaprostheses.

Concerns have emerged regarding elevated levels of cobalt and chromium in patients with metal-on-metal megaprostheses. This prospective study aims to identify systemic cobalt and chromium levels in metal-on-polyethylene knee and hip megaprostheses and their associations with other factors. 56 patients underwent knee or hip megaprosthesis surgery at 2 sarcoma centers. Serum cobalt and chromium levels were measured preoperatively and thrice within the first year using inductively coupled plasma mass spectrometry. A statistically significant difference in serum cobalt levels (1.4 ppb; 95% confidence interval [CI] 0.0-3.3) was observed 1 year after knee megaprosthesis surgery compared with preoperative levels. In contrast no difference in chromium levels was observed after 1 year compared with preoperative levels (0.05 ppb; CI 0.0-0.8). An association between younger age, higher eGFR, and increased cobalt levels was observed. No significant correlations were found between ion levels and resection length or the number of modular connections. We found elevated serum ion levels in metal-on-polyethylene knee megaprostheses in contrast to metal-on-polyethylene hip megaprostheses. Furthermore, a positive correlation between cobalt and chromium levels, and between cobalt and eGFR was identified, along with a negative correlation between cobalt and age. This study highlights the importance of monitoring systemic cobalt and chromium levels in patients with megaprostheses.

Relationship between left-behind status and cognitive function in older Chinese adults: a prospective 3-year cohort study

BackgroundDue to the inaccuracy of the traditional geographical distance-based definition of left-behind status, data on the negative effect of left-behind status on cognitive function among older adults are controversial.AimsThis study...

Clinical course of patients with hepatorenal tyrosinemia treated with nitisinone – a 10-year prospective cohort study

ntroduction: Untreated type 1 tyrosinemia, when manifesting in infancy, causes severe liver enlargement, or, later in the first year, damages the hepatic and renal tubular function, leading to developmental impairment. Nitisinone (NTBC) treatment has been able to control liver dysfunction in patients and the extrahepatic manifestations of HT1. The present study aimed to eval- uate the effect of nitisinone on the clinical course of patients with tyrosinemia type 1. Methods: This prospective 10-year cohort study focused on patients with type 1 tyrosinemia referred to Shiraz Pediatric Gastroenterology Clinic between March 20, 2010, and March 20, 2018. The clinical course of patients treated with nitisinone was evaluated. Statistical analysis was performed using SPSS 20 software. Results: This study included 145 patients. The results showed clear correlation between the severity of clinical complications of tyrosinemia and the proper use of the drug. The outcome among the patients taking the medications (95%) was observed to be good in 52.6%, while 12.6% of patients were on the waiting list, 32.6% had undergone transplantation, and 2.1% passed away. On the other hand, out of 54 patients who did not take NTBC, only 12% showed good outcomes, 6% were on the waiting list, 56% had undergone transplantation, and 26% died. Conclusion: The results of this study support the role of nitisinone in decreasing the complications of type 1 tyrosinemia and improving clinical symptoms, as well as reducing mortality in these patients. Keywords tyrosinemia type 1, nitisinone (NTBC), liver transplantation, tyrosine

Gait recovery is not associated with meniscus and/or knee ligament injuries following lateral tibial plateau fractures. A prospective 3-year cohort study of 56 patients

IntroductionThough associated meniscus and/or knee ligament injuries following lateral tibial plateau fractures (TPF) are common, the importance of development in gait recovery is unknown. This study aim to report the 12- and 36-month gait recovery in patients with lateral TPF divided into two groups presenting with and without associated meniscus and/or knee ligament injuries. (Associated meniscus and/or knee ligament injuries were grouped as: 1) missing, 2) lateral or medial menisci, 2) posterior and anterior cruciate ligament (PCL/ACL), and 4) lateral or medial collateral ligament.) HypothesisComparable results at the 12- and 36-month follow-up between groups presenting with and without soft tissue injuries. Patients and methodsStudy design: cohort study. Included were patients admitted following a lateral TPF (AO-type 41 B) between December 1, 2013 and November 30, 2016. The primary outcome score was gait sample. ResultsFifty-six patients were included. The mean age of the patients at the time of fracture was 56 years (range from 22 to 86). Female gender represents 75%. MRI-verified associated meniscus and/or knee ligament injuries were observed in 28 patients (50%). The average gait speed at the 12- and 36-month follow-up were 125.7 (SD31.3) and 127.7 (SD16.6) cm/sec. for patients with associated meniscus and/or knee ligament injuries and 125.2 (SD31.1) and 130.1 (SD15.6) cm/sec. for patients without associated meniscus and/or knee ligament injuries (p=0.96, p=0.17). Regardless of soft tissue injuries, the development in percent of gait asymmetry for step-length and single-support decrease significantly between the 12- and the 36-month follow-up. (p>0.002) DiscussionThis study indicates that gait recovery following lateral TPFs were not associated with associated meniscus and/or knee ligament injuries at the 12- and 36-month follow-up. Between the 12- and 36-month follow-up asymmetry of the gait function decline significantly indicating a prolonged recovery period of gait function following TPFs. Level of evidenceII; prospective cohort study.

Mini-Implants Retaining Removable Partial Dentures in Subjects without Posterior Teeth: A 5-Year Prospective Study Comparing the Maxilla and the Mandible

Background and objectives: Long-term studies of clinical outcomes of mini-implants (MDIs) in the first premolar/canine sites retaining a bilateral free-ending removable partial dentures (RPD) in Kennedy class I subjects have not been well documented. The aim was to assess clinical outcomes in a prospective 5-year cohort study comparing the mandible and maxilla. Material and Methods: Participants (n = 92) who received two MDIs each and a new RPD were reviewed after one, three and five years. A total of 71 participants (82 mini-implants in the mandible; 58 in the maxilla) completed the study. Marginal bone level change, success, survival rates, Modified Plaque (MPI) and Bleeding Indices (MBI) were assessed. Results: The five-year success rate was 93.3% and 93.4% (p > 0.05), in the mandible and the maxilla, respectively. Mean peri-implant bone loss (MBL) increased significantly over five years (p < 0.01) to 0.50 mm in the mandible and 0.52 mm in the maxilla. Age had a significant effect on the MBL (higher rates in younger participants), while jaw of insertion, gender, and antagonistic jaw status did not. MPI and MBI were not significantly correlated with MBL. Conclusions: The insertion of two MDIs in previous first premolar/canine sites for retention of a free-end saddle RPD can be a successful treatment modality in subjects with narrow alveolar ridges.

Incidence and temporal changes in lumbar degeneration and low back pain in child and adolescent weightlifters: A prospective 5-year cohort study.

This study was conducted to investigate the incidence of lumbar degeneration findings and low back pain (LBP) in children and adolescent weightlifters using magnetic resonance imaging (MRI) and medical questionnaires over a 5-year period. Moreover, we aimed to reveal the temporal changes in the lumbar vertebrae caused by long-term weightlifting training during the growth period. Twelve children and adolescent weightlifters who participated in weightlifting for >2 years (six boys, six girls, 11.4±2.0 years) were enrolled. Participants underwent annual medical questionnaire surveys, including data on practice frequency, competition history, presence of LBP, and lumbar examinations using MRI during the 5-year follow-up. Lumbar disc degeneration was detected in all the participants after 4 years, and lumbar disc herniation findings were detected in 33% of participants after 5 years; one underwent herniotomy during the follow-up period. Lumbar spondylolysis was detected in 58% of patients at 5 years. Although there were three participants who had LBP in the final year, none had LBP that prevented them from returning to weightlifting. This 5-year cohort study of 12 children and adolescent weightlifters detected lumbar degeneration in all participants. High frequency weightlifting training over a long period during the growth period may increase the risk of developing current and future LBP.

Diabetic nephropathy ameliorated in patients with normal home blood pressure compared to those with isolated high home systolic blood pressure: A 5-year prospective cohort study among patients with type 2 diabetes mellitus.

Background:Using normal home blood pressure (home BP) as a reference, isolated high home systolic blood pressure (IH-home SBP) increases the risk of diabetic nephropathy. However, whether diabetic nephropathy would improve among diabetic patients without IH-home SBP has not been previously assessed.Methods:This prospective 5-year cohort study of 264 patients with moderate or severe albuminuria investigated the effect of IH-home SBP or normal home BP on the risk of diabetic nephropathy in patients with type 2 diabetes mellitus. Improvement of diabetic nephropathy was defined as remission or regression from moderate or severe albuminuria to normal or mildly increased albuminuria.Results:Improvement of diabetic nephropathy was shown in 59 out of 264 patients during 5 years. The adjusted odds ratio (95% confidence interval) of normal home BP for improving diabetic nephropathy was 2.52 (1.01–5.99, p = 0.05).Conclusion:Normal home BP had relation to an improvement in diabetic nephropathy among type 2 diabetic patients with moderate and severe increased albuminuria in the observation period of 5 years. Good home BP control might be valuable to ameliorate diabetic nephropathy.

P182 Health literacy and gout characteristics in a primary care cohort

Abstract Background/Aims Gout is the most common inflammatory arthritis, affecting 2.5% of the UK population. It is often suboptimally managed, despite the availability of effective urate-lowering therapy. Health literacy has been conceptualised to include dimensions relating to ‘the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion settings’. The objective of this study was to examine the cross-sectional associations between health literacy and gout characteristics. Methods In a prospective 5-year cohort study, adults living with gout registered with 20 general practices, who had consulted their GP about gout or been prescribed allopurinol or colchicine in the preceding two years were mailed a questionnaire. This cross-sectional analysis used data from the 4-year follow-up time-point only. Health literacy was assessed using the Single Item Literacy Screener (SILS). Poor health literacy was defined as answering ‘sometimes’, ‘often’ or ‘always’ to the question ‘How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?’ Multiple logistic regression was used to obtain adjusted odds ratios for the associations between poor health literacy and individual gout characteristics (frequency of flares, age of gout onset, history of oligo/polyarticular flares, allopurinol use, allopurinol dose, serum urate level) with 95% confidence intervals and adjustment for age, sex, deprivation and attendance at further education. Results Five hundred and fifty-one participants responded to the questionnaire at four years (adjusted response 63.5%). Mean (SD) age was 64.4 (11.2) years and 498 (90.4%) were male. One hundred and sixty-three (30.1%) participants reported ≥2 flares in the previous 12 months. Fifty-one (9.4%) participants had poor health literacy. Poor health literacy was associated with more frequent flares (≥2 flares in the last 12 months; adjusted OR 4.10; 95%CI 2.04, 8.19; compared with no flares) and having a history of oligo/polyarticular flares (adjusted OR 1.93; 95%CI 1.06, 3.55), after adjustment for age, sex, deprivation and attendance at further education. No associations between other gout characteristics and health literacy were identified in the adjusted analysis. Conclusion Frequent flares and a history of oligo/polyarticular flares were associated with poor health literacy in people with gout in primary care. Our findings provide further evidence to counter the common misconception that gout is a ‘rich man’s disease’ and highlight the importance of considering health literacy when providing information and education to all people with gout. Disclosure L. Watson: Grants/research support; Lorraine Watson is funded by the National Institute for Health Research (NIHR) School for Primary Care Research. J. Protheroe: None. C.D. Mallen: Grants/research support; Christian Mallen is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, and the NIHR School for Primary Care Research, The School of Medicine as received funding from BMS for a non-pharmacological AF screening trial. S. Muller: Grants/research support; Sara Muller is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands. E. Roddy: None.

Delayed development of cerebral atrophy after cerebral hyperperfusion following arterial bypass for adult patients with ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort.

Adult patients with moyamoya disease (MMD) occasionally exhibit cerebral hyperperfusion after arterial bypass surgery, leading to persistent cognitive decline. The present supplementary analysis of a prospective 5-year cohort study aimed to determine whether cerebral hyperperfusion after arterial bypass surgery for adult patients with misery perfusion due to ischemic MMD causes cerebral atrophy, and whether the development of cerebral atrophy is related to persistent cognitive decline. In total, 31 patients who underwent arterial bypass surgery also underwent fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) and neuropsychological testing before surgery and at the end of a 5-year follow-up. The development of cerebral hyperperfusion and hyperperfusion syndrome after surgery was defined based on brain perfusion single-photon emission computed tomography (SPECT) findings and clinical symptoms. Univariate and multivariate logistic regression analyses of factors related to the development of cerebral atrophy on FLAIR MRI or cognitive decline on neuropsychological testing at the end of the 5-year follow-up were performed. Eleven patients (35%) developed cerebral atrophy in the frontal lobe where the superficial temporal artery was anastomosed. Cerebral hyperperfusion on brain perfusion SPECT (odds ratio [OR], 50.6; p = 0.0008) or cerebral hyperperfusion syndrome (OR, 41.8; p = 0.0026) was independently associated with the development of cerebral atrophy, and cerebral atrophy development was significantly associated with cognitive decline (OR, 47.7; p = 0.0010). Cerebral hyperperfusion after arterial bypass surgery for adult patients with misery perfusion due to ischemic MMD can cause cerebral atrophy related to persistent cognitive decline.

The Impact of Undernutrition on Cognition in Children with Severe Malaria and Community Children: A Prospective 2-Year Cohort Study.

The frequency of recovery from undernutrition after an episode of severe malaria, and the relationship between undernutrition during severe malaria and clinical and cognitive outcomes are not well characterized. We evaluated undernutrition and cognition in children in Kampala, Uganda 18 months to 5 years of age with cerebral malaria (CM), severe malarial anemia (SMA) or community children (CC). The Mullen Scales of Early Learning was used to measure cognition. Undernutrition, defined as 2 SDs below median for weight-for-age (underweight), height-for-age (stunting) or weight-for-height (wasting), was compared with mortality, hospital readmission and cognition over 24-month follow-up. At enrollment, wasting was more common in CM (16.7%) or SMA (15.9%) than CC (4.7%) (both p < 0.0001), and being underweight was more common in SMA (27.0%) than CC (12.8%; p = 0.001), while prevalence of stunting was similar in all three groups. By 6-month follow-up, prevalence of wasting or being underweight did not differ significantly between children with severe malaria and CC. Undernutrition at enrollment was not associated with mortality or hospital readmission, but children who were underweight or stunted at baseline had lower cognitive z-scores than those who were not {underweight, mean difference [95% confidence interval (CI)] -0.98 (-1.66, -0.31), -0.72 (-1.16, -0.27) and -0.61 (-1.08, -0.13); and stunted, -0.70 (-1.25, -0.15), -0.73 (-1.16, -0.31) and -0.61 (-0.96, -0.27), for CM, SMA and CC, respectively}. In children with severe malaria, wasting and being underweight return to population levels after treatment. However, being stunted or underweight at enrollment was associated with worse long-term cognition in both CC and children with severe malaria.

Relationship between medical students’ negative perceptions of colleagues’ work–life and burn-out during clerkships: a longitudinal observational cohort study

ObjectiveBecause work and educational environments are closely related and can affect each other, this study examined whether medical students’ negative perceptions of their colleagues’ work–life balance (NWLB) during their clinical...

Home parenteral nutrition patients on mixed oil lipid emulsion have a higher rate of hospitalizations compare to those on soybean oil– a prospective 2-year cohort study

Mixed oil intravenous lipid emulsion (MO ILE) that contains 30% soybean oil (SO), 30% medium chain triglycerides, 25% olive oil and 15% fish oil can benefit hospitalized patients receiving parenteral nutrition (PN) but there are very few studies on its long-term use. Our goal was to evaluate the clinical outcomes of adults receiving home PN (HPN) with MO versus those receiving SO ILE over a 2-year period. This is a retrospective analysis of data collected prospectively from a cohort of patients recorded in the Canadian HPN Registry over a 2-year period. HPN patients from academic programs across Canada were entered in the Registry according to a validated protocol. For this study, demographic, nutritional, laboratory and clinical data were extracted from January 1st 2015, when MO lipid emulsion became available in Canada, to July 24th 2019. Clinical data for each patient included: number of hospitalizations, number of hospitalizations related to HPN and number of hospitalization days related to HPN, over a year; incidence of line sepsis per 1000 catheter days and mortality. Data are presented as median (1st, 3rd quartile) for continuous variables and frequency (percentage) for categorical variables. Comparisons between groups were performed using two sample t-test or Wilcoxon Rank Sum tests for continuous variables and Chi-square tests or Fisher's exact tests for categorical variables. Univariate and multiple linear regressions were also carried out. Statistical significance is set at a p-value <0.05. A total of 120 patients were included (MO n=68, SO n=52). Significant differences at baseline between the two groups were a higher use of Hickman line (62.12% vs 42%, p=0.038) and more western Canada based hospital care with MO (75% vs 42.31%, p=0.0002). The MO group had significantly more hospitalizations (p=0.001), more hospitalizations related to HPN (p=0.012) and more hospitalization days related to HPN (p=0.016) per patient per year compared to SO patients. There was no significant difference between groups for line sepsis per 1000 catheter days (MO: 0.05 (0.0, 1.0) vs SO: 0.0 (0.0, 0.22), p=0.053) or mortality. All other variables, including biochemical variables, were similar between groups. In a multiple regression analysis, the following factors were significantly associated with a greater number of hospitalizations per patient per year: use of MO, high blood glucose from the last recorded value and having died by the end of the study period. This 2-year prospective cohort study suggests an increased risk of hospitalization in HPN patients receiving MO lipid emulsion. The long-term effect of using MO lipid emulsion in HPN patients should be further evaluated using a large randomized controlled trial. THE STUDY WAS REGISTERED IN CLINICALTRIALS.GOV: (NCT02299466).

Impact of Isolated High Home Systolic Blood Pressure and Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus: A 5-Year Prospective Cohort Study.

Background: A previous 2-year cohort study has shown that isolated high home systolic blood pressure (IH-HSBP) may increase the risk of diabetic nephropathy, using normal HBP as a reference. However, this association has not been previously assessed in the medium to long term. Methods: This prospective 5-year cohort study of 424 patients, with normal or mildly increased albuminuria, investigated the effect of IH-HSBP on the risk of diabetic nephropathy in patients with type 2 diabetes mellitus. Diabetic nephropathy was defined as an advancement from normal or mildly increased albuminuira to moderate or severely increased albuminuria. Results: Among 424 patients, 75 developed diabetic nephropathy during the study period. The adjusted odds ratio for developing diabetic nephropathy given IH-HSBP was 2.39 (95% confidence interval, 1.15–4.96, p = 0.02). The odds ratio for developing nephropathy in patients with IH-HSBP younger than 65 years was higher than that in patients with IH-HSBP older than 65 years. Conclusion: IH-HSBP was associated with an increased risk of diabetic nephropathy among type 2 diabetes mellitus patients with normal or mildly increased albuminuria in the medium to long term. The results support and strengthen previous reports. These findings suggest that IH-HSBP might be a useful marker in disease prognostication.

Genetic Implications in High-Risk Pregnancy and Its Outcome: A 2-Year Study.

The aim of this study is to evaluate high-risk pregnant females' offspring as regard the presence of any medical condition, hereditary disorder, or major anomaly as well as to document parental sociodemographic characteristics and compliance with follow-up schedules of fetal medicine and clinical genetic clinics. This prospective 2-year cohort study of neonates and infants reported the referral indications, investigations, and diagnoses obtained through prenatal and postnatal examinations. It also reported their parental follow-up vigilance. Of the 811 infants of high risk females referred 460 (56.7%) came for assessment. Mean parental consanguinity and endogamy were 67 and 71.3%, respectively. All pregnant mothers underwent first-trimester biochemical testing (plasma protein-A, α-fetoprotein [AFP], human chorionic gonadotropin [hCG]) and serial ultrasound examinations. Seventy mothers needed second-trimester biochemical testing (AFP, hCG, and estriol). Sixty-two mothers underwent amniocentesis where G-banding karyotype, fluorescence in situ hybridization and targeted molecular testing for the specific gene mutation of single gene disorders were conducted according to suspected disorders. High quality fetal ultrasound was performed when brain malformations were suspected, while 16 fetuses required brain MRI examination. Mean age of newborns at first examination was 26.5 days. They were grouped according to the maternal indication for referral. Upon examination, 18 neonates had confirmed congenital malformations/genetic disorders. Five of them were diagnosed prenatally. In four other fetuses with single gene disorder, the molecular diagnosis of their affected siblings was not established prior to this pregnancy; thus, prenatal diagnosis was not possible. The remaining nine cases were diagnosed postnatally. Parental consanguinity and endogamy were increased among high-risk pregnancies. Public awareness about potential adverse effects of consanguineous marriages and the importance of genetic testing are imperative. A structured multidisciplinary team of specialists in fetal medicine, clinical genetics, and neonatology provides good genetic services. Expansion and financial support of these services are urgently required. · A multidisciplinary team provides good genetic services in high-risk pregnancies.. · Parental consanguinity and endogamy are increased among high-risk pregnancies.. · Increased public awareness about genetic testing importance and financial support are imperative..

Vitamin D deficiency as the risk of respiratory tract infections in the institutionalized elderly: A prospective 1-year cohort study.

Respiratory tract infections (RTIs) are one of the major causes of morbidity and mortality in the elderly. Since vitamin D is known to play important roles in immunity, and its deficiency has been reported to be prevalent in the elderly, we have studied the relationship between serum 25-hydroxyvitamin D [25(OH)D] level, which is the most reliable marker for vitamin D status, and the incidence of RTIs in the institutionalized elderly by a prospective observational study. From 208 Japanese subjects aged 60 and older fulfilling the inclusion criteria, 148 subjects remained after propensity score matching. Data were obtained from the medical records including their age, gender, histories of co-morbidities and medications, the incidence of acute RTIs including pneumonia. Measurement of serum 25(OH)D level and assessment of nutrients intake including vitamin D were done at baseline. Cox's proportional hazard analysis was performed to assess the significant predictors for RTIs during the follow-up period. The median observation duration was 354.2 days, and the incidence of RTIs was 75.8 person-years. Subjects with RTIs had significantly lower serum 25(OH)D concentration, and a higher prevalence of vitamin D deficiency (25(OH)D<10ng/mL). Cox's proportional hazard analysis revealed that vitamin D deficiency was a significant predictor for RTIs. Our results suggested that vitamin D deficiency was a significant predictor for an increased incidence of RTIs in institutionalized elderly, and the necessity of vitamin D supplementation for the prevention of RTIs was considered.

Risk factors for noncontact anterior cruciate ligament injury in female high school basketball and handball players: A prospective 3-year cohort study

IntroductionThe risk factors of noncontact anterior cruciate ligament (ACL) injury remain an enigma. The purpose of this study was to prospectively evaluate the risk factors for noncontact ACL injury in female high school basketball and handball players. Materials and MethodsWe conducted a 3-year prospective cohort study between 2009 and 2014, and it included 317 female high school athletes aged 15 years. At baseline, they underwent detailed examinations for various parameters that were documented during their first year of high school. The parameters assessed were height (cm), weight (kg), general joint laxity (points), navicular drop (mm), anterior laxity of the knee using the KT-1000 Knee Ligament Arthrometer (mm), angle of femoral anteversion (º), knee extensor/flexor muscle strength (Nm/kg), and hip abductor strength (Nm/kg). All ACL injuries that occurred during these 3 years were recorded. ResultsOf 317 players, 27 were excluded because they either had a history of ACL injury or could not complete the study. Thirty ACL tears occurred. Three of the ACL injuries were contact injuries, whereas the remaining 27 were noncontact injuries. Greater body weight (95% confidence interval [CI], 1.030–1.174; P = 0.004), a high hip abductor strength (95% CI, 1.462–4.827; P = 0.001), and small femoral anteversion (95% CI, 0.746–0.982; P = 0.027) were found to be risk factors in logistic regression analysis. ConclusionGreater body weight, a high hip abductor strength, and small femoral anteversion were risk factors for noncontact ACL injury in female high school basketball and handball players.

Bathing Frequency and Onset of Functional Disability Among Japanese Older Adults: A Prospective 3-Year Cohort Study From the JAGES.

BackgroundWhile bathing styles vary among countries, most Japanese people prefer tub bathing to showers and saunas. However, few studies have examined the relationship between tub bathing and health outcomes. Accordingly, in this prospective cohort study, we investigated the association between tub bathing frequency and the onset of functional disability among older people in Japan.MethodsWe used data from the Japan Gerontological Evaluation Study (JAGES). The baseline survey was conducted from August 2010 through January 2012 and enrolled 13,786 community-dwelling older people (6,482 men and 7,304 women) independent in activities of daily living. During a 3-year observation period, the onset of functional disability, identified by new certification for need of Long-Term Care Insurance, was recorded. Tub bathing frequencies in summer and winter at baseline were divided into three groups: low frequency (0–2 times/week), moderate frequency (3–6 times/week), and high frequency (≥7 times/week). We estimated the risks of functional disability in each group using a multivariate Cox proportional hazards model.ResultsFunctional disability was observed in a total of 1,203 cases (8.7%). Compared with the low-frequency group and after adjustment for 14 potential confounders, the hazard ratios of the moderate- and high-frequency groups were 0.91 (95% confidence interval [CI], 0.75–1.10) and 0.72 (95% CI, 0.60–0.85) for summer and 0.90 (95% CI, 0.76–1.07) and 0.71 (95% CI, 0.60–0.84) for winter.ConclusionHigh tub bathing frequency is associated with lower onset of functional disability. Therefore, tub bathing might be beneficial for older people’s health.

Incidence of invasive breast cancer in women treated with testosterone implants: a prospective 10-year cohort study

BackgroundTestosterone implants have been used for over eighty years to treat symptoms of hormone deficiency in pre and postmenopausal women. Evidence supports that androgens are breast protective. However, there is a lack of data on the long-term effect of testosterone therapy on the incidence of invasive breast cancer (IBC). This study was specifically designed to investigate the incidence of IBC in pre and postmenopausal women (presenting with symptoms of androgen deficiency) treated with subcutaneous testosterone implants or testosterone implants combined with anastrozole.MethodsThe 10-year prospective cohort study was approved in March 2008 at which time recruitment was initiated. Recruitment was closed March 2013. Pre and postmenopausal women receiving at least two pellet insertions were eligible for analysis (N = 1267). Breast cancer incidence rates were reported as an unadjusted, un-weighted value of newly diagnosed cases divided by the sum of ‘person-time of observation’ for the at-risk population. Incidence rates on testosterone therapy were compared to age-specific Surveillance Epidemiology and End Results (SEER) incidence rates and historical controls. Bootstrap sampling distributions were constructed to verify comparisons and tests of significance that existed between our results and SEER data.ResultsAs of March 2018, a total of 11 (versus 18 expected) cases of IBC were diagnosed in patients within 240-days following their last testosterone insertion equating to an incidence rate of 165/100000 p-y, which is significantly less than the age-matched SEER expected incidence rate of 271/100000 p-y (p < 0.001) and historical controls.ConclusionLong term therapy with subcutaneous testosterone, or testosterone combined with anastrozole, did not increase the incidence of IBC. Testosterone should be further investigated for hormone therapy and breast cancer prevention.

Isolated high home systolic blood pressure in patients with type 2 diabetes is a prognostic factor for the development of diabetic nephropathy: KAMOGAWA-HBP study

BackgroundIsolated high home systolic blood pressure (IH-HSBP) has been revealed to be correlated with cardiovascular disease and diabetic nephropathy, however, the prognostic significance of IH-HSBP with the development of diabetic nephropathy is unclear. MethodsIn this prospective 2-year cohort study of 477 patients with normoalbuminuria, we investigated the effect of IH-HSBP on the development of diabetic nephropathy defined by diabetic nephropathy advanced from normoalbuminuira to micro or macroalbuminuria. ResultsAmong 477 patients, 67 patients showed the development of diabetic nephropathy. In the multivariate logistic regression analyses, IH-HSBP was prognostic factor for the development of nephropathy after adjusting for sex, age, duration of diabetes mellitus, body mass index, total cholesterol, hemoglobin A1c, creatinine, smoking habits and use of renin-angiotensin-aldosterone system inhibitors (odds ratio: 2.53, 95% confidence interval: 1.16–5.56, p = 0.020). ConclusionIH-HSBP in patients with type 2 diabetes with normoalbuminuria was prognostic factor for the development of diabetic nephropathy. We should pay more attention to IH-HSBP to prevent the development of diabetic nephropathy.

Does access to saltwater swimming pools reduce ear pathology and hearing loss in school children of remote arid zone aboriginal communities? A prospective 3-year cohort study.

To assess whether access to saltwater chlorinated swimming pools in remote Aboriginal communities is beneficial in reducing levels of middle ear disease and hearing loss in school children. A prospective 3-year cohort study of children in 10 remote Aboriginal communities in South Australia with (n=4) or without (n=6) swimming pools. Outback Australia. Eight hundred and thirteen school-age children residing in remote South Australia. Prevalence of open and closed middle ear disease and prevalence of hearing loss. About 2107 ear assessments were conducted during the study period. 70.7% of children in communities with pools failed a screening test of hearing compared with 68.6% of children in non-pool communities (P=0.637). 32.3% of children had chronic otitis media (COM). There was no difference between pool and non-pool communities in the frequency of either inactive (19.4% pool vs 22.6% non-pool; P=0.232) or active (19.8% pool vs 17.8% non-pool; P=0.383) COM. In children with bilateral intact tympanic membranes, 21.2% had unilateral and 20.6 had bilateral type B tympanograms. There was no difference between pool and non-pool communities in the frequency of type B tympanometry (P=0.465). Hearing loss associated with both open and closed middle ear disease remains highly prevalent in children living in remote Aboriginal communities in South Australia. Access to swimming pools in this population does not appear to significantly reduce these high levels of middle ear disease or associated hearing loss.