Random Sample Of General Population Research Articles

Long-term ambient air pollution and coronary atherosclerosis: Results from the Swedish SCAPIS study

Background and aimsDespite firm evidence for an association between long-term ambient air pollution exposure and cardiovascular morbidity and mortality, results from epidemiological studies on the association between air pollution exposure and atherosclerosis have not been consistent. We investigated associations between long-term low-level air pollution exposure and coronary atherosclerosis. MethodsWe performed a cross-sectional analysis in the large Swedish CArdioPulmonary bioImaging Study (SCAPIS, n = 30 154), a random general population sample. Concentrations of total and locally emitted particulate matter <2.5 μm (PM2.5), <10 μm (PM10), and nitrogen oxides (NOx) at the residential address were modelled using high-resolution dispersion models. We estimated associations between air pollution exposures and segment involvement score (SIS), coronary artery calcification score (CACS), number of non-calcified plaques (NCP), and number of significant stenoses, using ordinal regression models extensively adjusted for potential confounders. ResultsMedian 10-year average PM2.5 exposure was 6.2 μg/m3 (range 3.5–13.4 μg/m3). 51 % of participants were women and 51 % were never-smokers. None of the assessed pollutants were associated with a higher SIS or CACS. Exposure to PM2.5 was associated with NCP (adjusted OR 1.34, 95 % CI 1.13, 1.58, per 2.05 μg/m3). Associations with significant stenoses were inconsistent. ConclusionsIn this large, middle-aged general population sample with low exposure levels, air pollution was not associated with measures of total burden of coronary atherosclerosis. However, PM2.5 appeared to be associated with a higher prevalence of non-calcified plaques. The results suggest that increased risk of early-stage atherosclerosis or rupture, but not increased total atherosclerotic burden, may be a pathway for long-term air pollution effects on cardiovascular disease.

Novel linkage of health and prison data in Scotland: Investigating access to services for mental health and substance use following release from prison

ObjectivesTo compare the use of NHS services for mental health and substance use (MH/SU) between people released from prison and the general population. This paper describes the data linkage and analytical process, discusses policy implications and highlights the methodological contributions for future administrative data research in public health and justice.&#x0D; MethodsRetrospective cohort study using linked Scottish health data and the Scottish Prison Service (SPS), involving all individuals released from prison in 2015 (n = 14,000), and a random general population sample (n = 70,000), matched on index date, age, sex, and postcode. Analysis will include descriptive comparison of service use between the two cohorts. Multiple regression models will be fitted to examine the influence of confounding variables in service use, and multilevel models will specifically assess cross-level geographical variation where feasible.&#x0D; ResultsResults of the data linkage and analysis to date will be presented. This research will contribute to understanding the complex range of contacts people have with health services for MH/SU following imprisonment. It is the first research in Scotland to provide a national-level description of access to health services for MH/SU among people released from prison and offer a comparison to the general population. It also explores within-group differences in service access for people released from prison.&#x0D; ConclusionThe linking and analysis of multiple justice and health-related datasets will provide crucial evidence to inform future healthcare delivery for justice-experienced populations. This research also advances our understanding of public health approaches and administrative data research in justice-related contexts.

Life satisfaction, positive affect, depression and anxiety symptoms, and their relationship with sociodemographic, psychosocial, and clinical variables in a general elderly population sample from Chile.

This study aims to describe the relationship between life satisfaction, positive affect, depression and anxiety symptoms with sociodemographic, psychosocial and clinical variables, and to identify the relative importance of these predictor groups. We evaluated life satisfaction (SWLS), positive affect (PANAS), depressive (PHQ-9), and anxiety (GAI) symptoms and their association with sociodemographic, psychosocial and clinical variables in a multistage, random general population sample of fully functioning individuals aged 60-80 years from the Concepción province and Gran Santiago, Chile (n = 396). We performed weighted multiple regression analysis, considering the complex sample structure with age group, sex, and geographical area, complemented with general and conditional dominance analyses to estimate the relevance of the predictor groups. We found significant associations with the geographical area, sex, age, education level, household members, having a partner, employment status, caregiver status, economic satisfaction, presence of chronic diseases, medication use, and alcohol use. Satisfaction with health was the most important predictor for positive affect (p < 0.001), depressive (p < 0.001), and anxiety (p < 0.001) symptoms, while alcohol use was the most significant predictor for life satisfaction (p < 0.001). Simultaneously studying the positive and negative dimensions of wellbeing and mental health in older adults allows for a more comprehensive perspective on the challenges faced during this stage of life. This study accounts for previously unknown associations and contributes to the identification of common and specific predictors in both dimensions.

Headache impact and socioeconomic status: findings from a study of the German Migraine and Headache Society (DMKG)

BackgoundHeadache disorders are not only among the most prevalent, they are also among the most disabling disorders worldwide. This paper investigates the association between headache impact on daily life and the socioeconomic status (SES) of headache sufferers.MethodsData stem from a random general population sample in Germany. Respondents who reported having headache for at least a year and were aged ≥ 18 years were included in the study. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey. The impact of headache on daily life was measured using the German version of the Headache Impact Test (HIT-6).ResultsHigher headache impact was found in low and medium SES compared to high SES. After adjustment for sociodemographics, headache-related factors (analgesic use, headache duration, headache frequency, migraine diagnosis), depressive symptoms, physical inactivity and obesity, an increased odds ratio of having higher headache impact in low SES compared to high SES was found: OR = 1.83, 95% CI [1.43, 2.23], p = .014. When the interactions "SES*obesity", "SES*depressive symptoms", and "SES*physical inactivity" were added, the results showed a significant interaction effect of “SES*obesity”. Obese persons with low SES were 3.64 times more likely to have higher headache impact than non-obese persons with low SES. No significant differences between obese and non-obese persons were found in the medium and high SES groups.ConclusionsSES is an important factor that should not be neglected in headache awareness campaigns and headache treatment. Longitudinal studies are needed in the future to investigate whether lifestyle interventions, such as weight reduction, can help to reduce headache impact in people in lower SES.

Multi‐modal machine learning based on electrocardiogram data for prediction of patients with ischemic heart disease

Electrocardiogram is a non-invasive method to diagnose patients with cardiovascular diseases. Electrocardiogram analysis methods using deep neural networks have been widely used in recent years and are becoming more efficient and accurate than traditional machine learning methods. Exercise electrocardiogram is useful in the diagnosis of ischemic heart disease, but the study of long-term ischemic heart disease prediction based on exercise electrocardiogram is still limited. To investigate the early predictive value of exercise electrocardiogram in addition to basic physiological data in incident ischemic heart disease in a random general population sample followed from 40 to 69 years of age, a multi-modal fusion model is designed to predict ischemic heart disease based on machine learning methods. With the deep feature extractor and multi-modal feature fusion module, the proposed model performance is better than the traditional expert feature based methods and only deep neural networks. This implies that this proposed model may be improved in a contemporary era of ischemic heart disease prevention with the gradually declining incidence of ischemic heart disease.

Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study

BackgroundStimulant use has been rising among people with opioid use disorder in recent years in North America, alongside a parallel rise in illicit drug toxicity (overdose) deaths. This study aimed to examine the association between stimulant use and overdose mortality.MethodsData from a universal health insurance client roster were used to identify a 20% random general population sample (aged ≥12) in British Columbia, Canada (N = 1,089,682). Provincial health records were used to identify people who used opioids and/or stimulants. Fatal overdose observed during follow-up (January 1 2015-December 31 2018) was retrieved from Vital Statistics Death Registry and BC Coroners Service Data. Potential confounders including age, sex, health region, comorbidities and prescribed medications were retrieved from the provincial client roster and health records.ResultsWe identified 7460 people who used stimulants and or opioids. During follow-up there were 272 fatal overdose events. People who used both opioids and stimulants had more than twice the hazard of fatal overdose (HR: 2.02, 95% CI: 1.47-2.78, p < 0.001) compared to people who used opioids only. The hazard of death increased over time among people who used both opioids and stimulants.ConclusionsThere is an urgent need to prioritize the service needs of people who use stimulants to reduce overdose mortality in British Columbia. Findings have relevance more broadly in other North American settings, where similar trends in opioid and stimulant polysubstance use have been observed.

Interplay of ADHD Polygenic Liability With Birth-Related, Somatic, and Psychosocial Factors in ADHD: A Nationwide Study.

Attention deficit hyperactivity disorder (ADHD) is a multifactorial neurodevelopmental disorder, yet the interplay between ADHD polygenic risk scores (PRSs) and other risk factors remains relatively unexplored. The authors investigated associations, confounding, and interactions of ADHD PRS with birth-related, somatic, and psychosocial factors previously associated with ADHD. Participants included a random general population sample (N=21,578) and individuals diagnosed with ADHD (N=13,697) from the genotyped Danish iPSYCH2012 case cohort, born between 1981 and 2005. The authors derived ADHD PRSs and identified 24 factors previously associated with ADHD using national registers. Logistic regression was used to estimate associations of ADHD PRS with each risk factor in the general population. Cox models were used to evaluate confounding of risk factor associations with ADHD diagnosis by ADHD PRS and parental psychiatric history, and interactions between ADHD PRS and each risk factor. ADHD PRS was associated with 12 of 24 risk factors (odds ratio range, 1.03-1.30), namely, small gestational age, infections, traumatic brain injury, and most psychosocial risk factors. Nineteen risk factors were associated with ADHD diagnosis (odds ratio range, 1.20-3.68), and adjusting for ADHD PRS and parental psychiatric history led to only minor attenuations. Only the interaction between ADHD PRS and maternal autoimmune disease survived correction for multiple testing. Higher ADHD PRS in the general population is associated with small increases in risk for certain birth-related and somatic ADHD risk factors, and broadly to psychosocial adversity. Evidence of gene-environment interaction was limited, as was confounding by ADHD PRS and family psychiatric history on ADHD risk factor associations. This suggests that the majority of the investigated ADHD risk factors act largely independently of current ADHD PRS to increase risk of ADHD.

Prevalence of fatty liver and advanced fibrosis by ultrasonography and FibroScan in a general population random sample.

Fatty liver is the most common liver disease. This study examined fatty liver and advanced fibrosis prevalence in a random sample of the Japanese general population. A total of 6000 people randomly selected from two cities in Hiroshima Prefecture were invited to participate in this cross-sectional study originally carried out for hepatitis virus screening. Ultrasonography and FibroScan (controlled attenuation parameter [CAP] and liver stiffness measurement [LSM]) were provided as additional tests. Of 6000 invited individuals, 1043 participated in hepatitis virus screening, of which 488 randomly selected individuals (median age, 56years; interquartile range, 45-68years; male participants, 49.8%) underwent ultrasonography, CAP, and LSM. Ultrasonography showed fatty liver in 24.6% and mild fatty liver in 32.8%. Controlled attenuation parameter showed severe steatosis in 27.5%, moderate steatosis in 12.5%, and mild steatosis in 11.1%. Overall, 62.1% were diagnosed with fatty liver based on ultrasonography or CAP. Nonalcoholic fatty liver disease (NAFLD) prevalence was 50.6%. Liver stiffness measurement found cirrhosis in 1.0% and severe fibrosis in 1.8%. Multivariate analysis of risk factors associated with ≥F2 or higher liver fibrosis showed that age ≥60years and above (adjusted odds ratio [AOR], 3.2; 95% confidence interval [CI], 1.5-6.9; p=0.0031), hepatitis C virus antibody positivity (AOR, 8.4; 95% CI, 1.0-68.4; p=0.0467), and fatty liver (AOR, 2.3; 95% CI, 1.1-6.2; p=0.0317) are independent risk factors. In the general population, 62.1% had fatty liver, and NAFLD prevalence was twice as high as previously reported. Screening that is noninvasive, low-cost, and does not require special techniques or equipment is needed to detect advanced liver fibrosis.

Chronic opioid use before and after exercise therapy and patient education among patients with knee or hip osteoarthritis

To investigate changes in opioid use after supervised exercise therapy and patient education among knee or hip osteoarthritis patients with chronic opioid use. In this cohort study, we linked data from the Good Life with osteoArthritis in Denmark register (GLA:D®; standardised treatment program for osteoarthritis; January 2013 to November 2018) with national health registries. Among 35,549 patients, 1,262 were classified as chronic opioid users based on amount and temporal distribution of dispensed opioids the year before the intervention. We investigated changes in opioid use, measured as mg oral morphine equivalents (OMEQs), from the year before the intervention to the year after using generalized estimating equations. We found a 10% decrease in mg OMEQs from the year before to the year after the intervention (incidence rate ratio [IRR]: 0.90, 95% confidence interval [CI]: 0.86, 0.94). Additional analyses suggested this decrease to be mainly attributable to regulatory actions targeting opioid prescribing during the study period (IRR among patients participating in the intervention before: 0.98 [95% CI: 0.89, 1.07] vs after: 0.83 [0.74, 0.93] regulatory actions). In a random general population sample of matched chronic opioid users, a similar opioid use pattern was observed over time, further supporting the impact of regulatory actions on the opioid use in the study population. Among patients with knee or hip osteoarthritis and chronic opioid use, a standardised treatment program did not change opioid use when regulatory changes in opioid prescribing were taken into account.

SEASONAL VARIATION IN METEOROLOGICAL PARAMETERS AND BLOOD PRESSURE IN CROATIAN ADULT POPULATION

Objective: There are many reports on the seasonality of cardiovascular risk factors particularly of blood pressure (BP). Our aim was to analyze association of BP with various meteorological parameters in random sample of general Croatian adult population. Design and method: EHUH -2 study is nation-wide survey (Croatian Science Foundation) on prevalence, treatment and control of hypertension in Croatia. In 2018–2021 a random sample of 1321 subjects were enrolled. Office blood pressure (BP) and heart rate were measured in sitting position using Omron 3 device three times and average BP values were calculated. Estimated pulse wave velocity (ePWV) was calculated using validated equation. Meteorological data (mean daily 2 m air temperature – T2m, atmosphere pressure, air humidity measured at meteorological stations according to WMO standards) were collected in Croatian Meteorological and Hydrological Service. Results: We found significant difference in systolic and diastolic BP, heart rate and ePWV accorss nalys (Figure 1a and Figure 2), as well significant correlation between all parameters and T2m. (Figure 3 for systolic BP). There is nonsignificant trend in association between systolic BP and air humidity. We failed to find association of diastolic BP, heart rate and ePWV with any of nalysed meteorological parameters. Furthermore, we found inverse association between systolic BP, diastolic BP and heart rate with T2m i.e. we confirmed seasonal fluctuations (Figure 1b). Conclusions: Our data confirmed findings of seasonal (inverse) variation between BP and T2m. Interestingly, we found association of seasonal variation and ePWV. T2m has impact on long-term BP variability but also on ePWV and should be taken into account in clinical research as well as in regular clinical work.

Physical Activity is Associated with Less Analgesic Use in Women Reporting Headache-A Cross-Sectional Study of the German Migraine and Headache Society (DMKG).

IntroductionThe aim of this analysis is to determine whether regular physical activity is associated with less analgesic use in men and women suffering from headache disorders based on population-based cross-sectional data.MethodsWe used data from a random general population sample in Germany that comprised 2477 participants aged ≥ 14 years. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey.ResultsThirty-nine percent of the participants reported headache. Of these, 37.5% of men and 33.6% of women were physically active. Of the participants with headache, 43.3% reported taking analgesics on < 2 days a month, 40.7% on 2–5 days a month, 10.1% on 6–10 days a month, and 5.9% on > 10 days a month. Frequent headache, severe impact of headache on daily life, and depressive symptoms were associated with higher analgesic use in both men and women. For women, physical inactivity was associated with the frequency of analgesic use adjusted for sociodemographic and headache-related variables. For men, results did not suggest any association between physical inactivity and frequency of analgesic use.ConclusionsThere are both sex-unspecific and sex-specific factors associated with analgesic use among men and women with headache. In women with increased analgesic use, promoting physical activity may reduce analgesic use. For men, education about the therapeutic effects of physical activity for headaches is an important resource.

Prevalence of benign prostatic hyperplasia among the adult general population of five Middle Eastern Countries: Results of the SNAPSHOT programme

ABSTRACT Objectives To present data on the prevalence of benign prostatic hyperplasia (BPH) in five Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia, and the United Arab Emirates; the latter three forming a Gulf cluster). Subjects and Methods The SNAPSHOT programme was a multi-country, cross-sectional epidemiological survey conducted by telephone in a random sample of the adult general population. Subjects were considered to have BPH if they fulfilled the screening criteria, based on diagnosis, symptoms, and treatments received in the past 12 months. Current prevalence (last 12 months) was estimated. Association with co-morbidities was investigated via multivariate logistic regressions. Quality of life (QoL) was assessed using the three-level EuroQol five-dimensions questionnaire (EQ-5D-3 L). Results In total, 5034 of 33,486 subjects enrolled in the SNAPSHOT programme were men aged ≥50 years. In all, 998 of these men fulfilled the BPH screening criteria. The overall prevalence of BPH ranged from 13.84% (95% confidence interval[CI] 12.3–15.4%) in Turkey, to 23.76% (95% CI 21.8–25.6%) in Egypt, and 23.79% (95% CI 21.2–26.3%) in the Gulf cluster. Co-morbidities occurred more frequently in men with BPH compared to the non-BPH population (57% vs 31%; P < 0.001). Principal co-morbidities associated with BPH were cardiovascular, renal, and diabetes mellitus (P < 0.001). The men with BPH reported significantly reduced QoL, with lower EQ-5D-3 L utility values (0.8) compared to the male general population (0.9) aged ≥50 years (P < 0.001). Conclusion The prevalence of BPH in these five Middle Eastern countries ranges from 13.84% to 23.79%. BPH has a negative impact on QoL and is associated with high levels of co-morbid diseases, indicating a need to better understand the management of the disease to reduce the impact on healthcare systems.

Iodine Intake from Food and Iodized Salt as Related to Dietary Salt Consumption in the Italian Adult General Population.

Since the Italian iodoprophylaxis strategy is based on the use of iodized salt, we assessed the relationship between dietary salt consumption and iodine intake in the Italian adult population. We estimated the relative contribution given by the use of iodized salt and by the iodine introduced by foods to the total iodine intake. The study population included 2219 adults aged 25–79 years (1138 men and 1081 women) from all Italian regions, participating to the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008–2012 (OEC/HES), and examined for sodium and iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary sodium and total iodine intake were assessed by the measurement of 24 h urinary excretion, while the EPIC questionnaire was used to evaluate the iodine intake from food. Sodium and iodine intake were significantly and directly associated, upon accounting for age, sex, and BMI (Spearman rho = 0.298; p < 0.001). The iodine intake increased gradually across quintiles of salt consumption in both men and women (p < 0.001). The European Food Safety Authority (EFSA) adequacy level for iodine intake was met by men, but not women, only in the highest quintile of salt consumption. We estimated that approximately 57% of the iodine intake is derived from food and 43% from salt. Iodized salt contributed 24% of the total salt intake, including both discretionary and non-discretionary salt consumption. In conclusion, in this random sample of the Italian general adult population examined in 2008–2012, the total iodine intake secured by iodized salt and the iodine provision by food was insufficient to meet the EFSA adequate iodine intake.

Health-related quality of life in a general population sample in Kazakhstan and its sociodemographic and occupational determinants

BackgroundHealth-related quality of life (HRQL) in the general population of Kazakhstan has never been characterized. We constructed this population-based study of the largest city in Kazakhstan, Almaty with the aim to quantitatively assess HRQL and ascertain whether occupation and lifestyle are associated with HRQL in this population.MethodsIn a random sample (N = 1500) of general population in Almaty (median age 49 (interquartile range 28) years, 50% women), we collected data on demographics, socioeconomic status, lifestyle, lifetime occupational history and general HRQL using SF-8 instrument. The association of demographic and occupational predictors with HRQL was tested in multiple regression models.ResultsNo occupational associations were found for physical component score in the models adjusted for age, sex, income, cigarette and waterpipe smoking, electronic cigarette use, physical activity, alcohol and exposure to secondhand smoke. Ever being a manager (β − 1.63 (95% confidence interval (CI) − 2.92; − 0.34)), a welder (β − 5.11 (95% CI − 8.77; − 1.46)) and a secretary (β − 5.06 (95% CI − 8.56; − 1.56)) for one year or more was associated with poorer mental component score in the models adjusted for age, sex, income, cigarette smoking, physical activity and each other. Age, income and physical activity were independent predictors of both physical and mental components.ConclusionsOccupational history is associated with HRQL in the general population in Almaty, Kazakhstan, but the mechanism explaining this association should be further elucidated.

Severe alpha‐1‐antitrypsin deficiency increases the risk of venous thromboembolism

BackgroundSevere alpha‐1‐antitrypsin deficiency (AATD), phenotype PiZZ, is associated with increased risk of liver disease and chronic obstructive pulmonary disease (COPD), but the risk of venous thromboembolism (VTE) is unknown. Our aim was to evaluate the risk of VTE in individuals with severe AATD compared with control subjects from the general population. MethodsIndividuals with severe AATD (n = 1577) were recruited from the Swedish national AATD register. Control subjects (n = 5969) were selected from the OLIN (Obstructive Lung Disease in Northern Sweden) studies, that include a random general population sample. Longitudinal data on VTE and diagnoses were obtained from the Swedish National Patient Registry. Associations were analyzed using multivariable Cox regression. ResultsAt inclusion, 46% of the AATD individuals and 53% of the controls were never‐smokers. COPD was present in 46% of the AATD individuals compared with 4% of the controls. During a median follow‐up of 18 years, 116 (7%) of the AATD individuals and 89 (1%) of the control subjects developed VTE, unadjusted hazard ratio 6.5 (95% confidence interval 4.9–8.6). Risk factors for incident VTE were male gender, age, COPD, cancer, and liver disease. Adjusting for these factors, the AATD individuals had a significantly higher risk of incident VTE, adjusted hazard ratio 4.2 (95% confidence interval 2.9–6.2) as compared with the controls. ConclusionSubjects with severe AATD have considerably increased risk of developing VTE compared with the general population, even after accounting for risk factors. This calls for optimized risk factor management and clinical follow‐up of this patient group.

Iodine Intake Estimated by 24 h Urine Collection in the Italian Adult Population: 2008-2012 Survey.

Monitoring the population iodine status is essential for iodine deficiency eradication. This study assessed the average dietary iodine intake and the iodine status of a random sample of the Italian general adult population. The study population included 2378 adults aged 35–79 years (1229 men and 1149 women) from all 20 Italian regions, participating in the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008–2012 (OEC/HES), and were examined for iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary iodine intake was assessed by the measurement of 24 h urinary iodine excretion. The median daily iodine intake of the whole population was lower (96 µg/d, interquartile range 51–165) than the daily adequate iodine intake according to both EFSA and WHO recommendation (150 µg/d), with a significantly lower value among women (85 µg/d) compared with men (111 µg/d). Iodine intake diminished with age and increased with BMI (body mass index) in male but not in female participants, without achieving the adequate intake in any sex, age, or BMI category. In this random sample of Italian general adult population examined in 2008–2012, iodine intake still remained lower than the recommended values despite the implementation of a strategy of iodoprophylaxis based on salt iodization in 2005. These data represent a valuable reference for future monitoring of iodine status in our country.

Multi-modality biomarkers in the early prediction of ischaemic heart disease in middle-aged men during a 21-year follow-up

BackgroundIschaemic heart disease (IHD) often develops after decades of preceding subclinical coronary atherosclerosis. Biomarkers are useful prognostic predictors of IHD, but their long-term predictive value in a general population has not been adequately studied.PurposeTo investigate the early predictive value of multi-modality biomarkers in addition to clinical risk factors in incident IHD in a random male general population sample followed from 50 to 71 years of age.Method“The Study of Men Born in 1943” is a longitudinal cohort study during follow-up. All the men underwent a baseline examination in 1993, where a panel of biomarkers were analysed and incident IHD was registered during 21-year follow-ups.ResultsOf 739 participants, 97 men (13.1%) developed an IHD event. For time to first occurrence of IHD, univariable analyses showed that elevated levels of high sensitivity troponin T (hs-TNT), high sensitivity-C reactive protein (hs-CRP) and interleukin-6 (IL-6) were significant predictors of IHD. In addition, a high number of biomarkers with elevated levels (hs-TNT > 10 ng/L, hs-CRP > 1 mg/L, IL-6 > 8 ng/L and N-terminal pro b-type natriuretic peptide (NT-proBNP) > 100 pg/mL) increased predictive ability. In univariable and multivariable analysis high-density lipoprotein-cholesterol (HDL-C) had the highest predictive ability. Hs-TNT provided better predictive ability than smoking, body mass index and glucose, and was an independent significant predictor when adjusted for HDL-C, total cholesterol and hypertension. Addition of biomarkers on top of clinical risk factors provided significantly better prediction as tested by likelihood ratio test (p = 0.033), but did not significantly enhance the model’s discriminative ability However, it appeared contributing to higher sensitivity in the late phase of follow-up.ConclusionIn this random, middle-aged male population sample, the addition of biomarker hs-TNT was an independent significant predictor of IHD and significantly improved prediction, indicating the probability of a better prediction of long-term risk of IHD in a low-risk population.Trial registration: The study is registered at Clinical Trials.gov Identifier number: NCT03138122

A comparison of the prevalence of health problems among adults with and without intellectual disability: A total administrative population study.

There is considerable international research indicating health disparities between people with and without intellectual disabilities. It is important that comparative studies use representative population samples. This study compares a total administrative population of adults with intellectual disability to a random stratified general population sample. An administrative population of 217 adults with intellectual disability and a random stratified sample of 2,350 adults without intellectual disability participated. A questionnaire using the International Classification of Diseases (ICD-10) Chapter Headings was administered to all participants to enable a like-for-like comparison. Unadjusted comparisons identified that adults with intellectual disability have a greater prevalence of health problems. These problems start early in adulthood and continue throughout life. However, they were less likely to experience cancers and musculoskeletal diseases. These findings are consistent with the hypothesis that adults with intellectual disabilities have greater prevalence rates of health problems than the general population.

0878 Association of Obstructive Sleep Apnea with Internalizing Symptoms vs. Externalizing Behaviors in Adolescents with Attention Deficit Hyperactivity Disorder

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) in children has been associated with insomnia, obstructive sleep apnea (OSA), and abnormal periodic limb movements (PLMS). However, there is lack of data examining the contribution of OSA to ADHD-related internalizing symptoms and externalizing behaviors in adolescents. Methods We studied the Penn State Child Cohort, a random general population sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y, 53.9% male). All adolescents underwent a 9-hour PSG, clinical history and physical examination. ADHD was ascertained by a parent- or self-report of having been diagnosed with ADHD. OSA was defined as an apnea hypopnea index (AHI) of ≥2 events per hour of sleep, while a periodic limb movement index (PLMI) ≥5 events per hour of sleep was indicative of PLMS. Controls, OSA-alone, ADHD-alone and ADHD+OSA were identified. The Child or Adult Behavior Checklist were used to ascertain internalizing and externalizing behaviors. Multivariable-adjusted models controlled for sex, race, age, and body mass index (BMI) percentile. Results As compared to controls, adolescents with ADHD-alone or ADHD+OSA had significantly greater externalizing behaviors (p&amp;lt;0.001), inattention (p&amp;lt;0.001) and thought problems (p&amp;lt;0.001). While adolescents with ADHD-alone had higher internalizing symptoms (p=0.021), specifically withdrawn-depression (p&amp;lt;0.01), adolescents with ADHD+OSA had more somatic problems than controls (p=0.048). There were no statistically significant differences in behavioral outcomes between controls and adolescents with OSA-alone or between adolescents with ADHD-alone and ADHD+OSA. Conclusion Adolescents with comorbid ADHD and OSA do not present with worse behavioral outcomes than those with ADHD alone. Future studies should examine whether the progression of these adolescents into young adulthood differs in terms of their behavioral outcomes and development of mental health disorders. Support National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

Adherence k principům kardiovaskulární prevence u osob s vysokým rizikem

Asymptomatic high-risk individuals represent one of the highest priorities of cardiovascular prevention, in clinical practice frequently overlooked. We analyzed the real adherence to recommended principles of cardiovascular prevention in primary care subjects.Our analysis is based on random general population sample, examined in the frame of post-MONICA survey in 2016/17. Each subject was categorized with regard to its individual cardiovascular risk (based on Sixth Joint European Guidelines) and the real adherence to recommended targets was ascertained.In total 898 subjects aged 25-75 years (47% males) were analyzed. Of them, 16.7% were classified into &#8220;very high risk&#8220; and 36.8% into &#8220;high risk&#8220; subgroup; remaining 46.5% were only at moderate or low risk. Regarding adherence to recommended principles, in &#8220;very high risk&#8220; category only 58.7% abstain from any form of tobacco, 38% reported appropriate physical activity (150 minutes of at least moderate activity weekly), 16.7% had recommended body constitution (BMI 20-25 kg/m2 ), 39.3% appropriate blood pressure (.