Risk Of Subsequent Disease Research Articles

Blood Pressure Tracking From Childhood to Adulthood

Hypertension is the most common non-communicable disease among adults and is the most important modifiable risk factor for premature cardiovascular disease. The increasing worldwide burden of hypertension is a major global health issue. Early prevention with lifestyle modification or pharmaceutical treatment reduces the incidence of hypertension and the risk of subsequent cardiovascular disease. Therefore, identification of young persons at risk for hypertension has the obvious benefit of providing a chance for early intervention. Previous studies have demonstrated the positive association of elevated childhood blood pressure with hypertension in adulthood. Accumulated evidence also indicates the possibility that elevated pediatric blood pressure is associated with increased risk of future cardiovascular disease. In this article, we review the tracking of blood pressure from childhood to adulthood and emphasize the importance of pediatric blood pressure monitoring and control for predicting and preventing adult hypertension and cardiovascular disease.

Hematuria and subsequent long-term risk of end-stage kidney disease: A Danish population-based cohort study

BackgroundHematuria is a frequent incidental clinical finding and may be a symptom of pre-existing underlying benign or malignant urinary tract or kidney disease. However, in patients with no apparent underlying cause of hematuria, long-term prognosis of hematuria remains unknown. ObjectivesTo assess the long-term risk of end-stage-kidney disease (ESKD) in patients with a hospital-based hematuria diagnosis and no apparent underlying cause. MethodsPatients with a hospital diagnosis of hematuria were included and matched in a 1:5 ratio with comparison persons from the background population by age, sex and residency. We calculated the cumulative risk of ESKD considering death as a competing risk. Furthermore, we computed unadjusted and adjusted hazard ratios with 95% confidence intervals using Cox hazard regression with adjustment for age, sex, and comorbidities. ResultsWe included 170,189 hematuria-diagnosed patients. The absolute 10-year risk of ESKD was 0.7% (95%CI: 0.7–0.8) in patients with hematuria and 0.4% (95%CI: 0.3–0.4) in comparison persons, hence yielding an overall adjusted hazard ratio of 1.6 (95%CI: 1.4–1.7). Hematuria also increased the risk of EKSD in patients with pre-existing comorbidities like diabetes (adjusted HR: 1.3 [95%CI: 1.1–1.5]) and urogenital cancer (adjusted HR: 1.4 ([95%CI: 1.1–1.9]), whereas no association was observed in patients with previous kidney disease (adjusted HR: 0.9 (95%CI: 0.8–1.0). ConclusionA hospital-based hematuria diagnosis in patients with no apparent underlying cause of hematuria is a marker of an increased risk of future ESKD.

Correction to: Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study.

Correction to: Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study.

Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study.

The associations of changes in noncombustible nicotine or tobacco product (NNTP) and combustible cigarette (CC) use habits with subsequent cardiovascular disease (CVD) risk are still unclear. The study population consisted of 5 159 538 adult men who underwent health screening examinations during both the first (2014-2015) and second (2018) health screening periods from the Korean National Health Insurance Service database. All participants were divided into continual CC-only smokers, CC and NNTP users, recent (<5 years) CC quitters without NNTP use, recent CC quitters with NNTP use, long-term (≥5 years) CC quitters without NNTP use, long-term CC quitters with NNTP use, and never smokers. Propensity score matching analysis was conducted to further compare CVD risk among CC quitters according to NNTP use. Starting from the second health screening date, participants were followed up until the date of CVD event, death, or December 31, 2019, whichever came earliest. Multivariable Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% CIs for CVD risk according to changes in NNTP and CC smoking habits. Compared with continual CC-only smokers, CC and NNTP users (aHR, 0.83 [95% CI, 0.79-0.88]) and initial CC smokers who quit CCs and switched to NNTP use only (recent CC quitters with NNTP use, aHR, 0.81 [95% CI, 0.78-0.84]) had lower risk for CVD. After propensity score matching, recent CC quitters with NNTP use (aHR, 1.31 [95% CI, 1.01-1.70]) had higher risk for CVD than recent CC quitters without NNTP use. Similarly, compared with long-term CC quitters without NNTP use, long-term CC quitters with NNTP use (aHR, 1.70 [95% CI, 1.07-2.72]) had higher CVD risk. Switching to NNTP use among initial CC smokers was associated with lower CVD risk than continued CC smoking. On CC cessation, NNTP use was associated with higher CVD risk than CC quitting without NNTPs. Compared with CC smokers who quit without NNTP use, CC quitters who use NNTPs may be at higher future CVD risk.

Risk factors associated with ticks and Rickettsia spp. exposure in wild boars (Sus scrofa), hunting dogs, and hunters of Brazil.

Background and Aim:Wild boars have recently been implicated as the maintainers and carriers of Amblyomma spp. ticks, which are essential for Rickettsia spp. transmission. Consequently, wild boar hunting may increase the risk of tick exposure and subsequent human tick-borne infection and disease. Therefore, this study was conducted to evaluate the risk factors for ticks and Rickettsia spp. exposure in wild boars, hunting dogs, and hunters in Brazilian biomes.Materials and Methods:The statistical relationship of Rickettsia spp. antibodies were evaluated using the Chi-square test in 80 wild boars, 170 hunting dogs, and 49 hunters.Results:The only statistically significant difference in seropositivity found in this study was between male and female wild boars (p=0.034), probably associated with in-park exposure to Amblyomma brasiliense infected with Rickettsia spp.Conclusion:The absence of statistical differences in the associated risk factors for hunting dogs and hunters may indicate a random exposure to Rickettsia spp.

Possibilities of perinatal nutrition in implementation of fetal programming

Micronutrient deficiency in the diet of a pregnant woman can negatively affect not only the course and outcome of childbirth, but lead to long-term changes in the metabolism, structure and function of fetal organs. The results of numerous studies confirm the influence of nutrition on adaptation reserves, the ability to learn and the predisposition to the development of diseases in offspring. Fetal programming can influence the course of ontogenesis, the processes of development, maturation and aging of the body. The nature of intrauterine nutrition affects the health and the risk of subsequent diseases not only in children, but also in adults in the long term. For the prevention of unfavorable fetal programming, timely examination of pregnant women is necessary to detect the presence of nutritional disorders. To correct micronutrient deficiency in pregnant women, an integrated approach is used, including diet therapy using appropriate vitamin and mineral complexes. in the prevention and complex therapy of somatic diseases.

Sampling and Reporting of Inflammatory Bowel Disease.

Pathologists have an important and expanding role in the diagnosis and management of inflammatory bowel disease. This role includes the initial diagnosis of the disease, assessment of the response to treatment and the identification of short-term complications such as cytomegalovirus infection and long-term complications such as dysplasia. Furthermore, the assessment of resection specimens for complication of disease is important to determining the risk of subsequent disease or inflammation within an ileal pouch. Adequate sampling of the disease at endoscopy and from the surgical resection specimen is vital to determining the ultimate information that can be provided by the pathologist. This sampling is determined by the clinical scenario. Similarly, a standardized approach to reporting and synthesizing the histologic findings will improve patient management. This is best exemplified by the increasing interest in histologic activity indices, such as the Nancy index in ulcerative colitis, and in the standardized reporting for inflammatory bowel disease dysplasia recommended by the SCENIC international consensus.

Incidence of chronic immune-mediated inflammatory diseases after diagnosis with Kawasaki disease: a population-based cohort study.

Kawasaki disease (KD) is an immune-mediated vasculitis of childhood with multi-organ inflammation. We determined the risk of subsequent immune-mediated inflammatory disease (IMID), including arthritis, type 1 diabetes, IBD, autoimmune liver disease, primary sclerosing cholangitis and multiple sclerosis. We conducted a matched population-based cohort study using health administrative data from Ontario, Canada. Children aged <18 years born between 1991 and 2016 diagnosed with KD (n = 3753) were matched to 5 non-KD controls from the general population (n = 18 749). We determined the incidence of IMIDs after resolution of KD. Three- and 12-month washout periods were used to exclude KD-related symptoms. There was an elevated risk of arthritis in KD patients compared with non-KD controls, starting 3 months after index date [103.0 vs 12.7 per 100 000 person-years (PYs); incidence rate ratio 8.07 (95% CI 4.95, 13.2); hazard ratio 8.08 (95% CI 4.95, 13.2), resulting in the overall incidence of IMIDs being elevated in KD patients (175.1 vs 68.0 per 100 000 PYs; incidence rate ratio 2.58 (95% CI 1.93, 3.43); hazard ratio 2.58, 95% CI 1.94, 3.43]. However, there was no increased risk for diabetes, IBD, autoimmune liver disease, primary sclerosing cholangitis or multiple sclerosis in KD patients. Similar results were observed using a 12-month washout period. Children diagnosed with KD were at increased risk of arthritis following the acute KD event, but not other IMIDs. Health-care providers should monitor for arthritis in children following a diagnosis of KD.

200Pneumonia hospitalization and the subsequent risk of incident ischemic cardiovascular disease in Chinese adults

Abstract Background Acute respiratory infections have been associated with a transient increase in cardiovascular risk. However, whether such an association persists beyond one month, and the potential modifying effect of cardiovascular risk factors on such an association is less well established. Methods The China Kadoorie Biobank study enrolled 512,726 participants from 10 areas across China during 2004-08. By the end of 2017, a total of 5,444 participants with ischemic heart disease (IHD) and 4,846 with ischemic stroke (IS) who also had at least a record of hospitalization for pneumonia during follow-up were included. We used a self-controlled case series method and calculated the age- and season-adjusted relative incidences (RIs) and 95% confidence intervals (CIs) for ischemic cardiovascular disease (CVD) after pneumonia. Results The risk of ischemic CVD increased during days 1-3 after pneumonia hospitalization, with a RI (95% CI) of 4.24 (2.92-6.15) for IHD and 1.85 (1.02-3.35) for IS. The risk gradually reduced with longer duration since pneumonia hospitalization but remained elevated until days 92-365 for IHD (1.23, 1.12-1.35), and days 29-91 for IS (1.25, 1.05-1.48). Pre-existing cardiovascular risk factors amplified the associations between pneumonia and ischemic CVD risks. Besides, the risk of ischemic CVD was also higher among the participants aged ≥70 years (Pinteraction&amp;lt;0.001 for IHD and =0.033 for IS). Conclusions Among middle-aged and older Chinese adults, pneumonia hospitalization was associated with both short- and long-term increases in ischemic CVD risk for up to one year. Key messages Pneumonia hospitalizations were associated with increased subsequent risk of ischemic CVD.

Delivery mode and the incidence of atopic sensitization and food allergy in a Finnish child population.

Caesarean section (CS) has been associated with an increased risk of subsequent atopic diseases, particularly asthma and respiratory allergies, but controversial findings have also been reported. Our aim was to clarify the association between the delivery mode and longitudinal (atopic) outcomes. The target population was identified from the population register and comprised all children born between 2001 and 2006 and living in the province of South Karelia, Finland (N=5564). The information on the delivery mode was available for 5552 children from the Finnish Medical Birth Register. Results of allergy tests (skin prick tests, specific IgE and open food challenges, OFCs) were collected from patient records of all healthcare units in the area. By 12years of age, the cumulative incidence of atopic sensitization was 15% for those born by normal vaginal delivery (VD), 20% (adjusted RR 1.28; 95% CI 0.99-1.65) by assisted VD, 20% (adjusted RR 1.28; 95% CI 1.02-1.61) by elective CS and 20% (adjusted RR 1.24; 95% CI 0.99-1.56) by others, for example emergency CS. Among the offspring of mothers without atopic diseases, the incidence of food allergy (positive OFC) was 6% for those born by elective CS and 2% for those born by normal VD (adjusted RR 2.41; 95% CI 1.19-4.88), while the respective incidences were 5% and 6% (adjusted RR 0.82; 95% CI 0.33-2.06) among the offspring of mothers with atopic diseases. By adolescence, the cumulative incidences of atopic sensitization was highest among those born by assisted VD or CS. The incidence of food allergy was highest among those born by elective CS among the offspring of mothers without atopic diseases.

Irritable bowel syndrome and subsequent risk of Parkinson's disease: a nationwide population-based matched-cohort study.

Gastrointestinal dysfunction (GI) is the most prevalent non-motor symptom of Parkinson's disease (PD), and its role in the risk of PD has been studied. In this study, we tried to evaluate whether irritable bowel syndrome (IBS) increased the risk of PD development stratified by sex, age, and IBS duration using a large nationwide cohort in Korea. Patients aged ≥ 20years with a primary diagnosis of IBS (ICD-10 codes: G56) more than three times were selected. A randomly matched cohort without IBS was enrolled by exact matching patients for sex, age, socioeconomic status, comorbidities, and year of enrollment to the IBS group with a ratio of 1:3. Cause-specific Cox regression models were used to identify hazards associated with PD development depending on the presence of IBS during the 11-year follow-up period. In total, 285,064 patients were enrolled in the study: 71,806 in the IBS cohort and 213,258 in the comparison cohort. Cause-specific Cox regression model showed a hazard ratio of 1.436 (95% CI, 1.226-1.682) for PD development in the IBS cohort, which is consistent in both male and female sexes. Subgroup analyses according to age groups showed that IBS increased PD risk only in individuals ≥ 65years (HR = 1.449, 95% CI, 1.207-1.741). We found temporal relationship between IBS and PD at aged ≥ 65years. There might be a possibility that IBS was an early manifestation of PD, and future studies for causal link between the two diseases to elucidate biomechanism are warranted.

Lifestyle Factors and Subsequent Ischemic Heart Disease Risk after Hematopoietic Cell Transplantation

Purpose: To evaluate whether modifiable cardiovascular risk conditions and lifestyle factors are associated with increased risk for subsequent ischemic heart disease (IHD) and overall mortality among hematopoietic cell transplant (HCT) survivors.Methods: Greater than one-year HCT survivors aged ≥20 years, treated from 1970-2010 (n=3,833) were surveyed in 2010-2011 about cardiovascular health and lifestyle factors. Respondents (n=2,360, 61.6%) were then followed longitudinally with annual surveys from 2011-2016 for development of IHD. A series of adjusted models evaluated the relationship (hazard ratio, HR) between conventional cardiovascular risk conditions (obesity, hypertension, dyslipidemia, and diabetes) and lifestyle factors (smoking, fruit/vegetable intake, and physical activity) present at the baseline survey with subsequent IHD and overall mortality.Results: Of the 2,360 HCT survivors (median age at baseline survey, 55.9 years; median time since transplant, 10.8 years), 162 (6.9%) had IHD at time of the baseline survey. Compared with HCT survivors without IHD at the baseline survey, those with IHD had higher rates of hypertension (55.6% vs. 25.8%), dyslipidemia (77.8% vs. 30.6%) and diabetes (34.0% vs. 12.8%), and were less physically active at baseline (54.0% vs. 66.4% met national activity recommendations); p<0.001 for all comparisons. The 5-year overall mortality was markedly higher in HCT survivors with existing IHD compared with those without (28.2% vs. 15.2%, p<0.001). Among those without IHD at time of the baseline survey (n=2,198), the 5-year cumulative incidence of subsequent IHD was 4.3%. Obesity, dyslipidemia, diabetes, and physical inactivity at baseline were all associated with an increased risk for subsequent IHD (Table 1). In contrast, greater physical activity and greater fruit/vegetable intake at baseline were both associated with subsequent reduced overall mortality. When jointly considered, each additional cardiovascular risk condition and each adverse lifestyle factor were independently associated with subsequent IHD (HRs 1.4 [95% CI 1.0-1.9] and 1.9 [95% CI 1.2-2.9], respectively), and adverse lifestyle factors remained associated with overall mortality (HR 1.8 [95% CI 1.5-2.3]). Among those free of IHD at the baseline survey, 492 (23.7%) had Framingham risk scores predicting ≥20% 10-year risk for a serious cardiovascular event, and as expected, those with higher risk scores were more likely to experience subsequent IHD and mortality (Table 1). Overall results remained similar even if HCT survivors who experienced post-HCT relapse were excluded (n=255).Conclusions: In HCT survivors, cardiovascular risk conditions and adverse lifestyle factors influence the subsequent risk of ischemic heart disease and overall mortality. These results support strong efforts to promote healthy lifestyle behaviors and to treat cardiovascular risk factors more aggressively in HCT survivors. Such efforts may reduce future IHD and overall mortality in this high-risk population. [Display omitted] DisclosuresFlowers:Pharmacyclics: Consultancy. Martin:Fresenius, Neovii: Research Funding; Pfizer: Consultancy; Procter and Gamble: Equity Ownership; Incyte: Consultancy. Lee:Kadmon: Other: One-time advisory board member; Mallinckrodt: Honoraria; Amgen: Other: One-time advisory board member; Bristol-Myers-Squibb: Other: One-time advisory board member.

Evaluation of the extended efficacy of the Dengvaxia vaccine against symptomatic and subclinical dengue infection.

More than half of the world's population lives in areas at risk for dengue virus infection. A vaccine will be pivotal to controlling spread, however, the only licensed vaccine, Dengvaxia, has been shown to increase the risk of severe disease in a subset of individuals. Vaccine efforts are hampered by a poor understanding of antibody responses, including those generated by vaccines, and whether antibody titers can be used as a marker of protection from infection or disease. Here we present the results of an ancillary study to a phase III vaccine study (n = 611). All participants received three doses of either Dengvaxia or placebo and were followed for 6 years. We performed neutralization tests on annual samples and during confirmed dengue episodes (n = 16,508 total measurements). We use mathematical models to reconstruct long-term antibody responses to vaccination and natural infection, and to identify subclinical infections. There were 87 symptomatic infections reported, and we estimated that there were a further 351 subclinical infections. Cumulative vaccine efficacy was positive for both subclinical and symptomatic infection, although the protective effect of the vaccine was concentrated in the first 3 years following vaccination. Among individuals with the same antibody titer, we found no difference between the risk of subsequent infection or disease between placebo and vaccine recipients, suggesting that antibody titers are a good predictor of both protection and disease risk.

Bartonella alsatica in Wild and Domestic Rabbits (Oryctolagus cuniculus) in The Netherlands

Members of the genus Bartonella are Gram-negative facultative intracellular bacteria that are transmitted by arthropod vectors. Bartonella alsatica was detected in the spleens and livers of 7 out of 56 wild rabbits (Oryctolagus cuniculus) and in the liver of 1 out of 87 domestic rabbits in the Netherlands. The molecular evidence of B. alsatica infection in wild as well as domestic rabbits indicates the possibility of exposure to humans when these come in close contact with rabbits and possibly their fleas with subsequent risk of Bartonella infection and disease.

Change in Diet Quality and Meal Sources During the COVID-19 Pandemic in a Subset of Men and Women in the Cancer Prevention Study-3

ObjectivesThe massive spread of the novel coronavirus SARS-CoV2 (COVID-19) and subsequent restrictive measures caused disruptions in daily routines and behaviors, including changes in diet that may have consequences on immediate health and longer term risk of chronic disease. Our objective was to assess two-year changes in diet quality among subgroups of the Cancer Prevention Study-3 (CPS-3) cohort.MethodsIn August 2020, an online COVID-19 survey that assessed food group intakes, meal sources, and COVID-related questions was completed by a subgroup of 2,335 CPS-3 participants. Paired t-tests evaluated reported change in behaviors from 2018 to 2020. A diet quality score assigned higher points for greater frequency of foods recommended by cancer prevention guidelines, and lower points for foods that are not recommended.ResultsWhile diet quality improved slightly, on average, from 2018 to 2020, consumption of component food groups decreased (P < 0.001),with the greatest decreases in vegetables and whole grains. The greatest decrease in vegetable intake occurred in Black participants, as well as participants who gained weight. On average, Asian/Pacific Islander participants increased fruit consumption. Participants who lost ≥20 pounds had the greatest decrease in refined grain consumption and greatest improvements in diet quality. Low diet quality scores during the pandemic were associated with being male, current smoking, less education, lower physical activity, higher BMI, and weight gain of ≥20 pounds since 2018. Participants who worried about food insecurity, were at high risk of COVID-19 complications, and reported more COVID-related stressors also had lower scores. Changes in diet quality did not appear to vary by other demographic factors. On average, total alcohol intake decreased in most groups examined. Frequency of meals from all sources decreased (P < 0.001), and the greatest decreases were observed in full-service restaurants and prepared ready-to-eat meals.ConclusionsUndesirable changes in diet during the pandemic, particularly decreases in vegetables and whole grains, may contribute to weight gain, poor metabolic health, and subsequent higher risk of chronic disease.Funding SourcesThe American Cancer Society funds the creation, maintenance, and updating of the Cancer Prevention Study-3 Cohort.

Sex differences in biological aging with a focus on human studies.

Aging is a complex biological process characterized by hallmark features accumulating over the life course, shaping the individual's aging trajectory and subsequent disease risks. There is substantial individual variability in the aging process between men and women. In general, women live longer than men, consistent with lower biological ages as assessed by molecular biomarkers, but there is a paradox. Women are frailer and have worse health at the end of life, while men still perform better in physical function examinations. Moreover, many age-related diseases show sex-specific patterns. In this review, we aim to summarize the current knowledge on sexual dimorphism in human studies, with support from animal research, on biological aging and illnesses. We also attempt to place it in the context of the theories of aging, as well as discuss the explanations for the sex differences, for example, the sex-chromosome linked mechanisms and hormonally driven differences.

The Flavor Train: The Nature and Extent of Flavored Cigarettes in Low- and Middle-Income Countries.

IntroductionFlavors and depictions of flavors are attractive and facilitate initiation and use of tobacco products. However, little is known about the types of flavored products on the market, particularly in low- and middle-income countries. We describe the nature and extent of flavored cigarettes sold in nine low- and middle-income countries from four of the six World Health Organization (WHO) regions.Aims and MethodsWe employed a systematic protocol to purchase unique cigarette packs in Bangladesh, Brazil, China, India, Indonesia, Philippines, Russia, Thailand, and Vietnam. Packs were double coded for flavor descriptors and imagery using a standard codebook. Frequencies and crosstabs were conducted to examine the proportion of packs with flavor descriptors and/or flavor imagery, and flavor capsules, by country and by major manufacturer.ResultsOverall, 15.4% of the country-unique cigarette packs had flavor descriptors and/or imagery, representing a variety of flavors: menthol or mint (8.2%), “concept” descriptors (3.5%) (eg, Fusion blast), fruit or citrus (3.3%), beverages (1.4%), and others (1.4%). Flavor was mostly communicated using descriptors (15.2%), with flavor imagery being less common (2.2%). Flavor capsules were prevalent (6.2%), with almost half having “concept” descriptors. All major tobacco companies produced cigarettes with flavors, and with capsules.ConclusionsA range of flavored cigarettes remain on the market in the low- and middle-income countries with the greatest number of smokers. This finding is particularly concerning given the appeal of flavored cigarettes among youth and their potential to circumvent country bans on flavored tobacco products if those laws are not sufficiently comprehensive. Laws addressing flavored tobacco products need to account for flavor capsules and concept descriptors.ImplicationsWhile a number of countries have restricted flavors in tobacco products to reduce their appeal and attractiveness, a range of flavors continue to be on the market in low- and middle-income countries, putting people in these countries at increased risk for tobacco use and subsequent tobacco-caused death and disease. The presence of capsules and concept descriptors is particularly concerning given their appeal among youth and their potential to circumvent country bans on flavored tobacco products if those laws are not sufficiently comprehensive.

Associations of Microvascular Complications With the Risk of Cardiovascular Disease in Type 1 Diabetes.

We examined whether the presence of microvascular complications was associated with increased subsequent risk of cardiovascular disease (CVD) among participants with type 1 diabetes in the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study followed for >35 years. Standardized longitudinal data collection included: 1) stereoscopic seven-field retinal fundus photography centrally graded for retinopathy stage and clinically significant macular edema; 2) urinary albumin excretion rate (AER) and estimated glomerular filtration rate (eGFR); 3) cardiovascular autonomic neuropathy (CAN) reflex testing; and 4) adjudicated CVD events, including death from CVD, nonfatal myocardial infarction, stroke, subclinical myocardial infarction on electrocardiogram, confirmed angina, or coronary artery revascularization. Cox proportional hazards models assessed the association of microvascular complications with subsequent risk of CVD. A total of 239 participants developed CVD, including 120 participants who suffered major adverse cardiovascular events (MACE) defined as nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. The presence of microvascular disease (diabetic retinopathy, kidney disease, or CAN) was associated with increased risk of subsequent CVD and MACE (hazard ratios 1.86 to 3.18 and 2.09 to 3.63, respectively), associations that remained significant after adjusting for age and HbA1c. After adjustment for traditional CVD risk factors, however, only sustained AER ≥30 mg/24 h occurring alone and/or with eGFR <60 mL/min/1.73 m2 and the presence of both retinal and kidney disease remained associated with CVD. Advanced microvascular disease, especially moderate to severe albuminuria or eGFR <60 mL/min/1.73 m2, conveyed an increased risk of subsequent cardiovascular disease in the DCCT/EDIC cohort.

Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits.

In addition to kidney diseases characterized by the precipitation and deposition of overproduced monoclonal immunoglobulin and kidney damage due to chemotherapy agents, a broad spectrum of renal lesions may be found in patients with hematologic malignancies. Glomerular diseases, in the form of paraneoplastic glomerulopathies and acute kidney injury with various degrees of proteinuria due to specific lymphomatous interstitial and/or glomerular infiltration, are two major renal complications observed in the lymphoid disorder setting. However, other hematologic neoplasms, including chronic lymphocytic leukemia, thymoma, myeloproliferative disorders, Castleman disease and hemophagocytic syndrome, have also been associated with the development of kidney lesions. These renal disorders require prompt recognition by the clinician, due to the need to implement specific treatment, depending on the chemotherapy regimen, to decrease the risk of subsequent chronic kidney disease. In the context of renal disease related to hematologic malignancies, renal biopsy remains crucial for accurate pathological diagnosis, with the aim of optimizing medical care for these patients. In this review, we provide an update on the epidemiology, clinical presentation, pathophysiological processes and diagnostic strategy for kidney diseases associated with hematologic malignancies outside the spectrum of monoclonal gammopathy of renal significance.

Safety and Health Implications of COVID-19 on the United States Construction Industry

The construction industry is an essential U.S. business sector, yet it suffers from an elevated risk for work-related fatalities and injuries. The COVID-19 pandemic has only exacerbated this risk, as well as shone a light on the severe economic/financial/labor burdens and safety/health concerns the sector has faced. As such, the purpose of this review paper is to synthesize the safety and health issues associated with COVID-19 pandemic in the construction industry, and summarize the challenges and opportunities for construction stakeholders in implementing COVID-19 safety and health measures in the construction industry. This paper has explored the challenges in construction and COVID-19; COVID-19 knowledge, preventative behaviors, and risk perception among construction workers; recommendations/practical implications/preventive measures; and COVID-19 education in compliance/guidance, strategies to combat impacts of COVID-19 pandemic, smart digital technologies, and worker wellbeing and work-related quality of life (e.g., mental health). It is warranted that the construction industry needs to take better steps in preparing for future, man-made or natural disaster events, and subsequent acute and chronic disease risk, in order to yield a healthier/safer construction workplace.