Two-year Cohort Study Research Articles

Two-year follow-up cohort study focused on gender-specific associations between socioeconomic status and body weight changes in overweight and obese middle-aged and older adults

ObjectiveAs overall spread of obesity in populations is generally acknowledged to result from unhealthy lifestyles rather than individual genetic makeup, this study aimed to gain specific insights into its determinants...

Analysis of treatment cost and persistence among migraineurs: A two-year retrospective cohort study in Pakistan.

The persistence pattern of anti-migraine drugs' use among migraineurs is very low in the United States and different European countries. However, the cost and persistence of antimigraine drugs in Asian countries have not been well-studied. Hence, the present study aimed to evaluate the treatment cost and persistence among migraineurs in Pakistan. Data from prescriptions collected from migraineurs who visited the Outpatient Department (OPD) of different public and private sector tertiary-care hospitals of Karachi, Pakistan were used to conduct this retrospective cohort study from 2017 to 2019. The minimum follow up period for each migraineur was about 12 months for persistence analysis while dropped-out patients data were also included in survival analysis as right censored data. Pairwise comparisons from Cox regression/hazards ratio were used to assess the predictors of persistence with the reference category of non-binary variables i.e. hazard ratio = 1 for low frequency migraineurs and NSAIDs users. Persistence with anti-migraine drugs was estimated using the Kaplan-Meier curve along with the Log Rank test. A total of 1597 patients were included in this study, 729 (45.6%) were male and 868 (54.3%) were female. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most prescribed class of drug initially for all classes of migraineurs (26.1%). Of them, 57.3% of migraineurs discontinued their treatment, 28.5% continued while 14.8% were switched to other treatment approaches. Persistence with initial treatment was more profound in female (58.8%) patients compared to males while the median age of continuers was 31 years. The total cost of migraine treatment in the entire study cohort was 297532.5 Pakistani Rupees ($1901.1). By estimating the hazard ratios (HR) using the Cox regression analysis, it can be observed that patients with high frequency (HR, 1.628; 95%CI, 1.221-2.179; p<0.0001) migraine, depression (HR, 1.268; 95%CI, 1.084-1.458; p<0.0001), increasing age (HR, 1.293; 95%CI, 1.092-1.458; p<0.0001), combination analgesics (HR, 1.817; 95%CI, 0.841-2.725; p = 0.0004) and prophylaxis drugs (HR, 1.314; 95%CI, 0.958-1.424; p<0.0001) users were at a higher risk of treatment discontinuation. However, patients with chronic migraine (HR, 0.881; 95%CI, 0.762-0.912; p = 0.0002), epileptic seizure (HR, 0.922; 95%CI, 0.654-1.206; p = 0.0002), other comorbidities (HR, 0.671; 95%CI, 0.352-1.011; p = 0.0003) and users of triptan(s) (HR, 0.701; 95%CI, 0.182-1.414; p = 0.0005) and triptan(s) with NSAIDs (HR, 0.758; 95%CI, 0.501-1.289; p<0.0001) had more chances to continue their initial therapy. Similar to western countries, the majority of migraineurs exhibited poor persistence to migraine treatments. Various factors of improved persistence were identified in this study.

Prognostic significance of psychotic relapse in patients with first-episode acute and transient psychosis: New empirical support for ICD-11

This study examined the impact of psychotic relapse on the diagnostic stability of acute and transient psychotic disorders (ATPD), and how this potential risk factor could differentiate ‘acute polymorphic psychotic disorder without symptoms of schizophrenia’ (APPD; ICD-10 code F23.0) from the remaining non-APPD subtypes (F23.1–9). A two-year cohort study was performed on 68 patients with first-episode ATPD. At the end of follow-up, the diagnostic stability of ATPD was 55.9% and the overall rate of psychotic relapse was 61.8%. Statistical analysis showed that recurrence was an independent risk factor for diagnostic shift in ATPDs (relative risk [RR] = 1.67, 95% confidence interval [CI] = 1.17–2.39; p = 0.005) and that this risk differed among their subtypes insofar as its appearance significantly increased the likelihood of diagnostic change in patients with non-APPD subtypes (RR = 2.52, 95% CI = 1.56–4.07; p < 0.001), but not in those with APPD (RR = 0.95, 95% CI = 0.57–1.57; p = 0.844). Our findings confirm the negative implications of recurrence in patients with ATPD, encourage long-term intervention targeting relapse prevention in this population, and provide new empirical evidence in support of narrowing the ATPD category to APPD in the upcoming ICD-11.

The association between anxiety and academic performance in children with reading disorder: A longitudinal cohort study.

The purpose of this study was to examine the association between anxiety and overall academic performance (AP) in children with reading disorder (RD). This two-year longitudinal cohort study included 128 participants (aged 7-14 years) with RD. Anxiety symptoms were evaluated using the School Anxiety Scale - Teacher Report for the first year and the eight-item Spence Children's Anxiety Scale for the second year. AP was assessed by teacher ratings of progress in academic content areas, including reading, writing and math. Teachers completed evaluations every 3months. We standardized all scores (to z scores). Multivariate linear regression models (adjusting for age, sex and Attention-Deficit/Hyperactivity Disorder symptoms) assessed the association cross-sectionally at each timepoint of survey completion. Repeated measures analysis using mixed models assessed the relationship longitudinally. Results from both univariate and multivariate analyses showed anxiety being significantly negatively associated with AP in children with RD, both cross-sectionally and longitudinally. Importantly, increased anxiety was significantly associated with reduced AP over time within an individual (adjusted β=-0.22, p=.002). This lends support to screening for anxiety disorders in children with RD. Future research should examine the directionality of this relationship, potential mediators in the pathway and whether interventions to reduce anxiety increase AP.

Falling insulin requirement in late pregnancy: association with obstetric and neonatal outcomes.

To investigate whether diminishing insulin requirement in the third trimester is associated with placental dysfunction. Two-year retrospective cohort study at one tertiary care center of women with pregestational or gestational diabetes, their insulin requirements, and complications associated with placental dysfunction. Of 157 women, 21 (13%) experienced declining insulin requirement, with average decline of 28% at 34 weeks. They were more likely to have pregestational diabetes (71.4% vs. 42.6%; p < 0.01) and delivered earlier (median 36w4d vs. 37w4d; p < 0.01). There was no difference in placental dysfunction related complications (33% vs. 24%; p = 0.37). There was an increased rate of polyhydramnios (42.9% vs. 8.8%; p < 0.01). NICU admission (62% vs. 33%; p < 0.01) and neonatal respiratory distress (52% vs. 24%; p < 0.01) was higher in cases of declining insulin requirement independent of gestational age. A decline in insulin requirement should raise concern for increased risk of NICU admission and neonatal respiratory distress.

The Epidemiology of Self-Harm in the Romanian Juvenile Prison System: A Two-Year Cohort Study

Background: There is no extensive literature on social predictors of self-harm in the juvenile justice system, over the time of a prisoner’s sentence. Self-harm behavior displays a higher prevalence in prison, 11 to 14 times greater than in the general population. Our study extended the current research in self-harm by examining dynamic factors of self-harm in adolescents over their sentence in the Romanian juvenile prison system. Method: The present research examined longitudinal predictors of self-harm behaviors in 439 adolescent inmates (Mage = 16.21; 5.2% female, 94.8% male), enrolled in prison during 2011-2012, following them for two years. A series of time-to-event analyses were applied to start from the time of the subject’s internment in the juvenile prison system. Results: Findings from the multivariate survival analyses show that adherence to self-harm conduct in prison was consistently influenced by family factors and prison contexts; although low ability to cope with frustration, sensitivity and emotion dysregulation also mattered. Keeping the other covariates invariant, serving a prison sentence in a closed regime reduces the probability of remaining free of self-harm events, increasing the monthly hazard of self-harm by a factor of 5.26 on average (HR = 5.26, 95% CI = 2.37 - 11.64) compared to the open regime. Conclusion: A greater focus on longitudinal studies may help improve the screening process and also follow the progress of each juvenile to warrant the efficacy of preventive programs in self-harm, according to their emerging needs.

Design of a virtual longitudinal observational study in Parkinson's disease (AT-HOME PD).

ObjectiveThe expanding power and accessibility of personal technology provide an opportunity to reduce burdens and costs of traditional clinical site‐centric therapeutic trials in Parkinson’s disease and generate novel insights. The value of this approach has never been more evident than during the current COVID‐19 pandemic. We sought to (1) establish and implement the infrastructure for longitudinal, virtual follow‐up of clinical trial participants, (2) compare changes in smartphone‐based assessments, online patient‐reported outcomes, and remote expert assessments, and (3) explore novel digital markers of Parkinson’s disease disability and progression.MethodsParticipants from two recently completed phase III clinical trials of inosine and isradipine enrolled in Assessing Tele‐Health Outcomes in Multiyear Extensions of Parkinson’s Disease trials (AT‐HOME PD), a two‐year virtual cohort study. After providing electronic informed consent, individuals complete annual video visits with a movement disorder specialist, smartphone‐based assessments of motor function and socialization, and patient‐reported outcomes online.ResultsFrom the two clinical trials, 226 individuals from 42 states in the United States and Canada enrolled. Of these, 181 (80%) have successfully downloaded the study’s smartphone application and 161 (71%) have completed patient‐reported outcomes on the online platform.InterpretationIt is feasible to conduct a large‐scale, international virtual observational study following the completion of participation in brick‐and‐mortar clinical trials in Parkinson’s disease. This study, which brings research to participants, will compare established clinical endpoints with novel digital biomarkers and thereby inform the longitudinal follow‐up of clinical trial participants and design of future clinical trials.

Association of Vaginal Microbiota With the Genitourinary Syndrome of Menopause Across Reproductive Stages

The genitourinary syndrome of menopause (GSM) is a collection of signs and symptoms related to estrogen decline that involves physical changes to the vulva, vagina, and lower urinary tract. GSM signs and symptoms may occur during any reproductive stage but are most common during menopause. Vaginal microbiota, particularly Lactobacillus spp., protect the female genital tract from multiple conditions; however, Lactobacillus spp. abundance declines during menopause. We aimed to determine the longitudinal association of vaginal microbiota with GSM signs and symptoms across reproductive stages. In a two-year cohort study comprising 750 women aged 35-60 years who contributed 2111 semiannual person-visits, low-Lactobacillus spp. vaginal microbiota communities were observed at 21.2% (169/798), 22.9% (137/597), and 49.7% (356/716) of person-visits among pre-, peri-, and post-menopausal women, respectively (p<.001). After covariate adjustment, low-Lactobacillus spp. communities characterized by high Atopobium and Megasphaera relative abundance were associated with vulvovaginal atrophy relative to high-Lactobacillus spp. communities dominated by L. crispatus (OR[Odds Ratio]=3.04, 95% Confidence Interval[CI]=1.02-9.06) among post-menopausal, but not among peri- or pre-menopausal women. Also, post-menopausal women with low-Lactobacillus spp. communities reported decreased libido (OR=1.79, 95%CI=1.04-3.12) and vaginal dryness (OR=1.61, 95%CI=0.89-2.90) more frequently than their counterparts with high-Lactobacillus spp. communities, but not among peri- or pre-menopausal women (p for interaction<.05). Specifically, low-Lactobacillus spp. communities characterized by high Atopobium and Megasphaera relative abundance were related to both decreased libido (OR=2.82, 95%CI=1.11-7.14) and vaginal dryness (OR=3.50, 95%CI=1.18-10.44) compared with high-Lactobacillus spp. communities dominated by L. gasseri/L. jensenii. Vaginal microbiota, particularly Lactobacillus spp., and menopause may synergistically influence GSM.

Improvement of locomotive syndrome after total hip arthroplasty: A two-year longitudinal cohort study

Objectives Patients requiring total hip arthroplasty (THA) may possibly have locomotive syndrome (LS). Therefore, we investigated changes of LS in patients undergoing THA and clarified key factors that affected LS stage. Methods A prospective cohort study was conducted with 88 patients undergoing THA (74 females, 14 males, mean age: 67.6 years). Data collected using LS stage, stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale results were evaluated before THA, and 6 months, 1 year, and 2 years after THA. Key factors were determined using multivariate analysis and receiver operating characteristic (ROC) curve analysis. Results Before THA, all patients had fallen LS (stage1: 3.4% and stage2: 96.6%). Overall, 56.8% patients improved their LS stage, and 17.0% of patients overcame LS at 2 years after THA. The key factors that affected LS stage were preoperative two-step test and age. ROC analyses showed a preoperative two-step test score of 0.988 and an age of 67.5 years as a cut-off value for the change of LS stage. Conclusions Patients experiencing LS due to hip disorders have the potential to recover after THA. Additional postoperative training may be beneficial for patients with low preoperative two-step test scores to improve their LS stage.

The influence of nurse allocated triage category on the care of patients with sepsis in the emergency department: A retrospective review

Background‘Gold standard’ sepsis care encompasses the recognition and treatment of sepsis within one hour of emergency department (ED) presentation. Early treatment of patients with sepsis reduces mortality. The aim of this study was to examine the effect that the nurse allocated Australasian Triage Scale (ATS) Category allocation had on ED patient treatment for severe sepsis and septic shock. MethodsA two-year retrospective observational cohort study from a single major metropolitan ED, including all patients with severe sepsis or septic shock. ResultsSixty patients were included in this study. Sepsis was recognised at triage for the majority of patients (n=38, 63%), and most were allocated an ATS Category Two (n=39). Almost half of the patients received all elements of the sepsis bundle within one hour of arrival (n=27,45%). Patients allocated an ATS Category One or Two had a shorter time to lactate collection (p=0.003), blood culture procurement (p=0.009) and intravenous antibiotic administration (p=0.021) compared with patients who were allocated ATS Category Three or Four. ConclusionsMost patients presenting with sepsis were recognised by the triage nurse and allocated a high acuity ATS category accordingly. As sepsis is a time-critical condition and a high acuity triage allocation reduces time to treatment, we recommend all Australian EDs should implement a standard approach to sepsis triage by allocating an ATS Category of One or Two to all patients suspected of having sepsis, thus reflecting the urgency of their disease.

A dose response relationship between accelerometer assessed daily steps and depressive symptoms in older adults: a two-year cohort study

this study investigated the prospective associations of accelerometer assessed daily steps with subsequent depressive symptoms in older adults. a 2-year prospective study was performed in the community. A total of 285 older adults ≥65years (mean age = 74.5) attended the baseline assessment in 2012. The second wave of assessment was carried out in 2014 including 274 (96.1%) participants. Daily step counts were measured with a triaxial accelerometer (ActiGraph GT3X+), and participants were divided into three categories (<3,500, 3,500-6,999 and ≥ 7,000 steps/day). The 15-item Geriatric Depression Scale was used to measure depressive symptoms. Negative binomial regression models with multivariable adjustment for covariates (baseline depressive symptoms, accelerometer wear time, age, gender, education, chronic disease, activities of daily living) were conducted to examine the association between daily steps and subsequent depressive symptoms. each 1,000-step increase in daily walking was linearly associated with a reduced rate of subsequent depressive symptoms (rate ratio [RR] = 0.95, 95% confidence interval [CI] = 0.92-0.98). Participants with daily step count in 3,500-6,999 (RR = 0.84, 95% CI = 0.70-0.99) and ≥7,000 steps (RR = 0.71, 95% CI = 0.55-0.92) per day had fewer depressive symptoms at follow-up. Sensitivity analyses assessing confounding and reverse causation provided further support for the stability of our findings. older adults engaging in more daily steps had fewer depressive symptoms after 2 years. Even as few as 3,500-6,999 steps a day was associated with a protecting effect. Accumulating ≥7,000 steps a day could provide the greatest protection against depressive symptoms.

Changes in the HIV continuum of care following expanded access to HIV testing and treatment in Indonesia: A retrospective population-based cohort study.

BackgroundIn 2013, the Indonesian government launched the strategic use of antiretroviral therapy (SUFA) initiative with an aim to move closer to achieving the UNAIDS 90-90-90 target. This study assessed the impact of SUFA on the cascade of HIV care.MethodsWe performed a two-year retrospective population-based cohort study of all HIV positive individuals aged ≥ 18 years residing in two cities where SUFA was operational using data from HIV clinics. We analysed data for one-year pre- and one-year post-SUFA implementation. We assessed the rates of enrolment in care, assessment for eligibility for antiretroviral therapy (ART), treatment initiation, loss to follow-up (LTFU) and mortality. Multivariate Cox regression was used to determine the pre-to-post-SUFA hazard ratio.ResultsA total of 2,292 HIV positive individuals (1,085 and 1,207 pre and post-SUFA respectively) were followed through their cascade of care. In the pre-SUFA period, 811 (74.6%) were enrolled in care, 702 (86.6%) were found eligible for ART, 485 (69.1%) initiated treatment, 102 (21%) were LTFU and 117 (10.8%) died. In the post-SUFA period, 930 (77%) were enrolled in care, 896 (96.3%) were found eligible for ART, 627 (70%) initiated treatment, 100 (16%) were LTFU and 148 (12.3%) dead. There was an 11% increase in the rate of HIV linkage to care (HR = 1.11; 95% CI 1.001, 1.22 p<0.05), a 13% increase in the rate of eligibility for ART (HR = 1.13, 95% CI 1.02,1.25, p<0.01) and a 27% reduction in LTFU (HR = 0.73, 95%CI 0.55, 0.97, p<0.05). Rates of ART initiation and mortality did not change.ConclusionSUFA was effective in improving HIV care in relation to linkage to care, eligibility and ART retention. Therefore, the scale up across the whole of Indonesia of the SUFA currently in the form of a test and treat policy, with improvement in testing and treatment strategies is justified.

A Two-Year Follow-Up Cohort Study-Improved Clinical Control over CVD Risk Factors through Weight Loss in Middle-Aged and Older Adults.

Modest weight loss enhances clinical control over cardiovascular disease (CVD) risk factors in overweight and obese individuals. This study aimed to assess the associations between individual weight loss and predefined criteria for clinical improvement in blood pressure, lipid levels, and glycemia. A two-year follow-up study involved 3388 (37.9% men) aged 45−64 years, BMI ≥ 25 kg/m2. Changes in body weight were calculated as a percentage of baseline weight; outcome variables: systolic (SBP), diastolic (DBP) blood pressure, high-density (HDL-C) and low-density (LDL-C) lipoproteins, fasting blood glucose (FBG), and triglycerides (TG) were construed as the differences between baseline and outcome values. Clinically significant improvement was defined as SBP/DBP reduction by 5 mm/Hg, FBG−20 mg/dL, LDL-C-10 mg/dL, TG−40 mg/dL, and HDL-C increase by 5 mg/dL. Apart from LDL-C, a modest 5%–10% weight loss was associated with clinically significantly improved outcomes. The incident rate ratios and 95% confidence intervals for clinical improvement of SBP were: 1.27 (1.14–1.40), DBP/1.30 (1.12–1.50), HDL/1.54 (1.18–2.02), and TG/1.69 (1.32–2.17). In the higher category of weight loss, associations were still manifest, although the results proved diagnostically challenging (low number of cases). Even though modest weight loss does enhance clinical control over CVD risk factors, offering regular medical guidance to patients is postulated to further boos the anticipated outcomes.

Adherence to a selective antenatal haemoglobinopathy screening policy within a tertiary level obstetric unit in Australia.

Haemoglobinopathies represent the most common single gene disorder worldwide; however, significant centre to centre variations in antenatal screening practices exist. To assess performance of a selective antenatal haemoglobinopathy screening policy within a presumed low-prevalence Australian population. Primary outcome was the failure to screen rate for women with at least one identifiable risk factor. Secondary outcomes included outcomes of maternal screening and rates, gestations and outcomes of paternal, prenatal and neonatal testing. A two-year retrospective cohort study identifying all women attending for public antenatal care with at least one identifiable risk factor for haemoglobinopathy. At least one risk factor for haemoglobinopathy was identified in 8.8% of the entire pregnant cohort; however, the failure to screen rate was high at 83.7% overall. Screening was significantly more likely to be undertaken in multiparous women, those with multiple risk factors and women originating from the Middle East. Twenty percent of screened women returned an abnormal result; however, this led to paternal haemoglobinopathy screening in only 66.6%. Where completed, the addition of partner screening reclassified offspring to low-risk status in 85.7% of cases. This study demonstrates an 83.7% screen failure rate within a selective screening model raising concerns regarding the clinical utility and health equity of this approach. This major drawback of selective screening suggests that institution of a universal antenatal screening system for haemoglobinopathies, even in anticipated low-prevalence areas, will improve detection rates and ensure families receive appropriate and timely counselling.

Maternal childbirth experience in induced and spontaneous labour measured in a visual analog scale and the factors influencing it; a two-year cohort study

BackgroundPoor maternal childbirth experience plays a role in family planning and subsequent pregnancies. The aim of this study was to compare childbirth experiences in induced and spontaneous labor and to investigate the factors influencing the childbirth experience.MethodsThis two-year cohort study included all women with term singleton pregnancies in cephalic presentation aiming for vaginal delivery at Helsinki University Hospital between January 2017 and December 2018. Maternal satisfaction in the childbirth experience was measured after delivery using a Visual Analog Scale (VAS) score. A low childbirth experience score was defined as VAS < 5. The characteristics and delivery outcomes of the study population were collected in the hospital database and analyzed by SPSS.ResultsA total of 18,396 deliveries were included in the study, of which 28.9% (n = 5322) were induced and 71.1% (n = 13 074) were of spontaneous onset. The total caesarean delivery rate was 9.3% (n = 1727). Overall, 4.5% (n = 819) of the women had a low childbirth experience VAS score. The women who underwent labor induction were less satisfied with their birth experience compared to women with spontaneous onset of labor [7.5% (n = 399) vs. 3.2% (n = 420); p < 0.001]. Poor childbirth experience was associated with primiparity [OR 2.0 (95% CI 1.6–2.4)], labor induction [OR 1.6 (95% CI 1.4–1.9)], caesarean delivery [OR 4.5 (95% CI 3.7–5.5)], operative vaginal delivery [OR 3.3 (95% CI 2.7-4.0)], post-partum hemorrhage [OR 1.3 (95% CI 1.1–1.6)], and maternal infections [OR 1.7 (95% CI 1.3–2.4)].ConclusionsPoor childbirth experience was associated with labor induction, primiparity, operative delivery, and labor complications, such as post-partum hemorrhage and maternal infections. These results highlight the aspects of care for which patient experience may be improved by additional support and counselling.

Inappropriate Dental Antibiotic Prescriptions: Potential Driver of the Antimicrobial Resistance in Albaha Region, Saudi Arabia.

PurposeThe aim of this study was to analyze and evaluate dental antibiotic prescriptions in Albaha Region, Saudi Arabia.Patients and MethodsA two-year retrospective cohort study was conducted between September 1, 2017 and September 1, 2019 in children and adults. Data collected from the patients’ medical records were analyzed using SPSS. The Z-test with Bonferroni correction and descriptive proportions were utilized to compare several levels of categorical variables.ResultsOf the 43,255 dental visits, antibiotics were provided during 12,573 (29.1%). The commonly prescribed antibiotics were amoxicillin and amoxicillin combined with metronidazole (56.3% and 16.9%, respectively). Alarmingly, antibiotics were provided in several conditions for which they are medically neither recommended nor indicated; together, they represented 27.8% of those consultations in which antibiotics were prescribed. Female dentists prescribed more antibiotics than male dentists (30%, P = < 0.000), with male patients receiving more antibiotics than female patients (36%, P = <0.0001). ConclusionUnnecessary prescription of antibiotics was observed in the present study. Improving knowledge and awareness of Saudi dentists on dental antibiotic prescription is warranted.

Divorce and conversational difficulties with parents: Impact on adolescent health and self-esteem.

Background: Divorce experience (DE) may cause health and self-conceptual problems, but these consequences might also be caused by conflicts and lack of conversational confidence (CC) with one or both parents. We investigated how DE impacted CC and how DE and CC impacted health complaints and self-esteem in a two-year longitudinal cohort study. Methods: The study was performed between 2011 and 2013 among 1225 students in junior high school (aged 11 and 13 years in 2011). We used binary logistic analyses to account for how DE impacted CC, and linear regression analyses to examine how DE and CC impacted on subjective health and self-esteem in 2013. Results: The study revealed that former and recent DEs impacted CC with fathers only. The impact was most evident for the more severe forms of conversational difficulties. DE in itself predicted only self-esteem, and CC with parents mediated this association. CC with both mothers and fathers had strong temporal causal associations with the outcomes two years later. Only CC with fathers impacted changes of the health complaints and self-esteem in full-model residual change analyses. Conclusions: The study proves a sex-specific effect on loss of CC between fathers and children after divorce. The impairment of CC has predictive repercussions on the health and self-conception of adolescents in their middle teenage years. From a public-health perspective, preserving the relation and the confidence between children and their fathers after divorce seems an important task.

Quality of Life in People with Young-Onset Dementia: A Nordic Two-Year Observational Multicenter Study.

BACKGROUND Cross-sectional studies of quality of life (QOL) of people with young-onset dementia show diverging results. OBJECTIVE To identify factors associated with QOL in people with young-onset Alzheimer's (AD) and frontotemporal dementia (FTD) and explore development in QOL over a two-year period, including differences between the two subtypes. METHODS A two-year cohort study of 88 community-dwelling people with young-onset AD and FTD recruited from Nordic memory clinics. QOL was assessed using the proxy version of the Quality of Life - Alzheimer's Disease questionnaire, dementia severity was rated with the Clinical Dementia Rating scale, depressive symptoms by the Cornell Scale for Depression in Dementia, awareness with the Reed anosognosia scale, and needs using the Camberwell Assessment of Needs in the Elderly questionnaire. Factors associated with QOL and development in QOL over time were explored with growth mixture model trajectories and mixed model analyses. RESULTS We identified two groups of people following trajectories with better (n = 35) versus poorer (n = 53) QOL. People with more depressive symptoms at baseline had higher odds of belonging to poorer QOL group, OR 1.2 (CI 1.1; 1.5, p = 0.011). Having Alzheimer's disease was associated with significantly better QOL (p = 0.047 at baseline, p = 0.009 at T1 and p = 0.033 at T2). Increasing number of unmet needs was significantly associated with poorer QOL at baseline (p = 0.007), but not later in follow-up. CONCLUSION Early assessment and treatment based on dementia subtype, depression, and individual needs may enhance quality of life in young-onset dementia.

A NOVEL VARIANT OF TAKOTSUBO CARDIOMYOPATHY

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Takotsubo cardiomyopathy (TCM) is a form of nonischemic cardiomyopathy that is characterized by transient regional systolic dysfunction of the left ventricle. It often mimics acute myocardial infarction but has a minimal release of cardiac enzymes. The hallmark is an absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. In most cases of TCM, the regional wall motion abnormality extends beyond the territory perfused by a single epicardial coronary artery. Classically, TCM is associated with a ballooned left ventricular apex and basal segmental hyperkinesis. While there have been reports of atypical TCM with midventricular hypokinesia and apical sparing, here we present a novel variant in which there is left ventricular hypokinesis of the anterior, septal, and lateral segments, with preservation of motion only in the inferior wall. CASE PRESENTATION: A 56 year old female presented with recent increased stress, poor sleep, and epigastric abdominal pain with radiation to the right shoulder for 4 days. EKG showed ST elevations in V1-V4 and reciprocal ST depressions in II, III, and aVF. Troponin-T peaked to 1.250. Left heart ventricular angiogram showed a left ventricular ejection fraction (LV EF) of 10-15%, with no obstructive coronary artery disease visualized on the angiogram. Transthoracic echocardiography showed LV wall hypokinesis of the anterior, septal, and lateral segments, with preserved motion only in the inferior wall. (Fig. A - F). Follow up TTE showed improvement of LV EF to 35%. DISCUSSION: TCM is a non-ischemic cardiomyopathy with transient contractility changes, presenting in middle-aged women with acute stress. This patient’s presentation - with EKG concerning for acute ST elevation myocardial infarction, no evidence of coronary artery disease, and extensive LV cardiomyopathy - implies a diagnosis of TCM. The pathogenesis of Takotsubo cardiomyopathy is not well understood. Postulated mechanisms include catecholamine excess, coronary artery spasm, and microvascular dysfunction. It is thought that catecholamines play a role in TCM because of the correlation of the disorder with physical or emotional stress. A catecholamine surge may cause diffuse microvascular spasm or dysfunction, resulting in myocardial stunning. Catecholamines can also have a direct myocardial toxicity effect, further contributing to the cardiomyopathy. On resolution of the catecholamine surge, the myocardium recovers and LV EF improves. CONCLUSIONS: This case demonstrates a novel, as of yet unseen, variant of TCM with hypokinesis of all but the inferior wall. Such specific sparing supports etiologies of TCM not related to epicardial coronary artery distribution, and lends credence to etiologies involving stress-induced catecholamine excess causing neurogenic stunned myocardium. Reference #1: Murthy, A., Arora, J., Singh, A., Gedela, M., Karnati, P., & Nappi, A. (2014). Takotsubo Cardiomyopathy: Typical and Atypical Variants, A Two-Year Retrospective Cohort Study. Cardiology research, 5(5), 139-144. Reference #2: Velankar, P., & Buergler, J. (2012). A mid-ventricular variant of Takotsubo cardiomyopathy. Methodist DeBakey cardiovascular journal, 8(3), 37-9. DISCLOSURES: no disclosure on file for Mandeep Kainth; No relevant relationships by Sharmila Sarkar, source=Web Response No relevant relationships by Alexander Volodarskiy, source=Web Response

Characteristics of prescription in 29 Level 3 Neonatal Wards over a 2-year period (2017-2018). An inventory for future research.

ObjectivesThe primary objective of this study is to determine the current level of patient medication exposure in Level 3 Neonatal Wards (L3NW). The secondary objective is to evaluate in the first month of life the rate of medication prescription not cited in the Summary of Product Characteristics (SmPC). A database containing all the medication prescriptions is collected as part of a prescription benchmarking program in the L3NW.Material and methodsThe research is a two-year observational cohort study (2017–2018) with retrospective analysis of medications prescribed in 29 French L3NW. Seventeen L3NW are present since the beginning of the study and 12 have been progressively included. All neonatal units used the same computerized system of prescription, and all prescription data were completely de-identified within each hospital before being stored in a common data warehouse.ResultsThe study population includes 27,382 newborns. Two hundred and sixty-one different medications (International Nonproprietary Names, INN) were prescribed. Twelve INN (including paracetamol) were prescribed for at least 10% of patients, 55 for less than 10% but at least 1% and 194 to less than 1%. The lowest gestational ages (GA) were exposed to the greatest number of medications (18.0 below 28 weeks of gestation (WG) to 4.1 above 36 WG) (p<0.0001). In addition, 69.2% of the 351 different combinations of an medication INN and a route of administration have no indication for the first month of life according to the French SmPC. Ninety-five percent of premature infants with GA less than 32 weeks received at least one medication not cited in SmPC.ConclusionNeonates remain therapeutic orphans. The consequences of polypharmacy in L3NW should be quickly assessed, especially in the most immature infants.