Younger Categories Research Articles

Estimation of Age by Evaluating the Occlusal Tooth Wear in Molars: A Study on Dakshina Kannada Population.

PurposeAssessment of teeth to estimate age in the living as well as the dead is well documented in the literature. Though applied in conjunction with other parameters in Gustafson’s technique, attrition of teeth solely is an underexplored indicator for age estimation mainly in India. Most of the studies using attrition of teeth have been conducted in bioarchaeology, and in populations where studies are being conducted in forensic contexts, the results are debatable. Thus, the present study aimed to evaluate the accuracy of age estimation using the Average Stage of Attrition (ASA) method by Li and Ji in adults of the Dakshina Kannada region.Materials and MethodsThis cross-sectional study assessed the degree of attrition in both maxillary and mandibular first and second molars of 136 adults of Dakshina Kannada origin (age range: 20–70 years) according to the 10 stages given by Li and Ji to derive population-specific linear regression equations.ResultsUnivariate analysis of prediction of age with attrition showed a significant association of attrition score with age, stratified by sex, arch as well as in total (p-value <0.001) with a standard error of estimate of 9.231 years. The estimated age was within ±5 years of the actual age in 44.2% of the females and 50.0% of the males. A comparative review of 23 studies done to estimate age from attrition score clinically is documented in the manuscript.ConclusionThe findings of this study suggest that evaluation of tooth wear by the Average Stage of Attrition (ASA) method can be used as a non-invasive means to aid in the determination of age in adults of Dakshina Kannada origin. Although the error increases with age, this method provides a measurable means of seriation into older and younger categories.

The potential impact of co-residence structures on socio-demographic inequalities in COVID-19 mortality

During the COVID-19 pandemic, confinement measures were adopted across the world to limit the spread of the virus. In France, these measures were applied between March 17 and May 10. Using high-quality population census data and focusing on co-residence structures on French territory, this article analyzes how co-residence patterns unevenly put different socio-demographic groups at risk of being infected and dying from COVID-19. The research ambition is to quantify the possible impact of co-residence structures heterogeneity on socio-economic inequalities in mortality stemming from within-household transmission of the virus. Using a simulation approach, the article highlights the existence of theoretical pronounced inequalities of vulnerability to COVID-19 related to cohabitation structures as well as a reversal of the social gradient of vulnerability when the age of the infected person increases. Among young age categories, infection is simulated to lead to more deaths in the less educated or foreign-born populations. Among the older ones, the inverse holds with infections having a greater potential to provoke deaths through the transmission of the virus within households headed by a highly educated or a native-born person. Demographic patterns such as the cohabitation of multiple generations and the survival of both partners of a couple help to explain these results. Even though inter-generational co-residence and large households are more common among the lower educated and foreign born in general, the higher educated are more likely to still live with their partner at higher ages.

Age-related differences in linear sprint in adolescent female soccer players

BackgroundSeveral studies have observed the contribution of chronological age, biological maturation, and anthropometric characteristics to sprinting performance in young soccer players. Nevertheless, there are no studies that have analysed the contribution of these characteristics to running speed qualities in adolescent female soccer players.ObjectiveThis study investigated age-related differences in sprint performance in adolescent female soccer players. Also, it examined the possible influence of anthropometry [body mass and body mass index (BMI)] and biological maturation [age at peak height velocity (APHV)] in sprint performance.MethodsEighty adolescent female soccer players [under (U) 14, n = 20; U16, n = 37; U18, n = 23] participated in this study. Players were tested for 40 m sprint (each 10 m split times).ResultsPosthoc analysis revealed better performance in all split sprint times of older soccer players (U18 and U16) compared with younger category (F: 3.380 to 6.169; p < 0.05; ES: 0.64 to 1.33). On the contrary in all split sprint times, there were no significant changes between U16 and U18 (p < 0.05; ES: 0.03 to 0.17). ANCOVA revealed differences in all parameters between groups, controlled for APHV (p < 0.05). In contrast, all between-group differences disappeared after body mass and BMI adjustment (p > 0.05). Finally, the results indicate that BMI and body mass were significantly correlated with 40 m sprint (p < 0.05; r: -0.31) and 20 m flying (p < 0.01; r: 0.38), respectively.ConclusionIn the present players’ sample, body mass and BMI had a significant impact on running speed qualities.

How Relative Age Effects Associate with Football Players' Market Values: Indicators of Losing Talent and Wasting Money.

Background: In football, annual age-group categorization leads to relative age effects (RAEs) in talent development. Given such trends, relative age may also associate with market values. This study analyzed the relationship between RAEs and market values of youth players. Methods: Age category, birthdate, and market values of 11,738 youth male football players were obtained from the “transfermarkt.de” database, which delivers a good proxy for real market values. RAEs were calculated using odds ratios (OR) with 95% confidence intervals (95%CI). Results: Significant RAEs were found across all age-groups (p < 0.05). The largest RAEs occurred in U18 players (Q1 [relatively older] v Q4 [relatively younger] OR = 3.1) ORs decreased with age category, i.e., U19 (2.7), U20 (2.6), U21 (2.4), U22 (2.2), and U23 (1.8). At U19s, Q1 players were associated with significantly higher market values than Q4 players. However, by U21, U22, and U23 RAEs were inversed, with correspondingly higher market values for Q4 players apparent. While large typical RAEs for all playing positions was observed in younger age categories (U18–U20), inversed RAEs were only evident for defenders (small-medium) and for strikers (medium-large) in U21–U23 (not goalkeepers and midfielders). Conclusions: Assuming an equal distribution of football talent exists across annual cohorts, results indicate the selection and market value of young professional players is dynamic. Findings suggest a potential biased selection, and undervaluing of Q4 players in younger age groups, as their representation and market value increased over time. By contrast, the changing representations and market values of Q1 players suggest initial overvaluing in performance and monetary terms. Therefore, this inefficient talent selection and the accompanying waste of money should be improved.

Health-Related Quality of Life in Ankle Osteoarthritis: A Case-Control Study.

ObjectiveAnkle osteoarthritis (OA) has a prevalence of 3.4% in the general population of which 70% to 78% is posttraumatic, affecting younger patients with a longer projected life span compared with hip and knee OA. The current literature reports the physical and mental quality of life (QoL) of patients with ankle OA, to be similar to end-stage hip OA, end-stage kidney disease and digestive heart failure. However, the QoL of ankle OA patients has not yet been determined compared with a matched control group representing the general population. Our aim is to determine the physical and mental QoL compared with a matched control group.DesignThe Physical and Mental Component Summaries of the Short Form–36 of 100 patients with ankle OA were compared with 91 age- and gender-matched controls. This case-control study is a substudy of the PRIMA trial, in which the efficacy of platelet-rich plasma injections for ankle OA is determined.ResultsA clinically relevant difference was found for both the Physical (P=0.003; 95% CI −6.7 to −1.3) and Mental Component Summary scores (P < 0.001; 95% CI −10 to −6). Patients with ankle OA had a median of 45 points (matched controls 52 points) and 43 points (matched controls 53 points) for the Physical and Mental Component summary scores, respectively.ConclusionsPatients with ankle OA had a clinically relevant poorer mental and physical QoL compared with matched controls from the general population. Furthermore, the physical QoL of patients with ankle OA from younger age categories was affected more than those in older age categories.

Age and sex differences in outcomes after in-hospital cardiac arrest

IntroductionWhile specific factors have been associated with outcomes after in-hospital cardiac arrest, the association between sex and outcomes remains debated. Moreover, age-specific sex differences in outcomes have not been fully characterized in this population. MethodsAdult patients (≥18 years) with an index in-hospital cardiac arrest were included from the Danish In-Hospital Cardiac Arrest Registry (DANARREST) from January 1st, 2017 to December 31st, 2018. Population-based registries were used to obtain data on patient characteristics, cardiac arrest characteristics, and outcomes. Unadjusted and adjusted estimates for return of spontaneous circulation (ROSC), survival to 30 days, survival to one year, duration of resuscitation, and post-cardiac arrest time-to-death were computed. ResultsA total of 3266 patients were included, of which 2041 (62%) patients were male with a median age of 73 years (quartiles: 64, 80). Among 1225 (38%) female patients, the median age was 76 years (quartiles: 67, 83). Younger age was associated with higher odds of ROSC and survival. Sex was not associated with ROSC and survival in the unadjusted analyses. In the adjusted analyses, women had 1.32 (95%CI: 1.12, 1.54) times the odds of survival to 30 days and 1.26 (95%CI: 1.02, 1.57) times the odds of survival to one year compared to men. The overall association between sex and survival did not vary substantially across age categories, although female sex was associated with a higher survival within certain age categories. Among patients who did not achieve ROSC, female sex was associated with a shorter duration of resuscitation, which was more pronounced in younger age categories. ConclusionsIn this study of patients with in-hospital cardiac arrest, female sex was associated with a shorter duration of resuscitation among patients without ROSC but a higher survival to 30 days and one year. While the overall association between sex and outcomes did not vary substantially across age categories, female sex was associated with a higher survival within certain age categories.

Use of Preventive Aspirin Among Older US Adults With and Without Diabetes

The net benefit of aspirin for prevention of cardiovascular disease (CVD), particularly primary prevention, remains debated in people with and without diabetes. Recent studies suggest that the benefits of preventive aspirin may be outweighed by the potential for harm in older adults; therefore, it is important to monitor current aspirin use in order to minimize risk for future harm in the oldest segment of the population. To determine the prevalence of preventive aspirin use in older US adults with and without diabetes for both primary and secondary prevention by age, sex, and CVD risk category. This cross-sectional analysis used nationally representative data from the National Health and Nutrition Examination Survey from 2011 to 2018. A total of 7103 individuals 60 years or older with and without diabetes completed a questionnaire on preventive aspirin use. Statistical analyses were performed from July 1, 2019, to April 1, 2021. Preventive aspirin use was defined as participants' self-reported use of low-dose aspirin therapy based on their physician's advice or their own decision. A total of 7103 individuals (mean [SD] age, 69.6 [0.1] years; 45.2% men; 75.8% White participants) were evaluated. Overall, 61.7% of older US adults with diabetes vs 42.2% without diabetes used aspirin. Among people with diabetes, in multivariable logistic models adjusting for race, sex, education, CVD risk category, and body mass index, the likelihood of aspirin use in older vs younger age categories (reference: 60-69 years) did not differ. Among people without diabetes, aspirin use was significantly greater in older age categories vs the reference (model 3, 70-79 years, odds ratio [OR], 1.50; 95% CI, 1.23-1.83; model 3, ≥80 years, OR, 1.59; 95% CI, 1.24-2.04). An estimated 9.9 million US adults 70 years or older with or without diabetes reported taking aspirin for primary prevention. The likelihood of aspirin use for primary prevention in those at high vs low risk for CVD did not differ among older adults with diabetes (model 3, OR, 1.69; 95% CI, 0.65-4.39) but was significantly higher in those without diabetes (model 3, OR, 2.46; 95% CI, 1.63-3.71). Women vs men with diabetes were less likely to be using aspirin for primary prevention (model 3, OR, 0.63; 95% CI, 0.48-0.83). This cross-sectional study found that preventive aspirin use was higher among older adults with diabetes than in those without diabetes. Results suggest that 9.9 million older US adults who previously took aspirin for primary prevention would not be recommended for its continued use, particularly among those with diabetes.

Incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes

BackgroundDiabetes has strongly been linked to atrial fibrillation, ischaemic heart disease and heart failure. The epidemiology of these cardiovascular diseases is changing, however, due to changes in prevalence of obesity-related conditions and preventive measures. Recent population studies on incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes are needed.MethodsA dynamic longitudinal cohort study was performed using primary care databases of the Julius General Practitioners’ Network. Diabetes status was determined at baseline (1 January 2014 or upon entering the cohort) and participants were followed-up for atrial fibrillation, ischaemic heart disease and heart failure until 1 February 2019. Age and sex-specific incidence and incidence rate ratios were calculated.ResultsMean follow-up was 4.2 years, 12,168 patients were included in the diabetes group, and 130,143 individuals in the background group. Incidence rate ratios, adjusted for age and sex, were 1.17 (95% confidence interval 1.06–1.30) for atrial fibrillation, 1.66 (1.55–1.83) for ischaemic heart disease, and 2.36 (2.10–2.64) for heart failure. Overall, incidence rate ratios were highest in the younger age categories, converging thereafter.ConclusionThere is a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably with heart failure with a more than twice increased risk.

Treatment Need as an Indicator for Planning Dental Postgraduate Programs at Umm Al-Qura University, Saudi Arabia

Background: The treatment need is one of the fundamental factors for effective planning of postgraduate dental programs that improve the competency of dental practitioners. Aims: To assess the treatment need of patients at Umm Al-Qura University, Dental Teaching Hospital utilizing statistically representative sample of patients visiting the clinics. To use data analyzed to propose the need and design for postgraduate degrees in the college. Material and methods: Information were retrieved from the electronic database of 4,967 patients’ files anonymously including age, gender, treatment needs and referred clinic specialty. The obtained data were subjected to descriptive statistics in the form of mean ± SD, frequencies, cross tabulations, and percentages using Statistical Package for the Social Sciences (SPSS) software. Results: The percentage of females' records was significantly higher (52%) than that of males. The mean age of males was higher than females (36.66 versus 35.10) while young adult age category constituted the greatest number (36.6%). The most common treatment need recorded in patients' files were periodontics (73.3%), restorative (60.4%) followed by fixed prosthodontics (54.8%). Nearly half of the patients’ (48.9%) were in need of endodontic treatment. The common significantly higher needs in females were restorative and periodontics, while among males, significantly higher treatment needs for surgery, endodontics and prosthodontics were recorded. Conclusion: Patient treatment needs at Faculty of Dentistry, Umm Al-Qura University reflect a high priority for proposing postgraduate degrees in periodontics and restorative dentistry. Also, devoting considerable time and effort in counseling and providing undergraduates with information that guide in making career decisions and match the treatment needs in Makkah, Saudi Arabia. Clinical Significance: Establishment of dental postgraduate degrees that meet the treatment needs of the community will lead to more professional diagnosis and management of patients by qualified specialists.

Are Soccer and Futsal Affected by the Relative Age Effect? The Portuguese Football Association Case.

A better understanding of the relative age effect (RAE) in youth will increase the awareness of the need for reducing the bias of (de)selection. Thus, we investigated the RAE in youth female and male soccer and futsal players in Portugal, using nationwide data. Birthdates of 5,306 female and 126,285 male soccer players, and 2,437 female and 23,988 male futsal players (U7–U19), registered in Portugal during the season 2019–2020, and Portuguese National teams (from U15 to AA soccer teams and from U17 to AA futsal teams) were analyzed. Data were categorized into age groups and certification levels [no certification, basic football training center, football school, and training institution] of the respective clubs/academies. Birthdates were stratified from the start of the selection year using quartiles (Q) and semesters (S). Differences between the observed and expected birthdate distributions were analyzed using chi-square statistics, and RAEs were calculated using odds ratios (OR). In both soccer and futsal, female players, in the age category U9, RAEs were found (Q1 vs. Q4, OR: 1.49 and 1.84, respectively). In male soccer, differences in the birthdate distribution were observed in all age categories (U7–U19) with significant OR between all comparisons (Q and S). In contrast, an over-representation of young male futsal players (Q1 vs. Q4) was observed only in the age categories U7 and U9 (OR: 1.54 and 1.34, respectively). The stratification by certification level showed a significant RAE for all certification levels in male soccer players. In contrast, in male futsal players, the RAE was significant only in clubs and academies with the highest level. For National teams, the RAE was more pronounced in male soccer, particularly in the U16 and U17 (OR: 9.84 and 12.36, respectively). Data showed a RAE in female and male youth soccer and futsal, particularly in male, younger age categories, and in clubs and academies having a higher certification level, which could be accompanied by a loss of valuable elite players during the youth phase of their careers. Thus, adjustments in the systems and structure of talent identification are recommended to prevent RAE-related discrimination in youth soccer and futsal.

Fall-Related Injuries Mediate the Relationship Between Self-Reported Hearing Loss and Mortality in Middle-Aged and Older Adults.

Hearing loss is associated with a greater risk of death in older adults. This relationship has been attributed to an increased risk of injury, particularly due to falling, in individuals with hearing loss. However, the link between hearing loss and mortality across the life span is less clear. We used structural equation modeling and mediation analysis to investigate the relationship between hearing loss, falling, injury, and mortality across the adult life span in public-use data from the National Health Interview Survey and the National Death Index. We examined (a) the association between self-reported hearing problems and later mortality, (b) the associations between self-reported hearing problems and the risk of injury and degree and type of injury, (c) the mediating role of falling and injury in the association between self-reported hearing problems and mortality, and (d) whether these relationships differ in young (18-39), middle-aged (40-59), and older (60+) age groups. In all 3 age ranges, those reporting hearing problems were more likely to fall, were more likely to sustain an injury, and were more likely to sustain a serious injury, than those not reporting hearing problems. While there was no significant association between hearing loss and mortality in the youngest category, there was for middle-aged and older participants, and for both, the fall-related injury was a significant mediator in this relationship. Fall-related injury mediates the relationship between hearing loss and mortality for middle-aged as well as older adults, suggesting a need for further research into mechanisms and remediation.

The Correlation of Age with Prognosis of Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Thyroid Nodules.

PurposeAlthough some prognostic variables and risk factors for thyroid cancer (TC) are age-related, the association between age and the risk of TC in patients with thyroid nodules (TNs) assigned to atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS) is poorly estimated. The aim of this study was to assess the histopathology of AUS/FLUS and the risk of TC according to the age of the patients at the time of AUS/FLUS diagnosis.Patients and MethodsAmong 5021 individuals treated for TNs at one institution from 2008 to 2018, 161 (3.2%) patients with 161 TNs assigned to the AUS/FLUS category (1 nodule per patient) were selected and stratified by age at initial diagnosis: <55 years, 55–75 years and >75 years. Logistic regression analysis was used to estimate the association of age with the risk of TC diagnosis.ResultsNinety-one (56.52%) patients <55 years old, 58 (36.02%) patients 55–75 years old, and 12 (7.45%) individuals >75 years old were identified. There were 130 (80.7%) females and 31 (19.3%) males with a mean age of 50.6 ± 16.12 years. Among the evaluated TNs, 142 (88.2%) were ultimately diagnosed as benign, and 19 (11.8%) were diagnosed as malignant. Younger age in patients was significantly related to malignancy outcome (p=0.024 for age <55 years). Patients aged 55–75 years had a significantly lower risk of TC than the other age categories (p=0.040). The risks of high vascularity and fast tumor growth were significantly higher in the youngest category than in the other categories (age <55 years old: p=0.045 and p=0.002, respectively).ConclusionAlthough patients with TNs classified as AUS/FLUS by ultrasound-guided fine needle aspiration biopsy (UG-FNAB) are not typically qualified for surgery, it is worth noting that younger patients with an AUS/FLUS diagnosis might be at a higher risk of TC.

Motor-functional profile of footballers of junior and cadet age

Football is probably the most popular game around the world, having taken over the globe with 256 million registered players in 208 countries. The aim of the study was to determine the differences in motor and functional abilities between football players of junior and cadet age. The research included a sample of 39 football players of the Kicker Football Club from Kraljevo, divided into two subsamples: 20 football players of junior age of chronological age of 17 ± 0.6 years and 19 football players of cadet age of chronological age of 15 ± 0.6 years. The following tests were used to assess motor skills: Starting acceleration at 10 m, Starting acceleration at 10 m flying start, maximum running speed during the test at 10 m, maximum running speed during the test at 10 m flying start, Illinois Agility test, while the following tests were used to assess functional abilities: Maximum oxygen consumption and maximum heart rates. The results of the study indicate that statistically significant differences were recorded only in motor abilities. The emphasis on working with younger categories should be placed on the long-term development process, to enable better success in senior age.

Strategy to identify priority groups for COVID-19 vaccination: A population based cohort study

BackgroundEvidence from COVID-19 outbreak shows that individuals with specific chronic diseases are at higher risk of severe prognosis after infection. Public health authorities are developing vaccination programmes with priorities that minimize the risk of mortality and severe events in individuals and communities. We propose an evidence-based strategy that targets the frailest subjects whose timely vaccination is likely to minimize future deaths and preserve the resilience of the health service by preventing infections. MethodsThe cohort includes 146,087 cases with COVID-19 diagnosed in 2020 in Milan (3.49 million inhabitants). Individual level data on 42 chronic diseases and vital status updated as of January 21, 2021, were available in administrative data. Analyses were performed in three sub-cohorts of age (16–64, 65–79 and 80+ years) and comorbidities affecting mortality were selected by means of LASSO cross-validated conditional logistic regression. Simplified models based on previous results identified high-risk categories worth targeting with highest priority. Results adjusted by age and gender, were reported in terms of odds ratios and 95%CI. ResultsThe final models include as predictors of mortality (7,667 deaths, 5.2%) 10, 12, and 5 chronic diseases, respectively. The older age categories shared, as risk factors, chronic renal failure, chronic heart failure, cerebrovascular disease, Parkinson disease and psychiatric diseases. In the younger age category, predictors included neoplasm, organ transplantation and psychiatric conditions. Results were consistent with those obtained on mortality at 60 days from diagnosis (6,968 deaths). ConclusionThis approach defines a two-level stratification for priorities in the vaccination that can easily be applied by health authorities, eventually adapted to local results in terms of number and types of comorbidities, and rapidly updated with current data. After the early phase of vaccination, data on effectiveness and safety will give the opportunity to revise prioritization and discuss the future approach in the remaining population.

Age Categories Differences in Subjective Quality of Life of Women with Physical Disabilities.

ObjectiveThe objective of the study was to analyse and compare the subjective quality of life (S-QoL) of women with physical disabilities (PDs) through satisfaction with the quality of life domains and the overall quality of life assessment.MethodsThe sample comprised of women with PDs (n=137), divided into 4 age categories: 19-29 yrs. (n=53); 30-44 yrs. (n=25); 45-59 yrs. (n=24) and over 60 yrs. (n=35). The Subjective Quality of Life Analyses questionnaire and the WHO User Manual were used as a primary research method. The Wilcoxon Signed Rank Test was used to assess the differences between QoLDs, Kruskal Wallis test to assess differences in S-QoL among four independent groups and Mann Whitney U-test between two age categories.ResultsThe highest satisfaction in all age categories of women was found in the social relations domain, and in the 19-29 yr-old women equally in the social relations and physical health domains. The highest dissatisfaction was reported with the psychological health and environment domains. The key finding is that the main differences are between the youngest category (aged 19-29 yrs) and the three older categories with regard to physical health, environment and overall QoL.ConclusionsIt is necessary to continue this line of research with a greater focus on exploring the ways in which the psychological health domain can be improved as an integral part of S-QoL, and to also focus on the QoL indicators that make up the environment domain and search for ways to enhance these.

Chronic prescription medication use in endurance runners: a cross-sectional study in 76,654 race entrants – SAFER XV

ABSTRACT Objective To determine the prevalence of chronic prescription medication (CPM) use in distant runners (by age and sex) and to compare CPM use in 21.1 km vs. 56 km race entrants. Methods A cross-sectional study of 76,654 race entrants who completed a pre-race medical screening questionnaire during race registration, which included questions on the use of CPM and CPM use in eight main categories of CPM. Prevalence (%, 95%CIs) and prevalence ratios (PR) are reported. Results The prevalence of any CPM use was 12.5% (12.2–12.8). CPM use was higher in older age categories vs. the youngest age category (31–40 yrs vs. ≤30 yrs: PR = 1.4; 41–50 yrs vs. ≤30 yrs: PR = 2.1; >50 yrs vs. ≤30 yrs: PR = 3.4) (p < 0.0001) and females vs. males (PR = 1.1; p < 0.0001). The use of any CPM was significantly higher in 21.1 km vs. 56 km race entrants (PR = 1.2; p < 0.0001). Prevalence of CPM use in main categories was: blood pressure lowering medication (3.7%), cholesterol lowering medication (3.6%), asthma medication (3.1%), and medication to treat anxiety/depression (2.6%). The pattern of CPM in the main categories differed between 21.1 km and 56 km race entrants. Conclusions One in eight race entrants use CPM, with a higher prevalence of use among older race entrants, female vs. males, and 21.1 km vs. 56 km race entrants. Frequent CPMs used are blood pressure lowering medication, cholesterol lowering medication, asthma medication, and medication to treat anxiety/depression. The use of CPM medications may increase the risk of medical complications during exercise, and these data help identify subgroups of entrants that may be at higher risk for race medical encounters.

Changing phenotype, early clinical course and clinical predictors of inflammatory bowel disease in Sri Lanka: a retrospective, tertiary care-based, multi-centre study

BackgroundInflammatory bowel disease (IBD) is increasing in the Asia-Pacific region, with changes in disease phenotype and course. We aimed to assess the changing phenotypes of IBD over ten years, describe the early clinical course (ECC) and identify the clinical predictors (CP) of poor outcomes among a large, multi-centre, cohort of Sri Lankan IBD patients.MethodsWe included patients [diagnosed between June/2003–December/2009-Group-1(G1), January/2010–June/2016-Group-2(G2)] with ulcerative colitis (UC) and Crohn disease (CD) from five national-referral centres. Changing phenotype from G1 to G2, ECC (disease duration < 3-years) and CP of poor outcomes (disease duration ≥ 1-year) was assessed. Poor outcomes were complicated-disease (CompD-stricturing/penetrating-CD, extensive-UC/pancolitis, perforation/bleeding/colectomy/malignancy) and treatment-refractory disease (TRD-frequently-relapsing, steroid-dependent/refractory and biologic use).Results375 (UC-227, CD-148) patients were recruited. Both G1/G2 had more UC than CD (77% vs 23%, 54.5 vs 45.5 respectively, p < 0.01). Increase of CD from G1-to-G2 was significant (23–45.4%, p < 0.001). In both groups, left-sided colitis (E2) and ileo-colonic (L3)/non-stricturing, non-penetrating disease behaviour (B1) CD predominated. Extensive-colitis (E3) (36.4% vs 22.7, p < 0.05) and stricturing-CD (B2) (26.1% vs 4.0%, p < 0.01) was commoner in G1. ECC was assessed in 173-patients (UC-94, CD-79). Aggressive disease behaviour and TRD were low among both UC and CD. Immunomodulator use was significantly higher among CD than UC (61.5% vs 29.0% respectively, p < 0.01). Anti-TNF use was low among both groups (UC-3.2%, CD-7.7%). Disease complications among UC [bleeding (2.1%), malignancy-(1.1%), surgery-(2.1%)] and CD [stricture-(3.9%), perforation-(1.3%), malignancy-(1.3%), surgery-(8.9%)] were generally low. CPs were assessed in 271-patients (UC-163, CD-108). Having a family history of IBD (for UC), extraintestinal manifestation (EIM), severe disease at presentation, being in younger age categories and severe disease at presentation, (for both UC and CD) predicted poor outcomes.ConclusionThere was an increase in CD over time without change in disease phenotype for both UC and CD. A relatively benign ECC was observed. Family history (UC), EIMs (UC/CD), severe disease at presentation (UC/CD), younger age (CD/UC) CPs of poor outcomes.

Strategy to Identify Priority Groups for COVID-19 Vaccination: A Population Based Cohort Study

Background: Evidence from COVID-19 outbreak shows that individuals with specific chronic diseases are at higher risk of severe prognosis after infection. Public health authorities are developing vaccination programmes with priorities that minimize the risk of mortality and severe events in individuals and communities. We propose an evidence-based strategy that targets the frailest subjects whose timely vaccination is likely to minimize future deaths and preserve the resilience of the health service by preventing infections. Methods: The cohort includes 146,087 cases with COVID-19 diagnosed in 2020 in Milan (3.49 million inhabitants). Individual level data on 42 chronic diseases and vital status updated as of January 21, 2021, were available in administrative data collected during the pandemic. Analyses were performed in three sub-cohorts of age (16-64, 65-79 and 80+ years) and comorbidities affecting mortality were selected by means of LASSO cross-validated conditional logistic regression. Simplified models based on previous results identified high-risk categories worth targeting with highest priority. Results adjusted by age and gender, were reported in terms of odds ratios and 95% confidence intervals. Findings: The final models include as predictors of mortality (7,667 deaths, 5.2%) 10, 12, and 5 chronic diseases, respectively. The older age categories shared, as risk factors, chronic renal failure, chronic heart failure, cerebrovascular disease, Parkinson disease and psychiatric diseases. In the younger age category, predictors included neoplasm, organ transplantation and psychiatric conditions. Results were consistent with those obtained on mortality at 60 days from diagnosis (6,968 deaths). Interpretation: This approach defines a two-level stratification for priorities in the vaccination that can easily be applied by health authorities, eventually adapted to local results in terms of number and types of comorbidities, and rapidly updated with current data. After the early phase of vaccination, data on effectiveness and safety will give the opportunity to revise prioritization and discuss the future approach in the remaining population. Funding: Agency for Health Protection, Metropolitan Area of Milan, ItalyDeclaration of Interests: None declared. Ethics Approval Statement: Ethics approval and consent to participate were not required, as this is an observational study based on data routinely collected by the Agency for Health Protection (ATS) of Milan, a public body of the Regional Health Service of Lombardy. Among the institutional functions of the ATS, established by the Lombardy regional legislation (R.L. 23/2015), is the management of individual care in the regional social and healthcare system, the evaluation of services provided to patients residing in the area covered by the ATS, and their health outcomes. This study is also ethically compliant with Italian law (Legislative Decree 101/2018) and the “General Authorisation to Process Personal Data for Scientific Research Purposes” (clauses no. 8 and 9/2016, referred to in the Data Protection Authority action of 13/12/2018). Data were anonymized with a unique identifier in the different datasets before being used for the analyses.

Population-based 10-year cumulative revision risks after hip and knee arthroplasty for osteoarthritis to inform patients in clinical practice: a competing risk analysis from the Dutch Arthroplasty Register

Background and purpose — A lifetime perspective on revision risks is needed for optimal timing of arthroplasty in osteoarthritis (OA) patients, weighing the benefit of total hip arthroplasty/total knee arthroplasty (THA/TKA) against the risk of revision, after which outcomes are less favorable. Therefore, we provide population-based 10-year cumulative revision risks stratified by joint, sex, fixation type, and age. Patients and methods — Data from the Dutch Arthroplasty Register (LROI) was used. Primary THAs and TKAs for OA between 2007 and 2018 were included, except metal-on-metal prostheses or hybrid/reversed hybrid fixation. Revision surgery was defined as any change of 1 or more prosthesis components. The 10-year cumulative revision risks were calculated stratified by joint, age, sex, at primary arthroplasty, and fixation type (cemented/uncemented), taking into account mortality as a competing risk. We estimated the percentage of potentially avoidable revisions assuming all OA patients aged < 75 received primary THA/TKA 5 years later while keeping age-specific 10-year revision risks constant. Results — 214,638 primary THAs and 211,099 TKAs were included, of which 31% of THAs and 95% of TKAs were cemented. The 10-year cumulative revision risk varied between 1.6% and 13%, with higher risks in younger age categories. Delaying prosthesis placement by 5 years could potentially avoid 23 (3%) THA and 162 (17%) TKA revisions. Interpretation — Cumulative 10- year revision risk varied considerably by age in both fixation groups, which may be communicated to patients and used to guide timing of surgery.

Risk of pacemaker implantation in patients treated for breast cancer: A study based on French nationwide health database sample

Cardiotoxicity of some medical anti-cancer treatments and radiotherapy for breast cancer (BC) patients is well known, but knowledge for conduction disorders or sinus node disease remains poor. To examine the risk of pacemaker (PM) implantation subsequent to BC treatment by comparing PM incidence in BC patients to that in the general population on an age-specific basis. Our study was based on the Échantillon généraliste de bénéficiaires (EGB), the 1/97 random sample, the French nationwide health database (SNDS). The study population consisted of adult women treated for a primo BC between 2008 and 2014, with no previous history of PM implantation, followed until 2016. For each year from 2008 to 2016, the reference population included all women present in the EGB with no PM or BC implantation. PM implantations were identified according to the Classification commune des actes médicaux . The standardised incidence ratio (SIR) was calculated as the ratio of the observed number of PM in the BC population to the expected number of PM computed using annual age-specific PM incidence rates from the reference population, weighted according to the age structure of the BC population. Between 2008 and 2016, the annual reference population consisted of nearly 193,000 individuals with an incidence rate of PM implantation that varied from 1case/100,000 in the younger category (< 40 years) to 552 cases/100,000 for women ≥ 85 years. The BC population included 2821 patients (approximately 400 per year, 50% aged > 60 years) in whom 18 PM implantations were observed compared with 11.5 expected yielding a SIR of 1.56 (95% CI: 0.93–2.36), indicating a 56% higher incidence of PM in the BC population. These preliminary results indicate that treatment for BC may be associated with an increased risk of PM implantation. Further analysis according to the type of treatment (radiotherapy, chemotherapy…) is ongoing.