From illness to inactivity: Exploring the influence of physical diseases on youth Not in Education, Employment, or Training status in Europe: A systematic literature review.

INTRODUCTION: In 2010, 33% of young Europeans (ages 15-29) were Not in Education, Employment, or Training (NEET), rising to 40 million by 2015. Those with disabilities or health challenges are 40% more likely to be NEET. Hence, we conducted a systematic search to identify health challenges as NEET risk factors. METHODS: A systematic search was conducted across four databases on February 21, 2023, with an update on January 15, 2024. Data collected after 1980 were included. The main findings from this search concerning risk factors are summarized in a chart. RESULTS: A total of 33,314 articles were screened, resulting in the inclusion of 32 articles in this review. The review identified multiple physical risk factors associated with NEET status, which were categorized into two primary domains: congenital conditions and birth-related factors, for example, factors encompassed neonatal life in utero and experiences related to birth, and health conditions during childhood and adolescence, for example, survivors of childhood cancer and other severe health conditions during childhood and adolescents. CONCLUSIONS: Our findings highlight that varying congenital conditions and birth-related factors as well as diseases from childhood to adulthood challenges or even hinder educational and job market participation, this emphasizing the importance of targeted support for children facing health challenges. These findings highlight the immediate requirement for comprehensive interventions specifically designed for children and adolescents who are for example, preterm, have experienced severe illness, or are coping with chronic diseases. These interventions should address the challenges encountered by youth in NEET. However, limited evidence on the impact of health conditions on NEET status underscores the necessity for further research into both short- and long-term effects.

Risk of dementia among older patients with lymphoma: A Danish nationwide matched cohort study.

INTRODUCTION: Treatment of lymphoma can be associated with cognitive challenges, and some patients may fear development of dementia as long-term complication. Studies report a lower risk of dementia after cancer. Some believe this difference to be a protective mechanism of cancer, others believe it to be driven by bias. The risk of developing dementia after lymphoma has not been investigated in a population-based setting. The aim of this study was to identify the risk of being diagnosed with dementia after lymphoma treatment. MATERIALS AND METHODS: This Danish nationwide matched cohort study included patients aged ≥65 years with a first-time diagnosis of a non-central nervous system lymphoma between 2005 and 2018 in complete remission after treatment with chemotherapy. Patients diagnosed with dementia or treated with dementia medication before lymphoma diagnosis were excluded. Each patient was matched 1:5 on sex, year of birth, and a modified Charlson comorbidity index. Patients and matched comparators were followed from the corresponding patient's date of complete remission. The risk of developing dementia was calculated using cause-specific hazard ratios (HR), and the cumulative risk was estimated by Aalen-Johansen with death as the competing risk. RESULTS: A total of 3,244 patients and 16,220 matched comparators were included in the study. There was no difference in risk of all-cause dementia among patients with lymphoma compared to matched comparators with cause-specific HR of 0.85 (95% confidence interval [CI]: 0.70;1.04). The risk of both Alzheimer's disease and non-Alzheimer's dementia was equal among patients and comparators: HR 0.89 (95% CI: 0.66;1.21) and 0.82 (95% CI: 0.63;1.07), respectively. Stratified by lymphoma subtype, age, or year of diagnosis, the risk of all-cause dementia remained equal among patients and matched comparators. The cumulative risk of all-cause dementia was significantly lower among patients with lymphoma compared to matched comparators (Gray's test p < 0.001), probably reflecting higher mortality in patients with lymphoma. DISCUSSION: The risk of all-cause dementia, Alzheimer's disease, and non-Alzheimer's dementia was equal among older patients with lymphoma compared to matched comparators. Our data suggests that risk of developing dementia is not changed after lymphoma treatment.

Discharge time after birth is associated with parity - A retrospective cohort study.

Background: All healthy mothers with uncomplicated births are recommended to be discharged directly from the labour ward a few hours after birth as a change in practice in three hospitals in Denmark. However, despite this practice, there is limited knowledge about when mothers leave the hospital after birth in clinical practice. Objective: The aim of this study is to examine 1) when mothers are discharged from hospital after birth, 2) if discharge time from the hospital after birth is associated with parity, and 3) which factors are associated with discharge time. Methods: This retrospective study is based on data from the North Denmark Regional Hospital and included mothers giving vaginal birth from March 25, 2019 to April 10, 2021. Results: A total of 1990 mothers were included. Nearly 50% of the new mothers stayed at the hospital less than 6 h after birth (26% of primiparous women vs 64% of multiparous women). Primiparous women had an adjusted RR 0.44 (95% CI 0.39-0.49) for discharge ≤6 h, RR 1.71 (95% CI 1.15-2.54) for discharge >6-12 h, and RR 3.76 (95% CI 3.03-4.67) for discharge >48 h after birth compared to multiparous women. Multiparous women's adjusted RR for discharge >6-12 h was 0.15 (95% CI 0.12-0.20) and for discharge >48 h 0.16 (95% CI 0.14-0.20) compared to discharge less than 6 h after birth. Furthermore, smoking, low education level, and younger age were associated with early discharge. Conclusion: There is a significant association with parity and discharge time after birth and factors related to discharge time which healthcare professionals should be aware of when planning inpatient and outpatient care. In addition, healthcare professionals should be aware of mothers discharged early who are smoking, of younger age, lower education level or multiparity.

Work Disability and Return to Work After Lymphoma: A Danish Nationwide Cohort Study.

Purpose: Many patients diagnosed with lymphoma are of working age. Cancer patients are known to have a higher risk of sick leave and disability pension, but this has only been delineated for certain subtypes of lymphoma. Therefore, this study aimed at investigating the overall risk of disability pension for all lymphoma subtypes and at quantifying return to work for patients with lymphoma in work before diagnosis. Patients and Methods: Patients aged 18-60 years with lymphoma in complete remission (CR) diagnosed between 2000 and 2019 were included in the study. Using national registers, each patient was matched with five comparators from the general population with same sex, birth year, and level of Charlson Comorbidity Index. Risk of disability pension was calculated from 90 days after CR or end of treatment with competing events (death, retirement pension, early retirement pension, relapse for patients, or lymphoma diagnosis for comparators). Return to work for patients was calculated annually until 5 years after diagnosis for patients employed before diagnosis. Results: In total, 4072 patients and 20,360 comparators were included. There was a significant increased risk of disability pension for patients with all types of lymphoma compared to the general population (5-year risk difference: 5.3 (95% confidence interval (CI): 4.4;6.2)). Patients with non-Hodgkin lymphoma were more likely to get disability pension than patients with Hodgkin lymphoma (sex- and age-adjusted 10-year risk difference: 2.9 (95% CI: 0.3;5.5)). One year after diagnosis, 24.5% of the relapse-free patients were on sick leave. Return to work was highest 2 years after diagnosis (82.1%). Conclusion: Patients with lymphoma across all subtypes have a significantly higher risk of disability pension. Return to work peaks at 2 years after diagnosis.

Temporal trends in low-dose aspirin therapy for primary prevention of cardiovascular disease in European adults with and without diabetes.

AIMS: Aspirin therapy for primary prevention of cardiovascular disease (CVD) is controversial, and guideline recommendations have changed throughout the last decades. We report temporal trends in primary prevention aspirin use among persons with and without diabetes and describe characteristics of incident aspirin users. METHODS AND RESULTS: Using Danish nationwide registries, we identified incident and prevalent aspirin users in a population of subjects ≥40 years without CVD eligible for primary preventive aspirin therapy from 2000 through 2020. Temporal trends in aspirin users with and without diabetes were assessed, as were CVD risk factors among incident users. A total of 522 680 individuals started aspirin therapy during the study period. The number of incident users peaked in 2002 (39 803 individuals, 1.78% of the eligible population) and was the lowest in 2019 (11 898 individuals, 0.49%), with similar trends for subjects with and without diabetes. The percentage of incident users with no CVD risk factors [diabetes, hypertension, hypercholesterolemia, or chronic obstructive pulmonary disease (a proxy for smoking)] decreased from 53.9% in 2000 to 30.9% in 2020. The temporal trends in prevalent aspirin users followed a unimodal curve, peaked at 7.7% in 2008, and was 3.3% in 2020. For subjects with diabetes, the peak was observed in 2009 at 38.5% decreasing to 17.1% in 2020. CONCLUSION: Aspirin therapy for primary prevention of CVD has decreased over the last two decades. However, the drug remained used in individuals with and without diabetes, and a large proportion of individuals started on aspirin therapy had no CVD risk factors.

One sentence summaryThis study investigated the temporal trends in aspirin use for primary prevention of cardiovascular disease in individuals with and without diabetes and found that even though the number of aspirin users has declined, the drug remains prescribed, and individuals even without cardiovascular risk factors were started on aspirin therapy. Lay summary key findingsThe number of aspirin users with and without diabetes for primary prevention of cardiovascular disease has decreased over the last two decades. Nevertheless, individuals with a low burden of cardiovascular risk factors were started on aspirin therapy.Efforts to inform appropriate use of aspirin are needed.

Mental health among patients with non-Hodgkin lymphoma: A Danish nationwide study of psychotropic drug use in 8750 patients and 43 750 matched comparators.

Psychological distress following cancer diagnosis may lead to mental health complications including depression and anxiety. Non-Hodgkin lymphomas (NHLs) include indolent and aggressive subtypes for which treatment and prognosis differ widely. Incident use of psychotropic drugs (PDs-antidepressants, antipsychotics, and anxiolytics) and its correlation to lymphoma types can give insights into the psychological distress these patients endure. In this prospective matched cohort study, we used nationwide population-based registries to investigate the cumulative risk of PD use in NHL patients compared to a sex- and age-matched cohort from the Danish background population. In addition, contact patterns to psychiatric departments and incident intentional self-harm or completed suicide were explored. In total, 8750 NHL patients and 43 750 matched comparators were included (median age 68; male:female ratio 1.6). Median follow-up was 7.1 years. Two-year cumulative risk of PD use was higher in NHL patients (16.4%) as compared to the matched comparators (5.1%, p < .01); patients with aggressive NHL subtypes had the highest incidence. Prescription rates were higher in the first years after diagnosis but approached the rate of the matched population 5 years into survivorship in aggressive NHLs, whereas patients with indolent subtypes continued to be at higher risk. NHL patients had a slightly higher two-year risk of suicide/intentional self-harm (0.3%) as compared to the matched comparators (0.2%, p = .01). These results demonstrate that mental health complications among NHL patients are frequent. Routine assessment for symptoms of depression and anxiety should be consider as part of standard follow-up of NHL patients.

Patients in complete remission after R-CHOP(-like) therapy for diffuse large B-cell lymphoma have limited excess use of health care services in Denmark.

For most patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL), R-CHOP immunochemotherapy leads to complete remission and 60-70% of patients remain progression-free after 5 years. Given a median age of 65, it is relevant to disentangle how DLBCL and DLBCL therapy influence health care use among the survivors. In this nationwide study, the health care use among Danish DLBCL patients diagnosed in 2007-2015, who achieved complete remission after R-CHOP(-like) therapy, was explored and compared to matched comparators from the Danish general population. The post-remission 5-year risk of hospitalization was significantly higher among DLBCL survivors (55%) compared to matched comparators (49%, P < 0.001). DLBCL survivors had on average 10.3 (9.3-11.3) inpatient bed days within 5 years of response evaluation, whereas matched comparators had 8.4 (7.9-8.8). The rate of outpatient visits was also significantly higher(excluding routine follow-up visits, incidence rate ratio, 1.3, P < 0.001), but translated into only a very small absolute difference of <1 outpatient visits within 5 years between DLBCL survivors (4.2 visits, 95% CI, 4.0-4.4) and matched comparators (3.8 visits, 95% CI, 3.7-3.9). In conclusion, DLBCL survivors have an increased incidence of hospital visits due to a wide range of conditions, but in absolute terms the excess use of health care services in DLBCL survivors was small.

Kawasaki disease, autoimmune disorders, and cancer: a register-based study.

Kawasaki disease has well-described cardiovascular complications. However, the association to autoimmunity and cancer in the long term is not well described. We investigated theses associations using a registry-based matched cohort follow-up study of patients diagnosed with Kawasaki disease. Patients with Kawasaki disease were included and matched 1:5 to a population control group, matched by birth year, sex and incident month of the Kawasaki disease diagnosis. A total of 820 cases < 21 years of age were identified. Median age at diagnosis was 3 years. Median follow-up time was 12 years. Patients with KD were at higher risk of being diagnosed with ischaemic heart disease at 10 years (HR 39.94 (95% CI 5.00-319.28)) and 30 years (HR 8.33 (95% CI 3.03-22.91)). The 10-, 20- and 30-year risks of developing autoimmune disorders were HR 4.23 (95% CI 3.01-5.94), HR 3.23 (95% CI 2.44-4.29) and 2.83 (95% CI, 2.17-3.68), all p < 0.001. Cancer risk was increased after 30 years (HR 2.42 (95% CI, 1.09-5.34)). All-cause mortality after 35 years was also significantly increased (HR 3.14 (95% CI, 1.03-9.60)). Children with KD have increased long-term risks of ischaemic heart disease also of autoimmune disease and cancer, as well as an increased all-cause mortality. The surprisingly increased risk of autoimmunity must be investigated further. What is known: • Kawasaki disease is characterized by acute vasculitis and inflammation that can affect the coronary arteries. • Anti-inflammatory medicine is effective in the acute stages of the disease. What is new: • Children with Kawasaki disease have an increased risk of developing autoimmune disease in the long term. • Kawasaki disease is associated with a slightly increased mortality rate driven by non-cardiovascular causes.

Epidemiology of Venous Thromboembolism After Second Cancer.

BACKGROUND: Venous thromboembolism (VTE) is a serious, yet preventable, complication in cancer. Some patients are diagnosed with a second cancer; however, little is known about the epidemiology of VTE in this population. METHODS: From Danish national healthcare registries, we studied all patients diagnosed with a first breast, prostate, lung, or colorectal cancer from 1995 to 2015. We estimated incidence rates (IRs) of VTE according to the timing of the diagnosis of a second cancer. We controlled for confounder variables in Poisson regression models. RESULTS: In total, 309,077 patients with a first breast, prostate, lung, or colorectal cancer were included in the study. A second cancer was diagnosed in 20,090 (6.5%) of these patients. In total, 11,908 VTEs were observed in the study period, 786 of these occurred after a diagnosis of second cancer. Second cancer types such as pancreas and stomach cancer were associated with fivefold higher IRs of VTE compared with second cancer types such as breast and prostate cancer. The IR of VTE was highest within the first 6 months after the second cancer was diagnosed (IR 40.5 per 1000 person-years, 95% CI 36.3-42.2) with no differences based on how long since the first cancer it was diagnosed. CONCLUSION: The epidemiology of VTE after a second cancer is similar to the epidemiology of VTE after a first cancer with higher rates within the first months after aggressive second cancer types.