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1.
Prim Health Care Res Dev ; 25: e15, 2024 Apr 08.
Article in English | MEDLINE | ID: mdl-38587013

ABSTRACT

BACKGROUND: Chronic musculoskeletal pain and anxiety/depression are significant public health problems. We hypothesised that adults with both conditions constitute a group at especially high risk of future cardiovascular health outcomes. AIM: To determine whether having comorbid chronic musculoskeletal pain and anxiety/depression is associated with the excess prevalence of selected known cardiovascular health risk behaviours. METHOD: A cross-sectional survey of adults aged 35+ years randomly sampled from 26 GP practice registers in West Midlands, England. Respondents were classified into four groups based on self-reported presence/absence of chronic musculoskeletal pain (pain present on most days for six months) and anxiety or depression (Hospital Anxiety and Depression Score 11+). Standardised binomial models were used to estimate standardised prevalence ratios and prevalence differences between the four groups in self-reported obesity, tobacco smoking, physical inactivity, and unhealthy alcohol consumption after controlling for age, sex, ethnicity, deprivation, employment status and educational attainment. The excess prevalence of each risk factor in the group with chronic musculoskeletal pain-anxiety/depression comorbidity was estimated. FINDINGS: Totally, 14 519 respondents were included, of whom 1329 (9%) reported comorbid chronic musculoskeletal pain-anxiety/depression, 3612 (25%) chronic musculoskeletal pain only, 964 (7%) anxiety or depression only, and 8614 (59%) neither. Those with comorbid chronic musculoskeletal pain-anxiety/depression had the highest crude prevalence of obesity (41%), smoking (16%) and physical inactivity (83%) but the lowest for unhealthy alcohol consumption (18%). After controlling for covariates, the standardised prevalence ratios and differences for the comorbid group compared with those with neither chronic musculoskeletal pain nor anxiety/depression were as follows: current smoking [1.86 (95% CI 1.58, 2.18); 6.8%], obesity [1.93 (1.76, 2.10); 18.9%], physical inactivity [1.21 (1.17, 1.24); 14.3%] and unhealthy alcohol consumption [0.81 (0.71, 0.92); -5.0%]. The standardised prevalences of smoking and obesity in the comorbid group exceeded those expected from simple additive interaction.


Subject(s)
Chronic Pain , Musculoskeletal Pain , Adult , Humans , Cross-Sectional Studies , Chronic Pain/epidemiology , Prevalence , Mental Health , Health Risk Behaviors , Comorbidity , Depression/epidemiology , Obesity/epidemiology
2.
Am J Surg ; 227: 208-212, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38587050

ABSTRACT

BACKGROUND: Asian gastric cancer patients have higher long-term survival rates post-gastrectomy. This study compares 30-day post-gastrectomy outcomes between Asians and non-Asians. METHODS: Gastric cancer patients undergoing elective gastrectomies were identified in 2014-2019 NSQIP datasets (n â€‹= â€‹1,438). Demographics, comorbidities, and postoperative outcomes were analyzed. RESULTS: Asians had lower odds of total gastrectomy (AOR â€‹= â€‹0.52, p â€‹= â€‹0.003), age ≥65 (AOR â€‹= â€‹0.60, p â€‹= â€‹0.006), smoking history (AOR â€‹= â€‹0.35, p â€‹< â€‹0.001), dyspnea (AOR â€‹= â€‹0.25, p â€‹= â€‹0.01), and hypoalbuminemia (AOR â€‹= â€‹0.62, p â€‹= â€‹0.025); they also had lower BMI (p â€‹< â€‹0.001). Postoperative outcomes were not significantly different aside from a shorter median length of hospital stay in days (LOS) (Asians: 7 (6, 11); non-Asians: 8 (6, 11); p â€‹< â€‹0.001). CONCLUSIONS: Asian gastric cancer patients have significantly lower odds of having select preoperative comorbidities and have shorter hospital LOS.


Subject(s)
Adenocarcinoma , Stomach Neoplasms , Humans , Adenocarcinoma/pathology , Length of Stay , Comorbidity , Postoperative Complications/etiology , Gastrectomy/adverse effects , Retrospective Studies
4.
BMJ Open ; 14(4): e078652, 2024 Apr 08.
Article in English | MEDLINE | ID: mdl-38589253

ABSTRACT

INTRODUCTION: Previous research has shown that cognitive bias modification of interpretations (CBM-I) may be a promising intervention for anxiety in youth; however, results are mixed. Given the high comorbidity between anxiety and depression in youth, it is surprising that no child studies have targeted biases associated with both. This study aims to evaluate the effectiveness and acceptability of an online CBM-I intervention (Mindmaster) for children with symptom scores of anxiety or depression above a borderline or clinical threshold. The intervention has been codesigned with children, parents and mental health professionals to promote user engagement. METHODS AND ANALYSIS: The study is a randomised controlled trial, with two parallel arms. Participants are 143 children aged 8-10 years with scores of anxiety and/or depressive symptoms above a borderline or clinical threshold. They will be allocated to either the intervention group or the waitlist control group. The intervention consists of 2 weeks of online CBM-I training, with four sessions (10-15 min) per week. Outcome assessments will be conducted at baseline, 4 weeks after baseline (post-training/post-waitlist) and 8 weeks after baseline (follow-up) for the intervention group only. The primary outcome is interpretation bias. Secondary outcomes are anxiety and depressive symptoms and life interference. Analyses will be conducted within an intention-to-treat framework using mixed models for repeated measures. ETHICS AND DISSEMINATION: The study was approved by the University of New South Wales Human Research Ethics Committee (HC220758). Findings will be reported to (1) participating families; (2) presented at scientific conferences and (3) disseminated to peer-review publications. Data will be available from the corresponding author on request. TRIAL REGISTRATION NUMBER: ACTRN12622001493730.


Subject(s)
Anxiety Disorders , Depression , Adolescent , Humans , Depression/psychology , Anxiety Disorders/therapy , Anxiety/therapy , Anxiety/psychology , Comorbidity , Cognition , Randomized Controlled Trials as Topic
5.
J Pak Med Assoc ; 74(3): 591-592, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38591307

ABSTRACT

While diabetes manifests multiple clinical presentations, complications and comorbidities, most modern discourse focuses on the cardiovascular aspects of the syndrome. In this communication, we explore the vast spectrum of fever and diabetes. We highlight the bidirectional interactions between febrile illness and diabetes, as well as drug-drug interactions. These multifaceted connections must be understood by all health care professionals who manage diabetes and/or fever.


Subject(s)
Diabetes Mellitus , Humans , Diabetes Mellitus/epidemiology , Fever/etiology , Comorbidity
6.
J Pak Med Assoc ; 74(3): 576-579, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38591302

ABSTRACT

Necrotizi ng fasciit is [NF] i s a m ultifaceted disease of the muscle fascia and body tissues which demands the earliest intervention. Past reviews have documented ver y few cases of Aeromonas Hydroph ila [AH] induced N F fol lo wing abdominal surgery. AH can cause fatal NF as seen in a 72 year old female patient reported at Liaquat National Hospital &Medical College; a ter tiary care center in Karachi, Pakistan on 2nd April, 2022. She had a k nown comorbidity of hypertension and presented with the chief complaint of symptomatic gallstones for which she unde rwent Laparoscopic Cholecystectomy (LAPCHOL). She developed NF of the lower ab domen post- oper atively. Following uneventful Laparoscopic Cholecystectomy our pati ent presented to the ER two days later with severe lower abdo minal pain and overlyi ng celluliti s. Fasc io to my revealed extensive myonecrosis with necrotizing soft tissue in fe ction. Despite u ndergoing extensive surgical debr idement and broad spectr um antibi ot ic administration; the patient died in the ICU on the fifth postoperat ive day followi ng septic complications. Histopathologica l an alysis, confirmed i nflammat ion and necrosis. Culture sensitivity of the debrided tissue revealed AH. Approach should lie towards analyzing the behaviour of such microbes in high risk patients through collective case studies. This is the first clinical case showcasing such parameters e ncountered in the General Surger y Department.


Subject(s)
Cholecystectomy, Laparoscopic , Fasciitis, Necrotizing , Gallstones , Female , Humans , Aged , Fasciitis, Necrotizing/etiology , Aeromonas hydrophila , Cholecystectomy, Laparoscopic/adverse effects , Comorbidity , Gallstones/surgery , Gallstones/complications
7.
Lakartidningen ; 1212024 Apr 08.
Article in Swedish | MEDLINE | ID: mdl-38591842

ABSTRACT

The Swedish national guidelines for epilepsy stipulate regular health care contacts in the years following diagnosis, referral for epilepsy surgery in cases of pharmacoresistant epilepsy, multidisciplinary teams, and adequate patient information particularly for women of childbearing age. The last years have seen advances in many research areas of relevance for the basic epilepsy care, and Sweden has contributed regarding pharmacotherapy, seizure-related risks, sudden unexpected death in epilepsy (SUDEP), and digital tools. An increasing prevalence of epilepsy and stagnating or decreasing health care resources makes nationwide implementation of this knowledge challenging and increases the risk of unequal access to care. Innovation and focus on prioritized groups, such as newly diagnosed and persons with pharmacoresistant epilepsy or comorbidities, will be needed.


Subject(s)
Death, Sudden , Epilepsy , Humans , Female , Prevalence , Death, Sudden/epidemiology , Epilepsy/epidemiology , Epilepsy/therapy , Seizures , Comorbidity , Risk Factors
8.
Ups J Med Sci ; 1292024.
Article in English | MEDLINE | ID: mdl-38571881

ABSTRACT

Background: The immune system declines with age, but the impact of chronological age may be affected by sex, co-morbidities, and sociodemographic factors. Objective: The article aims to study infections associated with hospital admission in the elderly in their last year of life and the impact of age, sex, co-morbidities, and sociodemographic factors. Method: A retrospective study based on registry data covering all care visits in Stockholm Region, Sweden, for 7 years was conducted. All deceased subjects with at least one hospital admission with infection as the main diagnosis in the last year of life were compared with subjects with no such admission. Subjects were categorized into three different age-groups 65-79, 80-89, and 90 years and above. Co-morbidity was measured by the Charlson Comorbidity Index (CCI) and sociodemographic factors were assessed using the 'Mosaic-system'. Subjects living in nursing homes were analyzed separately. Uni- and multivariable logistic regressions were conducted. Results: Of the 55,238 subjects in the study population, 14,192 (26%) had at least one hospital admission due to infection in the last year of life. The risk of having a severe infection increased with age, adjusted odds ratio (OR): 1.30 (1.25-1.36), and 1.60 (1.52-1.69) for the age-groups 80-89 and ≥ 90 compared to the age-group 65-79. The most important factor for infection was a high co-morbidity score; adjusted OR: 1.75 (1.68-1.82). Male sex and living in a less affluent area were weaker risk factors for infections. Conclusion: Chronological age and co-morbidities are independent risk factors of infections associated with hospital admission in the last year in life while male sex and sociodemographic factors have less impact.


Subject(s)
Hospitals , Humans , Male , Aged , Retrospective Studies , Comorbidity , Risk Factors , Registries , Morbidity
9.
West Afr J Med ; 41(2): 203-208, 2024 Feb 29.
Article in English | MEDLINE | ID: mdl-38583081

ABSTRACT

BACKGROUND: One of the recognized issues faced by cancer survivors is increasing weight. Weight gain has been associated with an increased death rate in cancer survivors. Research on weight gain among breast cancer survivors (BCS) is scarce in Nigeria. AIM: To assess the weight changes and its associated factors in breast cancer survivors (BCS). MATERIALS AND METHODS: A total of 98 breast cancer survivors attending the Radiation Oncology clinic were recruited. Sociodemographic variables, treatment history, weight at presentation, and present weight were obtained. Patients were then categorized into three groups: weight gain (>5% increase), stable weight (-5 to 5% change), or weight loss (>5% decrease). RESULT: The present mean weight and BMI were significantly higher than at presentation (75.14±17.59 kg vs 76.88±17.42 kg, p=< 0.0001) and (28.74 ± 6.30 vs 29.42 ±6.20, < 0.0001) respectively. Only 28 (29.6%) gained weight, 65 (66.3%) maintained stable weight while 5 (5.1%) lost weight. On univariate analysis, older age, living with partners, presence of comorbidity, year of last chemotherapy less than one year, and hormonal therapy use were associated with weight gain. Multivariate analysis revealed that the presence of comorbidities, patients receiving the last chemotherapy less than a year from the time of recruitment, and hormonal therapy were independently associated with weight gain. CONCLUSION: About a quarter of BCS gained weight. Older age, presence of comorbidity, year of last chemotherapy less than one year, and hormonal therapy use were associated with weight gain. The weight of cancer survivors should be monitored regularly during follow-up visits.


CONTEXTE: L'une des problématiques reconnues rencontrées par les survivantes du cancer est la prise de poids croissante. La prise de poids a été associée à un taux de mortalité accru chez les survivantes du cancer. La recherche sur la prise de poids parmi les survivantes du cancer du sein (SCS) est rare au Nigeria. OBJECTIF: Évaluer les changements de poids et leurs facteurs associés chez les survivantes du cancer du sein (SCS). MATÉRIAUX ET MÉTHODES: Au total, 98 survivantes du cancer du sein fréquentant la clinique d'oncologie radiationnelle ont été recrutées. Les variables sociodémographiques, l'historique des traitements, le poids à la présentation et le poids actuel ont été obtenus. Les patients ont ensuite été répartis en trois groupes : prise de poids (augmentation >5 %), poids stable (changement de -5 à 5 %) ou perte de poids (diminution >5 %). RÉSULTAT: La moyenne actuelle du poids et de l'IMC étaient significativement plus élevés qu'à la présentation (75,14 ± 17,59 kg contre 76,88 ± 17,42 kg, p < 0,0001) et (28,74 ± 6,30 contre 29,42 ± 6,20, p < 0,0001) respectivement. Seuls 28 (29,57%) ont pris du poids, 65 (66,3%) ont maintenu un poids stable tandis que 5 (5,1%) ont perdu du poids. À l'analyse univariée, l'âge plus avancé, la cohabitation avec un partenaire, la présence de comorbidité, l'année de la dernière chimiothérapie de moins d'un an et l'utilisation de thérapie hormonale étaient associées à une prise de poids. L'analyse multivariée a révélé que la présence de comorbidités, les patientes ayant reçu la dernière chimiothérapie moins d'un an avant le recrutement et la thérapie hormonale étaient indépendamment associées à une prise de poids. CONCLUSION: Environ un quart des survivantes du cancer du sein ont pris du poids. Le poids supplémentaire était associé à un âge plus avancé, à la présence de comorbidités, à la réception de la dernière chimiothérapie moins d'un an auparavant et à l'utilisation d'une thérapie hormonale. Il est donc recommandé de surveiller régulièrement le poids des survivantes du cancer lors des visites de suivi. Cela permettrait d'identifier les changements de poids précocement et de mettre en place des interventions appropriées pour prévenir une prise de poids excessive et ses conséquences néfastes sur la santé des survivantes du cancer. MOTS CLÉS: Changements de poids, Survivantes du cancer du sein, Corrélations.


Subject(s)
Breast Neoplasms , Cancer Survivors , Humans , Female , Breast Neoplasms/therapy , Weight Gain , Survivors , Comorbidity
10.
Neurol Clin ; 42(2): 573-584, 2024 May.
Article in English | MEDLINE | ID: mdl-38575267

ABSTRACT

Temporomandibular disorders (TMDs) and headache disorders are highly prevalent in the population. TMDs can present headache symptoms as a secondary headache and, in addition, be comorbid with primary headache disorders. This overlap has significant clinical implications for which it is essential for the physician to be aware, and they should screen for the potential presence of TMDs in a headache patient. Bruxism is a parafunctional behavior also prevalent in the population which has a role in TMDs and may influence headache symptomatology, but it is still necessary to clarify this relationship.


Subject(s)
Bruxism , Temporomandibular Joint Disorders , Humans , Bruxism/complications , Bruxism/diagnosis , Bruxism/epidemiology , Headache/diagnosis , Headache/etiology , Temporomandibular Joint Disorders/complications , Temporomandibular Joint Disorders/diagnosis , Temporomandibular Joint Disorders/epidemiology , Comorbidity
11.
Sci Rep ; 14(1): 7986, 2024 04 05.
Article in English | MEDLINE | ID: mdl-38575660

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted vulnerable groups, such as patients with dementia. We examined changes in mortality and loss to follow-up in patients with dementia using data from the Korean National Health Insurance Service research database. Patients with dementia who visited a medical institution with a recorded dementia-related diagnostic code, including Alzheimer's disease, and who received anti-dementia medication between February 2018 and January 2020 were included in this study. We divided patients with dementia receiving anti-dementia medications into two cohorts: those newly diagnosed with dementia between February 2018 and January 2019 (n = 62,631) and those diagnosed between February 2019 and January 2020 (n = 54,494). Then, we conducted a one-year follow-up of their records, tracking the cohort diagnosed between February 2018 and January 2019 from February 2019 to January 2020, as well as the cohort diagnosed between February 2019 and January 2020 from February 2020 to January 2021. There was a significant increase in follow-up loss among patients newly diagnosed with dementia during the COVID-19 outbreak, from 42.04% in 2019 to 45.89% in 2020. Female sex, younger age, fewer comorbidities, diagnosis of dementia at the Department of Neurology or Psychiatry, and higher income were associated with decreased follow-up loss and mortality. This study highlights the importance of paying extra attention to patients with dementia receiving anti-dementia medications, particularly during pandemics, given their increased risk of loss to follow-up.


Subject(s)
Alzheimer Disease , COVID-19 , Humans , Female , COVID-19/epidemiology , Pandemics , Follow-Up Studies , Alzheimer Disease/drug therapy , Alzheimer Disease/epidemiology , Comorbidity
12.
S Afr J Surg ; 62(1): 59-65, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38568128

ABSTRACT

BACKGROUND: Documentation on the spectrum, comorbidities, profile, and outcomes of adult surgical admissions in Botswana is limited. This information may guide manpower distribution for proposed rotations in the new general surgery training programmes. METHODS: The medical records of adult surgical admissions for a period of one year (August 2017 - July 2018) were reviewed retrospectively. Demographics, types of admissions, dates of admission and discharge, and known comorbidities were captured and the outcomes were analysed. RESULTS: Of the 2610 admissions the mean age was 44.4 years and 60.8% were male. Gastrointestinal tract (GIT), neurosurgical, and cardiothoracic admissions constituted 60.7%. Emergency admissions constituted 50.1%. Comorbidities were found in 45.6% of the admissions, and HIV-prevalence was 697/1822 (38.3%) among known HIV-status patients. Elective admissions underwent more surgical procedures, 776/1303 (59.6%), p = 0.001 (COR 1.9, 95% CI:1.7-2.3). A total of 220/2610 complications (8.4%) were documented, including 42/1355 (3.1%) superficial surgical site infections and 159/2610 deaths (6.1%). Hypertension and diabetes mellitus were associated with higher mortality, p = 0.002 (COR 1.8,95% CI:1.2-2.6) and p = 0.031 (COR 1.9, 95% CI:1.1-3.4) respectively. HIV-positive patients had longer hospital stays than HIV-negative patients, p = 0.001 (COR 1.03, 95% CI:1.02-1.04). HIV-positive admissions with CD4 count < 200 had significantly higher composite complication and mortality rate than those with ≥ 200, p = 0.002 (COR 3.03, 95% CI:1.52-6.04) and p = 0.001 (COR 4.34, 95% CI:2.08-9.05) respectively. CONCLUSION: Contributions of emergency and elective admissions were even. A higher burden of diseases was found in gastroenterology. The higher mortalities associated with hypertension, diabetes, and CD4 count < 200 warrant further study.


Subject(s)
HIV Infections , Hypertension , Adult , Humans , Male , Female , Botswana/epidemiology , Retrospective Studies , Hospitals, Teaching , Comorbidity , HIV Infections/epidemiology
13.
BMC Med ; 22(1): 144, 2024 Apr 02.
Article in English | MEDLINE | ID: mdl-38561783

ABSTRACT

BACKGROUND: Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes. METHODS: Multidisciplinary professionals from The Association of Children's Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. RESULTS AND DISCUSSION: Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events. CONCLUSIONS: This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.


Subject(s)
Diabetes Mellitus, Type 2 , Metformin , Adult , Humans , Child , Adolescent , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Comorbidity , Obesity , United Kingdom/epidemiology
14.
Ital J Pediatr ; 50(1): 59, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38561850

ABSTRACT

BACKGROUND: The aim of this study is to compare two groups of celiac patients: the first one, in which diagnosis was based on a "biopsy sparing" approach according to the 2012 ESPGHAN criteria, and the second one, based on the biopsy approach like the one of the 1991 Revised Criteria, in order to find relevant difference for sex, M/F ratio, age at diagnosis, clinical features at the onset, presence and prevalence of concomitant autoimmune disorders. METHODS: Our study involves 61 patients having the Celiac Disease (CD) onset from February 2013 to February 2020. The 32 patients who received diagnosis according "biopsy sparing" criteria were enrolled in group (1) The 29 patients who received diagnosis by duodenal biopsy were enrolled in group (2) Prevalence of comorbidities was analysed through chi-square test. RESULTS: In group 1 the prevalence of comorbidities such as Insulin-Dependent Diabetes Mellitus (IDDM) and thyroiditis was of 53%, while in group 2 it was only of 24%. Analysing the IDDM prevalence between the two groups we found a relevant difference. At the same time, the prevalence of thyroiditis was also significantly different. In group 1, male patients, in particular, would seem to have a higher incidence of CD related autoimmune disorders. CONCLUSIONS: An increased prevalence of IDDM, thyroiditis and juvenile idiopathic arthritis (JIA) in the first group would show that the "biopsy sparing" approach could expose patients to a greater length of disease activity that might be responsible for the onset of such comorbidities. Further studies should be carried out on more numerous samples of patients in order to confirm or not these data.


Subject(s)
Arthritis, Juvenile , Celiac Disease , Diabetes Mellitus, Type 1 , Thyroiditis , Humans , Male , Celiac Disease/diagnosis , Celiac Disease/epidemiology , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/complications , Comorbidity , Arthritis, Juvenile/epidemiology , Thyroiditis/complications , Thyroiditis/epidemiology , Prevalence
15.
BMC Med ; 22(1): 151, 2024 Apr 08.
Article in English | MEDLINE | ID: mdl-38589864

ABSTRACT

BACKGROUND: Clinical complexity, as the interaction between ageing, frailty, multimorbidity and polypharmacy, is an increasing concern in patients with AF. There remains uncertainty regarding how combinations of comorbidities influence management and prognosis of patients with atrial fibrillation (AF). We aimed to identify phenotypes of AF patients according to comorbidities and to assess associations between comorbidity patterns, drug use and risk of major outcomes. METHODS: From the prospective GLORIA-AF Registry, we performed a latent class analysis based on 18 diseases, encompassing cardiovascular, metabolic, respiratory and other conditions; we then analysed the association between phenotypes of patients and (i) treatments received and (ii) the risk of major outcomes. Primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). Secondary exploratory outcomes were also analysed. RESULTS: 32,560 AF patients (mean age 70.0 ± 10.5 years, 45.4% females) were included. We identified 6 phenotypes: (i) low complexity (39.2% of patients); (ii) cardiovascular (CV) risk factors (28.2%); (iii) atherosclerotic (10.2%); (iv) thromboembolic (8.1%); (v) cardiometabolic (7.6%) and (vi) high complexity (6.6%). Higher use of oral anticoagulants was found in more complex groups, with highest magnitude observed for the cardiometabolic and high complexity phenotypes (odds ratio and 95% confidence interval CI): 1.76 [1.49-2.09] and 1.57 [1.35-1.81], respectively); similar results were observed for beta-blockers and verapamil or diltiazem. We found higher risk of the primary outcome in all phenotypes, except the CV risk factor one, with highest risk observed for the cardiometabolic and high complexity groups (hazard ratio and 95%CI: 1.37 [1.13-1.67] and 1.47 [1.24-1.75], respectively). CONCLUSIONS: Comorbidities influence management and long-term prognosis of patients with AF. Patients with complex phenotypes may require comprehensive and holistic approaches to improve their prognosis.


Subject(s)
Atrial Fibrillation , Stroke , Female , Humans , Middle Aged , Aged , Aged, 80 and over , Male , Atrial Fibrillation/drug therapy , Atrial Fibrillation/epidemiology , Prospective Studies , Risk Factors , Treatment Outcome , Comorbidity , Anticoagulants , Registries , Stroke/epidemiology
16.
Wiad Lek ; 77(2): 247-253, 2024.
Article in English | MEDLINE | ID: mdl-38592985

ABSTRACT

OBJECTIVE: Aim: based on a retrospective analysis, the relationship between external genital endometriosis and comorbid breast pathology was established and risk factors were identified, their comparison and the formation of a prognostic risk criterion were determined. PATIENTS AND METHODS: Materials and Methods: to address the objectives of the study, a retrospective analysis of 470 cases of patients treated for external genital endometriosis after surgical treatment and comorbid breast pathology was conducted. The control group included 30 healthy non-pregnant women. Statistical processing was performed on a personal computer using the statistical software package Statistica 10. RESULTS: Results: As a result of the analysis, the age of the patients ranged from 23 to 40 years. The average age of patients in the study group was (32.2}1.18) years, and in the control group (31.1}1.35) (p>0.05). The groups were homogeneous in terms of age (p>0.05), marital status (p>0.05) and level of education (p>0.05). Close relatives in 208 (44.25}2.18) % (OR=8.86; 95 % CI: (0.68-10.53); p<0.002) cases suffered from benign (hormone-dependent) tumours and tumour-like diseases of the uterus and appendages in isolation or in various combinations (fibroids, adenomyosis, endometrial hyperplasia). It was also found that 102 (21.70}1.67) % of patients had endometriosis, which may indicate a genetic predisposition to this disease. In the closest relatives of EM patients: in 118 (25.10}2.01) % of the examined parents, breast problems were noted, in 66 (14.04}1.12) % - diabetes mellitus, and in 98 (20.85}1.22) % thyroid diseases were detected, which in total amounted to (60.00}2.23) % (OR=9.12; 95 % CI: (0.58-11.54); p<0.002). Early menarche almost tripled the risk of EM (OR=2.72; 95% CI: (1.02-5.11); p<0.002), and menstrual irregularities doubled it (OR=2.04; 95% CI: (1.09-3.14); p<0.05), higher education, urban residents - 2.2 times higher (OR= 2.27; 95 % CI: (1.11-3.63); p<0.05), diseases of the gastrointestinal tract and hepatobiliary complex - 5.2 times higher (OR=5.27; 95 % CI: (1.89-12.03); p<0.05), frequently recurrent inflammatory diseases of the appendages - 3 times higher (OR=3.14; 95 % CI: (0.91-5.14); p<0.05), dysmetabolic manifestations (thyroid dysfunction) - 5 times higher (OR=5.11; 95 % CI: (1.61-9.503); p<0.002). CONCLUSION: Conclusions: Thus, in endometriosis and dyshormonal diseases of the mammary glands, menstrual and generative function disorders, along with clinical symptoms of pelvic pain, dysmenorrhoea, autonomic nervous system disorders and sexual dysfunction, are significant components of this problem, initiating comorbidity processes in target organs in the setting of hormonal maladaptation. Therefore, these comorbidities become a trigger for the activation of systemic hormonal imbalance and become an urgent interdisciplinary problem that requires further study.


Subject(s)
Endometriosis , Mammary Glands, Human , Female , Humans , Infant , Young Adult , Adult , Endometriosis/epidemiology , Mammary Glands, Human/pathology , Retrospective Studies , Risk Factors , Comorbidity , Prognosis
17.
Sci Rep ; 14(1): 8290, 2024 04 09.
Article in English | MEDLINE | ID: mdl-38594283

ABSTRACT

Traumatic spinal cord injury (TSCI) has significant physical, psychological, and socioeconomic impacts. However, the epidemiological characteristics and treatment patterns of TSCI in South Korea remain unclear. This study aimed to investigate TSCI incidence and treatment behaviors in South Korea from 2008 to 2020. We included data from 30,979 newly diagnosed TSCI patients obtained from the Health Insurance Review and Assessment Service (HIRA). Treatment trends, location of surgery, surgical method, comorbidities, factors affecting hospital stay, and risk factors affecting readmission were analyzed. Patients were divided into the surgery group [n = 7719; (25%)] and the non-surgery group [n = 23,260; (75%)]. Surgical cases involved cervical (64%), thoracic (17%), and lumbar/sacral (19%) lesions. Anterior fusion (38%), posterior fusion (54%), and corpectomy (8%) were the surgical methods. Surgical treatments increased annually. Factors influencing hospital stay included male sex, older age, and higher Charlson comorbidity index (CCI). Female sex and higher CCI scores were associated with readmission. In conclusion, a quarter of all TSCI patients underwent surgery, with an upward trend. Risk factors for longer hospital stays were thoracic spine injury, older age, higher CCI, and male sex. Risk factors for readmission included age range of 40-59 years, lumbar/sacral spine injuries, CCI score of 2, and female sex.


Subject(s)
Back Injuries , Spinal Cord Injuries , Spinal Diseases , Humans , Male , Female , Adult , Middle Aged , Spinal Cord Injuries/epidemiology , Spinal Cord Injuries/etiology , Spinal Cord Injuries/surgery , Comorbidity , Length of Stay , Spinal Diseases/complications , Retrospective Studies
18.
Nat Commun ; 15(1): 2966, 2024 Apr 05.
Article in English | MEDLINE | ID: mdl-38580683

ABSTRACT

Between 30% and 70% of patients with breast cancer have pre-existing chronic conditions, and more than half are on long-term non-cancer medication at the time of diagnosis. Preliminary epidemiological evidence suggests that some non-cancer medications may affect breast cancer risk, recurrence, and survival. In this nationwide cohort study, we assessed the association between medication use at breast cancer diagnosis and survival. We included 235,368 French women with newly diagnosed non-metastatic breast cancer. In analyzes of 288 medications, we identified eight medications positively associated with either overall survival or disease-free survival: rabeprazole, alverine, atenolol, simvastatin, rosuvastatin, estriol (vaginal or transmucosal), nomegestrol, and hypromellose; and eight medications negatively associated with overall survival or disease-free survival: ferrous fumarate, prednisolone, carbimazole, pristinamycin, oxazepam, alprazolam, hydroxyzine, and mianserin. Full results are available online from an interactive platform ( https://adrenaline.curie.fr ). This resource provides hypotheses for drugs that may naturally influence breast cancer evolution.


Subject(s)
Breast Neoplasms , Humans , Female , Breast Neoplasms/drug therapy , Breast Neoplasms/epidemiology , Breast Neoplasms/pathology , Cohort Studies , Comorbidity , Simvastatin
19.
BMC Womens Health ; 24(1): 221, 2024 Apr 05.
Article in English | MEDLINE | ID: mdl-38580996

ABSTRACT

BACKGROUND: Polycystic ovary syndrome (PCOS) has previously been associated with several comorbidities that may have shared genetic, epigenetic, developmental or environmental origins. PCOS may be influenced by prenatal androgen excess, poor intrauterine or childhood environmental factors, childhood obesity and learned health risk behaviors. We analyzed the association between PCOS and several relevant comorbidities while adjusting for early-life biological and socioeconomic conditions, also investigating the extent to which the association is affected by familial risk factors. METHODS: This total-population register-based cohort study included 333,999 full sisters, born between 1962 and 1980. PCOS and comorbidity diagnoses were measured at age 17-45 years through national hospital register data from 1997 to 2011, and complemented with information on the study subjects´ early-life and social characteristics. In the main analysis, sister fixed effects (FE) models were used to control for all time-invariant factors that are shared among sisters, thereby testing whether the association between PCOS and examined comorbidities is influenced by unobserved familial environmental, social or genetic factors. RESULTS: Three thousand five hundred seventy women in the Sister sample were diagnosed with PCOS, of whom 14% had obesity, 8% had depression, 7% had anxiety and 4% experienced sleeping, sexual and eating disorders (SSE). Having PCOS increased the odds of obesity nearly 6-fold (adjusted OR (aOR): 5.9 [95% CI:5.4-6.5]). This association was attenuated in models accounting for unobserved characteristics shared between full sisters, but remained considerable in size (Sister FE: aOR: 4.5 [95% CI: 3.6-5.6]). For depression (Sister FE: aOR: 1.4 [95% CI: 1.2-1.8]) and anxiety (Sister FE: aOR: 1.5 [95% CI: 1.2-1.8), there was a small decrease in the aORs when controlling for factors shared between sisters. Being diagnosed with SSE disorders yielded a 2.4 aOR (95% CI:2.0-2.6) when controlling for a comprehensive set of individual-level confounders, which only decreased slightly when controlling for factors at the family level such as shared genes or parenting style. Accounting for differences between sisters in observed early-life circumstances influenced the estimated associations marginally. CONCLUSION: Having been diagnosed with PCOS is associated with a markedly increased risk of obesity and sleeping, sexual and eating disorders, also after accounting for factors shared between sisters and early-life conditions.


Subject(s)
Pediatric Obesity , Polycystic Ovary Syndrome , Child , Pregnancy , Female , Humans , Adolescent , Young Adult , Adult , Middle Aged , Polycystic Ovary Syndrome/complications , Cohort Studies , Siblings , Pediatric Obesity/complications , Comorbidity
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