Cognitive stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of population cohort studies

AbstractObjectivesTo examine the association between cognitively stimulating work and subsequent risk of dementia and to identify protein pathways for this association.DesignMulticohort study with three sets of analyses.SettingUnited Kingdom, Europe, and the United States.ParticipantsThree associations were examined: cognitive stimulation and dementia risk in 107 896 participants from seven population based prospective cohort studies from the IPD-Work consortium (individual participant data meta-analysis in working populations); cognitive stimulation and proteins in a random sample of 2261 participants from one cohort study; and proteins and dementia risk in 13 656 participants from two cohort studies.Main outcome measuresCognitive stimulation was measured at baseline using standard questionnaire instruments on active versus passive jobs and at baseline and over time using a job exposure matrix indicator. 4953 proteins in plasma samples were scanned. Follow-up of incident dementia varied between 13.7 to 30.1 years depending on the cohort. People with dementia were identified through linked electronic health records and repeated clinical examinations.ResultsDuring 1.8 million person years at risk, 1143 people with dementia were recorded. The risk of dementia was found to be lower for participants with high compared with low cognitive stimulation at work (crude incidence of dementia per 10 000 person years 4.8 in the high stimulation group and 7.3 in the low stimulation group, age and sex adjusted hazard ratio 0.77, 95% confidence interval 0.65 to 0.92, heterogeneity in cohort specific estimates I2=0%, P=0.99). This association was robust to additional adjustment for education, risk factors for dementia in adulthood (smoking, heavy alcohol consumption, physical inactivity, job strain, obesity, hypertension, and prevalent diabetes at baseline), and cardiometabolic diseases (diabetes, coronary heart disease, stroke) before dementia diagnosis (fully adjusted hazard ratio 0.82, 95% confidence interval 0.68 to 0.98). The risk of dementia was also observed during the first 10 years of follow-up (hazard ratio 0.60, 95% confidence interval 0.37 to 0.95) and from year 10 onwards (0.79, 0.66 to 0.95) and replicated using a repeated job exposure matrix indicator of cognitive stimulation (hazard ratio per 1 standard deviation increase 0.77, 95% confidence interval 0.69 to 0.86). In analysis controlling for multiple testing, higher cognitive stimulation at work was associated with lower levels of proteins that inhibit central nervous system axonogenesis and synaptogenesis: slit homologue 2 (SLIT2, fully adjusted β −0.34, P<0.001), carbohydrate sulfotransferase 12 (CHSTC, fully adjusted β −0.33, P<0.001), and peptidyl-glycine α-amidating monooxygenase (AMD, fully adjusted β −0.32, P<0.001). These proteins were associated with increased dementia risk, with the fully adjusted hazard ratio per 1 SD being 1.16 (95% confidence interval 1.05 to 1.28) for SLIT2, 1.13 (1.00 to 1.27) for CHSTC, and 1.04 (0.97 to 1.13) for AMD.ConclusionsThe risk of dementia in old age was found to be lower in people with cognitively stimulating jobs than in those with non-stimulating jobs. The findings that cognitive stimulation is associated with lower levels of plasma proteins that potentially inhibit axonogenesis and synaptogenesis and increase the risk of dementia might provide clues to underlying biological mechanisms.

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Incidence and Risk of Venous Thromboembolism Among Taiwan Osteoporotic Fracture Population under Osteoporosis Pharmacological Treatments

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-3114 ◽

2014 ◽

Vol 99 (5) ◽

pp. 1599-1607 ◽

Cited By ~ 4

Author(s):

Tzu-Chieh Lin ◽

Cheng-Han Lee ◽

Chyun-Yu Yang ◽

Yea-Huei Kao Yang ◽

Swu-Jane Lin

Keyword(s):

Venous Thromboembolism ◽

Confidence Interval ◽

Osteoporotic Fracture ◽

Osteoporotic Fractures ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Osteoporosis Therapy ◽

Treatment Scenario ◽

Fracture Population

Context: There was no clear evidence for the association between oral bisphosphonates or raloxifene and venous thromboembolism (VTE). There might also be ethnic differences in VTE risk. Objective: The purpose of this study was to compare the incidence and risk of VTEs for different classes of osteoporosis drugs in the Taiwanese osteoporotic fracture population. Design: This was a retrospective cohort study from 2003 to 2007, with up to 6 years follow-up. Setting: Enrollees were participants in Taiwan National Health Insurance. Patients: Patients older than 50 years who had vertebral or hip fractures and were new to osteoporosis therapy were recruited. Intervention: Patients were classified into the alendronate, calcitonin, or raloxifene group according to exposure after follow-up. Main Outcome Measure: The primary outcome of our study was all incident VTEs, including deep vein thrombosis and pulmonary embolism. Cox proportional hazard models were used to compare the relative VTE risk among alendronate, raloxifene, and calcitonin groups under an on-treatment scenario. Results: There were 25 443, 9642, and 31 900 patients in the alendronate, raloxifene, and calcitonin groups, and the mean age was 74.5 years (SD, 9.6). The incidence of VTE in the alendronate, raloxifene, and calcitonin groups was 11.2, 8.5, and 18.8 per 10 000 person-years. Results from Cox analyses showed that alendronate or raloxifene recipients did not have a higher risk for VTE than calcitonin recipients (adjusted hazard ratio for alendronate, 0.84; 95% confidence interval, 0.47–1.51; adjusted hazard ratio for raloxifene, 0.64; 95% confidence interval, 0.33–1.28). Conclusion: This retrospective analysis found that the incidence of VTE in Taiwanese patients with osteoporosis was low, and the risk of VTE was similar across alendronate, raloxifene, and calcitonin recipients in patients with osteoporotic fractures who were new to osteoporosis therapy.

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Preterm delivery and long term mortality in women: national cohort and co-sibling study

BMJ ◽

10.1136/bmj.m2533 ◽

2020 ◽

pp. m2533 ◽

Cited By ~ 1

Author(s):

Casey Crump ◽

Jan Sundquist ◽

Kristina Sundquist

Keyword(s):

Environmental Factors ◽

Confidence Interval ◽

Preterm Delivery ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Term Delivery ◽

National Cohort ◽

Long Term Mortality

Abstract Objectives To examine the long term mortality associated with preterm delivery in a large population based cohort of women, and to assess for potential confounding by shared familial factors. Design National cohort study. Setting Sweden. Participants All 2 189 477 women with a singleton delivery in 1973-2015. Main outcome measures All cause and cause specific mortality up to 2016, identified from nationwide death records. Cox regression was used to calculate hazard ratios while adjusting for confounders, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and environmental) factors. Results In 50.7 million person years of follow-up, 76 535 (3.5%) women died (median age at death was 57.6). In the 10 years after delivery, the adjusted hazard ratio for all cause mortality associated with preterm delivery (<37 weeks) was 1.73 (95% confidence interval 1.61 to 1.87), and when further stratified was 2.20 (1.63 to 2.96) for extremely preterm delivery (22-27 weeks), 2.28 (2.01 to 2.58) for very preterm delivery (28-33 weeks), 1.52 (1.39 to 1.67) for late preterm delivery (34-36 weeks), and 1.19 (1.12 to 1.27) for early term delivery (37-38 weeks) compared with full term delivery (39-41 weeks). These risks declined but remained significantly raised after longer follow-up times: for preterm versus full term births, 10-19 years after delivery, the adjusted hazard ratio was 1.45 (95% confidence interval 1.37 to 1.53); 20-44 years after delivery, the adjusted hazard ratio was 1.37 (1.33 to 1.41). These findings did not seem to be attributable to shared genetic or environmental factors within families. Several causes were identified, including cardiovascular and respiratory disorders, diabetes, and cancer. Conclusions In this large national cohort of women, the findings suggested that preterm and early term delivery were independent risk factors for premature mortality from several major causes. These associations declined over time but remained raised up to 40 years later.

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Histological Inflammation in the Endoscopically Uninflamed Mucosa is Associated With Worse Outcomes in Limited Ulcerative Colitis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab069 ◽

2021 ◽

Author(s):

Catarina Geraldes de Frias Gomes ◽

Alexandra Sofia Ribeiro de Almeida ◽

Catarina Callé Lucas Mendes ◽

Pierre Ellul ◽

Johan Burisch ◽

...

Keyword(s):

Ulcerative Colitis ◽

Confidence Interval ◽

Retrospective Cohort ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Newly Diagnosed ◽

Disease Extent ◽

Treatment Naïve ◽

Disease Extension

Abstract Background The Montreal classification categorizes patients with ulcerative colitis (UC) based on their macroscopic disease extent. Independent of endoscopic extent, biopsies through all colonic segments should be retrieved during index colonoscopy. However, the prognostic value of histological inflammation at diagnosis in the inflamed and uninflamed regions of the colon has never been assessed. Methods This was a multicenter retrospective cohort study of newly diagnosed patients with treatment-naïve proctitis and left-sided UC. Biopsies from at least 2 colonic segments (endoscopically inflamed and uninflamed mucosa) were retrieved and reviewed by 2 pathologists. Histological features in the endoscopically inflamed and uninflamed mucosa were scored using the Nancy score. The primary outcomes were disease complications (proximal disease extension, need for hospitalization or colectomy) and higher therapeutic requirements (need for steroids or for therapy escalation). Results Overall, 93 treatment-naïve patients were included, with a median follow-up of 44 months (range, 2-329). The prevalence of any histological inflammation above the endoscopic margin was 71%. Proximal disease extension was more frequent in patients with histological inflammation in the endoscopically uninflamed mucosa at diagnosis (21.5% vs 3.4%, P = 0.04). Histological involvement above the endoscopic margin was the only predictor associated with an earlier need for therapy escalation (adjusted hazard ratio, 3.69; 95% confidence interval, 1.05-13.0); P = 0.04) and disease complications (adjusted hazard ratio, 4.79; 95% confidence interval, 1.10-20.9; P = 0.04). Conclusions The presence of histological inflammation in the endoscopically uninflamed mucosa at the time of diagnosis was associated with worse outcomes in limited UC.

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Estimated Glomerular Filtration Rate and the Risk of Cancer

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.10820918 ◽

2019 ◽

Vol 14 (4) ◽

pp. 530-539 ◽

Cited By ~ 9

Author(s):

Hong Xu ◽

Kunihiro Matsushita ◽

Guobin Su ◽

Marco Trevisan ◽

Johan Ärnlöv ◽

...

Keyword(s):

Cancer Risk ◽

Confidence Interval ◽

Cancer Incidence ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Reverse Causation ◽

Detection Bias ◽

Lower Egfr ◽

Risk Of Cancer

Background and objectivesCommunity-based reports regarding eGFR and the risk of cancer are conflicting. We here explore plausible links between kidney function and cancer incidence in a large Scandinavian population–based cohort.Design, setting, participants, & measurementsIn the Stockholm Creatinine Measurements project, we quantified the associations of baseline eGFR with the incidence of cancer among 719,033 Swedes ages ≥40 years old with no prior history of cancer. Study outcomes were any type and site-specific cancer incidence rates on the basis of International Classification of Diseases-10 codes over a median follow-up of 5 years. To explore the possibility of detection bias and reverse causation, we divided the follow-up time into different time periods (≤12 and >12 months) and estimated risks for each of these intervals.ResultsIn total, 64,319 cases of cancer (affecting 9% of participants) were detected throughout 3,338,226 person-years. The relationship between eGFR and cancer incidence was U shaped. Compared with eGFR of 90–104 ml/min, lower eGFR strata associated with higher cancer risk (adjusted hazard ratio, 1.08; 95% confidence interval, 1.05 to 1.11 for eGFR=30–59 ml/min and adjusted hazard ratio, 1.24; 95% confidence interval, 1.15 to 1.35 for eGFR<30 ml/min). Lower eGFR strata were significantly associated with higher risk of skin, urogenital, prostate, and hematologic cancers. Any cancer risk as well as skin (nonmelanoma) and urogenital cancer risks were significantly elevated throughout follow-up time, but they were higher in the first 12 months postregistration. Associations with hematologic and prostate cancers abrogated after the first 12 months of observation, suggesting the presence of detection bias and/or reverse causation.ConclusionsThere is a modestly higher cancer risk in individuals with mild to severe CKD driven primarily by skin and urogenital cancers, and this is only partially explained by bias.

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Association of Urinary Prostaglandin E2 Metabolite and Mortality among Adults

10.21203/rs.3.rs-195622/v1 ◽

2021 ◽

Author(s):

Wanqing Wen ◽

Gong Yang ◽

Qiuyin Cai ◽

Xiao-ou Shu ◽

Wei Zheng

Keyword(s):

Confidence Interval ◽

Cohort Studies ◽

Prostaglandin E2 ◽

Causes Of Death ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Health Study ◽

Mortality Data ◽

Urine Collection ◽

Cardiometabolic Diseases

Abstract Background Prostaglandins play a critical role in inflammatory response. It has become widely accepted that chronic inflammation is a driving force behind many chronic diseases, such as cancers and cardiovascular diseases, the major causes of death in the world today. The studies on the association between biomarkers of inflammation and mortality are limited. Methods To investigate the association of urinary PGE-M, a stable end-product of prostaglandin E2 (PGE2) with overall and cause-specific mortality and examine potential effect modifiers, we obtained urinary PGE-M levels of 2,927 non-cancerous adults from our previous case-control studies nested in the Shanghai Women’s Health Study and Shanghai Men’s Health Study, two cohort studies conducted in Shanghai, China. We collected mortality data and modifiable factors associated with urinary PGE-M were obtained from the parent cohort studies. Results Using linear regression models, we found that high urinary PGE-M levels were significantly associated with low education, heaving smoking, old age at urine collection, and abdominal obesity. Using Cox proportional hazards models, we found that increase (per standard deviation) of urinary PGE-M levels were significantly associated with overall mortality (adjusted hazard ratio = 1.19, 95% confidence interval: 1.07, 1.33) and particularly deaths from cardiometabolic diseases (adjusted hazard ratio = 1.27, 95% confidence interval: 1.11, 1.44). The increased death risks persisted across different time intervals during the follow-up and were stronger among participants who were younger than 60 (P = 0.0014 for all- cause mortality and P = 0.007 for deaths from cardiometabolic diseases) at urine collection or perhaps among those who had higher education. Conclusions High urinary PGE-M levels were associated with a significantly increased risk of all causes of death and particularly deaths from cardiometabolic diseases. Improving lifestyles, e.g., stopping smoking and controlling body weight, would help decrease mortality through decreasing over-production of PGE2.

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Association Between Kawasaki Disease and Childhood Epilepsy: A Nationwide Cohort Study in Taiwan

Frontiers in Neurology ◽

10.3389/fneur.2021.627712 ◽

2021 ◽

Vol 12 ◽

Author(s):

Chien-Heng Lin ◽

Jung-Nien Lai ◽

Inn-Chi Lee ◽

I-Ching Chou ◽

Wei-De Lin ◽

...

Keyword(s):

Kawasaki Disease ◽

Confidence Interval ◽

Incidence Rate ◽

Significant Risk ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Cardiac Complications ◽

Research Database ◽

Seizure Disorders

Background: Kawasaki disease is a common vasculitis of childhood in East Asia. The complications following Kawasaki disease mostly included cardiovascular sequelae; non-cardiac complications have been reported but less studied. This study investigated potential epilepsy following Kawasaki disease in Taiwanese children.Objectives: Through National Health Insurance Research Database, we retrospectively analyzed the data of children aged <18 years with clinically diagnosed Kawasaki disease from January 1, 2000 to December 31, 2012 in Taiwan. These patients were followed up to estimate the incidence of epilepsy in the Kawasaki cohort in comparison with that in the non-Kawasaki cohort in Taiwan.Results: A total of 8,463 and 33,872 patients in the Kawasaki and non-Kawasaki cohorts were included in the study, respectively. Of the total eligible study subjects, 61.1% were boys and 38.9% were girls; most patients with newly diagnosed Kawasaki disease were aged <5 years [88.1%]. Patients with Kawasaki disease showed a higher incidence rate [47.98 vs. 27.45 every 100,000 person years] and significantly higher risk [adjusted hazard ratio = 1.66, 95% confidence interval = 1.13–2.44] of epilepsy than those without the disease. Additionally, female sex [adjusted hazard ratio = 2.30, 95% confidence interval = 1.31–4.04] and age <5 years [adjusted hazard ratio = 1.82, 95% confidence interval = 1.22–2.72] showed a significantly higher risk of epilepsy in the Kawasaki cohort.Conclusion: Results revealed a higher incidence rate and significant risk of epilepsy in Taiwanese children with Kawasaki disease than in those without the disease. Therefore, children diagnosed with Kawasaki disease are recommended follow-up as they have a high risk of epilepsy and seizure disorders.

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SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study

BMJ ◽

10.1136/bmj-2021-068665 ◽

2021 ◽

pp. e068665

Author(s):

Anders Husby ◽

Jørgen Vinsløv Hansen ◽

Emil Fosbøl ◽

Emilia Myrup Thiesson ◽

Morten Madsen ◽

...

Keyword(s):

Cohort Study ◽

Confidence Interval ◽

Population Based ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Absolute Rate ◽

Hazard Ratios ◽

Increased Risk ◽

The Absolute

AbstractObjectiveTo investigate the association between SARS-CoV-2 vaccination and myocarditis or myopericarditis.DesignPopulation based cohort study.SettingDenmark.Participants4 931 775 individuals aged 12 years or older, followed from 1 October 2020 to 5 October 2021.Main outcome measuresThe primary outcome, myocarditis or myopericarditis, was defined as a combination of a hospital diagnosis of myocarditis or pericarditis, increased troponin levels, and a hospital stay lasting more than 24 hours. Follow-up time before vaccination was compared with follow-up time 0-28 days from the day of vaccination for both first and second doses, using Cox proportional hazards regression with age as an underlying timescale to estimate hazard ratios adjusted for sex, comorbidities, and other potential confounders.ResultsDuring follow-up, 269 participants developed myocarditis or myopericarditis, of whom 108 (40%) were 12-39 years old and 196 (73%) were male. Of 3 482 295 individuals vaccinated with BNT162b2 (Pfizer-BioNTech), 48 developed myocarditis or myopericarditis within 28 days from the vaccination date compared with unvaccinated individuals (adjusted hazard ratio 1.34 (95% confidence interval 0.90 to 2.00); absolute rate 1.4 per 100 000 vaccinated individuals within 28 days of vaccination (95% confidence interval 1.0 to 1.8)). Adjusted hazard ratios among female participants only and male participants only were 3.73 (1.82 to 7.65) and 0.82 (0.50 to 1.34), respectively, with corresponding absolute rates of 1.3 (0.8 to 1.9) and 1.5 (1.0 to 2.2) per 100 000 vaccinated individuals within 28 days of vaccination, respectively. The adjusted hazard ratio among 12-39 year olds was 1.48 (0.74 to 2.98) and the absolute rate was 1.6 (1.0 to 2.6) per 100 000 vaccinated individuals within 28 days of vaccination. Among 498 814 individuals vaccinated with mRNA-1273 (Moderna), 21 developed myocarditis or myopericarditis within 28 days from vaccination date (adjusted hazard ratio 3.92 (2.30 to 6.68); absolute rate 4.2 per 100 000 vaccinated individuals within 28 days of vaccination (2.6 to 6.4)). Adjusted hazard ratios among women only and men only were 6.33 (2.11 to 18.96) and 3.22 (1.75 to 5.93), respectively, with corresponding absolute rates of 2.0 (0.7 to 4.8) and 6.3 (3.6 to 10.2) per 100 000 vaccinated individuals within 28 days of vaccination, respectively. The adjusted hazard ratio among 12-39 year olds was 5.24 (2.47 to 11.12) and the absolute rate was 5.7 (3.3 to 9.3) per 100 000 vaccinated individuals within 28 days of vaccination.ConclusionsVaccination with mRNA-1273 was associated with a significantly increased risk of myocarditis or myopericarditis in the Danish population, primarily driven by an increased risk among individuals aged 12-39 years, while BNT162b2 vaccination was only associated with a significantly increased risk among women. However, the absolute rate of myocarditis or myopericarditis after SARS-CoV-2 mRNA vaccination was low, even in younger age groups. The benefits of SARS-CoV-2 mRNA vaccination should be taken into account when interpreting these findings. Larger multinational studies are needed to further investigate the risks of myocarditis or myopericarditis after vaccination within smaller subgroups.

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Survival rate of HIV-infected children after initiation of the antiretroviral therapy and its predictors in Ethiopia: A facility-based retrospective cohort

SAGE Open Medicine ◽

10.1177/2050312119838957 ◽

2019 ◽

Vol 7 ◽

pp. 205031211983895 ◽

Cited By ~ 1

Author(s):

Getachew Arage ◽

Mekonnen Assefa ◽

Teshager Worku ◽

Agumasie Semahegn

Keyword(s):

Antiretroviral Therapy ◽

Confidence Interval ◽

Psychosocial Support ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Cd4 Count ◽

Risk Of Mortality ◽

Lower Baseline ◽

Study Participants

Objective: To determine the survival rate and predictors of HIV-infected children on antiretroviral therapy at two selected facilities in North Ethiopia. Methods: A facility-based retrospective cohort study was conducted in Debre Tabor General Hospital and Dessie Referral Hospital from December 2005 to November 2015. A total of 426 records were included in the study. Multivariable Cox proportional hazards regression model was used to identify independent predictors of survival. Results: At the end of follow-up, 97 (22.9%) HIV-infected children died and 325 (77.1%) were alive. The probabilities of survival at 12, 24, 36 and 48 months of on antiretroviral therapy were 0.91, 0.85, 0.84 and 0.80, respectively. The median survival time was 91.6 months (95% confidence interval: 89.0–94.2). Almost half (51%) of the deaths occurred within the first 2 years of treatment. Study participants who had poor adherence to antiretroviral therapy (adjusted hazard ratio = 3.0; 95% confidence interval: 1.2–7.5) and who started antiretroviral therapy with lower baseline weight-for-age Z-score (adjusted hazard ratio = 2.5; 95% confidence interval: 1.1–6.1) were significantly associated with high risk of mortality. On the other hand, study participants with a baseline CD4 count above 200 cells/mm3 (adjusted hazard ratio = 0.7; 95% confidence interval: 0.4–0.9) and those participants who had psychosocial support during follow-up (adjusted hazard ratio = 0.03; 95% confidence interval: 0.1–0.7) were significantly associated with less mortality event. Conclusion: Mortality of children on antiretroviral therapy was high. The risk of mortality is increased if the child was underweight at the commencement of antiretroviral therapy, had lower baseline CD4 count, had poor adherence to antiretroviral therapy and had no psychosocial support. Concerned stakeholders should focus on antiretroviral therapy adherence, nutritional interventions, psychological support and early initiation of antiretroviral therapy regardless of their CD4 count to enhance survival of HIV-infected children on antiretroviral therapy.

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THE RELATIONSHIP BETWEEN INFLAMMATORY DIETARY PATTERN AND INCIDENCE OF PERIODONTITIS

British Journal Of Nutrition ◽

10.1017/s0007114520005231 ◽

2021 ◽

pp. 1-36

Author(s):

Ahmed A. Alhassani ◽

Frank B. Hu ◽

Bernard A. Rosner ◽

Fred K. Tabung ◽

Walter C. Willett ◽

...

Keyword(s):

Confidence Interval ◽

Periodontal Disease ◽

Secondary Analysis ◽

Hazard Ratio ◽

Reduced Rank Regression ◽

Rank Regression ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Study Population

ABSTRACT The long-term inflammatory impact of diet could potentially elevate the risk of periodontal disease through modification of systemic inflammation. The aim of the present study was to prospectively investigate the associations between a food based, reduced rank regression (RRR) derived, empirical dietary inflammatory pattern (EDIP) and incidence of periodontitis. The study population was composed of 34,940 men from the Health Professionals Follow-Up Study, who were free of periodontal disease and major illnesses at baseline (1986). Participants provided medical and dental history through mailed questionnaires every 2 years, and dietary data through validated semi-quantitative food frequency questionnaires every 4 years. We used Cox proportional hazard models to examine the associations between EDIP scores and validated self-reported incidence of periodontal disease over a 24-year follow-up period. No overall association between EDIP and the risk of periodontitis was observed; the hazard ratio comparing the highest EDIP quintile (most proinflammatory diet) to the lowest quintile was 0.99 (95% confidence interval: 0.89 -1.10, p-value for trend = 0.97). A secondary analysis showed that among obese non-smokers (i.e. never and former smokers at baseline), the hazard ratio for periodontitis comparing the highest EDIP quintile to the lowest was 1.39 (95% confidence interval: 0.98 -1.96, p-value for trend = 0.03). In conclusion, no overall association was detected between EDIP and incidence of self-reported periodontitis in the study population. From the subgroups evaluated EDIP was significantly associated with increased risk of periodontitis only among nonsmokers who were obese. Hence, this association must be interpreted with caution.

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Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved?

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118822671 ◽

2019 ◽

Vol 10 (2) ◽

pp. 164-170 ◽

Cited By ~ 3

Author(s):

Valdano Manuel ◽

Humberto Morais ◽

Aida L. R. Turquetto ◽

Gade Miguel ◽

Leonardo A. Miana ◽

...

Keyword(s):

Confidence Interval ◽

African Country ◽

Single Ventricle ◽

Hazard Ratio ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Lost To Follow Up ◽

Single Ventricle Palliation

Introduction: Single ventricle physiology management is challenging, especially in low-income countries. Objective: To report the palliation outcomes of single ventricle patients in a developing African country. Methods: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between March 2011 and December 2017. Preoperative data, surgical factors, postoperative results, and survival outcomes were analyzed. The patients were divided by palliation stage: I (pulmonary artery banding [PAB] or Blalock–Taussig shunt [BTS]), II (Glenn procedure), or III (Fontan procedure). Results: Of the 83 patients who underwent palliation (stages I-III), 38 deaths were observed (31 after stage I, six after stage II, and one after stage III) for an overall mortality of 45.7%. The main causes of operative mortality were multiple organ dysfunction due to sepsis, shunt occlusion, and cardiogenic shock. Twenty-eight survivors were lost to follow-up (22 after stage I, six after stage II). Thirteen stage II survivors are still waiting for stage III. The mean follow-up was 366 ± 369 days. Five-year survival was 28.4 % for PAB and 30.1% for BTS, while that for stage II and III was 49.8% and 57.1%, respectively. Age (hazard ratio, 0.61; 95% confidence interval: 0.47-0.7; P = .000) and weight at surgery (hazard ratio, 0.45; 95% confidence interval: 0.31-0.64; P = .002) impacted survival. Conclusion: A high-mortality rate was observed in this initial experience, mainly in stage I patients. A large number of patients were lost to follow-up. A task force to improve outcomes is urgently required.

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