Occupational variation in incidence of bladder cancer: a comparison of population-representative cohorts from Nordic countries and Canada

AbstractThe incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.

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Emotional states and future risk of venous thromboembolism

Thrombosis and Haemostasis ◽

10.1160/th11-09-0667 ◽

2012 ◽

Vol 107 (03) ◽

pp. 485-493 ◽

Cited By ~ 13

Author(s):

Sigrid K. Brækkan ◽

Ida J. Hansen-Krone ◽

John-Bjarne Hansen ◽

Kristin F. Enga

Keyword(s):

Venous Thromboembolism ◽

Incidence Rate ◽

Population Based ◽

Emotional States ◽

Depressive Feelings ◽

Increased Risk ◽

Adjusted Incidence Rate ◽

Adjusted Incidence ◽

Reduced Risk

SummaryEmotional states of depression and loneliness are reported to be associated with higher risk and optimism with lower risk of arterial cardiovascular disease (CVD) and death. The relation between emotional states and risk of venous thromboembolism (VTE) has not been explored previously. We aimed to investigate the associations between self-reported emotional states and risk of incident VTE in a population-based, prospective study. The frequency of feeling depressed, lonely and happy/optimistic were registered by self-administered questionnaires, along with major co-morbidities and lifestyle habits, in 25,964 subjects aged 25–96 years, enrolled in the Tromsø Study in 1994–1995. Incident VTE-events were registered from the date of inclusion until September 1, 2007. There were 440 incident VTE-events during a median of 12.4 years of follow-up. Subjects who often felt depressed had 1.6-fold (95% CI:1.02–2.50) higher risk of VTE compared to those not depressed in analyses adjusted for other risk factors (age, sex , body mass index, oes-trogens), lifestyle (smoking, alcohol consumption, educational level) and co-morbidities (diabetes, CVD, and cancer). Often feeling lonely was not associated with VTE. However, the incidence rate of VTE in subjects who concurrently felt often lonely and depressed was higher than for depression alone (age-and sex-adjusted incidence rate: 3.27 vs. 2.21). Oppositely, subjects who often felt happy/optimistic had 40% reduced risk of VTE (HR 0.60, 95% CI: 0.41–0.87). Our findings suggest that self-reported emotional states are associated with risk of VTE. Depressive feelings were associated with increased risk, while happiness/ optimism was associated with reduced risk of VTE.

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A modified ileal conduit technique in patients undergoing radical cystectomy: Single-centre experience

Journal of Clinical Urology ◽

10.1177/20514158211041483 ◽

2021 ◽

pp. 205141582110414

Author(s):

Francesco Chiancone ◽

Francesco Persico ◽

Marco Fabiano ◽

Maurizio Fedelini ◽

Clemente Meccariello ◽

...

Keyword(s):

Bladder Cancer ◽

Postoperative Complications ◽

Blood Loss ◽

Radical Cystectomy ◽

Ileal Conduit ◽

Intraoperative Complications ◽

Perioperative Outcomes ◽

Multivariate Logistic Regression Model ◽

Increased Risk

Objective: We aimed to evaluate perioperative outcomes and complications of a modified technique of ileal conduit diversion. Methods: Forty-seven cases of radical cystectomy with modified ileal conduit diversion were performed at our institution from January 2015 to January 2020. After radical cystectomy, a segment of ileum was used to pack the conduit and was placed below the digestive anastomosis. Then, the mesentery window of the ileo-ileal anastomosis was sutured. The ureters were anastomosed on their native side on single loop ureteral stents. All procedures were performed by a single surgical team. Intra- and postoperative complications were classified and reported according to the Satava and Clavien–Dindo grading systems. Results: The mean age of population was 66.40±10.14 years, and 76.6% were male. Concomitant diabetes was found in 31.9% of patients. About three quarters of patients had T2G3 bladder cancer. Mean blood loss was 449.36±246.50 ml, and hospitalization was 10.32±5 days. With a mean follow-up of 17.36±12.63 months, the recurrence rate was 17%, and 14.9% of patients died of bladder cancer. Out of the 47 patients, three (4.3%) experienced intraoperative complications, while 15 (31.9%) had postoperative complications. Of these, only three patients experienced Clavien–Dindo complications ⩾grade 3. Multivariate logistic regression model showed that diabetes ( p=0.023) and higher blood loss ( p=0.010) were significantly associated with an increased risk of postoperative complications. We reported one case of ureterointestinal anastomosis stenosis on the left side and none on the right side. Despite our results being promising, larger randomized trials with longer follow-up are needed to explore further the feasibility of this technique on a larger scale. Conclusion: We describe a safe and simple surgical technique with a similar postoperative complications rate and a lower incidence of ureteroileal anastomosis stenosis compared to the standard technique. Level of evidence 4.

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Associations of Metabolic Syndrome and Its Components with the Risk of Incident Knee Osteoarthritis Leading to Hospitalization: A 32-Year Follow-up Study

Cartilage ◽

10.1177/1947603519894731 ◽

2019 ◽

pp. 194760351989473

Author(s):

Sanna Konstari ◽

Katri Sääksjärvi ◽

Markku Heliövaara ◽

Harri Rissanen ◽

Paul Knekt ◽

...

Keyword(s):

Metabolic Syndrome ◽

Confidence Interval ◽

Knee Osteoarthritis ◽

Fasting Glucose ◽

Full Model ◽

Knee Oa ◽

Increased Risk ◽

Metabolic Syndrome Components ◽

Reduced Risk

Objectives To examine whether metabolic syndrome or its individual components predict the risk of incident knee osteoarthritis (OA) in a prospective cohort study during a 32-year follow-up period. Design The cohort consisted of 6274 participants of the Mini-Finland Health Survey, who were free from knee OA and insulin-treated diabetes at baseline. Information on the baseline characteristics, including metabolic syndrome components, hypertension, elevated fasting glucose, elevated triglycerides, reduced high-density lipoprotein, and central obesity were collected during a health examination. We drew information on the incidence of clinical knee OA from the national Care Register for Health Care. Of the participants, 459 developed incident knee OA. In our full model, age, gender, body mass index, history of physical workload, smoking history, knee complaint, and previous injury of the knee were entered as potential confounding factors. Results Having metabolic syndrome at baseline was not associated with an increased risk of incident knee OA. In the full model, the hazard ratio for incident knee OA for those with metabolic syndrome was 0.76 (95% confidence interval [0.56, 1.01]). The number of metabolic syndrome components or any individual component did not predict an increased risk of knee OA. Of the components, elevated plasma fasting glucose was associated with a reduced risk of incident knee OA (hazard ratio 0.71, 95% confidence interval [0.55, 0.91]). Conclusions Our findings do not support the hypothesis that metabolic syndrome or its components increase the risk of incident knee OA. In fact, elevated fasting glucose levels seemed to predict a reduced risk.

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Screening for bladder cancer

10.1093/med/9780199659579.003.0073 ◽

2017 ◽

Author(s):

Maree Brinkman ◽

Maurice Zeegars

Keyword(s):

Bladder Cancer ◽

Screening Tools ◽

Treatment Modalities ◽

Urinary Cytology ◽

Urological Malignancies ◽

Increased Risk ◽

Urological Symptoms ◽

Disease Specific Mortality ◽

Asymptomatic Individuals

Bladder cancer (BC) is one of the most common urological malignancies and ranks ninth among all cancers worldwide. While screening has the potential to detect early cases of BC and reduce disease specific mortality, to date there are no routine screening programmes of asymptomatic individuals conducted anywhere in the world. There are however, a range of tests and procedures available for the detection and subsequent diagnosis of BC for select individuals presenting with urological symptoms and who are at increased risk of the disease.This chapter provides an overview of the traditional screening tools used for the detection of BC, such as urinalysis for haematuria and urinary cytology, as well as a brief description of follow-up procedures including cystoscopy, imaging, and treatment modalities.

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Real-world Evidence of Time-varying Effects of Renin-angiotensin System Inhibitors on Pneumonia and Related Deaths: A Territory-wide Cohort Study in 252,616 Patients With Diabetes (2002-2019)

10.21203/rs.3.rs-665328/v1 ◽

2021 ◽

Author(s):

Aimin Yang ◽

Mai Shi ◽

Hongjiang Wu ◽

Eric SH Lau ◽

Baoqi Fan ◽

...

Keyword(s):

Renin Angiotensin System ◽

Chinese Patients ◽

Cumulative Exposure ◽

Time Varying ◽

Angiotensin System ◽

Renin Angiotensin ◽

Increased Risk ◽

Patients With Diabetes ◽

Reduced Risk

Abstract BackgroundDiabetes is associated with increased risk of respiratory infections. Renin-angiotensin system (RAS) inhibition with anti-fibrotic, anti-inflammatory effects may reduce pneumonia risk. Prior studies did not account for time-varying and cumulative exposure to RAS inhibitors (RASi), with short follow-up periods, nor compared angiotensin converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) use in Asians. We investigated the association of long-term use of RASi with risk of pneumonia and related death in Chinese people with diabetes using electronic medical record (EMR) data.MethodsThis was a prospective analysis of EMR with overlap propensity-score weighting of a territory-wide cohort (n=252,616, 1.7 million person-years) and a register-based cohort (n=13,017, 0.1 million person-years) in Hong Kong. We compared new-users of RASi (ACEi/ARBs) following baseline assessment with non-RASi users and new-users of calcium-channel blockers as active comparator. The main outcome was first hospitalization and death from pneumonia. ResultsAmongst 252,616 patients with diabetes in the population-based cohort (mean age=61.0 [SD=12.2] years), 73,161 were new-ACEi-only users; 20,907 new-ARBs-only users; 38,778 ACEi/ARBs users; and 119,770 never-ACEi/ARBs users. Over a mean follow-up period of 6.7 years, 5.2% (n=13,057) of patients had pneumonia and 2.2% (n=5,480) died with pneumonia. Compared with non-RASi use, time-varying RASi exposure was associated with reduced risk of pneumonia (hazard ratio, HR, 95% CI): 0.78 (0.75-0.82) and pneumonia-related death (HR=0.49, 0.46-0.53). The respective HRs for ARBs-only were 0.70 (0.62-0.78) and 0.41 (0.33-0.52) and that of ACEi-only were 0.98 (0.91-1.05) and 0.77 (0.68-86). In the Aalen-additive hazards model, the effect of RASi use was time-invariant for pneumonia (P=0.340) and time-varying for related death (P<0.001) with prevention of 0.6 (0.2-0.9) and 1.4 (1.0-1.6) per-1000-person-years pneumonia events and related deaths, respectively.ConclusionsLong-term use of RASi, notably ARB, was associated with reduced risk of pneumonia and related deaths in Chinese patients with diabetes.

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Extended Mortality Follow-up of a Cohort of 25,460 Workers Exposed to Acrylonitrile

American Journal of Epidemiology ◽

10.1093/aje/kwz086 ◽

2019 ◽

Vol 188 (8) ◽

pp. 1484-1492 ◽

Cited By ~ 2

Author(s):

Stella Koutros ◽

Jay H Lubin ◽

Barry I Graubard ◽

Aaron Blair ◽

Patricia A Stewart ◽

...

Keyword(s):

Bladder Cancer ◽

Proportional Hazards ◽

Cox Regression ◽

The United States ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Increased Risk ◽

Total Cancer ◽

Standardized Mortality Ratios

Abstract We extended the mortality follow-up of a cohort of 25,460 workers employed at 8 acrylonitrile (AN)-producing facilities in the United States by 21 years. Using 8,124 deaths and 1,023,922 person-years of follow-up, we evaluated the relationship between occupational AN exposure and death. Standardized mortality ratios (SMRs) based on deaths through December 31, 2011, were calculated. Work histories and monitoring data were used to develop quantitative estimates of AN exposure. Hazard ratios were estimated by Cox proportional hazards regression. All-cause mortality and death from total cancer were less than expected compared with the US population. We observed an excess of death due to mesothelioma (SMR = 2.24, 95% confidence interval (CI): 1.39, 3.42); no other SMRs were elevated overall. Cox regression analyses revealed an elevated risk of lung and bronchial cancer (n = 808 deaths; for >12.1 ppm-year vs. unexposed, hazard ratio (HR) = 1.43, 95% CI: 1.13, 1.81; P for trend = 0.05), lagged 10 years, that was robust in sensitivity analyses adjusted for smoking and co-exposures including asbestos. Death resulting from bladder cancer (for >2.56 ppm vs. unexposed, lagged 10-year HR = 2.96, 95% CI: 1.38, 6.34; P for trend = 0.02) and pneumonitis (for >3.12 ppm-year vs. unexposed, HR = 4.73, 95% CI: 1.42, 15.76; P for trend = 0.007) was also associated with AN exposure. We provide additional evidence of an association between AN exposure and lung cancer, as well as possible increased risk for death due to bladder cancer and pneumonitis.

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Influenza Vaccination is Associated with Reduced Cardiovascular Mortality in Adults with Diabetes. A Nationwide Cohort Study

10.2337/figshare.12436376.v1 ◽

2020 ◽

Author(s):

Daniel Modin ◽

Brian Claggett ◽

Lars Køber ◽

Morten Schou ◽

Jens Ulrik Stæhr Jensen ◽

...

Keyword(s):

Influenza Vaccination ◽

Vaccine Coverage ◽

Influenza Infection ◽

Chronic Obstructive Lung Disease ◽

Cardiovascular Death ◽

Chronic Obstructive ◽

Risk Of Death ◽

Increased Risk ◽

Reduced Risk

Background: Recent influenza infection is associated with an increased risk of atherothrombotic events, including acute myocardial infarction (AMI) and stroke. Little is known about the association between influenza vaccination and cardiovascular outcomes in patients with diabetes mellitus (DM). Methods: We used nationwide register data to identify DM patients in Denmark during 9 consecutive influenza seasons in the period 2007-2016. DM was defined as use of glucose-lowering medication. Patients who were not 18-100 years old or had ischemic heart disease, heart failure, chronic obstructive lung disease, cancer or cerebrovascular disease were excluded. Patient exposure to influenza vaccination was assessed prior to each influenza season. We considered outcomes death from all causes, from cardiovascular causes and death from AMI or stroke. For each season, patients were followed from December 1 until April 1 the next year. Results: A total of 241,551 Patients were followed for a median of 4 seasons (interquartile range: 2-8 seasons) for a total follow-up of 425,318 person-years. The vaccine coverage during study seasons ranged from 24% to 36%. During follow-up, 8,207 patients died of all-causes (3.4%), 4,127 patients died of cardiovascular causes (1.7%) and 1,439 patients died of AMI/stroke (0.6%). After adjustment for confounders, vaccination was significantly associated with reduced risks of all-cause death (HR 0.83, p<0.001), cardiovascular death (HR 0.84, p<0.001), death from AMI or stroke (HR 0.85, p=0.028) and a reduced risk of being admitted to hospital with acute complications associated with DM (diabetic ketoacidosis, hypoglycemia or coma) (HR 0.89, p=0.006). Conclusion: In patients with DM, influenza vaccination was associated with a reduced risk of death, cardiovascular death and death from AMI or stroke. Influenza vaccination may improve outcome in patients with DM.

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Influenza Vaccination is Associated with Reduced Cardiovascular Mortality in Adults with Diabetes. A Nationwide Cohort Study

10.2337/figshare.12436376 ◽

2020 ◽

Author(s):

Daniel Modin ◽

Brian Claggett ◽

Lars Køber ◽

Morten Schou ◽

Jens Ulrik Stæhr Jensen ◽

...

Keyword(s):

Influenza Vaccination ◽

Vaccine Coverage ◽

Influenza Infection ◽

Chronic Obstructive Lung Disease ◽

Cardiovascular Death ◽

Chronic Obstructive ◽

Risk Of Death ◽

Increased Risk ◽

Reduced Risk

Background: Recent influenza infection is associated with an increased risk of atherothrombotic events, including acute myocardial infarction (AMI) and stroke. Little is known about the association between influenza vaccination and cardiovascular outcomes in patients with diabetes mellitus (DM). Methods: We used nationwide register data to identify DM patients in Denmark during 9 consecutive influenza seasons in the period 2007-2016. DM was defined as use of glucose-lowering medication. Patients who were not 18-100 years old or had ischemic heart disease, heart failure, chronic obstructive lung disease, cancer or cerebrovascular disease were excluded. Patient exposure to influenza vaccination was assessed prior to each influenza season. We considered outcomes death from all causes, from cardiovascular causes and death from AMI or stroke. For each season, patients were followed from December 1 until April 1 the next year. Results: A total of 241,551 Patients were followed for a median of 4 seasons (interquartile range: 2-8 seasons) for a total follow-up of 425,318 person-years. The vaccine coverage during study seasons ranged from 24% to 36%. During follow-up, 8,207 patients died of all-causes (3.4%), 4,127 patients died of cardiovascular causes (1.7%) and 1,439 patients died of AMI/stroke (0.6%). After adjustment for confounders, vaccination was significantly associated with reduced risks of all-cause death (HR 0.83, p<0.001), cardiovascular death (HR 0.84, p<0.001), death from AMI or stroke (HR 0.85, p=0.028) and a reduced risk of being admitted to hospital with acute complications associated with DM (diabetic ketoacidosis, hypoglycemia or coma) (HR 0.89, p=0.006). Conclusion: In patients with DM, influenza vaccination was associated with a reduced risk of death, cardiovascular death and death from AMI or stroke. Influenza vaccination may improve outcome in patients with DM.

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