scholarly journals Acute and long-term grief reactions and experiences in parentally cancer-bereaved teenagers

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tove Bylund-Grenklo ◽  
Dröfn Birgisdóttir ◽  
Kim Beenaert ◽  
Tommy Nyberg ◽  
Viktor Skokic ◽  
...  
Keyword(s):  
Family Cohesion ◽  
Population Based ◽  
Unresolved Grief ◽  
Good Family ◽  
Increased Risk ◽  
Death Of A Parent ◽  
Parent Grief ◽  
Grief Resolution ◽  
Grief Reactions

Abstract Background Previous research shows that many cancer-bereaved youths report unresolved grief several years after the death of a parent. Grief work hypothesis suggests that, in order to heal, the bereaved needs to process the pain of grief in some way. This study explored acute grief experiences and reactions in the first 6 months post-loss among cancer-bereaved teenagers. We further explored long-term grief resolution and potential predictors of having had “an okay way to grieve” in the first months post-loss. Methods We used a population-based nationwide, study-specific survey to investigate acute and long-term grief experiences in 622 (73% response rate) bereaved young adults (age > 18) who, 6–9 years earlier, at ages 13–16 years, had lost a parent to cancer. Associations were assessed using bivariable and multivariable logistic regression. Results Fifty-seven per cent of the participants reported that they did not have a way to grieve that felt okay during the first 6 months after the death of their parent. This was associated with increased risk for long-term unresolved grief (odds ratio (OR): 4.32, 95% confidence interval (CI): 2.99–6.28). An association with long-term unresolved grief was also found for those who reported to have been numbing and postponing (42%, OR: 1.73, 95% CI: 1.22–2.47), overwhelmed by grief (24%, OR: 2.02, 95% CI: 1.35–3.04) and discouraged from grieving (15%, OR: 2.68, 95% CI: 1.62–4.56) or to have concealed their grief to protect the other parent (24%, OR: 1.83, 95% CI: 1.23–2.73). Predictors of having had an okay way to grieve included being male, having had good family cohesion, and having talked about what was important with the dying parent. Conclusion More than half of the cancer-bereaved teenagers did not find a way to grieve that felt okay during the first 6 months after the death of their parent and the acute grief experiences and reaction were associated with their grief resolution long-term, i.e. 6–9 years post-loss. Facilitating a last conversation with their dying parent, good family cohesion, and providing teenagers with knowledge about common grief experiences may help to prevent long-term unresolved grief.

Infertility Treatments and Long-Term Neurologic Morbidity of the Offspring

2018 ◽  
Vol 36 (09) ◽  
pp. 949-954 ◽  
Author(s):  
Shai Levin ◽  
Eyal Sheiner ◽  
Tamar Wainstock ◽  
Asnat Walfisch ◽  
Idit Segal ◽  
...  
Keyword(s):  
Medical Center ◽  
Cohort Analysis ◽  
Multivariable Analysis ◽  
Maternal Diabetes ◽  
Population Based ◽  
Vitro Fertilization ◽  
Increased Risk ◽  
Attention Deficit Hyperactivity Disorders

Objective To determine the risk of long-term neurologic morbidity among children (up to 18 years) born following in vitro fertilization (IVF) or ovulation induction (OI) treatments as compared with spontaneously conceived. Study Design A population-based cohort analysis was performed, including data from the perinatal computerized database on all singleton infants born at the Soroka University Medical Center (SUMC) between the years 1991 and 2014. This perinatal database was linked and cross-matched with the SUMC computerized dataset of all pediatric hospitalizations. Results Neurologic morbidity was significantly more common in IVF (3.7%) and OI (4.1%) offspring as compared with those following spontaneous pregnancies (3.1%; p = 0.017). In particular, attention deficit/hyperactivity disorders and headaches were more common in the OI group and sleep disorders in the IVF group, whereas autism and cerebral palsy were comparable between the groups. In the Weibull multivariable analysis, while controlling for maternal age, preterm delivery, birthweight centile, maternal diabetes, and hypertensive disorders, IVF (adjusted hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.14–1.71; p = 0.001), but not OI (adjusted HR: 1.17' 95% CI: 0.92–1.48; p = 0.196), was noted as an independent risk factor for long-term pediatric neurologic morbidity. Conclusion IVF offspring appear to be at an increased risk of long-term neurologic morbidity up to 18 years of age.

scholarly journals Frailty Assessed by Administrative Tools and Mortality in Patients With Pneumonia Admitted to the Hospital and ICU: a Population-based Data-linkage Study

2021 ◽  
Author(s):  
Tamas Szakmany ◽  
Joe Hollinghurst ◽  
Richard Pugh ◽  
Ashley Akbari ◽  
Rowena Griffiths ◽  
...  
Keyword(s):  
Data Linkage ◽  
Social Deprivation ◽  
Frailty Index ◽  
Significant Risk ◽  
Population Based ◽  
Linkage Study ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Population Scale

Abstract Background: The ideal method of identifying frailty is uncertain, and data on long-term outcomes is relatively limited. We examined frailty indices derived from population-scale linked data on Intensive Care Unit (ICU) and hospitalised non-ICU patients with pneumonia to elucidate the influence of frailty on mortality.Methods: Longitudinal cohort study between 2010-2018 using population-scale anonymised data linkage of healthcare records for adults admitted to hospital with pneumonia in Wales. Primary outcome was in-patient mortality. Age, hospital frailty risk score (HFRS), electronic frailty index (eFI), Charlson comorbidity index (CCI), and social deprivation index were entered in the multivariate regression models.Results: Of the 107,188 patients, mean (SD) age was 72.6 (16.6) years, 50% were men. The two frailty indices and the comorbidity index had an increased risk of mortality for individuals with an ICU admission. Advancing age, increased frailty and comorbidity affected short- and long-term mortality. For predicting inpatient deaths, the CCI and HFRS based models were similar, however for longer term outcomes the CCI based model was superior. Discussion: Frailty and comorbidity are significant risk factors for patients admitted to hospital with pneumonia. Frailty and comorbidity scores based on administrative data have only moderate ability to predict outcome.

scholarly journals Increased mortality in patients with corticosteroid-dependent asthma: a nationwide population-based study

2019 ◽  
Vol 54 (5) ◽  
pp. 1900804 ◽  
Author(s):  
Hyun Lee ◽  
Jiin Ryu ◽  
Eunwoo Nam ◽  
Sung Jun Chung ◽  
Yoomi Yeo ◽  
...  
Keyword(s):  
Baseline Period ◽  
Population Based ◽  
High Dose ◽  
Population Based Study ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Korean National Health Insurance ◽  
Independent Cohort ◽  
Long Term Mortality

IntroductionChronic systemic corticosteroid (CS) therapy is associated with an increased risk of mortality in patients with many chronic diseases. However, it has not been elucidated whether chronic systemic CS therapy is associated with increased mortality in patients with asthma. The aim of this study was to determine the effects of chronic systemic CS therapy on long-term mortality in adult patients with asthma.MethodsA population-based matched cohort study of males and females aged ≥18 years with asthma was performed using the Korean National Health Insurance Service database from 2005 to 2015. Hazard ratio (HR) with 95% confidence interval for all-cause mortality among patients in the CS-dependent cohort (CS use ≥6 months during baseline period) relative to those in the CS-independent cohort (CS use <6 months during baseline period) was evaluated.ResultsThe baseline cohort included 466 941 patients with asthma, of whom 8334 were CS-dependent and 458 607 were CS-independent. After 1:1 matching, 8334 subjects with CS-independent asthma were identified. The HR of mortality associated with CS-dependent asthma relative to CS-independent asthma was 2.17 (95% CI 2.04–2.31). In patients receiving low-dose CS, the HR was 1.84 (95% CI 1.69–2.00); in patients receiving high-dose CS, the HR was 2.56 (95% CI 2.35–2.80).ConclusionsIn this real-world, clinical practice, observational study, chronic use of systemic CS was associated with increased risk of mortality in patients with asthma, with a significant dose–response relationship between systemic CS use and long-term mortality.

scholarly journals Influence of Acetylsalicylic Acid Use on Risk and Outcome of Community-Acquired Staphylococcus aureus Bacteremia: A Population-Based Study

2019 ◽  
Vol 6 (9) ◽  
Author(s):  
Jesper Smit ◽  
Michael Dalager-Pedersen ◽  
Kasper Adelborg ◽  
Achim J Kaasch ◽  
Reimar W Thomsen ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Acetylsalicylic Acid ◽  
Population Based ◽  
Socioeconomic Indicators ◽  
Medical Databases ◽  
Staphylococcus Aureus Bacteremia ◽  
Increased Risk ◽  
First Time ◽  
Population Controls

Abstract Objective To investigate the influence of acetylsalicylic acid (ASA) use on risk and outcome of community-acquired Staphylococcus aureus bacteremia (CA-SAB). Method We used population-based medical databases to identify all patients diagnosed in northern Denmark with first-time CA-SAB and matched population controls from 2000–2011. Categories for ASA users included current users (new or long-term users), former users, and nonusers. The analyses were adjusted for comorbidities, comedication use, and socioeconomic indicators. Results We identified 2638 patients with first-time CA-SAB and 26 379 matched population controls. Compared with nonusers, the adjusted odds ratio (aOR) for CA-SAB was 1.00 (95% confidence interval [CI], 0.88–1.13) for current users, 1.00 (95% CI, 0.86–1.16) for former users, 2.04 (95% CI, 1.42–2.94) for new users, and 0.95 (95% CI, 0.84–1.09) for long-term users. Thirty-day cumulative mortality was 28.0% among current users compared with 21.6% among nonusers, yielding an adjusted hazard rate ratio (aHRR) of 1.02 (95% CI, 0.84–1.25). Compared with nonusers, the aHRR was 1.10 (95% CI, 0.87–1.40) for former users, 0.60 (95% CI, 0.29–1.21) for new users, and 1.06 (95% CI, 0.87–1.31) for long-term users. We observed no difference in the risk or outcome of CA-SAB with increasing ASA dose or by presence of diseases commonly treated with ASA. Conclusions Use of ASA did not seem to influence the risk or outcome of CA-SAB. The apparent increased risk among new users may relate to residual confounding from the circumstances underlying ASA treatment initiation. Our finding of no association remained robust with increasing ASA dose and across multiple patient subsets.

Childhood sexual abuse, stressful life events and risk for major depression in women

2004 ◽  
Vol 34 (8) ◽  
pp. 1475-1482 ◽  
Author(s):  
KENNETH S. KENDLER ◽  
JONATHAN W. KUHN ◽  
CAROL A. PRESCOTT
Keyword(s):  
Sexual Abuse ◽  
Major Depression ◽  
Childhood Sexual Abuse ◽  
Life Events ◽  
Stressful Life Events ◽  
Population Based ◽  
Stress Sensitivity ◽  
Stressful Life ◽  
Increased Risk

Background. In animals, early trauma can produce long-lasting changes in sensitivity to the pathogenic effects of stress. To explore whether similar processes occur in humans, we examine whether childhood sexual abuse (CSA) in women alters sensitivity in adulthood to the depressogenic effects of stressful life events (SLEs).Method. A history of CSA was obtained from a population-based sample of 1404 female adult twins. Cox Proportional hazard models were used to predict onsets of episodes of DSM-III-R major depression (MD) in the past year from previously assessed levels of neuroticism (N), CSA and past-year SLEs scored on long-term contextual threat.Results. In the best-fit model, onset of MD was predicted by CSA, SLEs and N. Individuals with CSA (and especially with severe CSA) had both an overall increased risk for MD and a substantially increased sensitivity to the depressogenic effects of SLEs. A ‘dose–response’ relationship between severity of CSA and sensitivity to SLEs was clearer in those with low to average levels of N than in those with high levels of N.Conclusion. As documented with physiological responses to a standardized laboratory stressor, CSA increases stress sensitivity in women in a more naturalistic setting. Both genetic and early environmental risk factors can produce long-term increase in the sensitivity of individuals to depressogenic life experiences.

Comparing mortality of colorectal cancer and gastrointestinal bleeding among patients with long-term use of low dose aspirin: A population-based study of 689,209 patients.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 527-527
Author(s):  
Joseph Sung ◽  
Kelvin Kf Tsoi
Keyword(s):  
Colorectal Cancer ◽  
Gastrointestinal Bleeding ◽  
Large Scale ◽  
Low Dose ◽  
Population Based ◽  
Dose Aspirin ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
Low Dose Aspirin

527 Background: Aspirin, commonly used for prevention of cardiovascular and cerebrovascular diseases, is well-known to protect against colorectal cancer (CRC) development but increase risk of gastrointestinal bleeding (GIB). Few large-scale studies have compared the benefit and risk of long-term aspirin usage. This cohort study aims to evaluate the use of low-dose aspirin to prevent CRC and the risk of GIB associated with the aspirin use. Methods: A population-based clinical dataset was used to compare incidence and mortality of CRC and GIB patients receiving low-dose aspirin with sex-and-age matched controls (in 1:2 ratio). Patients with aspirin≤6 months were excluded. Clinical data of 206,243 aspirin users (mean dose 80 mg/day, mean duration 7.7 years) and 482,966 non-users were included. All patients must have at least 10-year follow up on clinical outcome. Results: Among aspirin users 5,776 (2.80%) were diagnosed with CRC; 2,097 (1.02%) died of the malignancy. 16,483 (3.41%) non-users were diagnosed with CRC; 7,963 (1.65%) died of CRC. Using the cox-proportional hazard regression, aspirin usage showed a modest but significant reduction in CRC mortality (HR = 0.65; 95% CI = 0.62 to 0.69). On the other hand, 11,187 (5.42%) aspirin users developed GIB, and 841 (0.41%) died. 15,186 (3.14%) non-users developed GIB, and 1,682 patients (0.35%) died. Aspirin users showed modest but significant increased risk of GIB-related mortality (HR = 1.24; 95% CI = 1.14 to 1.35). Conclusions: The long-term use of low dose aspirin shows preventive effect on CRC, but also increases the associated GIB risk. Considerations of prophylactic use of aspirin should balance the benefit and the risk of this treatment to the target population. [Table: see text]

Chemotherapy and Cardiotoxicity in Older Breast Cancer Patients: A Population-Based Study

2005 ◽  
Vol 23 (34) ◽  
pp. 8597-8605 ◽  
Author(s):  
John J. Doyle ◽  
Alfred I. Neugut ◽  
Judith S. Jacobson ◽  
Victor R. Grann ◽  
Dawn L. Hershman
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Breast Cancer Patients ◽  
Primary Tumors ◽  
Increased Risk

Purpose Adjuvant chemotherapy, especially with anthracyclines, is known to cause acute and chronic cardiotoxicity in breast cancer patients. We studied the cardiac effects of chemotherapy in a population-based sample of breast cancer patients aged ≥ 65 years with long-term follow-up. Patients and Methods In the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we analyzed treatments and outcomes among women ≥ 65 years of age who were diagnosed with stage I to III breast cancer from January 1, 1992 to December 31, 1999. Propensity scores were used to control for baseline heart disease (HD) and other known predictors of chemotherapy, and Cox proportional hazards models were used to estimate the risk of cardiomyopathy (CM), congestive heart failure (CHF), and HD after chemotherapy. Results Of 31,748 women with stage I to III breast cancer, 5,575 (18%) received chemotherapy. Chemotherapy was associated with younger age, fewer comorbidities, hormone receptor negativity, multiple primary tumors, and advanced disease. Patients who received chemotherapy were less likely than other patients to have pre-existing HD (45% v 55%, respectively; P < .001). The hazard ratios for CM, CHF, and HD for patients treated with doxorubicin (DOX) compared with patients who received no chemotherapy were 2.48 (95% CI, 2.10 to 2.93), 1.38 (95% CI, 1.25 to 1.52), and 1.35 (95% CI, 1.26 to 1.44), respectively. The relative risk of cardiotoxicity among patients who received DOX compared with untreated patients remained elevated 5 years after diagnosis. Conclusion When baseline HD was taken into account, chemotherapy, especially with anthracyclines, was associated with a substantially increased risk of CM. As the number of long-term survivors grows, identifying and minimizing the late effects of treatment will become increasingly important.

scholarly journals Preeclampsia and the risk of chronic kidney disease: a national registry-based cohort study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P M Barrett ◽  
F P McCarthy ◽  
M Evans ◽  
M Kublickas ◽  
I J Perry ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Absolute Risk ◽  
Population Based ◽  
National Registry ◽  
Medical Birth Register ◽  
Increased Risk ◽  
History Of

Abstract Background Preeclampsia is associated with increased risk of future cardiovascular disease, but evidence for associations with chronic kidney disease (CKD) has been inconsistent to date. We aimed to measure associations between preeclampsia and long-term CKD in a population-based sample of parous women, and to identify whether the risk differs by CKD subtype. Methods Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulo-interstitial, other/non-specific CKD. Cox proportional hazard regression models were used for analysis. Women with pre-pregnancy comorbidities were excluded. Results The dataset included 1,924,591 unique women who had 3,726,819 singleton pregnancies. The median follow-up was 20.7 (interquartile range 9.9-30.0) years. Overall, 90,964 women (4.7%) experienced preeclampsia and 18,146 (0.9%) developed CKD. Women who had preeclampsia had higher risk of developing any CKD during follow-up (aHR 1.88, 95% CI 1.79-1.98). The risk differed by CKD subtype, and was higher for hypertensive CKD (aHR 3.76, aHR 3.09-4.57), diabetic CKD (aHR 3.45, 95% CI 2.83-4.21) and glomerular/proteinuric CKD (aHR 2.08, 95% CI 1.90-2.29). Women who had preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity were also at greater risk of any CKD. Conclusions Women with a history of preeclampsia are at increased risk of long-term CKD. The risk is most marked for hypertensive CKD, diabetic CKD, and glomerular/proteinuric CKD. The absolute risk of CKD related to preeclampsia is substantial, and these women may warrant systematic renal monitoring in the years following delivery. Key messages Preeclampsia is an independent predictor of long-term risk of chronic kidney disease in otherwise healthy parous women. Women with a history of preeclampsia may warrant systematic renal monitoring through additional blood pressure, blood glucose, and proteinuria checks.

Long-term central venous catheters and infections in older adults with cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 125-125
Author(s):  
Allison Nicole Lipitz Snyderman ◽  
Kent Sepkowitz ◽  
Elena B. Elkin ◽  
Laura C. Pinheiro ◽  
Peter Bach
Keyword(s):  
Breast Cancer ◽  
Older Adults ◽  
Population Based ◽  
Infection Risk ◽  
Central Venous Catheters ◽  
Care Quality ◽  
Central Venous ◽  
Increased Risk ◽  
The Impact

125 Background: Long-term central venous catheters (CVCs) facilitate venous access to administer intravenous fluids and treatments such as chemotherapy. However, CVCs can also be a source of harmful bloodstream infections, a risk that may be underappreciated. Our objective was to assess the impact of long-term CVC use on the risk of infections in a population-based cohort of cancer patients. Methods: Retrospective analysis using the population-based SEER-Medicare dataset for patients over age 65, diagnosed from 2005 to 2007 with invasive colorectal cancer (n = 36,272), head and neck cancers (n = 8,459), lung cancer (n = 56,770), pancreatic cancer (n = 10,536), or non-Hodgkin lymphoma (n = 14,432), or invasive or non-invasive breast cancer (n = 42,271). Cox proportional hazards regression was used to examine the impact of CVC use on infection risk, with CVC exposure treated as a time-varying predictor. We used multivariable analysis and propensity score methods to control for patient characteristics. Results: Adjusting for demographic and disease characteristics, long-term CVCs significantly increased the risk of infection by at least 40%, across all cancer types (Table). The greatest effect of CVCs on infection risk was in patients with breast cancer. Conclusions: Long-term CVC use is associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs, and targeted strategies to reduce infections for patients requiring their use, are critical to improving cancer care quality. [Table: see text]

Risk of cancer among sarcoidosis patients with biopsy-verified non-necrotizing granulomatous inflammation: Population-based cohort study

2021 ◽  
pp. jrheum.210588
Author(s):  
Mikkel Faurschou ◽  
Lars H. Omland ◽  
Niels Obel ◽  
Jesper Lindhardsen ◽  
Bo Baslund
Keyword(s):  
Solid Tumors ◽  
Granulomatous Inflammation ◽  
Population Based ◽  
Risk Difference ◽  
Increased Risk ◽  
Incidence Functions ◽  
Risk Of Cancer ◽  
Population Controls

Objective To assess the long-term risk of hematologic cancers, invasive solid tumors, and nonmelanoma skin cancer (NMSC) among sarcoidosis patients with biopsy-verified non-necrotizing granulomatous inflammation. Methods We used Danish administrative registers with nationwide coverage to construct a cohort of 3892 sarcoidosis patients and an age- and gender-matched comparison cohort of 38.920 population-controls. For all patients, a biopsy demonstrating non-necrotizing granulomatous inflammation had been obtained from the lower respiratory tract at time of diagnosis. Study outcome was time to diagnosis of cancer. Follow-up began at time of sarcoidosis diagnosis and continued for up to 10 years. We calculated hazard ratios (HRs) as estimates of the cancer risk among the sarcoidosis patients relative to that among the population-controls and used cumulative incidence functions to calculate absolute 10-year risk estimates. Results We observed an increased long-term risk of hematologic cancers (HR during the first 2 years of follow-up: 2.71 (95% CI: 1.18-6.25); HR after >2 years of follow-up: 2.12 (95% CI: 1.29-3.47)) and NMSC (HR after >2 years of follow-up: 1.82 (95% CI: 1.43-2.32)) among the sarcoidosis patients. An increased risk of invasive solid tumors was only observed during the first 2 years (HR: 1.55 (95% CI: 1.18-2.04)). Compared with the population-controls, the sarcoidosis patients had an increased absolute 10-year risk of hematologic cancers (risk difference: 0.56% (95% CI: 0.11%-1.01%)) and NMSC (risk difference: 1.58% (95% CI: 0.70%-2.47%)). Conclusion Sarcoidosis patients with biopsy-verified non-necrotizing granulomatous inflammation have an increased long-term risk of hematologic cancers and NMSC compared with the general population.

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