Mixed Method Examination of the Brain Health of Former NCAA Division I Football Players and Former NFL Players

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S1.2-S1
Author(s):  
Samuel Fuller ◽  
Esha Jain ◽  
Newton Venkat Nagirimadugu ◽  
Robert W. Turner
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Return To School ◽  
Black Athletes ◽  
Symptom Resolution ◽  
Phone Calls ◽  
Sport Concussion ◽  
Television Time ◽  
Psychiatric Conditions ◽  
Specific Activities

ObjectiveYoung American athletes, at risk of sport-related concussion (SRC), represent many races; however, it is unknown how race influences the experience and outcome of SRC. Our objective was to compare White and Black athletes' recovery and subjective experiences after SRC.BackgroundNA.Design/MethodsA retrospective study was performed using the Vanderbilt Sport Concussion registry. Self-reported White (n = 211) and Black (n = 36) athletes (ages 12–23) treated for SRC between 2012 and 15 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data was collected by EMR review and phone calls to athletes and parents/guardians. The primary outcomes were: (1) days to symptom resolution (SR), (2) days to return-to-school, (3) changes in any daily activity (binary), (4) and sport behavior (binary). Secondary outcomes were changes in specific activities such as sleep, schoolwork, television time, as well as equipment (binary), playing style (more reckless, unchanged, less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards and logistic regression were performed.ResultsA retrospective study was performed using the Vanderbilt Sport Concussion registry. Self-reported White (n = 211) and Black (n = 36) athletes (ages 12–23) treated for SRC between 2012 and 15 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data was collected by EMR review and phone calls to athletes and parents/guardians. The primary outcomes were: (1) days to symptom resolution (SR), (2) days to return-to-school, (3) changes in any daily activity (binary), (4) and sport behavior (binary). Secondary outcomes were changes in specific activities such as sleep, schoolwork, television time, as well as equipment (binary), playing style (more reckless, unchanged, less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards and logistic regression were performed.ConclusionsRacial differences appear to exist in the outcomes and experience of SRC for young athletes, as Black athletes reached symptom resolution and return-to-school sooner than White athletes. Race should be considered as an important social determinant in SRC treatment.

Exploring the Outcomes and Experiences of Black and White Athletes Following a Sport-Related Concussion: A Retrospective Cohort Study

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S3.1-S3
Author(s):  
Viviana Jimenez ◽  
Aaron Yengo-Kahn ◽  
Jessica Wallace ◽  
Douglas Totten ◽  
Christopher Bonfield ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Return To School ◽  
Black Athletes ◽  
Symptom Resolution ◽  
Phone Calls ◽  
Sport Concussion ◽  
Television Time ◽  
Psychiatric Conditions ◽  
Specific Activities

ObjectiveYoung American athletes, at risk of sport-related concussion (SRC), represent many races, however, it is unknown how race influences the experience and outcome of SRC. Our objective was to compare White and Black athletes' recovery and subjective experiences after SRC.BackgroundNA.Design/MethodsA retrospective study was performed using the Vanderbilt Sport Concussion registry. Self-reported White (n = 211) and Black (n = 36) athletes (ages 12–23) treated for SRC between 2012 and 15 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data was collected by EMR review and phone calls to athletes and parents/guardians. The primary outcomes were: (1) days to symptom resolution (SR), (2) days to return-to-school, (3) changes in any daily activity (binary), (4) and sport behavior (binary). Secondary outcomes were changes in specific activities such as sleep, schoolwork, television time, as well as equipment (binary), playing style (more reckless, unchanged, less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards and logistic regression were performed.ResultsA retrospective study was performed using the Vanderbilt Sport Concussion registry. Self-reported White (n = 211) and Black (n = 36) athletes (ages 12–23) treated for SRC between 2012 and 15 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data was collected by EMR review and phone calls to athletes and parents/guardians. The primary outcomes were: (1) days to symptom resolution (SR), (2) days to return-to-school, (3) changes in any daily activity (binary), (4) and sport behavior (binary). Secondary outcomes were changes in specific activities such as sleep, schoolwork, television time, as well as equipment (binary), playing style (more reckless, unchanged, less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards and logistic regression were performed.ConclusionsRacial differences appear to exist in the outcomes and experience of SRC for young athletes, as Black athletes reached symptom resolution and return-to-school sooner than White athletes. Race should be considered as an important social determinant in SRC treatment.

scholarly journals Exploring the outcomes and experiences of Black and White athletes following a sport-related concussion: a retrospective cohort study

2021 ◽  
pp. 1-10
Author(s):  
Aaron M. Yengo-Kahn ◽  
Jessica Wallace ◽  
Viviana Jimenez ◽  
Douglas J. Totten ◽  
Christopher M. Bonfield ◽  
...  
Keyword(s):  
Racial Differences ◽  
Daily Activity ◽  
Social Determinant ◽  
Cox Proportional Hazards ◽  
Return To School ◽  
Median Income ◽  
Black Athletes ◽  
Young Athletes ◽  
Phone Calls ◽  
White Athletes

OBJECTIVE Young American athletes, at risk of sport-related concussion (SRC), represent many races; however, it is unknown how race may influence the experience and outcome of SRC. The authors’ objective was to compare White and Black athletes’ recovery and subjective experiences after SRC. METHODS A retrospective study was performed using the Vanderbilt Sports Concussion registry. Self-reported White and Black young athletes (ages 12–23 years) who had been treated for SRC between 2012 and 2015 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data were collected by electronic medical record review and phone calls to athletes and parents or guardians. The primary outcomes were as follows: 1) days to symptom resolution (SR), 2) days to return to school, and changes in 3) any daily activity (binary) and 4) sport behavior (binary). Secondary outcomes were changes (more, unchanged, or less) in specific activities such as sleep, schoolwork, and television time, as well as equipment (binary) or playing style (more reckless, unchanged, or less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards models, and logistic regression were performed. RESULTS The final cohort included 247 student-athletes (36 Black, 211 White). Black athletes were male (78% vs 58%) more often than White athletes, but both races were similar in age, sport, and medical/family histories. Black athletes more frequently had public insurance (33.3% vs 5.7%) and lived in areas with a low median income (41.2% vs 26.6%). After adjusting for age, sex, concussion history, insurance status, and zip code median income, Black athletes reached an asymptomatic status (HR 1.497, 95% CI 1.014–2.209, p = 0.042) and returned to school earlier (HR 1.522, 95% CI 1.020–2.270, p = 0.040). Black athletes were less likely to report a change in any daily activity than White athletes (OR 0.368, 95% CI 0.136–0.996, p = 0.049). Changes in sport behavior were comparable between the groups. CONCLUSIONS Racial differences appear to exist in the outcomes and experience of SRC for young athletes, as Black athletes reached SR and return to school sooner than White athletes. Race should be considered as an important social determinant in SRC treatment.

scholarly journals CLINICAL PREDICTORS OF SYMPTOM RESOLUTION FOR CHILDREN AND ADOLESCENTS WITH SPORT-RELATED CONCUSSION

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0000
Author(s):  
David R. Howell ◽  
Morgan N. Potter ◽  
Michael W. Kirkwood ◽  
Pamela E. Wilson ◽  
Aaron Provance ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Outcome Variable ◽  
Symptom Duration ◽  
Symptom Resolution ◽  
Gaze Stability ◽  
Headache Severity ◽  
Romberg Test ◽  
Tandem Gait

Background: Early prognosis of expected recovery duration after a sport-related concussion is a challenging task for sports medicine clinicians, as various pre-morbid, injury characteristic, and functional factors have been identified to help predict recovery. The purpose of this investigation was to determine which variables obtained as a part of a routine concussion clinical evaluation were independently associated with symptom resolution time among pediatric patients evaluated after sport-related concussion by a sports medicine physician. Methods: We conducted an analysis of data collected from a prospective clinical registry of children with concussion. Patients included in the current investigation were seen for care at a pediatric sports medicine concussion clinic between January 1, 2015 to August 31, 2017, were less than 19 years of age, evaluated within 10 days of a sport-related concussion, and followed until they no longer reported symptoms. The primary outcome variable was the number of days from injury until symptom resolution. The predictor variables included those assessed during the initial clinical evaluation. They were obtained via a medical history form (pre-injury history of attention-deficit/hyperactivity disorder, learning disability, anxiety, depression, and migraine or headaches), the Health and Behavior Inventory (HBI) symptom frequency questionnaire, headache severity rating (rated on a scale from 0-10), sleep disturbance questionnaire, and performance on a set of balance, vestibular, and oculomotor function tests (Balance Error Scoring System, Romberg, tandem gait, gaze stability, and near point of convergence). Tests were considered abnormal if patients could not maintain balance or demonstrated exaggerated upper body movement (Romberg/tandem gait tests), if they reported symptom provocation after test administration (gaze stability), or if the near point of convergence was greater than 5 cm from the tip of the nose. To identify the independent factors associated with symptom resolution time, we first constructed univariate Cox proportional models with time to symptom resolution as the outcome and each clinical variable as a separate predictor variable. Predictor variables with a univariate significance level of p < 0.05 were then used to construct a multivariate Cox proportional hazards model where total duration of concussion symptoms remained the outcome variable. Results: We examined data from 351 children and adolescents (mean age= 14.6±2.2 years, 33% female, evaluated 5.6±2.6 days after concussion) who required a median of 11.5 [interquartile range= 7-21] days for symptom resolution. One hundred and sixty-three (46%) of patients reported a prior history of concussion, while other pre-injury health conditions were reported less often (Table 1). The most commonly endorsed symptoms by patients at the initial visit were headaches, difficulty paying attention, difficulty concentrating, and getting distracted easily (Table 2). The most common abnormal vestibular or oculomotor test was symptom provocation brought on by gaze stability testing, while 20% of patients had an abnormal Romberg test, 15% demonstrated abnormal tandem gait, and 15% had abnormal near point of convergence (Table 3). Results from univariate Cox proportional hazards models indicated headache severity, headache frequency, confusion, forgetfulness, attentional difficulties, trouble remembering, getting tired often, getting tired easily, dizziness, and an abnormal Romberg test were associated with a longer symptom duration (Tables 2 and 3). The multivariate Cox proportional hazard model indicated that an abnormal Romberg test was independently associated with a longer symptom duration after adjusting for the effect of all other covariates included in the model (Table 4 and Figure 1). Headache frequency and “being tired easily” were not included in the final model due to collinearity with headache severity and “being tired a lot”, respectively. Conclusions: For adolescent and child patients assessed within 10 days of concussion, an abnormal Romberg test was independently associated with longer symptom duration during recovery. This is in line with other recent studies investigating early predictors of symptom resolution, demonstrating that postural instability appears to provide valuable prognostic information for sports medicine clinicians. [Table: see text]

scholarly journals Factors that Influence the Duration of Symptom Resolution in COVID-19 Patients in Ethiopia: A Follow up Study Involving 60 Symptomatic Cases.

2021 ◽  
Author(s):  
Saro Abrahim ◽  
Masresha Tesema ◽  
Eshetu Ejeta ◽  
Mahammed Ahmed ◽  
Atkure Defar ◽  
...  
Keyword(s):  
Median Duration ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Signs And Symptoms ◽  
Cox Proportional Hazards ◽  
Treatment Center ◽  
Symptom Resolution ◽  
Proportional Hazards Regression ◽  
Study Participants

Abstract Background: The newly identified virus, Severe Acute Respiratory Syndrome Corona Virus-two (SARS-CoV-2) has claimed more than a million lives worldwide since it was first recognized in Wuhan, China in December 2019. Understanding the clinical features of COVID-19 and duration for resolution of symptoms is crucial for isolation of patients and tailoring public health messaging, interventions, and policy. Therefore, this study aims to assess the median duration of COVID-19 signs and symptoms resolution and explore it’s predictors among symptomatic COVID-19 patients in EthiopiaMethods: A hospital-based prospective cohort study involving 60 COVID-19 cases was conducted at Eka Kotebe General Hospital, COVID-19 Isolation and Treatment Center. The study participants were all symptomatic COVID-19 adult patients admitted to the hospital from March 18 to June 27, 2020. Physicians at the center recorded the data using a log sheet. Cox proportional-hazards regression model was conducted. Statistical significance was defined at P<0.05. All analyses were done using STATA version 16.1 software.Results: A total of 60 symptomatic COVID-19 patients with a mean age of 34.8 years (+1.8) were involved in the study. The median duration of symptom resolution of COVID-19 was seven days with a minimum of two and a maximum of 68 days. Sex and Body Mass Index (BMI) were statistically significant predictors of the symptom resolution. The hazard of having delayed sign or symptom resolution in males was 55% higher than in females (P=0.039, CI: 0.22 to 0.96) and the hazard of the delayed sign or symptom in those with BMI ≥25 was 48% higher than in those with BMI <25 (P=0.051; CI: 0.272 to 1.003). In this study, age and comorbidity had no association with the duration of sign or symptom resolution in COVID-19 patients.Conclusions: The median duration of COVID-19 symptom resolution was seven days. Being male or having a BMI ≥ 25 were predictors for having a delayed sign or symptom resolution time. Therefore, understanding the duration of COVID-19 sign or symptom resolution helps to guide the patient isolation period and prioritize COVID-19 patients to be shielded.

scholarly journals Clinical predictors of symptom resolution for children and adolescents with sport-related concussion

2019 ◽  
Vol 24 (1) ◽  
pp. 54-61 ◽  
Author(s):  
David R. Howell ◽  
Morgan N. Potter ◽  
Michael W. Kirkwood ◽  
Pamela E. Wilson ◽  
Aaron J. Provance ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Outcome Variable ◽  
Duration Of Symptoms ◽  
Symptom Resolution ◽  
Hazards Model ◽  
Romberg Test ◽  
Abnormal Performance

OBJECTIVEThe goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients.METHODSData collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable.RESULTSThe sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85–0.96]), headache frequency (HR 0.83 [95% CI 0.71–0.96]), confusion (HR 0.79 [95% CI 0.69–0.92]), forgetfulness (HR 0.79 [95% CI 0.68–0.92]), attention difficulties (HR 0.83 [95% CI 0.72–0.96]), trouble remembering (HR 0.84 [95% CI 0.72–0.98]), getting tired often (HR 0.86 [95% CI 0.76–0.97]), getting tired easily (HR 0.86 [95% CI 0.76–0.98]), dizziness (HR 0.86 [95% CI 0.75–0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40–0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44–0.98]; p = 0.038).CONCLUSIONSFor children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.

scholarly journals Factors that influence the duration of symptom resolution in COVID-19 patients in Ethiopia: A follow up study involving 60 symptomatic cases. 

2020 ◽  
Author(s):  
Saro Abdella Abrahim ◽  
Masresha Tessema ◽  
Eshetu Ejeta ◽  
Mahammed Ahmed ◽  
Atkure Defar ◽  
...  
Keyword(s):  
Median Duration ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Signs And Symptoms ◽  
Cox Proportional Hazards ◽  
Treatment Center ◽  
Symptom Resolution ◽  
Proportional Hazards Regression ◽  
Study Participants

Abstract Background: The newly identified virus, Severe Acute Respiratory Syndrome Corona Virus-two (SARS-CoV-2) has claimed more than a million lives worldwide since it was first recognized in Wuhan, China in December 2019. Understanding the clinical features of COVID-19 and duration for resolution of symptoms is crucial for isolation of patients and tailoring public health messaging, interventions, and policy. Therefore, this study aims to assess the median duration of COVID-19 signs and symptoms resolution and explore it’s predictors among symptomatic COVID-19 patients in EthiopiaMethods: A hospital-based prospective cohort study involving 60 COVID-19 cases was conducted at Eka Kotebe General Hospital, COVID-19 Isolation and Treatment Center. The study participants were all symptomatic COVID-19 adult patients admitted to the hospital from March 18 to June 27, 2020. Physicians at the center recorded the data using a log sheet. Cox proportional-hazards regression model was conducted. Statistical significance was defined at P<0.05. All analyses were done using STATA version 16.1 software.Results: A total of 60 symptomatic COVID-19 patients with a mean age of 34.8 years (+1.8) were involved in the study. The median duration of symptom resolution of COVID-19 was seven days with a minimum of two and a maximum of 68 days. Sex and Body Mass Index (BMI) were statistically significant predictors of the symptom resolution. The hazard of having delayed sign or symptom resolution in males was 55% higher than in females (P=0.039, CI: 0.22 to 0.96) and the hazard of the delayed sign or symptom in those with BMI ≥25 was 48% higher than in those with BMI <25 (P=0.051; CI: 0.272 to 1.003). In this study, age and comorbidity had no association with the duration of sign or symptom resolution in COVID-19 patients.Conclusions: The median duration of COVID-19 symptom resolution was seven days. Being male or having a BMI ≥ 25 were predictors for having a delayed sign or symptom resolution time. Therefore, understanding the duration of COVID-19 sign or symptom resolution helps to guide the patient isolation period and prioritize COVID-19 patients to be shielded.

Abstract 15644: Proinflammatory Diet Independently Predicts Shorter Event-free Survival in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Junghee Kang ◽  
Debra K Moser ◽  
Martha J Biddle ◽  
Terry A Lennie
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Enzyme Inhibitor ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Event Free Survival ◽  
Free Survival ◽  
Phone Calls

Introduction: Inflammation is a common biological process accompanying chronic conditions, such as heart failure (HF) that can be moderated by diet. The association between foods thought to promote inflammation and event-free survival in patients with HF has not been investigated. Hypothesis: The inflammatory potential of individuals’ diets, measured using the dietary inflammatory index (DII), will be associated with event-free survival in patients with HF. Methods: The DII scores were calculated from 4-day food diaries recorded at baseline by 213 patients with HF (age 61±12years, 35% female, 43% NYHA III/IV). Patients were followed for a median of 365 days by monthly phone calls, medical record review, and death records to determine time to all cause-hospitalization or death. The DII scores were dichotomized using median value for the Cox regression model. Hierarchical multivariate Cox proportional hazards model was used to determine whether DII scores predicted event-free survival after controlling for age, gender, body mass index, prescribed angiotensin-converting-enzyme inhibitor, beta-blocker, cholesterol lowering agent, antiinflammatory agent, N-terminal pro B-type natriuretic peptide, comorbidity, depressive symptoms, and the New York Heart Association functional classification. Results: The DII scores independently predicted event-free survival in the model constant ( p = 0.012). Higher DII scores were associated with more than double the risk of an event compared to lower DII scores (HR: 2.28, 95% Confidence Interval =1.21-4.36). Conclusions: Greater intake of foods considered to promote inflammation was associated with shorter event-free survival in patients with HF. These results provide further evidence of the importance of diet to HF outcomes.

scholarly journals Clinical Predictors of Mortality in Adults with Intellectual Disabilities with and without Down Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Lilian Thorpe ◽  
Punam Pahwa ◽  
Vernon Bennett ◽  
Andrew Kirk ◽  
Josephine Nanson
Keyword(s):  
Down Syndrome ◽  
Intellectual Disabilities ◽  
Cognitive Abilities ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Clinical Predictors ◽  
Phone Calls ◽  
Modifiable Factors ◽  
Adults With Intellectual Disabilities

Background.Mood, baseline functioning, and cognitive abilities as well as psychotropic medications may contribute to mortality in adults with and without Down Syndrome (DS).Methods.Population-based (nonclinical), community-dwelling adults with intellectual disabilities (IDs) were recruited between 1995 and 2000, assessed individually for 1–4 times, and then followed by yearly phone calls.Results.360 participants (116 with DS and 244 without DS) were followed for an average of 12.9 years (range 0–16.1 years as of July 2011). 108 people died during the course of the followup, 65 males (31.9% of all male participants) and 43 females (27.6% of all female participants). Cox proportional hazards modeling showed that baseline practical skills, seizures, anticonvulsant use, depressive symptoms, and cognitive decline over the first six years all significantly contributed to mortality, as did a diagnosis of DS, male gender, and higher age at study entry. Analysis stratified by DS showed interesting differences in mortality predictors.Conclusion.Although adults with DS have had considerable improvements in life expectancy over time, they are still disadvantaged compared to adults with ID without DS. Recognition of potentially modifiable factors such as depression may decrease this risk.

Age at Exposure to Parental Suicide and the Subsequent Risk of Suicide in Young People

Crisis ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 27-36 ◽  
Author(s):  
Kuan-Ying Lee ◽  
Chung-Yi Li ◽  
Kun-Chia Chang ◽  
Tsung-Hsueh Lu ◽  
Ying-Yeh Chen
Keyword(s):  
Young People ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Birth Registry ◽  
Data Set ◽  
Parental Suicide ◽  
The Impact ◽  
Age At Exposure

Abstract. Background: We investigated the age at exposure to parental suicide and the risk of subsequent suicide completion in young people. The impact of parental and offspring sex was also examined. Method: Using a cohort study design, we linked Taiwan's Birth Registry (1978–1997) with Taiwan's Death Registry (1985–2009) and identified 40,249 children who had experienced maternal suicide (n = 14,431), paternal suicide (n = 26,887), or the suicide of both parents (n = 281). Each exposed child was matched to 10 children of the same sex and birth year whose parents were still alive. This yielded a total of 398,081 children for our non-exposed cohort. A Cox proportional hazards model was used to compare the suicide risk of the exposed and non-exposed groups. Results: Compared with the non-exposed group, offspring who were exposed to parental suicide were 3.91 times (95% confidence interval [CI] = 3.10–4.92 more likely to die by suicide after adjusting for baseline characteristics. The risk of suicide seemed to be lower in older male offspring (HR = 3.94, 95% CI = 2.57–6.06), but higher in older female offspring (HR = 5.30, 95% CI = 3.05–9.22). Stratified analyses based on parental sex revealed similar patterns as the combined analysis. Limitations: As only register-­based data were used, we were not able to explore the impact of variables not contained in the data set, such as the role of mental illness. Conclusion: Our findings suggest a prominent elevation in the risk of suicide among offspring who lost their parents to suicide. The risk elevation differed according to the sex of the afflicted offspring as well as to their age at exposure.

Proliferation-dominant high-grade astrocytoma: survival benefit associated with extensive resection of FLAIR abnormality region

2020 ◽  
Vol 132 (4) ◽  
pp. 998-1005 ◽  
Author(s):  
Haihui Jiang ◽  
Yong Cui ◽  
Xiang Liu ◽  
Xiaohui Ren ◽  
Mingxiao Li ◽  
...  
Keyword(s):  
Survival Benefit ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Characteristic Curve ◽  
Extent Of Resection ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
High Grade ◽  
Extensive Resection ◽  
High Grade Astrocytoma

OBJECTIVEThe aim of this study was to investigate the relationship between extent of resection (EOR) and survival in terms of clinical, molecular, and radiological factors in high-grade astrocytoma (HGA).METHODSClinical and radiological data from 585 cases of molecularly defined HGA were reviewed. In each case, the EOR was evaluated twice: once according to contrast-enhanced T1-weighted images (CE-T1WI) and once according to fluid attenuated inversion recovery (FLAIR) images. The ratio of the volume of the region of abnormality in CE-T1WI to that in FLAIR images (VFLAIR/VCE-T1WI) was calculated and a receiver operating characteristic curve was used to determine the optimal cutoff value for that ratio. Univariate and multivariate analyses were performed to identify the prognostic value of each factor.RESULTSBoth the EOR evaluated from CE-T1WI and the EOR evaluated from FLAIR could divide the whole cohort into 4 subgroups with different survival outcomes (p < 0.001). Cases were stratified into 2 subtypes based on VFLAIR/VCE-T1WIwith a cutoff of 10: a proliferation-dominant subtype and a diffusion-dominant subtype. Kaplan-Meier analysis showed a significant survival advantage for the proliferation-dominant subtype (p < 0.0001). The prognostic implication has been further confirmed in the Cox proportional hazards model (HR 1.105, 95% CI 1.078–1.134, p < 0.0001). The survival of patients with proliferation-dominant HGA was significantly prolonged in association with extensive resection of the FLAIR abnormality region beyond contrast-enhancing tumor (p = 0.03), while no survival benefit was observed in association with the extensive resection in the diffusion-dominant subtype (p=0.86).CONCLUSIONSVFLAIR/VCE-T1WIis an important classifier that could divide the HGA into 2 subtypes with distinct invasive features. Patients with proliferation-dominant HGA can benefit from extensive resection of the FLAIR abnormality region, which provides the theoretical basis for a personalized resection strategy.

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