Family history increases the risk of late seizures after stroke

ObjectiveTo assess the association between a family history of epilepsy and risk of late poststroke seizures (LPS).MethodsThis register-based cohort study was based on adult patients from the Swedish Stroke Register (Riksstroke) with stroke from 2001 to 2012 and no prior epilepsy. LPS (>7 days after stroke) and epilepsy were ascertained in cases and in their first-degree biological relatives by cross-referencing Riksstroke, the Multi-Generation Register, and the National Patient Register.ResultsOf 86,550 patients with stroke, a family history of epilepsy was detected in 7,433 (8.6%), and LPS (>7 days after stroke) occurred in 7,307 (8.4%). The survival-adjusted risk of LPS was higher in patients with compared to those without a family history of epilepsy: 6.8% (95% confidence interval [CI] 6.2%–7.4%) vs 5.9% (95% CI 5.7%–6.1%) at 2 years and 9.5% (95% CI 8.7%–10.3%) vs 8.2% (95% CI 8.0%–8.4%) at 5 years. In a Cox model adjusted for age, sex, and stroke type, the hazard ratio (HR) for LPS in patients with stroke with ≥1 relative with epilepsy was 1.18 (95% CI 1.09–1.28). The increased HR remained significant with adjustments for stroke severity and in multiple sensitivity analyses. A higher risk for patients with stroke with >1 relative with epilepsy was also seen but was not significant in all Cox models.ConclusionsAlthough stroke characteristics remain the most important risk factors for LPS, having a first-degree relative with epilepsy also increases the risk in a multivariate analysis. The findings highlight the need for family history assessment in patients with stroke and the need for future studies on genetic vulnerability and environmental factors that may aid in the identification of at-risk individuals.

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A Group Therapy Approach to Facilitate Integration of Risk Information for Women at Risk for Breast Cancer

The Canadian Journal of Psychiatry ◽

10.1177/070674379804300405 ◽

1998 ◽

Vol 43 (4) ◽

pp. 375-380 ◽

Cited By ~ 17

Author(s):

Mary Jane Esplen ◽

Brenda Toner ◽

Jonathan Hunter ◽

Gordon Glendon ◽

Kate Butler ◽

...

Keyword(s):

Breast Cancer ◽

At Risk ◽

Family History ◽

Group Therapy ◽

Perceived Risk ◽

Positive Family History ◽

Risk Information ◽

Degree Relative ◽

Therapy Approach ◽

History Of

Objective: To describe and illustrate elements of a group counselling approach designed to enhance the communication of risk information on breast cancer (BC) to women with a family history of this disease. Breast cancer is a leading cause of female cancer death. The most important risk factor for BC is a positive family history in at least 1 first-degree relative, and approximately one-third of women with BC have a family history of the disease. Recent evidence suggests that there is a significant psychological impact associated with having a family history of BC, and this may influence the psychological adjustment and response to being counselled for personal risk. New counselling approaches are required. Method: This paper describes a group therapy approach that incorporates principles of supportive-expressive therapy designed to address the emotional impact of being at risk for BC and to promote accuracy of perceived risk. The key elements of the intervention are described along with clinical illustrations from groups that are part of an ongoing study to develop and standardize the group therapy. Conclusion: Qualitative data from the groups suggest that this model of therapy is both feasible and effective.

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Family history of prostate cancer in patients with localized prostate cancer: an independent predictor of treatment outcome.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.4.1478 ◽

1997 ◽

Vol 15 (4) ◽

pp. 1478-1480 ◽

Cited By ~ 69

Author(s):

P A Kupelian ◽

V A Kupelian ◽

J S Witte ◽

R Macklis ◽

E A Klein

Keyword(s):

Prostate Cancer ◽

Treatment Outcome ◽

Family History ◽

Treatment Modality ◽

Proportional Hazards ◽

Positive Family History ◽

Specific Antigen ◽

Tumor Stage ◽

Degree Relative ◽

History Of

PURPOSE To determine if familial prostate cancer patients have a less favorable prognosis than patients with sporadic prostate cancer after treatment for localized disease with either radiotherapy (RT) or radical prostatectomy (RP). PATIENTS AND METHODS One thousand thirty-eight patients treated with either RT (n = 583) or RP (n = 455) were included in this analysis. These patients were noted as having a positive family history if they confirmed the diagnosis of prostate cancer in a first-degree relative. The outcome of interest was biochemical relapse-free survival (bRFS). We used proportional hazards to analyze the effect of the presence of family history and other potential confounding variables (ie, age, treatment modality, stage, biopsy Gleason sum [GS], and initial prostate-specific antigen [iPSA] levels) on treatment outcome. RESULTS Eleven percent of all patients had a positive family history. The 5-year bRFS rates for patients with negative and positive family histories were 52% and 29%, respectively (P < .001). The potential confounders with bRFS rates were iPSA levels, biopsy GS, and clinical tumor stage; treatment modality and age did not appear to be associated with outcome. After adjusting for potential confounders, family history of prostate cancer remained strongly associated with biochemical failure. CONCLUSION This is the first study to demonstrate that the presence of a family history of prostate cancer correlates with treatment outcome in a large unselected series of patients. Our findings suggest that familial prostate cancer may have a more aggressive course than nonfamilial prostate cancer, and that clinical and/or pathologic parameters may not adequately predict this course.

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Does a family history of RA influence the clinical presentation and treatment response in RA?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-207670 ◽

2015 ◽

Vol 75 (6) ◽

pp. 1120-1125 ◽

Cited By ~ 6

Author(s):

Thomas Frisell ◽

Saedis Saevarsdottir ◽

Johan Askling

Keyword(s):

Family History ◽

Disease Activity ◽

Treatment Response ◽

Clinical Presentation ◽

Degree Relative ◽

Eular Response ◽

Logistic Regression Models ◽

Drug Survival ◽

Early Ra ◽

History Of

ObjectivesTo assess whether family history of rheumatoid arthritis (RA), among the strongest risk factors for developing RA, also carries information on the clinical presentation and treatment response.MethodsThe prospective Swedish Rheumatology register was linked to family history of RA, defined as diagnosed RA in any first-degree relative, ascertained through the Swedish Multi-Generation and Patient registers. Clinical presentation was examined among patients with early RA 2000–2011 (symptom onset <12 months before inclusion, N=6869), and response to methotrexate (MTX) monotherapy in the subset starting this treatment (N=4630). Response to tumour necrosis factor inhibitors (TNFi) was examined among all patients with RA starting a TNFi as the first biological disease-modifying antirheumatic drug 2000–2011 (N=9249). Association of family history with clinical characteristics, drug survival, European League Against Rheumatism (EULAR) response and change in disease activity at 3 and 6 months was estimated using linear and generalised logistic regression models. Correlation in relatives’ response measures was also assessed.ResultsPatients with early RA with family history of RA were more often rheumatoid factor positive, but with no other clinically meaningful differences in their clinical presentation. Family history of RA did not predict response to MTX or TNFi, with the possible exception of no versus good EULAR response to TNFi at 6 months (OR=1.4, 95% CI 1.1 to 1.7). Having a relative who discontinued TNFi within a year increased the odds of doing the same (OR=3.7, 95% CI 1.8 to 7.5), although we found no significant familial correlations in change in disease activity measures.ConclusionsFamily history of RA did not modify the clinical presentation of RA or predict response to standard treatment with MTX or TNFi. Treatment response, particularly drug survival, may itself be familial.

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Incidence of Mitral Valve Prolapse in Adolescent Scoliosis and Thoracic Hypokyphosis

PEDIATRICS ◽

10.1542/peds.70.3.451 ◽

1982 ◽

Vol 70 (3) ◽

pp. 451-454

Author(s):

Stephen S. Hirschfeld ◽

Charles Rudner ◽

Clyde L. Nash ◽

Eliezer Nussbaum ◽

Eleanor M. Brower

Keyword(s):

Family History ◽

Mitral Valve ◽

Mitral Valve Prolapse ◽

Soft Tissue Defect ◽

Skeletal Abnormality ◽

Degree Relative ◽

Familial History ◽

High Incidence ◽

History Of ◽

Echocardiographic Evidence

Seventy-four patients with adolescent scoliosis underwent cardiac examination and M-mode echocardiography to detect the presence of mitral valve prolapse (MVP). Twenty-one (28%) had echocardiographic evidence of MVP, whereas 18 had auscultatory findings of a nonejection click or late systolic murmur. A subset of 41 patients had a family history of scoliosis and 37% had MVP. The incidence of MVP increased to 41% when a first degree relative, such as a sibling, parent, or offspring, had scoliosis. Thirty-six patients with scoliosis had additional thoracic hypokyphosis (straight back) and 13 (36%) had MVP. The incidence of MVP was 48% when the scoliosis and hypokyphosis were hereditary and increased to 53% when a familial history of skeletal abnormality was present. This study indicates a high incidence of MVP in patients with scoliosis and hypokyphosis, especially when the skeletal abnormality is familial. It suggests that the cardiac and skeletal systems may be affected by a generalized soft-tissue defect.

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Development of a questionnaire to identify persons with a family history of aneurysmal subarachnoid hemorrhage

International Journal of Stroke ◽

10.1177/17474930211069004 ◽

2022 ◽

pp. 174749302110690

Author(s):

Charlotte CM Zuurbier ◽

Jacoba P Greving ◽

Gabriel JE Rinkel ◽

Ynte M Ruigrok

Keyword(s):

Subarachnoid Hemorrhage ◽

Family History ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Positive Family History ◽

Stroke Patients ◽

Degree Relative ◽

First Degree Relatives ◽

Family History Questionnaire ◽

Affected Relative ◽

History Of

Background: Preventive screening for intracranial aneurysms is effective in persons with a positive family history of aneurysmal subarachnoid hemorrhage (aSAH), but for many relatives of aSAH patients, it can be difficult to assess whether their relative had an aSAH or another type of stroke. Aim: We aimed to develop a family history questionnaire for people in the population who believe they have a first-degree relative who had a stroke and to assess its accuracy to identify relatives of aSAH patients. Methods: A questionnaire to distinguish between aSAH and other stroke types (ischemic stroke and intracerebral hemorrhage) was developed by a team of clinicians and consumers. The level of agreement between the questionnaire outcome and medical diagnosis was pilot tested in 30 previously admitted aSAH patients. Next, the sensitivity and specificity of the questionnaire were assessed in 91 first-degree relatives (siblings/children) of previously admitted stroke patients. Results: All 30 aSAH patients were identified by the questionnaire in the pilot study; 29 of 30 first-degree relatives of aSAH patients were correctly identified. The questionnaire had a sensitivity of 97% (95% confidence interval (CI) = 83–100%) and a specificity of 93% (95% CI = 84–98%) when tested in the first-degree relatives of stroke patients. Conclusion: Our questionnaire can help persons to discriminate an aSAH from other types of stroke in their affected relative. This family history questionnaire is developed in the Netherlands but could also be used in other countries after validation.

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Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden

BMC Medicine ◽

10.1186/s12916-020-1498-z ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 9

Author(s):

Louise Lindberg ◽

Emilia Hagman ◽

Pernilla Danielsson ◽

Claude Marcus ◽

Martina Persson

Keyword(s):

Risk Factors ◽

Family History ◽

General Population ◽

Children And Adolescents ◽

Neuropsychiatric Disorders ◽

Obesity Treatment ◽

Sensitivity Analyses ◽

Anxiety And Depression ◽

History Of ◽

Anxiety Depression

Abstract Background Anxiety and depression are more common in children with obesity than in children of normal weight, but it is unclear whether this association is independent of other known risk factors. Interpretation of results from previous studies is hampered by methodological limitations, including self-reported assessment of anxiety, depression, and anthropometry. The aim of this study was to investigate whether obesity increases the risk of anxiety or depression independently of other risk factors in a large cohort of children and adolescents, using robust measures with regard to exposure and outcome. Methods Children aged 6–17 years in the Swedish Childhood Obesity Treatment Register (BORIS, 2005–2015) were included (n = 12,507) and compared with a matched group (sex, year of birth, and area of residence) from the general population (n = 60,063). The main outcome was a diagnosis of anxiety or depression identified through ICD codes or dispensed prescribed medication within 3 years after the end of obesity treatment. Hazard ratios (HRs) with 95% confidence intervals (CIs) from Cox proportional models were adjusted for several known confounders. Results Obesity remained a significant risk factor for anxiety and depression in children and adolescents after adjusting for Nordic background, neuropsychiatric disorders, family history of anxiety/depression, and socioeconomic status. Girls in the obesity cohort had a 43% higher risk of anxiety and depression compared to girls in the general population (adjusted HR 1.43, 95% CI 1.31–1.57; p < 0.0001). The risk in boys with obesity was similar (adjusted HR 1.33, 95% CI 1.20–1.48; p < 0.0001). In sensitivity analyses, excluding subjects with neuropsychiatric disorders and a family history of anxiety/depression, the estimated risks in individuals with obesity were even higher compared with results from the main analyses (adjusted HR [95% CI]: girls = 1.56 [1.31–1.87], boys = 2.04 [1.64–2.54]). Conclusions Results from this study support the hypothesis that obesity per se is associated with risk of both anxiety and depression in children and adolescents.

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22-year longitudinal study of repetitive colonoscopy in patients with a family history of colorectal cancer

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2013.95.8.586 ◽

2013 ◽

Vol 95 (8) ◽

pp. 586-590 ◽

Cited By ~ 1

Author(s):

JK Randall ◽

CS Good ◽

JM Gilbert

Keyword(s):

Colorectal Cancer ◽

Family History ◽

British Society ◽

Degree Relative ◽

Surveillance Programme ◽

Patients With Cancer ◽

Significant Pathology ◽

History Of

Introduction We report the outcomes of a long-term surveillance programme for individuals with a family history of colorectal cancer. Methods The details of patients undergoing a colonoscopy having been referred on the basis of family history of colorectal cancer were entered prospectively into a database. Further colonoscopy was arranged on the basis of the findings. The outcomes assessed included incidence of cancer and adenoma identification at initial and subsequent colonoscopy. Results The records of 2,293 patients (917 men; median patient age: 51 years) were entered over 22 years, giving data on 3,982 colonoscopies. Eight adverse events (0.2%) were recorded. Twenty-seven cancers were found at first colonoscopy and thirteen developed during the follow-up period. There were significantly more cancers identified in those with more than one first-degree relative with cancer than in other groups (p=0.01). The number of adenomas identified at subsequent surveillance colonoscopies remained constant with between 9.3% and 12.0% of patients having adenomas that were removed. Two-thirds (68%) of patients with cancer and three-quarters (77%) with adenomas fell outside the British Society of Gastroenterology (BSG) 2006 guidelines. Conclusions Repeated colonoscopy continues to yield significant pathology including new cancers. These continue to occur despite removal of adenomas at prior colonoscopies. The majority of patients with cancers and adenomas fell outside the BSG 2006 guidelines; more would have fallen outside the 2010 guidelines.

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Individual vulnerabilities to psychosis after antiepileptic drug administration

BMJ Neurology Open ◽

10.1136/bmjno-2019-000036 ◽

2020 ◽

Vol 2 (2) ◽

pp. e000036

Author(s):

Nozomi Akanuma ◽

Naoto Adachi ◽

Peter Fenwick ◽

Masumi Ito ◽

Mitsutoshi Okazaki ◽

...

Keyword(s):

Family History ◽

Focal Epilepsy ◽

Individual Characteristics ◽

New Drugs ◽

Individual Vulnerability ◽

Intellectual Function ◽

State Dependent ◽

History Of ◽

History Of Epilepsy ◽

The Individual

BackgroundPsychosis often develops after the administration of antiepileptic drugs (AEDs) in patients with epilepsy. However, the individual vulnerability and clinical condition of such patients have been rarely scrutinised. We investigated the effect of individually consistent (trait-dependent) and inconsistent (state-dependent) characteristics.MethodsThe individual characteristics, clinical states and psychotic outcome of patients from eight adult epilepsy clinics were retrospectively reviewed over 6-month periods after a new drug (AED or non-AED) administration between 1981 and 2015.ResultsA total of 5018 new drugs (4402 AEDs and 616 non-AEDs) were used in 2015 patients with focal epilepsy. Subsequently, 105 psychotic episodes (81 interictal and 24 postictal) occurred in 89 patients. Twelve patients exhibited multiple episodes after different AED administrations. Trait-dependent characteristics (early onset of epilepsy, known presumed causes of epilepsy, lower intellectual function and a family history of psychosis) were significantly associated with the patients who exhibited psychosis. Absence of family history of epilepsy was also associated with psychosis but not significantly. Subsequent logistic regression analysis with a model incorporating family history of psychosis and epilepsy, and intellectual function was the most appropriate (p=0.000). State-dependent characteristics, including previous psychotic history and epilepsy-related variables (longer duration of epilepsy, AED administration, higher seizure frequency and concomitant use of AEDs) were significantly associated with psychotic episodes. Subsequent analysis found that a model including AED administration and previous psychotic history was the most appropriate (p=0.000).ConclusionPsychosis occurring after new AED administration was related to the individual vulnerability to psychosis and intractability of epilepsy.

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Familial colorectal cancer risk in half siblings and siblings: nationwide cohort study

BMJ ◽

10.1136/bmj.l803 ◽

2019 ◽

pp. l803 ◽

Cited By ~ 6

Author(s):

Yu Tian ◽

Elham Kharazmi ◽

Kristina Sundquist ◽

Jan Sundquist ◽

Hermann Brenner ◽

...

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Family History ◽

Cancer Risk ◽

Confidence Interval ◽

Cumulative Risk ◽

Degree Relative ◽

History Of ◽

Half Sibling ◽

Second Degree

AbstractObjectiveTo explore the risk of colorectal cancer in family members of patients with colorectal cancer, with an emphasis on subtypes of second degree relatives, especially half siblings, which were lacking in the literature.DesignAmbidirectional cohort study.SettingNationwide Swedish Family Cancer Data (record linkage).ParticipantsAll people residing in Sweden and born after 1931, with their biological parents, totalling >16 million individuals (follow-up: 1958-2015); of those with clear genealogy, 173 796 developed colorectal cancer.Main outcome measuresLifetime (0-79 years) cumulative risk and standardised incidence ratio of colorectal cancer among first degree relatives and second degree relatives.ResultsThe overall lifetime cumulative risk of colorectal cancer in siblings of patients was 7%, which represents a 1.7-fold (95% confidence interval 1.6 to 1.7; n=2089) increase over the risk in those without any family history of colorectal cancer. A similarly increased lifetime cumulative risk (6%) was found among half siblings (standardised incidence ratio 1.5, 95% confidence interval 1.3 to 1.8; n=140). The risk in people with colorectal cancer in both a parent and a half sibling (standardised incidence ratio 3.6, 2.4 to 5.0; n=32) was close to the risk in those with both an affected parent and an affected sibling (2.7, 2.4 to 3.0; n=396). Family history of colorectal cancer in only one second degree relative other than a half sibling (without any affected first degree relatives), such as a grandparent, uncle, or aunt, showed minor association with the risk of colorectal cancer.ConclusionFamily history of colorectal cancer in half siblings is similarly associated with colorectal cancer risk to that in siblings. The increase in risk of colorectal cancer among people with one affected second degree relative was negligible, except for half siblings, but the risk was substantially increased for a combination of family history in one affected second degree relative and an affected first degree relative (or even another second degree relative). These evidence based findings provide novel information to help to identify people at high risk with a family history of colorectal cancer that can potentially be used for risk adapted screening.

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