Five-Minute Apgar Score and the Risk of Mental Disorders During the First Four Decades of Life: A Nationwide Registry-Based Cohort Study in Denmark

Objectives:The associations of long-term risks of the full spectrum of mental disorders with clinically reassuring but suboptimal score range 7–9 remain unclear. This study investigated these associations during up to 38 years of follow-up.Methods:In a nationwide cohort study of 2,213,822 singletons born in Denmark during 1978–2015, we used cox regression to estimate the hazard ratio (HR) of mental disorders with a 95% CI.Results:A total of 3,00,679 (13.6%) individuals were diagnosed with mental disorders. The associations between suboptimal Apgar score 7–9 and mental disorders differed by attained age. In childhood (≤ 18 years), declining Apgar scores were associated with increased risks of overall mental disorders with HRs (95% CI) of 1.13(1.11-1.15), 1.34 (1.27–1.41), and 1.48 (1.31–1.67) for Apgar scores of 7–9, 4–6, and 1–3, respectively, compared with a score of 10. A dose-response association was seen even within the score range from 9 to 7 (HR 1.11 [95% CI: 1.08–1.13], 1.14 [1.10–1.18], and 1.20 [1.14–1.27], respectively). Of note, individuals with scores of 7–9 had increased risks of organic disorders (HR: 1.27, 95% CI: 1.05–1.53), neurotic disorders (HR: 1.07, 95% CI: 1.03–1.11), and a wide range of neurodevelopmental disorders, such as intellectual disability (1.87, 1.76–1.98), childhood autism (1.13, 1.05–1.22) and attention deficit hyperactivity disorder (1.10, 1.06–1.15). In early adulthood (19–39 years), suboptimal Apgar scores 7–9 were not associated with the risks of overall and specific mental disorders.Conclusion:Infants born with clinically reassuring but suboptimal 5-min scores 7–9 are at increased risks of a wide spectrum of mental disorders in childhood.

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Does screening shorten delays to care for post-deployment mental disorders in military personnel? A longitudinal retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-037853 ◽

2020 ◽

Vol 10 (8) ◽

pp. e037853

Author(s):

David Boulos ◽

Bryan Garber

Keyword(s):

Mental Health ◽

Cohort Study ◽

Mental Disorders ◽

Mental Disorder ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Health Concern ◽

Military Population

ObjectiveTo determine whether post-deployment screening is associated with a shorter delay to diagnosis and care among individuals identified with a deployment-related mental disorder.DesignRetrospective cohort study.SettingCanadian military population.ParticipantsThe cohort consisted of personnel (n=28 460) with a deployment within the 2009 to 2014 time frame. A stratified random sample (n=3004) was selected for medical chart review. We restricted our analysis to individuals who had an opportunity to undergo screening and were subsequently diagnosed with a mental disorder that a clinician indicated was deployment-related (n=1157).InterventionsPost-deployment health screening.Main outcome measureThe outcome was delay to diagnosis and care, the latency from individuals’ deployment return to their mental disorder diagnosis date. Cox proportional hazards regression assessed screening’s influence on this outcome.Results74.4% of the study population had screened. Overall, the median delay to care was 766 days, 578 days among screeners and 928 days among non-screeners—a 350-day difference. Cox regression indicated that screeners had a significantly shorter delay to care (adjusted HR (aHR), 1.43 (95% CI, 1.11 to 1.86)). Screening findings had a substantial influence on delay to care. Identification of a mental health concern, whether a ‘major’ concern (aHR, 3.36 (95% CI, 2.38 to 4.73)) or a ‘minor’ concern (aHR, 1.46 (95% CI, 1.08 to 1.99)), and a recommendation for mental health services follow-up (aHR, 2.35 (95% CI, 1.73 to 3.21)) were strongly associated with shorter delays to care relative to non-screeners.ConclusionsReduced delays to care are anticipated to lead to beneficial outcomes for both the individual and military organisation. We found that screening was associated with a shortened delay to care for mental disorders that were deployment-related. Future work will further explore this screening’s components and optimisation strategies.

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Association of Mental Disorders in Early Adulthood and Later Psychiatric Hospital Admissions and Mortality in a Cohort Study of More Than 1 Million Men

Archives of General Psychiatry ◽

10.1001/archgenpsychiatry.2011.2000 ◽

2012 ◽

Vol 69 (8) ◽

pp. 823 ◽

Cited By ~ 42

Author(s):

Catharine R. Gale ◽

G. David Batty ◽

David P. J. Osborn ◽

Per Tynelius ◽

Elise Whitley ◽

...

Keyword(s):

Cohort Study ◽

Mental Disorders ◽

Psychiatric Hospital ◽

Hospital Admissions ◽

Early Adulthood

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Penggunaan Asthma Control Test (ACT) secara Mandiri oleh Pasien untuk Mendeteksi Perubahan Tingkat Kontrol Asmanya

Jurnal Kesehatan Andalas ◽

10.25077/jka.v3i3.194 ◽

2014 ◽

Vol 3 (3) ◽

Author(s):

Yessy Susanty Sabri ◽

Yusrizal Chan

Keyword(s):

Cohort Study ◽

Prior Knowledge ◽

Asthma Control ◽

Educational Level ◽

Wide Spectrum ◽

Control Test ◽

Study Analysis ◽

Asthma Control Test ◽

Wide Range ◽

Asthma Patients

AbstrakAsma adalah penyakit dengan spekrum gejala yang luas dan gejala yang sering dilaporkan pasien kepada dokter sangat beragam, tergantung dari persepsi masing-masing pasien. Pendekatan terbaru dalam penatalaksanaan pasien asma yaitu pasien dapat hidup bebas tanpa terganggu oleh gejala penyakitnya. Tujuan dari penelitian ini adalah untuk mengetahui efektifitas penggunaan ACT secara mandiri oleh pasien asma untuk mendeteksi perubahan tingkat kontrol asmanya. Metode yang digunakan adalah Studi Analisis kohort Prospektif. Didapatkan 32 orang pasien asma yang berobat ke poliklinik Paru RS M. Djamil Padang, yang bersedia ikut dalam penelitian ini. Efektifitas penggunaan ACT secara mandiri oleh pasien sebagai alat untuk mendeteksi perubahan tingkat kontrol asma, cukup efektif karena penilaian tingkat kontrol asma pasien sama dengan dokter yaitu 78,1%. Efektifitas ACT tidak berhubungan dengan tingkat pendidikan pasien, derajat keparahan asma, tingkat pengetahuan awal pasien terhadap penyakit asma serta lama menderita asma. Selama penelitian tidak ditemukan kejadian eksaserbasi pada pasien penelitian.Kata kunci: Asma, asma kontrol tesAbstractAsthma is a disease with wide spectrum symptoms and the patient's symptoms are often reported to doctors also with wide range of diversity, depending on the perception of each patient. New approaches in the management of asthma patients i.e. patients can live freely without being distracted by the symptoms of the disease. The purpose of this study was to determine the effectiveness of the use of ACT independently by asthma patients to detect changes in the level of asthma control. The method used was a prospective cohort study analysis. There were 32 asthma patients who went to the Lung polyclinic of M. Djamil Hospital Padang and were willing to participate in the study.Effective use of ACT independently by the patient as a tool to detect changes in the level of asthma control is quite effective in which the assessment level of asthma control between patient and the doctor is equal with the value 78.1%. The effectiveness of ACT is not related to the educational level of the patient, severity of asthma, the level of prior knowledge of the patients and the period of suffering asthma. During the study found no incidence of exacerbations in the patients.English, Arial 9 italicKeywords: asthma, asthma control test

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Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden

BMJ ◽

10.1136/bmj.l1656 ◽

2019 ◽

pp. l1656 ◽

Cited By ~ 12

Author(s):

Neda Razaz ◽

Sven Cnattingius ◽

KS Joseph

Keyword(s):

Cohort Study ◽

Confidence Interval ◽

Respiratory Distress ◽

Neonatal Mortality ◽

Apgar Score ◽

Population Based ◽

Neonatal Hypoglycaemia ◽

Neonatal Infections ◽

Apgar Scores ◽

Mortality And Morbidity

Abstract Objective To investigate associations between Apgar scores of 7, 8, and 9 (versus 10) at 1, 5, and 10 minutes, and neonatal mortality and morbidity. Design Population based cohort study. Setting Sweden. Participants 1 551 436 non-malformed live singleton infants, born at term (≥37 weeks’ gestation) between 1999 and 2016, with Apgar scores of ≥7 at 1, 5, and 10 minutes. Exposures Infants with Apgar scores of 7, 8, and 9 at 1, 5, and 10 minutes were compared with those with an Apgar score of 10 at 1, 5, and 10 minutes, respectively. Main outcome measures Neonatal mortality and morbidity, including neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia. Adjusted odds ratios (aOR), adjusted rate differences (aRD), and 95% confidence intervals were estimated. Results Compared with infants with an Apgar score of 10, aORs for neonatal mortality, neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia were higher among infants with lower Apgar scores, especially at 5 and 10 minutes. For example, the aORs for respiratory distress for an Apgar score of 9 versus 10 were 2.0 (95% confidence interval 1.9 to 2.1) at 1 minute, 5.2 (5.1 to 5.4) at 5 minutes, and 12.4 (12.0 to 12.9) at 10 minutes. Compared with an Apgar score of 10 at 10 minutes, the aRD for respiratory distress was 9.5% (95% confidence interval 9.2% to 9.9%) for an Apgar score of 9 at 10 minutes, and 41.9% (37.7% to 46.4%) for an Apgar score of 7 at 10 minutes. A reduction in Apgar score from 10 at 5 minutes to 9 at 10 minutes was also associated with higher odds of neonatal morbidity, compared with a stable Apgar score of 10 at 5 and 10 minutes. Conclusions In term non-malformed infants with Apgar scores within the normal range (7 to 10), risks of neonatal mortality and morbidity are higher among infants with lower Apgar score values, and also among those experiencing a reduction in score from 5 minutes to 10 minutes (compared with infants with stable Apgar scores of 10).

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Cucurbitacins as Anticancer Agents: A Patent Review

Recent Patents on Anti-Cancer Drug Discovery ◽

10.2174/1574892813666181119123035 ◽

2019 ◽

Vol 14 (2) ◽

pp. 133-143 ◽

Cited By ~ 3

Author(s):

Hidayat Hussain ◽

Ivan R. Green ◽

Muhammad Saleem ◽

Khanzadi F. Khattak ◽

Muhammad Irshad ◽

...

Keyword(s):

Anticancer Agents ◽

Wide Spectrum ◽

Biological Effects ◽

Therapeutic Effects ◽

Cytotoxic Effects ◽

Natural Sources ◽

Oh Groups ◽

Drug Candidates ◽

The Past ◽

Wide Range

Background: Cucurbitacins belong to a group of tetracyclic triterpenoids that display a wide range of biological effects. In the past, numerous cucurbitacins have been isolated from natural sources and many active compounds have been synthesized using the privileged scaffold in order to enhance its cytotoxic effects. Objective: his review covers patents on the therapeutic effects of natural cucurbitacins and their synthetic analogs published during the past decade. By far, the majority of patents published are related to cancer and Structure-Activity Relationships (SAR) of these compounds are included to lend gravitas to this important class of natural products. Methods: The date about the published patents was downloaded via online open access patent databases. Results: Cucurbitacins display significant cytotoxic properties, in particular cucurbitacins B and D which possess very potent effects towards a number of cancer cells. Numerous cucurbitacins isolated from natural sources have been derivatized through chemical modification at the C(2)-OH and C(25)- OH groups. Most importantly, an acyl ester of the C(25)-OH and, iso-propyl, n-propyl and ethyl ether groups of the C(2)-OH demonstrated the most increased cytotoxic activity. Conclusion: The significant cytotoxic effects of natural and semi-synthetic cucurbitacins make them attractive as new drug candidates. Moreover, cucurbitacins have the capability to form conjugates with other anticancer drugs which will synergistically enhance their anticancer effects. The authors believe that in order to get lead compounds, there should be a greater focus on the synthesis of homodimers, heterodimers, and halo derivatives of cucurbitacins. In the opinion of the authors the analysis of the published patents on the cucurbitacins indicates that these compounds can be developed into a regimen to treat a wide spectrum of cancers.

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Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology

SAGE Open Medicine ◽

10.1177/20503121211022582 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110225

Author(s):

Mark A Pianka ◽

Joseph Serino ◽

Steven F DeFroda ◽

Blake M Bodendorfer

Keyword(s):

Wide Spectrum ◽

Pain Syndrome ◽

Operative Management ◽

Hip Pain ◽

Greater Trochanteric Pain Syndrome ◽

Trochanteric Bursitis ◽

Treatment Indications ◽

Careful Clinical Examination ◽

Wide Range ◽

Tendon Pathology

Greater trochanteric pain syndrome is a common cause of lateral hip pain, encompassing a spectrum of disorders, including trochanteric bursitis, abductor tendon pathology, and external coxa saltans. Greater trochanteric pain syndrome is primarily a clinical diagnosis, and careful clinical examination is essential for accurate diagnosis and treatment. A thorough history and physical exam may be used to help differentiate greater trochanteric pain syndrome from other common causes of hip pain, including osteoarthritis, femoroacetabular impingement, and lumbar stenosis. Although not required for diagnosis, plain radiographs and magnetic resonance imaging may be useful to exclude alternative pathologies or guide treatment of greater trochanteric pain syndrome. The majority of patients with greater trochanteric pain syndrome respond well to conservative management, including physical therapy, non-steroidal anti-inflammatory drugs, and corticosteroid injections. Operative management is typically indicated in patients with chronic symptoms refractory to conservative therapy. A wide range of surgical options, both open and endoscopic, are available and should be guided by the specific etiology of pain. The purpose of this review is to highlight pertinent clinical and radiographic features used in the diagnosis and management of greater trochanteric pain syndrome. In addition, treatment indications, techniques, and outcomes are described.

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Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study

Annals of Intensive Care ◽

10.1186/s13613-020-00652-0 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 3

Author(s):

Rene A. Posma ◽

Trine Frøslev ◽

Bente Jespersen ◽

Iwan C. C. van der Horst ◽

Daan J. Touw ◽

...

Keyword(s):

Cohort Study ◽

Mortality Rate ◽

Critically Ill ◽

Critically Ill Patients ◽

Cox Regression ◽

Lower Mortality ◽

Prognostic Impact ◽

Icu Admission ◽

Lactate Levels ◽

Restricted Cubic Splines

Abstract Background Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. Methods This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. Results Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2–3.2) in metformin users and 1.6 (1.0–2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. Conclusion In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.

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Metformin use and long-term risk of benign prostatic hyperplasia: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2020-041875 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041875

Author(s):

Mette Nørgaard ◽

Bianka Darvalics ◽

Reimar Wernich Thomsen

Keyword(s):

Cohort Study ◽

Benign Prostatic Hyperplasia ◽

Cox Regression ◽

Population Based ◽

Prostatic Hyperplasia ◽

Haemoglobin A1c ◽

First Line ◽

Intention To Treat ◽

Lowering Drug

ObjectiveTo assess whether metformin use affects risk of benign prostatic hyperplasia (BPH) by comparing the risk of BPH in men with type 2 diabetes who initiated first-line treatment with either metformin or sulfonylurea monotherapy between 2000 or 2006 in Northern Denmark. In this period, sulfonylurea and metformin were both frequently used as first-line glucose-lowering drug (GLD) treatment.DesignA population-based cohort study.SettingNorthern Denmark.ParticipantsAll men who filled at least two prescriptions for metformin or for sulfonylurea, respectively, during their first 6 months of GLD treatment. Follow-up started 6 months after treatment start.Primary outcome measuresRates of subsequent BPH, identified based on community prescriptions for BPH-related treatment or hospital BPH diagnoses, and rates of transurethral resection of the prostate (TURP). Rates in metformin and sulfonylurea users were compared overall and stratified by 6-month haemoglobin A1c (HbA1c) using Cox regression and an intention-to-treat (ITT) approach and an as-treated analysis.ResultsDuring follow-up, less than five persons were lost to follow-up due to emigration. In 3953 metformin initiators with a median follow-up of 10 years, the 10-year cumulative BPH incidence was 25.7% (95% CI 24.2 to 27.1). Compared with 5958 sulfonylurea users (median follow-up 8 years, 10-year cumulative incidence 27.4% (95% CI 26.2 to 28.6)), the crude HR for BPH was 0.83 (95% CI 0.77 to 0.89) and adjusted HR in the ITT analyses was 0.97 (95% CI 0.88 to 1.06). For TURP, the adjusted HR was 0.96 (95% CI 0.63 to 1.46). In the as-treated analysis, adjusted HR for BPH was 0.91 (95% CI 0.81 to 1.02).ConclusionsCompared with sulfonylurea, metformin did not substantially reduce the incidence of BPH in men with diabetes.

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Young adult cancer risk behaviours originate in adolescence: a longitudinal analysis using ALSPAC, a UK birth cohort study

BMC Cancer ◽

10.1186/s12885-021-08098-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Caroline Wright ◽

Jon Heron ◽

Ruth Kipping ◽

Matthew Hickman ◽

Rona Campbell ◽

...

Keyword(s):

Cohort Study ◽

Waist Circumference ◽

Cancer Risk ◽

Tobacco Smoking ◽

Early Adulthood ◽

Birth Cohort Study ◽

Risk Behaviours ◽

Harmful Drinking ◽

High Waist Circumference ◽

Adolescent Cancer

Abstract Background An estimated 40% of cancer cases in the UK in 2015 were attributable to cancer risk behaviours. Tobacco smoking, alcohol consumption, obesity, and unprotected sexual intercourse are known causes of cancer and there is strong evidence that physical inactivity is associated with cancer. These cancer risk behaviours co-occur however little is known about how they pattern longitudinally across adolescence and early adulthood. Using data from ALSPAC, a prospective population-based UK birth cohort study, we explored patterns of adolescent cancer risk behaviours and their associations with cancer risk behaviours in early adulthood. Methods Six thousand three hundred fifty-one people (46.0% of ALSPAC participants) provided data on all cancer risk behaviours at one time during adolescence, 1951 provided data on all cancer risk behaviours at all time points. Our exposure measure was quartiles of a continuous score summarising cumulative exposure to cancer risk behaviours and longitudinal latent classes summarising distinct categories of adolescents exhibiting similar patterns of behaviours, between age 11 and 18 years. Using both exposure measures, odds of harmful drinking (Alcohol Use Disorders Identification Test-C ≥ 8),daily tobacco smoking, nicotine dependence (Fagerström test ≥4), obesity (BMI ≥30), high waist circumference (females: ≥80 cm and males: ≥94 cm, and high waist-hip ratio (females: ≥0.85 and males: ≥1.00) at age 24 were estimated using logistic regression analysis. Results We found distinct groups of adolescents characterised by consistently high and consistently low engagement in cancer risk behaviours. After adjustment, adolescents in the top quartile had greater odds of all outcomes in early adulthood: nicotine dependency (odds ratio, OR = 5.37, 95% confidence interval, CI = 3.64–7.93); daily smoking (OR = 5.10, 95% CI =3.19–8.17); obesity (OR = 4.84, 95% CI = 3.33–7.03); high waist circumference (OR = 2.48, 95% CI = 1.94–3.16); harmful drinking (OR = 2.04, 95% CI = 1.57–2.65); and high waist-hip ratio (OR = 1.88, 95% CI = 1.30–2.71), compared to the bottom quartile. In latent class analysis, adolescents characterised by consistently high-risk behaviours throughout adolescence were at higher risk of all cancer risk behaviours at age 24, except harmful drinking. Conclusions Exposure to adolescent cancer risk behaviours greatly increased the odds of cancer risk behaviours in early adulthood. Interventions to reduce these behaviours should target multiple rather than single risk behaviours and should focus on adolescence.

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Association between early working life patterns, in publicly and privately owned companies, and the course of future sickness absence due to mental disorders: a cohort study in Catalonia (Spain)

BMJ Open ◽

10.1136/bmjopen-2020-040480 ◽

2021 ◽

Vol 11 (2) ◽

pp. e040480

Author(s):

Amaya Ayala-Garcia ◽

Laura Serra ◽

Monica Ubalde-Lopez

Keyword(s):

Cohort Study ◽

Mental Disorders ◽

Social Security ◽

Sickness Absence ◽

Multinomial Logistic Regression ◽

Working Life ◽

Men And Women ◽

Permanent Employment ◽

Life Patterns ◽

The Relationship

ObjectivesTo assess the relationship between early working life patterns, at privately and publicly held companies, and the course of sickness absence (SA) due to mental disorders.MethodsCohort study of workers aged 18–28 years, affiliated with the Spanish social security system, living in Catalonia, who had at least one episode of SA due to mental disorders between 2012 and 2014. Individual prior working life trajectories were reconstructed through sequence analysis. Optimal matching analysis was performed to identify early working life patterns by clustering similar individual trajectories. SA trajectories were identified using latent class growth modelling analysis. Finally, the relationship between early working life patterns and subsequent SA trajectories was assessed via multinomial logistic regression models.ResultsAmong both men and women, four labour market participation (LMP) patterns were identified: stable permanent employment (reference group), increasing permanent employment, fluctuating employment and delayed employment. Among women, an increasing permanent employment pattern in early working life was related to a decrease of accumulated SA days over time (adjusted OR (aOR) 2.08; 95% CI 1.18 to 3.66). In men, we observed a trend towards a middle stable accumulation of SA days in those with fluctuating employment (aOR 1.25, 95% CI 0.57 to 2.74) or delayed employment (aOR 1.79; 95% CI 0.59 to 5.41). In both men and women, an early working life in big companies was related to a more favourable SA trajectory.ConclusionsEarly LMP patterns characterised by an increasing stability—decreased number of transitions between temporary contracts and lack of social security coverage towards permanent contracts—were related to a better future SA course due to mental diagnosis.

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