scholarly journals Heads-Up: Risk-Specific Neurodegenerative Mortality and Years-Saved Analysis on the US Olympian Cohort

2021 ◽  
Vol 12 ◽  
Author(s):  
Moi Yamazaki ◽  
Quentin De Larochelambert ◽  
Guillaume Sauliere ◽  
Jean-François Toussaint ◽  
Juliana Antero
Keyword(s):  
General Population ◽  
Causes Of Death ◽  
Olympic Games ◽  
Reference Group ◽  
Elevated Risk ◽  
Vital Status ◽  
Contact Group ◽  
The Us ◽  
The Impact ◽  
Elite Sports

Purpose: This study aimed to identify the risk of neurodegenerative death (ND) that former Olympians endure due to their participation in sports grouped based on presumed repeated shocks to the head, and to understand the impact of their participation in such elite sports on their total longevity.Materials and Methods: The cohort included all former US Olympians, who participated in the Olympic Games (OG) between 1948 and 1972, and whose vital status and causes of death were verified (n = 2,193). Olympic sports were classified into three categories of exposure: Collision (the highest presumed risk of repeated shocks to the head), Contact, and No-Contact. The Fine-Gray competing risk regression model was used to compare the risk of ND where the No-Contact category was a reference group. The years-saved analysis was performed to quantify the number of years saved or lost to ND and total longevity compared with the US general population.Results: A total of 65 NDs were identified. Collision sports Olympians had a 3.11 (95% CI: 1.31–7.40) higher risk of ND while the Contact group showed a risk of 0.56 (95% CI: 0.21–1.48) compared with the No-Contact sports Olympians. Compared with the general population, the Collision group lost 0.61 (95% CI: -1.16—0.06) years of life from ND, while the Contact group saved 0.4 (95% CI: 0.26–0.54) and the No-Contact group saved 0.09 (-0.09–0.28) years of life up to the age of 90. Regarding the total longevity, Collision, Contact, and No-Contact groups saved 4.67 (95% CI: 3.13–6.22), 5.8 (95% CI: 4.93–6.67), and 6.24 (95% CI: 5.57–6.92) years of life, respectively, from all causes of death.Conclusion: There is an elevated risk of ND among US Olympians, who engaged in sports with the highest presumed risk of repeated shocks to the head compared with those exposed to no such hazard. Such risk does not jeopardize the total longevity among Olympians in Collision sports.

scholarly journals Uric acid and left ventricular hypertrophy: another relationship in hemodialysis patients

2019 ◽  
Author(s):  
Gjulsen Selim ◽  
Olivera Stojceva-Taneva ◽  
Liljana Tozija ◽  
Beti Zafirova-Ivanovska ◽  
Goce Spasovski ◽  
...  
Keyword(s):  
Uric Acid ◽  
General Population ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Reference Group ◽  
Left Ventricular ◽  
Reactive Protein ◽  
Cv Disease ◽  
The Impact

Abstract Background The impact of serum uric acid (UA) on morbidity and mortality in hemodialysis (HD) patients is quite controversial in relation to the general population. The aim of this study was to evaluate the association of serum UA with both mortality and left ventricular hypertrophy (LVH) in HD patients. Methods This longitudinal study enrolled 225 prevalent HD patients who were classified into three groups according to their follow-up-averaged UA (FA-UA) levels: low FA-UA (FA-UA <400 µmol/L), intermediate/reference FA-UA (FA-UA between 400 and 450 µmol/L) and high FA-UA (FA-UA >450 µmol/L). Echocardiography was performed on a nondialysis day and the presence of LVH was defined based on a left ventricular mass index (LVMI) >131 and >100 g/m2 for men and women, respectively. The patients were followed during a 60-month period. Results The mean FA-UA level was 425 ± 59 µmol/L (range 294–620). There was a consistent association of higher FA-UA with better nutritional status (higher body mass index, normalized protein catabolic rate, creatinine, albumin and phosphorus), higher hemoglobin, but lower C-reactive protein and LVMI. During the 5-year follow-up, 81 patients died (36%) and the main causes of death were cardiovascular (CV) related (70%). When compared with the reference group, the hazard ratio for all-cause mortality was 1.75 [95% confidence interval (CI) 1.02–2.98; P = 0.041] in the low FA-UA group, but there was no significant association with the high FA-UA group. In contrast, FA-UA did not show an association with CV mortality neither with the lower nor with the high FA-UA group. The unadjusted odds ratio (OR) of LVH risk in the low FA-UA compared with the reference FA-UA group was 3.11 (95% CI 1.38–7.05; P = 0.006), and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significantly only in the low FA-UA group [OR 2.82 (95% CI 1.16–6.88,); P = 0.002]. Conclusions Low serum UA is a mortality risk factor and is associated with LVH in HD patients. These results are in contrast with the association of UA in the general population and should be the subject of further research.

scholarly journals Risk of eating disorders in international adoptees: a cohort study using Swedish national population registers

2020 ◽  
Vol 29 ◽  
Author(s):  
M. Strand ◽  
R. Zhang ◽  
L. M. Thornton ◽  
A. Birgegård ◽  
B. M. D'Onofrio ◽  
...  
Keyword(s):  
Mental Health ◽  
Eating Disorders ◽  
Cohort Study ◽  
General Population ◽  
Anxiety Disorders ◽  
Elevated Risk ◽  
Compulsive Disorder ◽  
International Adoptees ◽  
Increased Risk ◽  
The Impact

Abstract Aims Compared to the general population, adoptees are more often referred to specialist psychiatric treatment, exhibit increased risk of suicide and display more symptoms of attention-deficit/hyperactivity-disorder. However, little is known about the impact of being an adoptee on the risk of developing an eating disorder. The aim of the present study was to assess whether international adoptees have a higher risk for eating disorders than native Swedes. Methods In the present retrospective cohort study, data from the Swedish total population registers on individuals born between 1979 and 2005 were used to assess whether international adoptees residing in Sweden (n = 25 287) have a higher risk for anorexia nervosa (AN) and other eating disorders (OED) than non-adoptees with Swedish-born parents from the general population (n = 2 046 835). The patterns of these results were compared to those for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and anxiety disorders to determine whether any observed effects were unique to eating disorders or reflected a more general impact on mental health outcomes. Results A survival analysis adjusting for relevant demographic covariates revealed an elevated risk of all examined psychiatric disorders in international adoptees: hazard ratios (95% confidence intervals) are 1.21 (1.04–1.41) for AN, 1.60 (1.44–1.79) for OED, 1.90 (1.81–2.00) for MDD, 1.25 (1.09–1.44) for OCD, and 1.69 (1.60–1.78) for anxiety disorders. Conclusions Elevated risk of eating disorders as well as of MDD, OCD, and anxiety disorders was found in international adoptees. A parallel pattern between AN and OCD was observed, which both display less elevated rates than the other diagnoses. A considerable number of biological, environmental, and societal factors have been suggested to explain the observed differences in mental health between adoptees and non-adoptees, but they remain primarily theoretical.

scholarly journals P0329CLINICAL SIGNIFICANCE OF CREATININE VARIABILITY AND ITS IMPACT ON CARDIOVASCULAR OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Soojin Lee ◽  
Yeonhee Lee ◽  
Sehoon Park ◽  
Kyungdo Han ◽  
Yaerim Kim ◽  
...  
Keyword(s):  
Renal Function ◽  
General Population ◽  
Patient Outcomes ◽  
National Health ◽  
Screening Program ◽  
Cardiovascular Outcomes ◽  
Elevated Risk ◽  
Adverse Outcomes ◽  
National Health Insurance System ◽  
The Impact

Abstract Background and Aims Linear decline of glomerular filtration rate (GFR) is associated with aggravating the patient outcomes. Serum creatinine, which is commonly used for estimating GFR, often fluctuates throughout the serial measurement. The clinical significance of creatinine fluctuation among the general population whose renal function is prior to chronic kidney disease (CKD) development had not been demonstrated yet. Thus, we investigated the study to evaluate the impact of creatinine variability on patient outcomes. Method A nationwide retrospective cohort study was performed usaing the database of Korean National Health Insurance System. Adult patients who received national health screening program and measured creatinine for ≥3 times between 2012 and 2016 were considered. Those who previously developed CKD were excluded. The variability of creatinine values were presented with variability independent of mean (VIM). The patients were classified into quartiles of the VIM and Q4 presented highest variability of creatinine. Then, the risks of myocardial infarction (MI), stroke and death were assessed according to the extent of variability. Results During the median follow up of 3.27 years, 3,509,899 participants were examined for association of creatinine variability and cardiovascular outcomes. Participants with higher creatinine variability were significantly associated with elevated risk of MI (hazard ratio (HR) (95% confidence interval (95% CI)) 1.11 (1.04-1.18), stroke (HR (95%CI) 1.06 (1.00-1.13)) and death (HR (95%CI) 1.15 (1.09-1.21)), compared to those with the lowest quartile of creatinine variability. Conclusion Increased creatinine variability exhibited association with elevated risk of MI, stroke and death. In general population, whose renal function is prior to CKD development, monitoring of creatinine variability needs to be considered as the parameter of predicting the adverse outcomes, in addition to the decline of GFR.

scholarly journals Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians

2020 ◽  
pp. bjsports-2019-101696 ◽  
Author(s):  
Juliana Antero ◽  
Hirofumi Tanaka ◽  
Quentin De Larochelambert ◽  
Maja Pohar-Perme ◽  
Jean-François Toussaint
Keyword(s):  
Mental Illness ◽  
Nervous System ◽  
General Population ◽  
Causes Of Death ◽  
Metabolic Diseases ◽  
Population Based ◽  
Years Of Life Lost ◽  
Olympic Athletes ◽  
The Us ◽  
External Causes

ObjectiveTo quantify US female and male Olympic athletes’ longevity and the years of life lost or saved due to multiple causes of death as compared with the US general population.MethodsFormer US athletes who had participated in the summer or winter Olympic Games at least once between 1912 and 2012 were included. Olympians’ date of birth, death and the underlying causes of death were certified by the National Death Index. The Olympians’ overall and cause-specific mortality were compared with the US general population based on the US life tables, adjusted by sex, period and age. Mortality differences between the populations were quantified using the years lost/years saved (YS) method.Results8124 US Olympians (2301 women and 5823 men) lived 5.1 years longer (YS 95% CI 4.3 to 6.0) than the general population, based on 2309 deaths observed (225 women, 2084 men). Different causes of death contributed to longevity for Olympians as follows: 2.2 years were saved (1.9 to 2.5) from cardiovascular diseases (CVDs); cancer, 1.5 years (1.3 to 1.8); respiratory diseases (eg, influenza, pneumonia), 0.8 years (0.7 to 0.9); external causes (eg, accidents, homicides), 0.5 years (0.4 to 0.6); endocrine and metabolic diseases (eg, diabetes, hyperlipidaemia), 0.4 years (0.2 to 0.5) and digestive system diseases (eg, cirrhosis, hepatic failure), 0.3 years (0.2 to 0.4). Mortality rates due to nervous system disorders (eg, Alzheimer’s and Parkinsons’s diseases) and mental illness (eg, dementia, schizophrenia) were not different from the general population.ConclusionUS Olympians lived longer than the general population, an advantage mainly conferred by lower risks of CVD and cancer. Nervous system disorders and mental illness did not differ between US Olympians and the general population.

Mortality and causes of death among people suspected of driving under the influence and testing positive for multiple substances

2019 ◽  
Vol 48 (8) ◽  
pp. 809-816
Author(s):  
Karoliina Karjalainen ◽  
Jari Haukka ◽  
Kristiina Kuussaari ◽  
Sanna Hautala ◽  
Pekka Hakkarainen
Keyword(s):  
General Population ◽  
Causes Of Death ◽  
Social Background ◽  
Reference Population ◽  
Elevated Risk ◽  
Driving Under The Influence ◽  
Finnish Population ◽  
Risk Of Death ◽  
Increased Risk ◽  
Specific Mortality

Aims: Understanding the mortality of drug users using multiple substances is helpful in preventing the harmful effects of polydrug use. We examined overall and cause-specific mortality and differences in mortality based on social background among people suspected of driving under the influence and testing positive for multiple substances (DUIMS) compared with the general Finnish population. Methods: Register data from 785 DUIMS during 2003–2006 were studied, with a reference population ( n = 25,381) drawn from the general Finnish population. The effect of DUIMS on all-cause and cause-specific mortality was estimated using a Poisson regression model. Results: DUIMS had an increased risk of death compared with the general population (MRR 5.3, 95% CI 4.2–6.6). The most common causes of death in DUIMS were poisonings (37.9%) and suicides (13.6%), whereas in the reference population these were cardiovascular diseases (30.8%) and cancer (26.6%). The cause-specific risk of death among DUIMS was higher in all observed causes of death, except for cancer. The effect of DUIMS on mortality was modified by age, employment status and marital status; DUIMS was associated with an elevated risk of death especially in younger age groups and in singles. Conclusions: DUIMS indicates higher mortality, and DUIMS’ profiles in causes of death differ from the general population. Elevated risk for, for instance, suicidal, accidental and violent death among those using multiple substances highlights the need to also pay attention to causes of death other than poisoning/overdose.

scholarly journals Rise in mortality involving poisoning by medicaments other than narcotics, including poisoning by psychotropic drugs in different age/racial groups in the US

2019 ◽  
Author(s):  
Edward Goldstein
Keyword(s):  
Native Americans ◽  
Psychotropic Drugs ◽  
Causes Of Death ◽  
Age Groups ◽  
Epidemiological Data ◽  
Psychotropic Medications ◽  
Racial Groups ◽  
The Us ◽  
Icd 10 ◽  
The Impact

AbstractBackgroundIncrease in mortality involving poisoning, particularly by narcotics, is known to have been one of the factors that affected life expectancy in the US during the last two decades, especially for white Americans and Native Americans. However, the contribution of medicaments other than narcotics to mortality in different racial/age groups is less studied.MethodsWe regressed annual rates of mortality involving poisoning by medicaments but not narcotics/psychodysleptics (ICD-10 codes T36-39.xx or T41-50.8 but not T40.xx present as either underlying or contributing causes of death), as well as annual rates of mortality for certain subcategories of the above, including mortality involving poisoning by psychotropic drugs but not narcotics/psychodysleptics (ICD-10 codes T43.xx but not T40.xx present as either underlying or contributing causes of death) in different age/racial groups for both the 2000-2011 period and the 2011-2017 period against calendar year.ResultsAnnual numbers of deaths involving poisoning by medicaments but not narcotics/psychodysleptics grew from 4,332 between 2000-2001 to 11,401 between 2016-2017, with the growth in the rates of those deaths being higher for the 2011-2017 period compared to the 2000-2011 period. The largest increases in the rates of mortality involving poisoning by medicaments but not narcotics/psychodysleptics were in non-elderly Non-Hispanic Native Americans, followed by Non-Hispanic whites. Most of those increases came from increases in the rates of mortality involving poisoning by psychotropic medications; the latter rates grew for the period of 2015-2017 vs. 2000-2002 by factors ranging from 2.75 for ages 35-44y to 5.37 for ages 55-64y.ConclusionsThere were major increases in mortality involving poisoning by non-narcotic, particularly psychotropic medicaments, especially in non-elderly non-Hispanic whites and Native Americans. Our results, and the epidemiological data on mortality involving poisoning by different drugs and medications in the US, which are quite different from the ones in many other countries support the need for a comprehensive evaluation of the effect of various drugs, including psychotropic medications on health-related outcomes, the associated mortality the does not involve poisoning being listed on a death certificate, and the impact of medication misuse.

scholarly journals Excess Mortality in Low-Risk MDS Can be Explained By MDS and AML Related Causes of Death

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4385-4385
Author(s):  
Krzysztof Madry ◽  
Ge Yu ◽  
Karol Lis ◽  
Pierre Fenaux ◽  
David Bowen ◽  
...  
Keyword(s):  
Overall Survival ◽  
General Population ◽  
Board Of Directors ◽  
Research Funding ◽  
Causes Of Death ◽  
Excess Mortality ◽  
Laboratory Data ◽  
Relative Survival ◽  
Advisory Committees ◽  
The Impact

Abstract Background Data on causes of death (COD) in patients with lower-risk (LR-MDS) is limited and sometimes conflicting. In contrast to higher-risk MDS, many LR-MDS patients die from conditions associated with advanced age, not directly associated with the underlying disease. Infections and cardiovascular disorders (CVD) have been reported as frequent COD in LR-MDS, but whether the incidence is higher than in age-matched population, is not known. The EUMDS Registry has been collecting prospective observational data on LR-MDS since 2008. The comprehensive clinical and laboratory data provides a unique chance to assess the impact of LR-MDS on survival either by causes related to MDS or indirectly related to MDS by aggravation of co-morbidities. Objectives To assess the impact of MDS and associated co-morbidities on COD in patients with LR-MDS and to evaluate the COD in the whole group and across participating countries. Methods: We evaluated clinical and laboratory data of LR-MDS patients registered in EUMDS registry from 2008 to 2018. Data were obtained by 145 centers from 16 European countries and Israel. MDS related causes of death were defined as infection, bleeding, MDS progression and AML transformation. Overall survival(OS) and relative survival(RS) were estimated using the Stata program 'strel' with age, sex and country specific background obtained from national life tables for the CONCORD program. RS is a standard approach used to take into account competing causes of death by adjusting for the age and sex specific mortality in the general population, estimating the excess mortality in these patients compared to that seen in the general population of each country. Results Overall data on 2235 LR-MDS patients was available in the EUMDS registry. Of these, 822 (36,7%) patients had died at the time of analysis. Median age was 77 years and 65% of the patients were male. Nearly half of them (46.9%) were diagnosed as IPPS low risk. The MDS-Comorbidity Index was low, intermediate and high in 55.7%, 37.5% and 6.8% of patients respectively. The most common COD were those considered as related to MDS 41.7% (Table 1). Deaths due to cardiovascular and pulmonary diseases were reported in 10.1% and 4.9% respectively. Other reasons (e.g. liver, renal failure, second malignancy) were found in 18.2%. In 25% of patients, the precise reason of death remained unknown. The proportion of MDS related COD were different between participating countries with lower rates in Germany (30%), France (31.3%) and higher in Portugal (55%), Greece (55.2%) and Romania (63.1%). Median follow-up was 2.1 years (0.1-10 years). Five-year overall survival in the whole cohort was 47.1% (95% CI: 44.1%-49.9%) and 5-year relative survival (attributed to MDS/AML only) was 59.1% (95% CI:55.4%-62.5%)(Figure 1). One year overall and relative survival was 90.4% (95% CI:89.1%-91.6%) and 94.4% (95% CI:93%-95.5%) respectively. Conclusions: MDS- related complications are the most common causes of death in LR-MDS patients. Comparison of overall and relative survival supports that observation and indicates that excess mortality in LR-MDS patients can be mainly explained by MDS/AML related causes. Interestingly, the strongest influence of MDS/AML attributable deaths was observed during the first year from diagnosis. Disclosures Fenaux: Janssen: Honoraria, Research Funding; Jazz: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Roche: Honoraria; Otsuka: Honoraria, Research Funding. Stauder:Teva: Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees. Germing:Novartis: Honoraria, Research Funding; Janssen: Honoraria; Celgene: Honoraria, Research Funding. de Witte:Novartis: Research Funding; Celgene: Honoraria, Research Funding; Amgen: Consultancy, Research Funding. Smith:Jazz Pharmaceuticals: Research Funding; Johnson & Johnson: Research Funding; Gilead Sciences: Consultancy; Novartis: Research Funding.

scholarly journals Risk and Prognosis of Secondary Bladder Cancer After Radiation Therapy for Rectal Cancer: A Large Population-Based Cohort Study

2021 ◽  
Vol 10 ◽  
Author(s):  
Xu Guan ◽  
Ran Wei ◽  
Runkun Yang ◽  
Zhao Lu ◽  
Enrui Liu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Bladder Cancer ◽  
Radiation Therapy ◽  
General Population ◽  
Large Population ◽  
Population Based ◽  
Competing Risk ◽  
Increased Risk ◽  
The Us ◽  
The Impact

BackgroundAlthough radiation therapy (RT) improves local control for rectal cancer (RC), the long-term risks from RT, including development of a secondary malignancy, are controversial. The risk and prognosis of secondary bladder cancer (SBC) in RC patients undergoing RT have not been adequately studied. Our goal is to investigate the impact of RT on the risk of developing SBC and assess their survival outcomes.MethodsThis large population-based study included RC patients as their initial primary cancer from nine registries of the Surveillance, Epidemiology and End Results (SEER) database between 1973 and 2015. The cumulative incidence of SBC was assessed by using Fine and Gray’s competing risk regression. The standardized incidence ratio (SIR) was used to compare the incidence of SBC in RC survivors to the US general population. The Kaplan-Meier method was used to evaluate the 10-year overall survival (OS) and 10-year cancer specific survival (CSS) for patients with SBC.ResultsOf 74,646 RC patients, 24,522 patients were treated with surgery and RT and 50,124 patients were treated with surgery alone. The incidence of SBC was 1.85% among patients who received RT and 1.24% among patients who did not. The incidence of SBC in RC patients who received RT was higher than the US general population (SIR, 1.35; 95% CI, 1.19-1.53, P<0.05), and decreased with increasing age at diagnosis, and increased with time since diagnosis. In competing risk regression analysis, undergoing RT was associated with a higher risk of SBC (hazard ratio [HR], 1.443, 95% confidence interval [CI], 1.209-1.720; P<0.001). The results of the dynamic SIR for SBC revealed that a slightly increased risk of SBC was observed after RT in the early latency, and was significantly related to the variations of age at RC diagnosis and decreased with time progress. The 10-year OS and CSS among SBC patients after RT were comparable to SBC patients after NRT.ConclusionRadiation was associated with an increased risk of developing SBC in RC patients, and special attention should be paid to the surveillance of these patients.

Systematic review methodology for development: An example from microfinance

2018 ◽  
Vol 43 (1) ◽  
pp. 65-77 ◽  
Author(s):  
Carina Van Rooyen ◽  
Ruth Stewart ◽  
Thea De Wet
Keyword(s):  
Systematic Review ◽  
International Development ◽  
Health Sector ◽  
Evidence Based ◽  
Systematic Review Methodology ◽  
Development Interventions ◽  
The Us ◽  
Sub Saharan ◽  
The Impact ◽  
Evidence Based Decision Making

Big international development donors such as the UK’s Department for International Development and USAID have recently started using systematic review as a methodology to assess the effectiveness of various development interventions to help them decide what is the ‘best’ intervention to spend money on. Such an approach to evidence-based decision-making has long been practiced in the health sector in the US, UK, and elsewhere but it is relatively new in the development field. In this article we use the case of a systematic review of the impact of microfinance on the poor in sub-Saharan African to indicate how systematic review as a methodology can be used to assess the impact of specific development interventions.

Doping in sports – conscious lack of interest or ethical Everest?

2017 ◽  
Vol 65 (4) ◽  
Keyword(s):  
Decision Making ◽  
General Population ◽  
Medical Setting ◽  
Doping In Sports ◽  
Physician Relationship ◽  
Pharmaceutical Agents ◽  
Similar Development ◽  
Level Performance ◽  
Elite Sports ◽  
Support Decision Making

Within a clinical sports medical setting the discussion about doping is insufficient. In elite-sports use of pharmaceutical agents is daily business in order to maintain the expected top-level performance. Unfortunately, a similar development could be observed in the general population of leisure athletes where medical supervision is absent. As a sports physician you are facing imminent ethical questions when standing in between. Therefore, we propose the application of a standardised risk score as a tool to promote doping-prevention and launch the debate within athlete-physician-relationship. In the longterm such kind of risk stratification systems may support decision-making with regard to «protective» exclusion of sporting competition.

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