Burden of chronic diseases associated with periodontal diseases: a retrospective cohort study using UK primary care data

ObjectivesTo identify the association between periodontal diseases (gingivitis and periodontitis) and chronic diseases including cardiovascular disease, cardiometabolic disease, autoimmune disease and mental ill health.DesignRetrospective cohort.SettingIQVIA Medical Research Data-UK between 1 January 1995 and 1 January 2019.Participants64 379 adult patients with a general practitioner recorded diagnosis of periodontal disease (exposed patients) were matched to 251 161 unexposed patients by age, sex, deprivation and registration date.Main outcome measuresLogistic regression models accounting for covariates of clinical importance were undertaken to estimate the adjusted OR (aOR) of having chronic diseases at baseline in the exposed compared with the unexposed group. Incidence rates for each outcome of interest were then provided followed by the calculation of adjusted HRs using cox regression modelling to describe the risk of outcome development in each group.ResultsThe average age at cohort entry was 45 years and the median follow-up was 3.4 years. At study entry, the exposed cohort had an increased likelihood of having a diagnosis of cardiovascular disease (aOR 1.43; 95% CI 1.38 to 1.48), cardiometabolic disease (aOR 1.16; 95% CI 1.13 to 1.19), autoimmune disease (aOR 1.33; 95% CI 1.28 to 1.37) and mental ill health (aOR 1.79; 95% CI 1.75 to 1.83) compared with the unexposed group. During the follow-up of individuals without pre-existing outcomes of interest, the exposed group had an increased risk of developing cardiovascular disease (HR 1.18; 95% CI 1.13 to 1.23), cardiometabolic disease (HR 1.07; 95% CI 1.03 to 1.10), autoimmune disease (HR 1.33; 95% CI 1.26 to 1.40) and mental ill health (HR 1.37; 95% CI 1.33 to 1.42) compared with the unexposed group.ConclusionsIn this cohort, periodontal diseases appeared to be associated with an increased risk of developing cardiovascular, cardiometabolic, autoimmune diseases and mental ill health. Periodontal diseases are very common; therefore, an increased risk of other chronic diseases represent a substantial public health burden.

Associations of COVID-19 lockdown with gestational length and preterm birth in China

Background The effects of COVID-19 lockdown measures on maternal and fetal health remain unclear. We examined the associations of COVID-19 lockdown with gestational length and preterm birth (PTB) in a Chinese population. Methods We obtained medical records of 595,396 singleton live infants born between 2015 and 2020 in 5 cities in Guangdong Province, South China. The exposed group (N = 101,900) included women who experienced the COVID-19 Level I lockdown (1/23–2/24/2020) during pregnancy, while the unexposed group (N = 493,496) included women who were pregnant during the same calendar months in 2015–2019. Cumulative exposure was calculated based on days exposed to different levels of emergency responses with different weighting. Generalized linear regression models were applied to estimate the associations of lockdown exposure with gestational length and risk of PTB (< 37 weeks). Results The exposed group had a shorter mean gestational length than the unexposed group (38.66 vs 38.74 weeks: adjusted β = − 0.06 week [95%CI, − 0.07, − 0.05 week]). The exposed group also had a higher risk of PTB (5.7% vs 5.3%; adjusted OR = 1.08 [95%CI, 1.05, 1.11]). These associations seemed to be stronger when exposure occurred before or during the 23rd gestational week (GW) than during or after the 24th GW. Similarly, higher cumulative lockdown exposure was associated with a shorter gestational length and a higher risk of PTB. Conclusions The COVID-19 lockdown measures were associated with a slightly shorter gestational length and a moderately higher risk of PTB. Early and middle pregnancy periods may be a more susceptible exposure window.

Characteristics of Environmental Exposure-Associated Versus Unexposed High-Grade B-Cell Lymphomas in Veterans: A Single Center, Matched Case-Control Study

Introduction: Environmental exposures, such as Agent Orange and other chemicals, are associated with the development of non-Hodgkin lymphomas (NHL). Military personnel and civilians in theaters of conflict are especially at high risk. The mechanism is still not well understood. We have initiated studies to examine the association of dioxin exposure, changes in DNA methylation, and the development of high-grade B-cell NHL. Methods: Patients diagnosed with high grade B-cell NHL were identified from the VA Long Beach medical record system for database abstraction and tissue analysis. Subjects with sufficient clinical data including diagnosis, date of diagnosis, age of diagnosis, exposure to toxins, treatments, date of last follow up, date of death, cause of death were included in the study. Patients were matched by exposure vs no exposure and international prognostic index (IPI), as well as duration in military and tour of duty when possible. Formalin-fixed paraffin-embedded specimens from a subset of these patients (where sufficient tissue was available for analysis) with and without known exposures were analyzed for differences in DNA methylation by enzymatic methyl sequencing. Descriptive statistics were used to summarize patient characteristics. Two sample t- and chi-square tests were used to compare the exposed and unexposed lymphoma groups. Overall survival was calculated from time of diagnosis to death from any cause and plotted on a Kaplan-Meier curve and compared using the Log rank test. The Fisher's exact test was used to compare the causes of death between the two groups using SAS 9. Results: Fifty-two patients were included in the study. Patient characteristics were well-balanced between the two groups. The duration of active duty, interval from military enlistment to diagnosis of NHL, and first-line therapy (generally anthracycline-based) were similar. There was a trend toward higher proportion of patients with advanced (stage III or IV) disease and younger age of diagnosis in patients with exposure-associated NHL (p=0.07). The median duration of response to first-line therapy (DOR1) trended towards being shorter (median, 0.8 years; range 0.03-25 years) in patients with exposure related NHL compared to median DOR1 of 2.7 (range, 0.02-25 years) in those without exposure, p=0.056. Median overall survival was 11.5 years in the exposure group and 10 years in the unexposed group, p=0.31. A higher portion of patients in the exposed group died from NHL compared to unexposed group (38% vs 15%), p=0.057. Other competing causes of death, which were more likely in the unexposed group, included other cancers, cardiac disease, infection, end stage kidney disease, dementia and unknown. Six exposed and six unexposed samples were sequenced with over 10,000 statistically significant differentially methylated regions (DMRs) out of 40,605 DMRs tested. Details of differences in methylation of specific genes and their potential pathophysiological and therapeutic implications will be discussed in the presentation. Conclusions: Patients with exposure-related high-grade B cell NHL who were matched by IPI with unexposed lymphomas did not differ significantly in baseline characteristics including time from enlistment to diagnosis and overall survival. In the exposure-related NHL group, certain findings trended toward significance, including younger age at diagnosis, higher proportion diagnosed at an advanced stage, shorter DOR1, and higher proportion died of NHL. This single center cohort, however, was small and heterogeneous. We are therefore currently expanding this study to examine a larger, multi-center cohort to confirm and extend our clinical and translational findings. Disclosures No relevant conflicts of interest to declare.

Blood Pressure and Arterial Stiffness in Association With Aircraft Noise Exposure: Long-Term Observation and Potential Effect of COVID-19 Lockdown

In a cross-sectional analysis of a case-control study in 2015, we revealed the association between increased arterial stiffness (pulse wave velocity) and aircraft noise exposure. In June 2020, we evaluated the long-term effects, and the impact of a sudden decline in noise exposure during the coronavirus disease 2019 (COVID-19) lockdown, on blood pressure and pulse wave velocity, comparing 74 participants exposed to long-term day-evening-night aircraft noise level > 60 dB and 75 unexposed individuals. During the 5-year follow-up, the prevalence of hypertension increased in the exposed (42% versus 59%, P =0.048) but not in the unexposed group. The decline in noise exposure since April 2020 was accompanied with a significant decrease of noise annoyance, 24-hour systolic (121.2 versus 117.9 mm Hg; P =0.034) and diastolic (75.1 versus 72.0 mm Hg; P =0.003) blood pressure, and pulse wave velocity (10.2 versus 8.8 m/s; P =0.001) in the exposed group. Less profound decreases of these parameters were noticed in the unexposed group. Significant between group differences were observed for declines in office and night-time diastolic blood pressure and pulse wave velocity. Importantly, the difference in the reduction of pulse wave velocity between exposed and unexposed participants remained significant after adjustment for covariates (−1.49 versus −0.35 m/s; P =0.017). The observed difference in insomnia prevalence between exposed and unexposed individuals at baseline was no more significant at follow-up. Thus, long-term aircraft noise exposure may increase the prevalence of hypertension and accelerate arterial stiffening. However, even short-term noise reduction, as experienced during the COVID-19 lockdown, may reverse those unfavorable effects.

The association between recently diagnosed cancer and incidence of falling in older adults: An exploratory study

INTRODUCTION: More than one in three older adults (≥65 years) fall within a two-year period. Over one third of cancer diagnoses are among people aged ≥75 years. Falls research in the UK cancer population is limited and contradictory. The aim of this study was to explore the association between a cancer diagnosis and incidence of falls in older adults in England. METHODS: Data were extracted from the English Longitudinal Study of Ageing (an ongoing panel study) collected between 2002 and 2014, consisting of a representative cohort of older adults living in England. Baseline data were collected within two-years of a cancer diagnosis. Falls data were extracted from the subsequent two-year period. The unexposed group included those with no chronic conditions. The fully adjusted logistic regression analysis model included age, sex, wealth, and education level as covariates. We defined odds ratios between 0.67 and 1.5 as the region of practical equivalence. RESULTS: A total of 139 people had a type of cancer (exposed group) (Breast = 18.7%, Colon, Rectum or Bowel = 14.4%, Melanoma or Skin = 7.2%, Lung = 4.3%, Somewhere else = 51.8%) (70.6±7.1 years; 58.3%male) with 3,899 in the unexposed group (69.5±7.3 years; 54.6%male). The fully-adjusted odds ratio was 1.21 (95%CI: 0.81 to 1.82; P = 0.348). The probability of falling among the exposed group was 22.7%versus 19.5%for the unexposed group. CONCLUSION: The cancer and control groups were not statistically equivalent for falls incidence, and a meaningful positive association between cancer and falls cannot be ruled out. Further research is required to elucidate this relationship.

Impact of prior antibiotic therapy on severe necrotizing soft-tissue infections in ICU patients: results from a French retrospective and observational study

Necrotizing soft-tissue infection (NSTI) is a life-threatening pathology that often requires management in intensive care unit (ICU). Therapies consist of early diagnosis, adequate surgical source control, and antimicrobial therapy. Whereas guidelines underline the need for appropriate routine microbiological cultures before starting antimicrobial therapy in patients with suspected sepsis or septic shock, delaying adequate therapy also strongly increases mortality. The aim of the present study was to compare the characteristics and outcomes of patients hospitalized in ICU for NSTI according to their antimicrobial therapy exposure > 24 h before surgery (called the exposed group) or not (called the unexposed group) before surgical microbiological sampling. We retrospectively included 100 consecutive patients admitted for severe NSTI. The exposed group consisted of 23(23%) patients, while 77(77%) patients belonged to the unexposed group. The demographic and underlying disease conditions were similar between the two groups. Microbiological cultures of surgical samples were positive in 84 patients and negative in 16 patients, including 3/23 (13%) patients and 13/77 (17%) patients in the exposed and unexposed groups, respectively (p = 0.70). The distribution of microorganisms was comparable between the two groups. The main antimicrobial regimens for empiric therapy were also similar, and the proportions of adequacy were comparable (n = 60 (84.5%) in the unexposed group vs. n = 19 (86.4%) in the exposed group, p = 0.482). ICU and hospital lengths of stay and mortality rates were similar between the two groups. In conclusion, in a population of severe ICU NSTI patients, antibiotic exposure before sampling did not impact either culture sample positivity or microbiological findings.

Health Risks of Low Dose Of Ionizing Radiation Among Health Care Providers at ain Shams University Hospitals

Introduction Ionizing radiation (IR) is an occupational hazard that can induce many health risks on exposed health care workers (HCWs). However, the health risks of low dose (below 100mSv) are controversial due to a lack of direct evidence on human. Aim of work To identify the health risks of exposure to low dose of ionizing radiation and its effect on general health status and to assess oxidative stress status of health care workers (HCWs) exposed to IR at Ain Shams University hospitals. Materials and methods A comparative cross-sectional study was conducted including 50 HCWs from different departments of Ain Shams University hospitals: exposed group (exposed to IR for at least I year) (No = 25) and matched unexposed control group (No = 25). Both groups were interviewed using a structured questionnaire. Assessment of health care workers' oxidative stress status was done for both groups by measure level of plasma malondialdehyde (MDA) level as biomarker for lipid peroxidation. Complete blood count was done for both groups. Recording readings of personal exposure to IR by badge film dosimeter after approval from workplace authority was also done. Results Regarding general health status and wellbeing of workers, most of exposed group had perception of average health status, while most of unexposed group had perception of good health status. A significantly higher sickness absenteeism during the last 6 months was found among the exposed group and a significant adverse health effects, were recorded among exposed group compared to control group as hair fall, musculoskeletal pain, pain in upper abdomen, constipation, decreased visual acuity, in addition to easily agitated. During the last 30 days exposed group had significantly higher frequencies of GIT disturbances and common cold or infections in comparison to unexposed group. The results showed that IR exposed group had the more oxidative stress status (higher level of plasma MDA) than unexposed group with significant difference (p value =0.014). Results showed also that the Mean Corpuscular Hemoglobin (MCH), Absolute lymphocyte and monocyte counts were significantly lower while relative basophile % was significantly higher among exposed group in comparison to unexposed group (although all parameters were within normal range in both groups). Conclusion Exposure to IR -even in small dose- may lead to significant health complains (adverse health effects), increase oxidative stress status and may affect general health status among exposed group compared to the non-exposed one. Recommendations Personal monitoring for ionizing radiation, periodic medical examination, and increasing level of protection for exposed workers are of utmost importance.

Clinical Significance of Intraoperative Exposure of Inferior Alveolar Nerve during Surgical Extraction of the Mandibular Third Molar in Nerve Injury

During extraction surgery, the inferior alveolar nerve (IAN) can occasionally be observed in the extraction socket of the mandibular third molar (M3). The purpose of this study was to investigate and compare the incidence of IAN injury in groups with and without intraoperative IAN exposure during surgical extraction of M3, and to identify additional risk factors for the IAN injury in addition to the IAN exposure. A total of 288 cases in 240 patients, who underwent surgical extraction of M3 by a single surgeon, were divided into the exposed group (n = 69) and the unexposed group (n = 219). The surgeon recorded the information regarding the procedure when the clinical observation of IAN exposure was made during the surgery. The incidence of IAN injury after the extraction surgery was significantly higher in the exposed group than in the unexposed group (4.3% versus 0%, p < 0.05). Paresthesia was recognized in three cases of the exposed group, but it showed complete recovery within three postoperative months. No case of permanent paresthesia was detected in both groups. According to the logistic regression, the only significant risk factor of IAN injury in the exposed group was the increase of age (OR 1.108, p < 0.05). Intraoperative IAN exposure during surgical extraction of M3 may show a higher incidence of IAN injury than the case without IAN exposure, representing an incidence of 4.3%. Even if the paresthesia associated with IAN exposure occurs, it is likely to be a temporary injury, and this risk may increase with age.

Airborne toxic exposure and pulmonary outcomes among petrochemical complex workers

Background Petrochemical workers are exposed to a variety of airborne toxic compounds which have been associated with increased risk for respiratory outcomes. However, long-term exposure to SO2, NO2, O3, H2S and NH3 in relation to spirometric parameters and self-reported respiratory problems is largely unknown. Methods Airborne concentration levels of SO2, NO2, O3, H2S and NH3 were collected from two fixed stations over a 3-year period in a petrochemical complex. We assessed spirometric parameters and respiratory symptoms in the petrochemical workers (n = 200) and in an unexposed group (n = 200). We calculated β-coefficients (β) and odds ratios (ORs) with 95% confidence intervals (CIs) before and after adjustment for covariates. Results The mean airborne pollution levels were 159 µg/m3 for SO2, 43 µg/m3 for NO2, 66 µg/m3 for O3, 6 µg/m3 for H2S, and 24 µg/m3 for NH3. We found a significant reduction in spirometric parameters among petrochemical workers compared to the unexposed: FEV1 (forced expiratory volume in 1s) (adjusted β -12; 95%CI -16, -7.64), FEV1/ FVC (forced vital capacity) (β -7.26; 95%CI -9.23, -5.28), and PEF (peak expiratory flow) (β -6.61; 95%CI -12, -0.76). Additionally, we observed higher adjusted risks for any respiratory symptom (OR 4.69; 95%CI 1.76, 12), mucus (OR 4.36; 95%CI 1.70, 11) and shortness of breath (OR 15; 4.95, 46) among petrochemical workers compared to the unexposed group. Conclusions Most measured airborne pollution levels were within the ambient recommendation levels. Still, long-term exposure to low level airborne pollutants, reduced FEV1, FEV1/FVC and PEF, and increased respiratory symptoms in Iranian petrochemical workers compared to unexposed controls.

Perceived Risk in the Population Living near the Turin Incinerator: Comparison between before and at Three Years of Operation

When the Turin incinerator went into operation in 2013, it was accompanied by surveillance of health effects that included a human biomonitoring survey of 394 residents. They responded to items investigating their awareness of environmental and health issues and perception of environmental health risks. In this study, we compared the questionnaire responses before plant startup and at 3 years of operation. To accomplish this, we investigated changes in perceived risk and evaluated the efficacy of communication strategies. A total of 344 participants equally distributed in an exposed and an unexposed group responded to the follow-up questionnaire. Survey items investigated the perception of a relationship between illness and exposure to environmental pollution, feeling at risk of developing an illness, and concern about natural and anthropogenic hazards. The proportion of ‘certain’ and ‘very probable’ responses was compared to the total using the difference-in-differences method. Analyses showed an overall decrease in the differences between the two groups, which suggests that the communication actions undertaken for the exposed group were effective. Future communication plans should also include initiatives targeting the unexposed group.