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2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aleksiina Martikainen ◽  
Alice Svensson Alavi ◽  
Kristina Alexanderson ◽  
Kristin Farrants

Abstract Background The proportion of people working beyond age 65 is increasing. We aimed to explore whether sickness absence (SA) and disability pension (DP) due to mental, somatic, or both diagnoses when aged 60–64 were associated with being in paid work when aged 66–71. Methods This prospective population-based cohort study included all 98,551 individuals who in 2010 turned 65 years, lived in Sweden, and were in paid work at some point when aged 60–64. Data from three nationwide registers were used with 2010 as baseline, with SA or/and DP as the exposure variables (2005–2009) and paid work as the outcome variable (2011–2016). Logistic regression was conducted to calculate odds ratios (OR) with 95% confidence intervals (CI) for the association between exposures and outcome, controlling for sociodemographic factors. The analyses were also stratified by sex. Results Nearly half were in paid work during follow-up. Those with SA due to mental diagnoses had lower likelihood of being in paid work among both sexes (women OR: 0.76; 95% CI: 0.69–0.84; men 0.74; 0.65–0.84), while this association was smaller for SA due to somatic diagnoses (women 0.87; 0.84–0.91; men 0.92; 0.89–0.96). SA due to both mental and somatic diagnoses was associated with a lower likelihood of paid work for men (0.77; 0.65–0.91), but not women (0.98; 0.88–1.09). Regardless of diagnosis group and sex, DP had the strongest association with not being in paid work (women mental DP 0.39; 0.34–0.45; women somatic DP 0.38; 0.35–0.41; women mental and somatic DP 0.28; 0.15–0.56; men mental DP 0.36; 0.29–0.43; men somatic DP 0.35; 0.32–0.38; men mental and somatic DP 0.22; 0.10–0.51). Combined SA and/or DP demonstrated ORs in-between the diagnosis groups of SA and DP alone (e.g., mental SA and/or DP women and men combined 0.61; 0.57–0.65). Conclusions SA and DP were negatively associated with being in paid work after the standard retirement age of 65. The association was especially strong for DP, irrespective of diagnosis group. Moreover, compared to somatic diagnoses, SA due to mental diagnoses had a stronger association with not being in paid work. More knowledge is needed on how mental SA impedes extending working life.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Aihua Pu ◽  
Hua Wang ◽  
Jichong Ying

To explore the computed tomography (CT) imaging characteristics and BPF algorithm fine lung CT image efficiency for the diagnosis of pelvic fracture patients and assist clinicians to carry out the disease care and treatment, CT images based on optimized back-projection filtering (BPF) algorithm were utilized to diagnose postoperative reduction of pelvic fractures and penetrating lung infection caused by long-term bed rest. A total of 100 patients with pelvic fracture were selected and all of them underwent pelvic fracture surgery and were rolled into conventional CT diagnosis group (conventional group) and BPF algorithm optimized CT image diagnosis group (BPF group). One group used conventional CT images to guide pelvic reduction and detect lung infections, and the other used BPF algorithm to optimize the images. The results showed that the BPF group was superior to the conventional CT group in both image clarity and shadow area, and the peak signal-to-noise ratio (PSNR) was significantly better than that of the conventional group ( P < 0.05 ). Nine more cases were detected in the algorithm group than in the conventional group, and the incidence of complications was 48% in the conventional group and 28% in the BPF group, with a statistical difference of 20% between the two groups ( P < 0.05 ). In addition, the satisfaction of returning patients was 96% in the BPF group and 77% in the conventional group ( P < 0.05 ). The diagnosis of pulmonary infection was more obvious in the BPF group, indicating that BPF optimization of the CT image was suitable for clinical diagnosis and had a practical application value.


2021 ◽  
Vol 15 (3) ◽  
Author(s):  
Menggang Yu ◽  
Chensheng Kuang ◽  
Jared D. Huling ◽  
Maureen Smith

2021 ◽  
Author(s):  
Paola Francesca Ajmone ◽  
Beatrice Allegri ◽  
Anna Cereda ◽  
Giovanni Michelini ◽  
Francesca Dall'Ara ◽  
...  

Abstract Background: Cornelia de Lange Syndrome (CdLS) is a rare genetic disorder and its phenotype clinical expression is widely variable. Despite the growing interest on genotype-phenotype correlations and on behaviour phenotype of genetic syndromes, specific studies in CdLS cohorts evaluating the correlations between genotype and neurodevelopmental characteristics, Behaviour and communicative aspects are limited, most of these studies are descriptive and there is a lack of specific assessment protocols.Methods: Neurodevelopmental and Behavioural phenotype of all the patients (N = 38) was assessed using a specific neuropsychiatric protocol, concerning Intellectual Quotient (IQ), General Quotient of Development (GQ), communicative skills, behavioural aspects and adaptive behaviour based on direct and indirect evaluation. Subsequently, we searched for possible genotype–phenotype correlations comparing individuals with NIPBL variants (CdLS NIPBL mutated group) and patients with negative molecular results (CdLS clinical diagnosis group). Results: The first part of the study showed a higher percentage of subjects with normal Intellectual Quotient (IQ) and Borderline Intellectual Functioning if compared with previous data; adaptive skills were lower than expected for age in all participants and the weakest areas were Socialization, Motor Skills, and Communication. Expressive language was more compromised than receptive language, nevertheless receptive abilities were also impaired. 39.5% of the sample presented with Autism Spectrum Disorder (ASD). By stratifying CdLS phenotypes by genetic, NIPBL mutated individuals demonstrated a worse trend in cognitive functioning, in communication expressive skills, in motor skills and in ASD symptoms in comparison with the Clinical Diagnosis Group. Individuals with non-Truncating mutation (mostly missense) displayed better abilities in Communication and in relational aspects with no ASD while Truncating individuals presented with worse abilities in Daily Living Skills, Socialization, Motor Skills, and Communicative abilities. Conclusions: These findings should increase our awareness of the strengths and weaknesses points in CdLS individuals to guide appropriate targeted management; interventions addressing communicative impairments represent a clinical priority in CdLS patients.


2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 854-854
Author(s):  
Woori Na ◽  
Yeji Lee ◽  
Hyeji Kim ◽  
Cheongmin Sohn

Abstract Objectives Irritable bowel syndrome (IBS) is accompanied by abdominal discomfort, stomachache, and diarrhea and deteriorates life quality. Limiting intakes such as Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) may relieve symptoms. However, studies on FODMAPs intake in Koreans have been conducted very rarely. Therefore, to provide basic data for preparing dietary guidelines for IBS in Koreans, this study was conducted to investigate the FODMAPs intake according to IBS diagnosis. Methods We performed an internet-based survey on 1,000 persons in their 20s-40s living in Korea from April to August 2020. Among them, data of 857 persons (428 men (49.9%)) who gave faithful answers were used for analysis. The survey variables are general information (sex, age, weight, height, gastro-intestinal (GI) related medical history), IBS diagnosis (ROME Ⅲ), dietary assessment (Food Frequency Questionnaire, FFQ), physical activity level (International Physical Activity Questionnaire, IPAQ), and stress-related questions (Brief Encounter Psychosocial Instrument-Korean version, BEPSI-K). Results Among the participants, 186 (21.7%) were diagnosed with IBS, and 671 (78.3%) were normal. Among the IBS diagnosis groups, there were 28 constipation type (15.0%), diarrhea type 66 (35.4%), mixed type 63 (33.9%), and unclassified 29 (15.8%). In the IBS diagnosis group, the GI-related disease history (p &lt; 0.001) and stress (p &lt; 0.001) were significantly higher than the normal group. There was no significant difference in total energy intake, but fat intake was 86.6 ± 55.1 g/day in the IBS diagnosis group and 76.9 ± 47.9 g/day in the normal group (p = 0.014). The total intake of FODMAPs was 13.9 ± 9.9 g/day in the IBS diagnosis group and 12.6 ± 9.7 g/day in the normal group (p = 0.030). Conclusions There was no significant difference in the intake of total FODMAPs according to the IBS subtype. As a result of this study, it is necessary to control fat and FODMAPs to improve IBS patients' symptoms in Korea especially. Funding Sources This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea Government (MSIP).


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10029-10029
Author(s):  
Amy Yuan Wang ◽  
Yan Chen ◽  
Yutaka Yasui ◽  
Wendy Stock ◽  
Wendy M. Leisenring ◽  
...  

10029 Background: Neurocognitive impairment in eAYA hematologic cancer survivors has not been well described, despite intensive neurotoxic therapies. We examined prevalence and risk for such impairment in hematologic cancer survivors diagnosed during eAYA compared to a younger age. Methods: We identified 1,213 eAYA (diagnosed at 15-21 years; median [range] follow-up age 40 [30-54]) and 4,538 childhood (diagnosed at <15 years; median age 30 [17-48]) survivors of ALL (n= 301 vs 3274), AML (n= 77 vs 424), and Hodgkin lymphoma (HL; n= 835 vs 840) from the CCSS (diagnosed 1970-1999) who completed the Neurocognitive Questionnaire. Impairment was defined as a score >90% of normative data in task efficiency (TE), organization (Org), memory (Mem), and emotional regulation (ER) domains. 1,014 age-matched siblings were controls. Treatment by diagnosis group, chronic health conditions, health status and health behaviors were examined as risk factors for neurocognitive impairment using multivariable logistic regression. Adjusted odds ratios (ORs) and corresponding 95% CI are reported. Results: Prevalence of neurocognitive impairment (≥1 impaired domain) was similar for eAYAs and childhood survivors of HL (31.0% vs 29.6%, p=0.54) and AML (36.4% vs 40.3%, p=0.51), although eAYA AML survivors were more likely to have impaired Mem (OR=2.3, 95% CI 1.0-5.4). eAYA ALL survivors were less likely to have neurocognitive impairment than childhood ALL survivors (28.2% vs 38.5%, p<.001) due to lower risk for impaired TE (OR=0.7, 95% CI 0.4-1.0) and Org (OR=0.5, 95% CI 0.4-0.9). No factors, including cranial radiation (RT), explained the rate differences. Treatment by diagnosis group (including cranial RT in ALL, chest RT in HL, and salvage therapy use) was not consistently associated with neurocognitive impairment in eAYA survivors. However, anthracycline dose ≥120mg/m2 was a risk factor for impaired ER (OR=6.0, 95% CI 2.0-17.9) only in eAYA ALL survivors. Presence of a neurologic health condition was associated with impairment in all 4 domains in eAYA (ORs ranged 1.7-2.9) and childhood cancer survivors (ORs ranged 1.9-5.3). eAYA survivors with a respiratory condition were more likely to have impaired TE (OR=2.1, 95% CI 1.2-3.8). Being in good general health was associated with less impairment across all 4 domains for eAYA (ORs ranged 0.2-0.4) and childhood survivors (ORs ranged 0.3-0.5). eAYA survivors who never smoked were less likely to have impaired ER (OR=0.4, 95% CI 0.2-0.6) than those who smoke. Conclusions: Survivors of hematologic cancers diagnosed during eAYA are susceptible to neurocognitive impairment at rates similar to those diagnosed at younger ages. Having comorbidities and being in fair/poor general health are risk factors for impairment. Higher anthracycline exposure in ALL survivors diagnosed during eAYA was the only therapy associated with impairment rates.


BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaegeun Lee ◽  
Seung Woo Yang ◽  
Long Jin ◽  
Chung Lyul Lee ◽  
Ji Yong Lee ◽  
...  

Abstract Background Serum prostate-specific antigen (PSA) is widely used in screening tests for prostate cancer. As the low specificity of PSA results in unnecessary and invasive prostate biopsies, we evaluated the clinical significance of various PSAs and PSA density (PSAD) related to peripheral zones in patients with gray zone PSA level (4–10 ng/mL). Methods A total of 1300 patients underwent transrectal ultrasonography-guided prostate biopsy from 2014 to 2019. Among them, 545 patients in the gray zone were divided into the prostate cancer diagnosis group and the non-prostate cancer diagnosis group, and PSA, relative extra transitional zone PSA (RETzPSA), estimated post holmium laser enucleation of the prostate PSA (EPHPSA), PSAD, peripheral zone PSA density (PZPSAD) and extra-transitional zone density (ETzD) were compared and analyzed using receiver-operating characteristics (ROC) analysis after 1:1 matching using propensity score. Results Area under the ROC curve values of PSA, EPHPSA, RETzPSA, PSA density, ETzD, and PZPSAD were 0.553 (95% CI: 0.495–0.610), 0.611 (95% CI: 0.554–0.666), 0.673 (95% CI: 0.617–0.725), 0.745 (95% CI: 0.693–0.793), 0.731 (95% CI: 0.677–0.780) and 0.677 (95% CI: 0.611–0.719), respectively. PSAD had 67.11% sensitivity, 71.71% specificity, and 70.34% positive predictive rate at 0.18 ng/mL/cc. ETzD had 69.08% sensitivity, 64.47% specificity, and 66.04% positive predictive rate at 0.04 ng/mL/cc. When the cut-off value of PSAD was increased to 0.18 ng/mL/cc, the best results were obtained with an odds ratio of 5.171 (95% CI: 3.171–8.432), followed by ETzD with 4.054 (95% CI: 2.513–6.540). Conclusions These results suggested that volume-adjusted parameters (ETzD and PSAD) might be more sensitive and accurate than various PSA in gray zone patients who required prostate biopsy to reduce unnecessary biopsy.


2021 ◽  
Author(s):  
Junping Liu ◽  
Xin Liu ◽  
Zhengying Guo ◽  
Xiaojuan Lv ◽  
Weimin Mao ◽  
...  

Abstract Objective: To investigate whether ultrasound guided fine-needle aspiration cytology(US-FNAC) is an effective technique for diagnosing para-aortic lymph nodes(PALNs) metastasis in uterine cervical cancer and access the impact on clinical therapeutic decision. Methods: We retrospectively reviewed the clinical data of 92 patients with PALN enlargement in cervical cancer between 2010 and 2018. The US-FNAC cytological results were classified by the same experienced cellular pathologists. The diagnostic indicators were calculated according to biopsy , imaging and clinical follow-up results. Univariate and multivariate analysis was used to analyze the differences of influencing factors. The effect of US-FNAC on clinical decision making was evaluated. Results: The results of cytological diagnosis by US-FNAC were categorized as malignancy(n=62;67.4%), suspicious malignancy(n=11;12.0%), undetermined(n=5;5.4%), benign (n=10;10.9%), and inadequacy(n=4;4.3%). The satisfactory biopsy samples were obtained from 95.7% of PLANs (88/92). The sensitivity, specificity, PPV, NPV and accuracy of FNAC in distinguishing benign from malignant were 90.1%(95%CI:0.809-0.953), 100%(95%CI:0.561-1), 100%(95%CI:0.938-1), 46.7%(95%CI:0.223-0.726) and 90.9%(95%CI:0.848-0.970) respectively. Univariate analysis indicated that experience of the puncture physicians(radiologists) was significant differences between the correct diagnosis group and wrong diagnosis group (P<0.05); the experience was confirmed as independent predictor of diagnostic accuracy by multivariate analysis (p=0.031,OR=0.077,95%CI:0.354-0.919). All patients tolerated the US-FNAC procedure well and only nine patients presented slight abdominal discomfort. Through US-FNAC technique, the therapeutic methods of 74 patients (80.4%) were subjected to affect.Conclusions: US-FNAC is a relatively safe and effective examination technique for enlarged para-aortic lymph nodes, which can be considered as a routine examination before treatment of cervical cancer to guide clinical decision-making.


2021 ◽  
Vol 10 (4) ◽  
pp. 826
Author(s):  
Felix M.L. Meyer ◽  
Mark G. Filipovic ◽  
Gianmarco M. Balestra ◽  
Kai Tisljar ◽  
Timur Sellmann ◽  
...  

Preventive strategies against diagnostic errors require the knowledge of underlying mechanisms. We examined the effects of a wrong a priori diagnosis on diagnostic accuracy of a focussed assessment in an acute myocardial infarction scenario. One-hundred-and-fifty-six medical students (cohort 1) were randomized to three study arms differing in the a priori diagnosis revealed: no diagnosis (control group), myocardial infarction (correct diagnosis group), and pulmonary embolism (wrong diagnosis group). Forty-four physicians (cohort 2) were randomized to the control group and the wrong diagnosis group. Primary endpoint was the participants’ final presumptive diagnosis. Among students, the correct diagnosis of an acute myocardial infarction was made by 48/52 (92%) in the control group, 49/52 (94%) in the correct diagnosis group, and 14/52 (27%) in the wrong diagnosis group (p < 0.001 vs. both other groups). Among physicians, the correct diagnosis was made by 20/21 (95%) in the control group and 15/23 (65%) in the wrong diagnosis group (p = 0.023). In the wrong diagnosis group, 31/52 (60%) students and 6/23 (19%) physicians indicated their initially given wrong a priori diagnosis pulmonary embolism as final diagnosis. A wrong a priori diagnosis significantly increases the likelihood of a diagnostic error during a subsequent patient encounter.


Author(s):  
Umut Alıcı ◽  
Çiğdem Öztunalı ◽  
Çiğdem Arslan Alıcı ◽  
Hüseyin İlhan ◽  
Baran Tokar

Objective: History and chest x-ray are the main diagnostic tools in children with foreign body aspiration (FBA). The study aims to evaluate clinical, radiological, and bronchoscopic findings associated with early and delayed diagnosis of FBA. Methods: The records of 249 children having bronchoscopy for suspected FBA were analyzed in three groups as negative bronchoscopy for FBA (group I), early diagnosis (group II), and delayed diagnosis (group III). Results: Choking episodes, coughing, and decreased breath sounds were determined significantly in FBA. The percentage of radiopaque FBs was 6.2%. Emphysema in groups II and III; atelectasis and pneumonia in group III were significantly higher on chest x-ray. Pneumonia and significant inflammation found during bronchoscopy were prominent in group III. FBs were mostly vegetable origin and the majority were found in the bronchus, more on the right side. FBs were successfully removed by rigid bronchoscopy except one having thoracotomy. Conclusion: Review of the literature, our current (2010-2019) and previous (1994-2003) studies designed in the same group structure showed that choking episode associated with a radiopaque FB leads to bronchoscopy. Emphysema and atelectasis are also valuable for early diagnosis. Regardless of radiological findings, bronchoscopy should be considered in patients with a strong history.


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