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Objective: To assess the validity of the Fetal Medicine Foundation (FMF) chorionicity‐specific models for fetal growth in twin pregnancy. Methods: This was an external validation study of the FMF models using a nationwide Danish cohort of twin pregnancies. The cohort included all dichorionic (DC) and monochorionic diamniotic (MCDA) twin pregnancies with an estimated delivery date between 2008 and 2018, which satisfied the following inclusion criteria: two live fetuses at the first‐trimester ultrasound scan (11–14 weeks' gestation); biometric measurements available for the calculation of estimated fetal weight (EFW) using the Hadlock‐3 formula; and delivery of two liveborn infants. Validation involved assessing the distributional properties of the models and estimating the mean EFW Z‐score deviations. Additionally, the models were applied to pregnancies that delivered preterm and attended non‐scheduled visits (complicated pregnancies). Results: Overall, 8542 DC and 1675 MCDA twin pregnancies met the inclusion criteria. In DC twins, 17 084 fetuses were evaluated at a total of 95 346 ultrasound scans, of which 44.5% were performed at scheduled visits in pregnancies carried to 37 + 0 weeks or later. The median number of growth scans per DC twin fetus from 20 + 0 weeks onwards was four. The model showed good agreement with the validation cohort for scheduled visits in DC twins delivered at 37 + 0 weeks or later (mean ± SD EFW Z‐score, –0.14 ± 1.05). In MCDA twins, 3350 fetuses underwent 31 632 eligible ultrasound scans, of which 59.5% were performed at scheduled visits in pregnancies carried to 36 + 0 weeks or later. The median number of growth scans per MCDA twin fetus from 16 + 0 weeks onwards was 10. The model showed favorable agreement with the validation cohort for scheduled visits in MCDA twins delivered at 36 + 0 weeks or later (mean ± SD EFW Z‐score, –0.09 ± 1.01). Non‐scheduled visits and preterm delivery before 37 + 0 weeks for DC twins and before 36 + 0 weeks for MCDA twins corresponded with smaller weight estimates, which was consistent with the study's definition of complicated pregnancy. Conclusions: The FMF models provide a good fit for EFW measurements in our Danish national cohort of uncomplicated twin pregnancies assessed at routine scans. Therefore, the FMF models establish robust criteria for subsequent investigations and potential clinical applications. Future research should focus on exploring the consequences of clinical implementation, particularly regarding the identification of twins that are small‐for‐gestational age, as they are especially susceptible to adverse perinatal outcome. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Purpose: Sexuality, a substantial factor in quality of life, may be altered after breast cancer (BC) treatments as they intimately afflict femininity. This study aimed to assess the prevalence of sexual dysfunction in women with a history of BC and to compare it with women without a BC history. Methods: The French general epidemiological cohort CONSTANCES includes more than 200,000 adults. All inclusion questionnaires from CONSTANCES non-virgin adult female participants were analyzed. Women reporting a history of BC were compared to controls in univariate analysis. Multivariate analysis was performed to highlight any demographic risk factor for sexual dysfunction. Results: Among the 2,680 participants who had a history of BC, 34% did not engage in sexual intercourse (SI) in the month preceding the completion of the questionnaire (n = 911), 34% had pain during SI (n = 901) and 30% were not satisfied with their sex life (n = 803). Sexual dysfunction was significantly more frequent in women who had a history of BC: they had less sexual interest (OR 1.79 [1.65;1.94], p < 0.001), experienced more pain during SI (OR 1.10 [1.02;1.19], p < 0.001) and were more dissatisfied with their sex life (OR 1.58 [1.47;1.71], p < 0.001). This stayed true after adjustment on multiple demographic factors such as age, menopausal status, body mass index and depression. Conclusions: Overall, in this real-life study in a large national cohort, history of BC appeared to be a risk factor for sexual disorders. Implications for cancer survivors: Efforts to detect sexual disorders in BC survivors and offer quality support must be pursued. [ABSTRACT FROM AUTHOR]

Background Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Twin pregnancy and cesarean delivery are well-known risk factors for PPH. However, few studies have investigated PPH risk factors in mothers who have undergone cesarean delivery for twin pregnancies. Therefore, this study investigated the risk factors associated with severe PPH after cesarean delivery for twin pregnancies. Methods We searched and reviewed the Korean Health Insurance Review and Assessment Service’s claims data from July 2008 to June 2021 using the code corresponding to cesarean delivery for twin pregnancy. Severe PPH was defined as hemorrhage requiring red blood cell (RBC) transfusion during the peripartum period. The risk factors associated with severe PPH were identified among the procedure and diagnosis code variables and analyzed using univariate and multivariate logistic regressions. Results We analyzed 31,074 cesarean deliveries for twin pregnancies, and 4,892 patients who underwent cesarean deliveries for twin pregnancies and received RBC transfusions for severe PPH were included. According to the multivariate analysis, placental disorders (odds ratio, 4.50; 95% confidence interval, 4.09–4.95; P < 0.001), general anesthesia (2.33, 2.18–2.49; P < 0.001), preeclampsia (2.20, 1.99–2.43; P < 0.001), hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome (2.12, 1.22–3.68; P = 0.008), induction failure (1.37, 1.07–1.76; P = 0.014), and hypertension (1.31, 1.18–1.44; P < 0.001) predicted severe PPH. Conclusions Placental disorders, hypertensive disorders such as preeclampsia and HELLP syndrome, and induction failure increased the risk of severe PPH after cesarean delivery for twin pregnancy.

Background and Aim: Colorectal cancer (CRC) was the fourth most common cancer in Republic of Korea in 2019. It has a gradually increasing mortality rate, indicating the importance of screening for CRC. Among the various CRC screening test, fecal immunochemical test (FIT) is a simple yet most commonly used. Neverthelss, there have been only few long‐term studies on subjects with FIT‐positive. Therefore, in this study, we aimed to investigate the risk factors for CRC in FIT‐positive patients using the National Health Insurance Service Bigdata database. Methods: Among 1 737 633 individuals with a FIT screening result for CRC in 2009, 101 143 (5.82%) were confirmed to be FIT positive. The CRC incidence over 10 years (up to 2018) of these participants was investigated using the National Cancer Registry. Results: Out of the 101 143 FIT‐positive participants, 4395 (4.35%) were diagnosed with CRC. The FIT‐positive patients who underwent a second round of screening showed a 5‐year cumulative CRC incidence of approximately 1.25%, whereas those who did not showed an incidence of approximately 3.75%. Among the FIT‐positive patients, the CRC incidence in the non‐compliance group for the second round of screening was 2.8 times higher than that in the compliance group. Conclusions: In FIT‐positive participants, non‐compliance with the second round of screening was identified as a major risk factor for CRC development. It is necessary to establish appropriate strategies for managing risk factors for CRC in FIT‐positive patients to increase the rate of compliance with the second round of CRC screening. [ABSTRACT FROM AUTHOR]

Background: Overweight and obesity are common challenges among childhood cancer survivors. Overweight may be disguised, as survivors can have normal weight but high fat percentage (fat%) on dual-energy X-ray absorptiometry (DXA). We aimed to assess prevalence, identify determinants and biomarkers, and assess which method captures overweight best, in a nationwide cohort. Methods: The prevalence of overweight and obesity, primarily defined by body mass index (BMI), was assessed in the DCCSS-LATER cohort of adult survivors treated from 1963-2002, with the LifeLines cohort as reference. The associations between risk factors and overweight metrics were investigated using logistic regression. Additional overweight metrics included DXA fat%, waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR), and high-molecular-weight (HMW) adiponectin. Results: A total of 2338 (mean age 35.5 years, follow-up 28.3 years) survivors participated. The overweight prevalence was 46.3% in men and 44.3% in women (obesity 11.2% and 15.9%, morbid obesity 2.4% and 5.4%), with highest rates among brain tumor survivors. Compared to controls, there was no overall increased overweight rate, but this was higher in women > 50 years, morbid obesity in men > 50 years. Overweight at cancer diagnosis (adjusted odds ratio [aOR] = 3.83, 95% CI 2.19-6.69), cranial radiotherapy (aOR = 3.21, 95% CI 1.99-5.18), and growth hormone deficiency (separate model, aOR = 1.61, 95% CI 1.00-2.59) were associated with overweight. Using BMI, WC, WHR, and WHtR, overweight prevalence was similar. Low HMW adiponectin, present in only 4.5% of survivors, was an insensitive overweight marker. Dual-energy X-ray absorptiometry–based classification identified overweight in an additional 30%, particularly after abdominal radiotherapy, total body irradiation, anthracyclines, and platinum. Conclusions: Overweight occurs in almost half of long-term survivors. There was no overall increased incidence of overweight compared to controls. We identified factors associated with overweight, as well as subgroups of survivors in whom DXA can more reliably assess overweight. [ABSTRACT FROM AUTHOR]

Objective Given the importance of sleep in maintaining neurocognitive health, both sleep duration and quality might be component causes of dementia. However, the possible role of insomnia symptoms as risk factors for dementia remain uncertain. Methods We prospectively studied 22,078 participants in the Swedish National March Cohort who were free from dementia and stroke at baseline. Occurrence of dementia was documented by national registers during a median follow-up period of 19.2 years. Insomnia symptoms and sleep duration were ascertained by Karolinska Sleep Questionnaire. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results Compared to participants without insomnia at baseline, those who reported any insomnia symptom experienced a greater incidence of dementia during follow-up (HR 1.08, 95% CI: 1.03, 1.35). Difficulty initiating sleep versus non-insomnia (HR 1.24, 95% CI: 1.02, 1.52), but not difficulty maintaining sleep or early morning awakening was associated with an increased risk of dementia. Short sleep duration was associated with increased risk of dementia (6 h vs. 8 h, HR 1.29, 95% CI: 1.11–1.51; 5 h vs. 8 h, HR 1.26, 95% CI: 1.00–1.57). Stratified analyses suggested that insomnia symptoms increased the risk of dementia only amongst participants with ≥7 h sleep (vs. non-insomnia HR 1.24, 95% CI: 1.00–1.54, P  = 0.05), but not amongst short sleepers (<7 h). Short sleep duration also did not further inflate the risk of dementia amongst insomniacs. Conclusion Insomnia and short sleep duration increase the risk of dementia amongst middle-aged to older adults. [ABSTRACT FROM AUTHOR]

RATIONALE & OBJECTIVE:Clinical practice guidelines recommend a target blood pressure (BP)

Purpose: To identify potential prognostic factors for patient-reported outcomes in an Icelandic cohort of ACL injured subjects. Methods: All knee MRI reports written in Iceland between the years 2001 to 2011 were read to identify individuals with a possible ACL injury. These individuals were contacted and asked to complete an online questionnaire regarding their injury and current knee related health. The questionnaire collected information on years since surgery, injury circumstance, brace use, physiotherapy, ACL surgery, second ACL injury and current smoking status. In addition, the baseline status of their meniscii were assessed from the original MRI report and medical records were used to identify any subsequent, non-ACL surgery. The patient-reported Knee Osteoarthritis and Injury Outcome Score (KOOS) was used assess current knee related health. A Bayesian proportional odds model was used to assess the effect of all potential prognostic factors above as well as age and sex on KOOS outcomes. Results: A total of 408 subjects completed the questionnaire indicating that they did rupture their ACL. The following variables were associated with worse outcomes across all KOOS subscales: having a subsequent arthroscopy, reinjury to your ACL, and smoking. Having physiotherapy for 9 months was associated with worse KOOS pain scores than having 6 months of physiotherapy. Conversely KOOS pain score tended to be higher if you injured your knee during sports. Conclusion: Reinjuring your ACL, smoking and having subsequent (non-ACLR) surgery predict your knee related health following an ACL injury. Strategies should be implemented to reduce the risk of secondary ACL injury, and patients should be strongly advised not to smoke. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the incidence of dementia by age and year as well as the population-attributable fractions (PAFs) for known dementia risk factors in Republic of Korea. Methods: A 12-year, nationwide, population-based, retrospective cohort study was conducted. We used customized health information from the National Health Insurance Service (NHIS) data from 2002 to 2017. We analyzed ageand sex-adjusted incidence rates and PAF of dementia for each risk factor such as depression, diabetes, hemorrhagic stroke, ischemic stroke, hypertension, osteoporosis and physical inactivity using Levin's formula. Results: Of the 794,448 subjects in the dementia-free cohort, 49,524 (6.2%) developed dementia. Dementia incidence showed annual growth from 1.56 per 1,000 person-years in 2006 to 6.94 per 1,000 person-years in 2017. Of all dementia cases, 34,544 subjects (69.8%) were female and 2,479 subjects (5.0%) were early onset dementia. AD dementia accounted for 66.5% of the total dementia incidence. Considering relative risk and prevalence, physical inactivity attributed the greatest to dementia (PAF, 8.1%), followed by diabetes (PAF, 4.2%), and hypertension (PAF, 2.9%). Altogether, the significant risk factors increased the risk of dementia by 18.0% (overall PAF). Conclusion: We provided the incidence of dementia and PAFs for dementia risk factors in Republic of Korea using a 12-year, nationwide cohort. Encouraging lifestyle modifications and more aggressive control of risk factors may effectively prevent dementia. [ABSTRACT FROM AUTHOR]

Simple Summary: Multiple endocrine neoplasia 2A (MEN 2A) is a rare hereditary cancer syndrome, in which primary hyperparathyroidism (PHPT) is reported in up to 35% of affected individuals. Recent studies suggest a lower frequency and a milder course of PHPT in MEN 2A, but these studies often lack a strict definition of PHPT and are frequently carried out at smaller research centers. This could result in diverging and incomplete data. Consequently, we aimed to investigate PHPT in a complete nationwide cohort of MEN 2A to suggest a representative frequency and clinical course of PHPT. This may alter the information given to MEN 2A patients by their caretakers on the likelihood of developing PHPT and on the clinical course of PHPT. Studies of primary hyperparathyroidism (PHPT) in multiple endocrine neoplasia type 2A (MEN 2A) shows divergence in frequency, disease definition, reporting of clinical characteristics and traces of selection bias. This is a nationwide population-based retrospective study of PHPT in MEN 2A, suggesting a representative frequency, with complete reporting and a strict PHPT definition. The Danish MEN 2A cohort 1930–2021 was used. Of 204 MEN 2A cases, 16 had PHPT, resulting in a frequency of 8% (CI, 5–12). Age-related penetrance at 50 years was 8% (CI, 4–15). PHPT was seen in the American Thyroid Association moderate (ATA-MOD) and high (ATA-H) risk groups in 62% and 38% of carriers, respectively. Median age at PHPT diagnosis was 45 years (range, 21–79). A total of 75% were asymptomatic and 25% were symptomatic. Thirteen underwent parathyroid surgery, resulting in a cure of 69%, persistence in 8% and recurrence in 23%. In this first study with a clear PHPT definition and no selection bias, we found a lower frequency of PHPT and age-related penetrance, but a higher age at PHPT diagnosis than often cited. This might be affected by the Danish RET p.Cys611Tyr founder effect. Our study corroborates that PHPT in MEN 2A is often mild, asymptomatic and is associated with both ATA-MOD and ATA-H variants. Likelihood of cure is high, but recurrence is not infrequent and can occur decades after surgery. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a disabling condition. Many people with chronic pain seek informal support for everyday activities of daily living (ADL). However, there remains uncertainty on the type of people with chronic pain who access this support, what types of support they need and who provides such support. The purpose of this analysis was to answer these uncertainties. Methods: Data from the Health Survey for England (HSE) and English Longitudinal Study of Ageing (ELSA) were accessed. People who reported chronic pain (moderate or above for minimum of 12 months) were identified. From these cohorts, we determined if individuals self-reported receiving informal care. Data on caregiver profiles and caregiving activities were reported through descriptive statistics. Logistic regression analyses were performed to compare health status outcomes between people with pain who received and who did not receive informal care. Results: 2178 people with chronic pain from the ELSA cohort and 571 from the HSE cohort were analysed. People who received care were frequently female, older aged with several medical morbidities including musculoskeletal diseases such as arthritis. People with chronic pain received informal care for several diverse tasks. Most frequently these related to instrumental activities of daily living (IADL) such as shopping and housework. They were most frequently provided by partners or their children. Although they reported greater disability and symptoms (p < 0.001), people who received care did not report differences in health status, loneliness or wellbeing (p = 0.27; p = 0.46). Conclusions: Whilst it may be possible to characterise people living in chronic pain who receive informal care, there is some uncertainty on the impact of informal caregiving on their health and wellbeing. Consideration should now be made on how best to support both care recipients and informal caregivers, to ensure their health and quality of life is promoted whilst living with chronic pain. [ABSTRACT FROM AUTHOR]

Background: Health implications of long-term exposure to ubiquitously present ultrafine particles (UFP) are uncertain. The aim of this study was to investigate the associations between long-term UFP exposure and natural and cause-specific mortality (including cardiovascular disease (CVD), respiratory disease, and lung cancer) in the Netherlands. Methods: A Dutch national cohort of 10.8 million adults aged ≥ 30 years was followed from 2013 until 2019. Annual average UFP concentrations were estimated at the home address at baseline, using land-use regression models based on a nationwide mobile monitoring campaign performed at the midpoint of the follow-up period. Cox proportional hazard models were applied, adjusting for individual and area-level socio-economic status covariates. Two-pollutant models with the major regulated pollutants nitrogen dioxide (NO2) and fine particles (PM2.5 and PM10), and the health relevant combustion aerosol pollutant (elemental carbon (EC)) were assessed based on dispersion modelling. Results: A total of 945,615 natural deaths occurred during 71,008,209 person-years of follow-up. The correlation of UFP concentration with other pollutants ranged from moderate (0.59 (PM2.5)) to high (0.81 (NO2)). We found a significant association between annual average UFP exposure and natural mortality [HR 1.012 (95 % CI 1.010–1.015), per interquartile range (IQR) (2723 particles/cm3) increment]. Associations were stronger for respiratory disease mortality [HR 1.022 (1.013–1.032)] and lung cancer mortality [HR 1.038 (1.028–1.048)] and weaker for CVD mortality [HR 1.005 (1.000–1.011)]. The associations of UFP with natural and lung cancer mortality attenuated but remained significant in all two-pollutant models, whereas the associations with CVD and respiratory mortality attenuated to the null. Conclusion: Long-term UFP exposure was associated with natural and lung cancer mortality among adults independently from other regulated air pollutants.

Abstract Purpose To identify potential prognostic factors for patient‐reported outcomes in an Icelandic cohort of ACL injured subjects. Methods All knee MRI reports written in Iceland between the years 2001 to 2011 were read to identify individuals with a possible ACL injury. These individuals were contacted and asked to complete an online questionnaire regarding their injury and current knee related health. The questionnaire collected information on years since surgery, injury circumstance, brace use, physiotherapy, ACL surgery, second ACL injury and current smoking status. In addition, the baseline status of their meniscii were assessed from the original MRI report and medical records were used to identify any subsequent, non‐ACL surgery. The patient‐reported Knee Osteoarthritis and Injury Outcome Score (KOOS) was used assess current knee related health. A Bayesian proportional odds model was used to assess the effect of all potential prognostic factors above as well as age and sex on KOOS outcomes. Results A total of 408 subjects completed the questionnaire indicating that they did rupture their ACL. The following variables were associated with worse outcomes across all KOOS subscales: having a subsequent arthroscopy, reinjury to your ACL, and smoking. Having physiotherapy for 9 months was associated with worse KOOS pain scores than having 6 months of physiotherapy. Conversely KOOS pain score tended to be higher if you injured your knee during sports. Conclusion Reinjuring your ACL, smoking and having subsequent (non‐ACLR) surgery predict your knee related health following an ACL injury. Strategies should be implemented to reduce the risk of secondary ACL injury, and patients should be strongly advised not to smoke.

Background An adequate large-scale pediatric cohort based on nationwide administrative data is lacking in Korea. Purpose This study established the National Investigation of Birth Cohort in Korea study 2008 (NICKs-2008) based on data from a nationwide population-based health screening program and data on healthcare utilization for children. Methods The NICKs-2008 study consisted of the Korean National Health Insurance System (NHIS) and the National Health Screening Program for Infants and Children (NHSPIC) databases comprising children born in 2008 (n=469,248) and 2009 (n=448,459) in the Republic of Korea. The NHIS database contains data on age, sex, residential area, income, healthcare utilization (International Classification of Diseases-10 codes, procedure codes, and drug classification codes), and healthcare providers. The NHSPIC consists of 7 screening rounds. These screening sessions comprised physical examination, developmental screening (rounds 2–7), a general health questionnaire, and age-specific anticipatory guidance. Results During the 10-year follow-up, 2,718 children (0.3%) died, including more boys than girls (hazard ratio, 1.145; P

Background Evidence of the cardiovascular benefits of adherence to quality indicators in diabetes care over a period of years is lacking. Methods and Results We conducted a population‐based, historical cohort study of 105 656 people aged 45 to 80 with pharmacologically treated diabetes and who were free of cardiac disease in 2010. Data were retrieved from electronic medical records of the 4 Israeli health maintenance organizations. The association between level of adherence to national quality indicators (2006–2010: adherence assessment) and incidence of cardiac outcome; ischemic heart disease or heart failure (2011–2016: outcome assessment) was estimated using Cox proportional hazards models. During 529 551 person‐years of follow‐up, 19 246 patients experienced cardiac disease. An inverse dose–response association between the level of adherence and risk of cardiac morbidity was shown for most of the quality indicators. The associations were modified by age, with stronger associations among younger patients (

Socioeconomic status (SES) is a well‐established determinant of health. Disparities in stress are thought to partially account for SES‐health disparities. We tested whether multiple indicators of SES show similar associations with psychological stress and whether race, sex, and geographic region moderate associations. Participants (n = 26,451) are from a well‐characterized national cohort of Black and White US adults aged 45 years or older. Psychological stress was measured using the 4‐item perceived stress scale. Income was assessed as annual household income and education as highest level of education completed. Occupation was assessed during a structured interview and subsequently coded hierarchically. For all sex‐race‐region groups, the largest SES‐stress associations were for income and the smallest were for occupation. Race moderated SES‐stress associations, such that income and education were more closely associated with stress in Black adults than White adults. Additionally, education was more strongly associated with stress in individuals living in the stroke belt region. Black Americans with lower income and education reported greater psychological stress and may be at higher risk for disease through stress‐related pathways. Thus, which SES indicator is examined and for whom may alter the magnitude of the association between SES and psychological stress. [ABSTRACT FROM AUTHOR]

Abstract Background Before the era of targeted therapies, cytokines were the main therapy for metastatic renal cell carcinoma (mRCC). Our aim was to analyze the changes in treatments and overall survival (OS) of all mRCC patients in Estonia in relation to the introduction of new medications. Methods All patients with mRCC who started medical therapy in Estonia during the years 2004–2012 were identified using the database of the Estonian Health Insurance Fund. Tumor and treatment data were gathered from medical records. Vital status data were obtained from the Estonian Population Registry. The only available therapy before 2008 was interferon alpha-2A (INFa2A), targeted agents added from 2008. For survival analysis, patients were divided into 2 groups: INFa therapy only (group 1) and INFa followed by targeted agents or targeted agents therapy only (group 2). Results Out of 416 identified patients, 380 were eligible for analysis. The most common 1st-line treatments were INFa (55%), sunitinib (32%) and INFa+bevacizumab (13%). 28% of patients received 2nd-line therapies and 15% 3rd-line treatments. Median survival of all patients was 13.7 months [95% confidence interval (CI) 11.3–16.2]; 7.6 months (CI 6.4–8.6) for group 1 and 19.8 months (CI 15.6–22.9) for group 2. In multivariate analysis, group 1 had nearly four times higher risk of dying than group 2 [hazard ration (HR) 3.88, 95% CI 2.64–5.72]. Conclusions The implementation of targeted therapies significantly changed the outcomes of mRCC in Estonia: it prolonged median survival, reduced the risk of death and also enlarged the proportion of patients who received medical therapy.

BackgroundWe have proposed the Taiwan AF score consisting of age, male sex, hypertension, heart failure, coronary artery disease, end-stage renal disease, and alcoholism to predict incident atrial fibrillation (AF) in Asian population. We hypothesized that the modified Taiwan AF score (mTaiwan AF score) excluding alcoholism remained useful for predicting new onset AF.MethodsA total of 7,220,654 subjects aged ≥ 40 years without a past history of cardiac arrhythmia were identified from a national cohort, and 438,930 incident AF occurred during a 16-year follow-up with an incidence of 0.42 per 100 person-years. The mTaiwan AF score ranging between −2 and 14 and its predictive accuracy of incident AF was analyzed.ResultsThe areas under the receiver operating characteristic curve (AUCs) of the mTaiwan AF scores in predicting AF are 0.861 for 1-year follow-up, 0.829 for 5-year follow-up, 0.795 for 10-year follow-up, and 0.751 for 16-year follow-up. The risk of incident AF increased from 0.05%/year for patients with a score of −2 to 6.98%/year for those having a score of 14. Patients were classified into three groups based on the tertile values of the mTaiwan AF scores—group 1 (score −2-3), group 2 (score 4-9) and group 3 (score 10-14). The annual risks of incident AF were 0.20, 1.33, and 3.36% for group 1, 2, and 3, respectively. Compared to patients in group 1, the hazard ratios of incident AF were 5.79 [95% confidence interval (CI) 3.75-7.75] for group 2 and 8.93 (95% CI 6.47-10.80) for group 3.ConclusionsWe demonstrated that the mTaiwan AF score based on age and clinical comorbidities could be used to predict incident AF in Asian population.

Introduction: Polypharmacy is a risk factor for adverse health outcomes, higher use of medical services and additional costs. The problem has gained attention as a consequence of aging and related multimorbidity. Therefore, there is an urgent need to adopt effective interventions aimed at reducing its burden. In order to achieve this, in-depth understanding of the prevalence of polypharmacy is required. Of particular interest is, however, assessing prevalence of polypharmacy in various age groups, to reach the right target for these interventions. So far, only limited data on polypharmacy among non-elderly individuals have been available.Aim of study: To assess overall prevalence of polypharmacy in Poland as well as its distribution in various age groups using real-world data.Methodology: A retrospective analysis of complete dispensation data of national payer organization for the years 2018–2019. The analyzed dataset included data on dispensation of reimbursed drugs, and exclusively for 2019, also non-reimbursed drugs. Polypharmacy was defined as dispensation of ≥5 prescription medications within six months.Results: In the analyzed national cohort of 38 million Polish citizens, the prevalence of polypharmacy was found to be 11.7% in 2018 and 11.6% in 2019. With age, the prevalence of polypharmacy increased, reaching the value of 56.0% in those aged 80+ in 2018, and 55.0% in 2019. Altogether, among those aged 65+, the polypharmacy was present in 43.1% in 2018, and 42.1% in 2019. In the youngest group of citizens, i.e., among those aged below 20 years, polypharmacy was found in 0.9%, and 0.8% in 2018 and 2019, respectively. Prevalence of polypharmacy, calculated for 2019 according to dispensation of five or more reimbursed and non-reimbursed drugs for the whole Polish population, was 21.8% for January-June, and 22.4% for July-December 2019. Among those aged 65+, the relevant numbers were 62.3%, and 62.9%, respectively.Conclusion: This study, being the first nationwide assessment of polypharmacy in Poland, confirmed its high prevalence. We found polypharmacy present in over one fifth of Polish society. Peaking in the elderly, polypharmacy occurred in each age group. These results lay the foundations for future interventions focused on reducing the scope of this problem in Poland.

Background: Norwegian hospitals have operated within capacity during the COVID-19 pandemic. We present patient and management characteristics, and outcomes for the entire cohort of adult (>18 years) COVID-19 patients admitted to Norwegian intensive care units (ICU) from 10 March to 19 June 2020.Methods: Data were collected from The Norwegian intensive care and pandemic registry (NIPaR). Demographics, co-morbidities, management characteristics and outcomes are described. ICU length of stay (LOS) was analysed with linear regression, and associations between risk factors and mortality were quantified using Cox regression.Results: In total, 217 patients were included. The male to female ratio was 3:1 and the median age was 63 years. A majority (70%) had one or more co-morbidities, most frequently cardiovascular disease (39%), chronic lung disease (22%), diabetes mellitus (20%), and obesity (17%). Most patients were admitted for acute hypoxaemic respiratory failure (AHRF) (91%) and invasive mechanical ventilation (MV) was used in 86%, prone ventilation in 38% and 25% of patients received a tracheostomy. Vasoactive drugs were used in 79% and renal replacement therapy in 15%. Median ICU LOS and time of MV was 14.0 and 12.0 days. At end of follow-up 45 patients (21%) were dead. Age, co-morbidities and severity of illness at admission were predictive of death. Severity of AHRF and male gender were associated with LOS.Conclusions: In this national cohort of COVID-19 patients, mortality was low and attributable to known risk factors. Importantly, prolonged length-of-stay must be taken into account when planning for resource allocation for any next surge. [ABSTRACT FROM AUTHOR]

AimPolypharmacy is becoming a global health problem. The aims of this study were to evaluate the temporal trends in the prevalence of polypharmacy in Sweden and to explore polypharmacy disparities by age, gender, education, and immigration status.MethodsPolypharmacy and excessive polypharmacy were evaluated using data extracted from the Swedish Prescribed Drug Register between 2006 and 2014. Polypharmacy was defined as being exposed to five or more drugs and excessive polypharmacy was defined as being exposed to 10 or more drugs during 1 month respectively. Average annual percent change (AAPC) was calculated using Joinpoint Statistical Software.ResultsThe prevalence of polypharmacy increased from 16.9% in 2006 to 19.0% in 2014 with an AAPC of 1.3; the prevalence of excess polypharmacy increased from 3.8% in 2006 to 5.1% in 2014 with an AAPC of 3.4. The prevalence of polypharmacy and excessive polypharmacy increased dramatically with age and peaked up to 79.6% and 36.4% in individuals aged 90 and above respectively. Females and individuals with lower education level were associated with a higher rate of polypharmacy and excessive polypharmacy. Immigrants from Middle-Eastern countries had the highest rate of polypharmacy and excessive polypharmacy, whereas individuals from Western Europe countries had the lowest rate.ConclusionThe prevalence of polypharmacy has increased gradually in Sweden during the past decade. Individuals with older age, female sex, or lower education have a higher rate of polypharmacy and excessive polypharmacy. Immigrants from Middle-Eastern countries showed a higher rate of polypharmacy.

Background: Patients with schizophrenia have a reduced life expectancy, but the association between antipsychotic usage and cause of death is uncertain.Methods: The authors observed associations of antipsychotic usage with the mortality rate and cause of death in a population-based cohort of the Korean National Health Insurance Service database from 2003 to 2017. A total of 86,923 patients with schizophrenia were categorized by the total duration of antipsychotic prescription after schizophrenia diagnosis into treated (n = 77,139) and untreated (n = 9784) groups. The main outcome was all-cause mortality; causes of death included cardiovascular disease, pulmonary disease, diabetes, cancer, accident, suicide and homicide.Results: The numbers of all-cause deaths and deaths from individual causes were significantly lower in the antipsychotic-treated group than in the untreated group (all cases, p < 10-4). When adjusted for covariates (age, sex, income, body mass index, alcohol consumption, hypertension, cancer and cerebral stroke), mortality rates due to ischemic heart disease (hazard ratio, HR, 0.38 [95% CI, 0.18-0.77]) and stroke (HR, 0.39 [95% CI, 0.19-0.80]) were significantly lower in the antipsychotic-treated group. Among 4 atypical antipsychotics (olanzapine, risperidone, aripiprazole and quetiapine), only aripiprazole was associated with a decreased mortality risk relative to olanzapine (HR, 0.55 [95% CI, 0.32-0.96]).Conclusions: Schizophrenia patients constantly prescribed antipsychotics had significantly lower rates of death from certain cardiovascular illnesses than untreated patients. Aripiprazole-treated schizophrenia was associated with a decreased risk of death compared with olanzapine-treated disease. [ABSTRACT FROM AUTHOR]

Background: South Africa is home to more people living with HIV than any other country, including nearly one in three pregnant women attending antenatal care. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with > 95% ART coverage during pregnancy and delivery, and vertical transmission of HIV greatly reduced. However, women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after delivery, leading to the potential for viral transmission, morbidity and mortality. It is difficult to evaluate the success of policies of expanded access to ART care, and assess continuity of care, due to the lack of a national longitudinal HIV care database. Also, patient movement between unlinked facilities. For the first time on a national level, we propose to utilize routinely-collected laboratory data to develop and validate a cohort of pregnant women living with HIV in South Africa in a way that is uniquely robust to facility transfer.Methods: Using laboratory test data matched to facility type, we will identify entry to antenatal care to build the cohort, then describe key treatment milestones, including 1) engagement in antenatal care, 2) initiation of ART, 3) HIV viremia, and 4) continuity of HIV care in the postpartum period. Second, we will measure the effect of system-wide factors impacting continuity of care among pregnant women. We will assess policies of expanded treatment access on continuity of care using regression-discontinuity analyses. We then will assess mobility and its effect on continuity of care during and after pregnancy. Third, we will identify individual-level risk factors for loss from HIV care in order to develop targeted interventions to improve engagement in HIV care.Discussion: This work will create the world's largest national cohort of pregnant women living with HIV. This novel cohort will be a powerful tool available to policymakers, clinicians and researchers for improving our understanding of engagement in care among pregnant women in South Africa and assessing the performance of the South African national ART program in caring for pregnant women living with HIV.Trial Registration: N/A (not a clinical trial). [ABSTRACT FROM AUTHOR]

Background: Although hepatocellular carcinoma (HCC) occurs mostly in patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection or heavy alcohol use or cirrhosis, some patients develop HCC without these risk factors. Our objective in this study was to develop and validate a new HCC risk score that could stratify HCC risk in patients who develop HCC without known risk factors.Methods: A new HCC risk score was developed using a nationwide, population-based cohort among individuals without chronic HBV infection, chronic HCV infection, heavy alcohol use or cirrhosis (n = 467 206, derivation cohort). The performance of the HCC risk score was validated using an independent Samsung Medical Center Health Promotion Center cohort (n = 91 357, validation cohort).Results: Multivariable Cox regression analysis identified six independent risk factors: age, sex, smoking, diabetes, total cholesterol level and serum alanine aminotransferase level. A 19-point scale for HCC risk score was developed, with 10-year risk of HCC ranging from 0.0% to 6.16% for the lowest and highest risk scores, respectively. The area under the receiver operating characteristics curve values (AUROCs) to predict HCC development were 0.83 [95% confidence interval (CI): 0.77, 0.88)] and 0.92 (95% CI: 0.89, 0.95) at 10 years in the derivation and validation cohorts, respectively. Predicted risk was well correlated with the Kaplan-Meier observed HCC risk.Conclusions: A simple-to-use, novel HCC risk score was developed for predicting HCC development in individuals without alleged risk factors. It can be used to assess the risk of HCC in this population so that decisions about their clinical management, including risk reduction interventions, can be subsequently made. [ABSTRACT FROM AUTHOR]

Introduction: The associations of epidural analgesia and low Apgar score found in the Swedish Registry might be a result of confounding by indication. The objective of this study was to assess the possible effect of intrapartum epidural analgesia on low Apgar score and neonatal intensive care unit (NICU) admission in term born singletons with propensity score matching.Material and Methods: This was a propensity score matched study (n = 257 872) conducted in a national cohort of 715 449 term live born singletons without congenital anomalies in the Netherlands. Mothers with prelabor cesarean section were excluded. Main outcome measures were 5-minute Apgar score <7, 5-minute Apgar score <4 and admission to a NICU for at least 24 hours. First, an analysis of the underlying risk factors for low Apgar score <7 was performed. Multivariable analyses were applied to assess the effect of the main risk factor, intrapartum epidural analgesia, on low Apgar score to adjust the results for confounding factors. Second, a propensity score matched analysis on the main risk factors for epidural analgesia was applied. By propensity score matching the (confounding) characteristics of the women who received epidural analgesia with the characteristics of the control women without epidural analgesia, the effect of possible confounding by indication is minimized.Results: Intrapartum epidural analgesia was performed in 128 936 women (18%). Apgar score <7 was present in 1.0%, Apgar score <4 in .2% and NICU admission in .4% of the deliveries. The strongest risk factor for Apgar score <7 was epidural analgesia (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.8-2.0). The propensity score matched adjusted analysis of women with epidural analgesia showed significant adverse neonatal outcomes: aOR 1.8 (95% CI 1.7-1.9) for AS <7, aOR 1.6 (95% CI 1.4-1.9) for AS <4 and aOR 1.7 (95% CI 1.6-1.9) for NICU admission. The results of epidural analgesia on AS <7 were also significantly increased for spontaneous start of labor (aOR 2.0, 95% CI 1.8-2.1) and for spontaneous delivery.Conclusions: Intrapartum epidural analgesia at term is strongly associated with low Apgar score and more NICU admissions, especially in spontaneous deliveries. This association needs further research and awareness. [ABSTRACT FROM AUTHOR]

The potential benefit of surgery of the primary tumour in patients with asymptomatic metastatic colorectal cancer is debated. This EURECCA international comparison analyses treatment strategies and overall survival in the Netherlands and Norway in patients with incurable metastatic colorectal cancer. National cohorts (2007–2013) from the Netherlands and Norway including all patients with synchronous metastatic colorectal cancer were compared on treatment strategy and overall survival. Using country as an instrumental variable, we assessed the effect of different treatment strategies on mortality in the first year. Of 21,196 patients (16,144 Dutch and 5052 Norwegian), 38.6% Dutch and 51.5% (p < 0.001) Norwegian patients underwent resection of the primary tumour. In the Netherlands, 58.2% received chemotherapy compared with 21.4% in Norway. Radiotherapy was given in 9.5% of Dutch patients and 7.2% of Norwegian patients. Using the Netherlands as reference, the adjusted HR for overall survival was 0.96 (95% CI 0.93–0.99; p = 0.024). Instrumental variable analysis showed an adjusted OR of 1.00 (95% CI 0.99–1.02; p = 0.741). Treatment strategies varied significantly between the Netherlands and Norway, with more surgery and less radiotherapy in Norway. Adjusted overall survival was better in Norway for all patients and patients <75 years, but not for patients ≥75 years. Instrumental variable analysis showed no benefit in one-year mortality for a treatment strategy with a higher proportion of surgery and a lower proportion of radiotherapy. Our findings emphasise the need for further research to select patients with incurable metastatic colorectal cancer for different treatment options. [ABSTRACT FROM AUTHOR]

Nationwide register data on the effect of primary treatment on survival in an unselected population of patients with pancreatic cancer (PC) have not been reported before. The study aim was to investigate the overall survival (OS) related to initial treatment with resection, chemotherapy, or best supportive care (BSC) in all patients diagnosed with PC in Denmark from 2011 to 2016. From 1 May 2011 to 30 April 2016, 4260 patients with PC were identified in the Danish Pancreatic Cancer Database. Ninety-seven patients (2%) were excluded, 56 because of treatment with preoperative chemotherapy, 39 because of incorrect registration of diagnosis or treatment, and 2 because of loss to follow-up; thus, 4163 patients were included. The 718 patients (17%) receiving resection had a median overall survival (mOS) of 21.9 months (range 20.0–24.2). In the chemotherapy group of 1746 patients (42%), those treated with FOLFIRINOX had the longest mOS of 10.0 months (9.2–11.0), whereas those treated with gemcitabine had the shortest mOS of 5.1 months (4.8–5.6). The 1697 patients (41%) receiving BSC had a mOS of only 1.6 months (1.5–1.7). The resected PC cohort had an OS comparable with that reported in randomised controlled trials (RCTs). The mOS of the chemotherapy-treated patients was slightly shorter compared with the results from RCTs and reflects the unselected population in this study. During the last decade, a larger fraction of patients received anticancer treatment, but the BSC group was still large and showed extremely poor OS. • During the last decade, an additional 15% of patients received anticancer treatment. • Patients with curative resection had the longest survival. • Treatment with FOLFIRINOX yielded the longest survival for the palliative patients. • The best supportive care group was large and had the worst survival. [ABSTRACT FROM AUTHOR]

Aim: Polypharmacy is becoming a global health problem. The aims of this study were to evaluate the temporal trends in the prevalence of polypharmacy in Sweden and to explore polypharmacy disparities by age, gender, education, and immigration status. Methods: Polypharmacy and excessive polypharmacy were evaluated using data extracted from the Swedish Prescribed Drug Register between 2006 and 2014. Polypharmacy was defined as being exposed to five or more drugs and excessive polypharmacy was defined as being exposed to 10 or more drugs during 1 month respectively. Average annual percent change (AAPC) was calculated using Joinpoint Statistical Software. Results: The prevalence of polypharmacy increased from 16.9% in 2006 to 19.0% in 2014 with an AAPC of 1.3; the prevalence of excess polypharmacy increased from 3.8% in 2006 to 5.1% in 2014 with an AAPC of 3.4. The prevalence of polypharmacy and excessive polypharmacy increased dramatically with age and peaked up to 79.6% and 36.4% in individuals aged 90 and above respectively. Females and individuals with lower education level were associated with a higher rate of polypharmacy and excessive polypharmacy. Immigrants from Middle-Eastern countries had the highest rate of polypharmacy and excessive polypharmacy, whereas individuals from Western Europe countries had the lowest rate. Conclusion: The prevalence of polypharmacy has increased gradually in Sweden during the past decade. Individuals with older age, female sex, or lower education have a higher rate of polypharmacy and excessive polypharmacy. Immigrants from Middle-Eastern countries showed a higher rate of polypharmacy. [ABSTRACT FROM AUTHOR]

Background: Before the era of targeted therapies, cytokines were the main therapy for metastatic renal cell carcinoma (mRCC). Our aim was to analyze the changes in treatments and overall survival (OS) of all mRCC patients in Estonia in relation to the introduction of new medications.Methods: All patients with mRCC who started medical therapy in Estonia during the years 2004-2012 were identified using the database of the Estonian Health Insurance Fund. Tumor and treatment data were gathered from medical records. Vital status data were obtained from the Estonian Population Registry. The only available therapy before 2008 was interferon alpha-2A (INFa2A), targeted agents added from 2008. For survival analysis, patients were divided into 2 groups: INFa therapy only (group 1) and INFa followed by targeted agents or targeted agents therapy only (group 2).Results: Out of 416 identified patients, 380 were eligible for analysis. The most common 1st-line treatments were INFa (55%), sunitinib (32%) and INFa+bevacizumab (13%). 28% of patients received 2nd-line therapies and 15% 3rd-line treatments. Median survival of all patients was 13.7 months [95% confidence interval (CI) 11.3-16.2]; 7.6 months (CI 6.4-8.6) for group 1 and 19.8 months (CI 15.6-22.9) for group 2. In multivariate analysis, group 1 had nearly four times higher risk of dying than group 2 [hazard ration (HR) 3.88, 95% CI 2.64-5.72].Conclusions: The implementation of targeted therapies significantly changed the outcomes of mRCC in Estonia: it prolonged median survival, reduced the risk of death and also enlarged the proportion of patients who received medical therapy. [ABSTRACT FROM AUTHOR]

Introduction: One of the most detrimental factors influencing development is growing up in poverty. According to the World Health Organization, extreme poverty is the leading cause of mortality and morbidity. Unfortunately, some children encounter more unhealthy and potentially detrimental circumstances than others, increasing their risk for later health problems. Poor perinatal outcomes are more often observed in deprived neighborhoods, with both more perinatal mortality and morbidity (prematurity and small for gestational age) in these neighborhoods. Additionally, growing up in families with a lower socio-economic status exposes children to more unsafe environments, making them more at risk for insecure attachment to their parents, behavioral problems, addiction, mental illnesses, deficits in cognitive development and domestic violence. In sum, children growing up in deprivation are more unhealthy, as a consequence of an increased risk of unfavorable perinatal outcomes in combination with growing up in a multidimensional unforgiving environment. We assume that the poor health status of these children is reflected in higher healthcare expenses, since they require more medical care than their healthy peers. Here, we aim to investigate the effects of deprivation on healthcare costs of young children in the Netherlands. Methods: This is a cross-sectional study, using data from several national registries. All children in the Netherlands, aged zero to three years old in 2014, were included. Healthcare costs included all expenses covered by obligatory basic health insurance. Deprivation was studied using monthly household income per 1000 euro’s and neighborhood deprivation scores. The final linear regression model was built for healthcare costs as function of both deprivation variables, perinatal morbidity, ethnicity, a 3-way interaction of household income, perinatal morbidity and ethnicity (including subsequent 2-way interactions) and the 2-way interaction of deprivation index and perinatal morbidity. Results: A total of 583,625 children were included in the analyses. Both household income (β = -4.72, 95% CI [-7.22, -2.23]) and deprivation score (β = 19.31, 95% CI [11.11, 27.51]) were significantly related to healthcare costs. Discussion and conclusion: This research shows that growing up with a lower household income and a higher neighborhood deprivation is significantly associated with higher healthcare costs in early life. These findings support the assumption that children growing up in deprivation have a poorer health status, resulting in (health) inequities already in early childhood. This inequity is particularly detrimental since the gap between poor and rich is widening, not only regarding income disparity, but also in the case of health inequality. Limitations: This research excluded children who died during, or soon after pregnancy, since these children have limited healthcare costs. Nevertheless, this outcome may be of even greater societal relevance when targeting the inequality gap. Suggestions for future research: Future research should focus attention on interventions targeting vulnerable population, before, during and after pregnancy, in order to gain highly necessary knowledge on how to provide an optimal start in life for all children. Lessons learned: More attention should be focused on marginalized populations in order to break through the intergenerational cycle of poor health.

With the failure to improve outcomes of patients with bladder cancer over the last 30 years, this study was developed to benchmark contemporary UK radiotherapy practice for the management of muscle invasive bladder cancer (MIBC) against published national guidance. All UK radiotherapy centres were invited to complete a questionnaire for each patient with MIBC starting bladder radiotherapy over a 16-week period from December 2016. Sixty-nine per cent (41/59) of UK radiotherapy centres completed a detailed questionnaire for 508 patients. The median age was 78 years and 64% (n = 323 patients) had stage II or III disease. Treatment intent was radical in 54% (n = 275). From transurethral resection of the bladder tumour, patients waited 57 days before starting neoadjuvant chemotherapy (NAC) (interquartile range 46–72 days). Patients who had radical radiotherapy as their first definitive treatment waited a median of 82 days (interquartile range 62–105 days). NAC was considered in 66% (n = 182) of all radical cases and given in 43% (n = 119). Concurrent radiosensitisation (CRT) was considered for 53% (n = 146) and delivered in 40% (n = 109) of patients. The most common fractionation was 55 Gy/20 fractions/4 weeks in 49% (n = 134) for radical patients and 36 Gy/6 fractions/6 weeks in 25% (n = 57) for palliative patients. This is the largest multicentre prospective study to define contemporary management of MIBC in patients receiving radiotherapy within the UK. The population studied is the oldest described to date. Timelines to starting definitive treatment confirm an urgent need to streamline the pathway. An increasing use of NAC is described, although the penetrance of CRT is disappointingly low. Areas for improvement with regards to the delivery and quality of radiotherapy have been identified. The detail within this study can be used to inform practice and future trial design, ultimately with the aim of improving outcomes for patients with MIBC. • Largest multicentre prospective study of muscle invasive bladder cancer in patients receiving radiotherapy within the UK. • Population studied is the oldest described to date. • Urgent need to streamline the pathway to reduce time to definitive treatment. • Increasing use of neoadjuvant chemotherapy, although penetrance of concurrent radiosensitisation is low. • Need to improve and standardise delivery and quality of radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Experimental infection with Plasmodium falciparum results in malaria attack within a few days of exposure. However, we have regularly observed malaria attack within a short time after return, regardless of the time spent in an endemic area. We therefore aimed to assess whether the time before return and malaria attack varies according to length of stay., Methods: We used anonymized data from the French National Reference Centre for Malaria between 2006 and 2016. We analyzed 11,823 cases aged at least 1 year and diagnosed with P. falciparum malaria 1 day to 1 year after returning to France, after a stay of 1 day to 1 year in an at-risk area., Results: Trips had a median duration of 31 days [IQR: 19-56]. Median time between return from the endemic area and onset of malaria symptoms was 5 days [IQR: 0-10], and the median between return and malaria diagnosis was 9 days [IQR: 5-14]. Times to symptom onset or diagnosis were longer for stays of fewer than 15 days vs 15 days or more (for symptoms: 7 vs 4 days for longer stays, for diagnosis: 11 vs 9 days). For stays longer than 15 days, no variation was observed according to length of stay., Conclusions: Aside from at-risk stays of fewer than 15 days, the time between return and malaria attack is constant and rather short, even after long stays. The 2 weeks following return should be considered as a risk period whatever the length of stay in an at-risk area., (Copyright © 2023. Published by Elsevier Masson SAS.)

Background: Improved outcome after liver resections have been reported in several series, but outcomes from national cohorts are scarce. Our aim was to evaluate nationwide practice and short-term outcomes after liver surgery in a universal healthcare system.Methods: A complete 5-year cohort of all liver resections from the Norwegian Patient Registry (NPR). Short-term outcomes were aggregated length of stay (a-LoS), reoperation and 90-day mortality.Results: Of 2118 liver resections, 605 (28.6%) were major, median age was 65 years and 1184 (55%) were male. Most common indication was metastatic disease (n = 1554; 73.4%) and primary malignancy (n = 328; 15.3%). Laparoscopy was performed in 513 (33.9%) of minor and 37 (6.1%) of major liver resections and increased over time to 39.1% of minor resections in 2016. Median a-LoS was 12 days for major resections, 8 days for open minor and 3 days for laparoscopic minor resections. Reoperation was reported for 159 (7.4%) and 90-day mortality for 44 (2.1%). Primary malignancy, male gender, elderly patients and major resections were associated with poorer outcome.Conclusions: In a national cohort, laparoscopy is used for a substantial proportion of minor resections and was associated with reduced a-LoS. Risk factors for reoperation and mortality were male gender, increased age and major resection for primary malignancy. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Neuropathic pain is a frequent consequence of cancer pain. Quite often, in the end stage, it is difficult to discern its presence and delineate its characteristics in the context of painful cancer complications. The aim of this study was to compare the diagnostic accuracy of the Douleur Neuropathique en 4 Questions (DN4) and painDETECT questionnaires, which were translated to the patient's native language, for the diagnosis of peripheral neuropathic pain in oncology patients. Methods: End‐stage cancer patients who presented to the outpatient pain clinic were prospectively followed. At presentation, all patients completed the DN4 and painDETECT questionnaires, which had been translated to their native language, and the output was compared to the pain specialist's diagnosis of the neuropathic or non‐neuropathic nature of the pain, which was considered as the gold standard. The diagnostic accuracy of both questionnaires was tested with receiver operating characteristic curves plotted from the data collected. Results: Ninety patients (48.5% of 185 in total) presented with severe pain. Seventy‐six had neuropathic pain (41.1%) and 109 had non‐neuropathic pain. Of those with neuropathic pain, most had a mixed pain (bone or visceral in addition to neuropathic pain). The DN4 questionnaire had a sensitivity of 71.1% and a specificity of 88.7% in detecting neuropathic pain, with a cutoff value of ≥ 4, while the painDETECT questionnaire had a sensitivity of 26.3% and a specificity of 100%, with a cutoff value of ≥ 19. Conclusion: At standard cutoff values, the DN4 and painDETECT questionnaires, despite having been translated to the patient's native language, failed to adequately discriminate between neuropathic and non‐neuropathic pain in our end‐stage cancer patients. [ABSTRACT FROM AUTHOR]