Search Results for: Artrite psoriasica e altre comorbilità in pazienti con psoriasi nel setting della medicina generale

Objective
Coronary artery disease (CAD) is a main cause of incapacitating adverse cardiac events in aviation. Military aircrew ≥40 years in the Netherlands undergo a 5-year exercise ECG (X-ECG), which lacks precision to identify relevant CAD. The study aim was to identify the screening value of cardiac CT (CCT) in asymptomatic military aircrew.

Design
Prospective, single-centre, cross-sectional study.

Setting
Conducted at the Centre for Man in Aviation, Royal Netherlands Air Force. CT scans were performed at the University Medical Centre, Utrecht.

Participants
Asymptomatic military aircrew ≥40 years were asked to undergo CCT, with coronary artery calcium score (CACS) and coronary CT angiography (CCTA), following their aeromedical exam. CCT was performed in 211 participants (median age 49.3 years (43.6–52.8), 98% men, 65% pilots).

Outcome measures
The main objective was to determine the prevalence of relevant CAD. Clinically relevant CAD (CR-CAD) is defined as CACS ≥100 and/or a stenosis ≥50%. Aeromedically relevant CAD (AR-CAD) includes CR-CAD and/or a left main stenosis >30% or an aggregate stenosis ≥120%. Secondary objectives included assessing the prevalence of mild coronary stenosis (defined as 25%–49% stenosis), the presence of high-risk plaque (HRP) features and CCT safety.

Results
CR-CAD was found in 25 male aircrew (12%), with a CACS of ≥100 in 21 (10%) and a stenosis ≥50% in 10 (5%), including two with CACS 0. Two additional men had ≥120% aggregate stenosis, bringing total AR-CAD to 27 (13%). Twenty-nine men (14%) had mild stenosis. HRP features were present in 44 (21%). There were no CT-related complications. Of 196 participants who underwent X-ECG, seven showed abnormal results; one had relevant CAD.

Conclusions
Contrast-enhanced CCTA provides additional information both on high-risk features and obstructive CAD compared with CACS only. CCT is safe and is of additional value to X-ECG in a low-risk population with a high-hazard occupation.

Trial registration number
NCT05508893.

Objective
A delayed diagnosis of pituitary adenomas (PAs) can lead to increased morbidity and reduced quality of life. The aim was to estimate diagnostic delay and investigate the concordance between patient-reported symptoms and the medical record documentation in patients with PA.

Design
Cross-sectional study.

Setting
Seven university hospitals.

Participants
654 patients: non-functioning PA (NFPA, 314), prolactinoma (118), acromegaly (164) and Cushing’s Disease (CD, 58).

Data collection
Questionnaires and medical record extraction.

Primary and secondary outcomes
Type of first healthcare contact, delay of PA diagnosis and patient-reported symptoms and symptoms documented in medical records.

Results
First healthcare contact was usually a general practitioner. Estimated time from symptoms to diagnosis varied from 10 years (9%). The longest diagnostic delays were observed in acromegaly and CD. A longer delay was observed in women compared with men (p0.6) and for menstrual irregularities in prolactinomas (Cohen’s kappa >0.7).

Conclusion
We report a large variation in symptom duration before diagnosis with a substantial diagnostic delay in patients with CD and acromegaly. An increased awareness about endocrine diseases in the general population and health professionals may contribute to earlier diagnosis of pituitary adenomas.

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Objective
To evaluate the prognostic ability of the haemoglobin-to-red blood cell distribution width ratio in predicting in-hospital mortality among elderly patients diagnosed with acute ischaemic stroke.

Design
Retrospective, longitudinal, observational study using a hospital-based database.

Setting
Claims data from 1 January 2014 until 31 January 2020 were extracted from the database of two hospitals affiliated with Nanjing University.

Participants
Patients aged ≥80 years who were diagnosed with acute ischaemic stroke, excluding those with cancers or other malignant diseases.

Outcome measures
Patients were stratified into three groups based on the tertiles of the haemoglobin-to-red blood cell distribution width ratio. The dose-dependent relationship between this ratio and in-hospital mortality risk was determined with robust locally weighted regression analyses and restrictive cubic spline on continuous variables. The primary endpoint was defined as all-cause mortality during the hospital stay, and the secondary endpoint centred on the duration of the hospital stay.

Results
A total of 606 patients constituted the dataset for the conclusive analysis (mean age, 84.6 ± 3.2 years; female, 40.3%). The haemoglobin-to-red blood cell distribution width ratio was categorised into three tertiles (T1, 8.34). After adjusting for relevant demographic and clinical variables, a statistically significant inverse correlation was observed between higher ratios and lower risk of in-hospital mortality, with HRs of 0.48 (95% CI, 0.34 to 0.68) for T2:T1 and 0.14 (95% CI, 0.08 to 0.23) for T3:T1. A dose-dependent relationship was evident between the haemoglobin-to-red blood cell distribution width ratio and in-hospital mortality risk. The sensitivity analysis indicated that no attenuation was observed in the HR in both non-anaemic and anaemic cases. The results also indicated that a shorter length of hospital stay was associated with a higher haemoglobin-to-red blood cell distribution width ratio.

Conclusions
A high haemoglobin-to-red blood cell distribution ratio may be an independent protective factor for in-hospital mortality and reduced length of stay in elderly patients suffering from acute ischaemic stroke.

Objective
To assess the association between educational level and cardiovascular age acceleration metric derived from ECG, and to determine whether this association is mediated by established cardiovascular disease (CVD) risk factors.

Design
Prospective population-based cohort study (the Tromsø Study).

Setting
General population of the Tromsø municipality, Norway.

Participants
The study sample consisted of 4367 participants of the Tromsø Study, who took part in both Tromsø6 (2007–2008) and Tromsø7 (2015–2016), had a 12-lead ECG obtained at Tromsø7 and did not report a history of heart attack, stroke or atrial fibrillation.

Primary outcome measures
-age, a biomarker of cardiovascular ageing, is defined as the difference (in years) between an individual’s ECG-predicted heart age and their chronological age. ECG-predicted heart age was estimated using a previously validated deep neural network.

Results
Our findings indicate an inverse association between education and -age, with a regression coefficient per increment increase in education of –0.24 (95% CI –0.41 to –0.07) in the overall sample, –0.38 (95% CI –0.59 to –0.16) for women and –0.04 (95% CI –0.31 to 0.23) for men. Participants with the highest level of education (university/college for 4 or more years) had the lowest estimated -age with a regression coefficient of –0.69 years (95% CI –1.23 to –0.16) compared with the group with primary education for the overall sample, –1.05 years (95% CI –1.73 to –0.37) for women and –0.15 years (95% CI –1.03 to 0.73) for men. CVD risk factors mediated up to 75% of the association between overall education and -age, and 80% of the association among those with the highest education level (university/college for 4 or more years). Among women, 50% of the effect of overall education on -age was mediated by CVD risk factors, rising to 53% in the category with the highest level of education. However, in the subsample of men, there was no significant association between education and -age, and the mediation analysis produced natural direct and indirect effects pointing in opposite directions.

Conclusions
Cardiovascular ageing is inversely associated with educational level, an effect that appears to be largely mediated through established risk factors.

Objectives
This study aims to assess positive and negative religious coping (PRC, NRC) in a sample of Moroccan women with breast cancer (BC) and examine the association with depression, anxiety, cancer clinical data and sociodemographic variables.

Design
We conducted a cross-sectional study.

Setting
The oncology departments of the public oncology hospital in the city of Fez, Morocco.

Participants
209 patients newly diagnosed with BC before receiving neoadjuvant chemotherapy from 2019 to 2023.

Outcome measures
Primary end-point variables included positive and negative religious coping, depression and anxiety. Secondary outcomes included demographic data and disease-related information.

Results
The patients, with a mean age of 47.43±9.45 years, had high PRC scores (26.87±3.12). Based on multiple linear regression, PRC was negatively associated with delay in diagnosis (discovery of first symptoms after more than 12 months), β=–0.19 (95% CI=–1.97 to –0.27; p=0.01). For NRC, there was a significant association with progesterone receptor β=0.14 (95% CI=0.08 to 1.12; p=0.02) and a positive association with psychological distress (Hospital Anxiety and Depression Scale total score) β=0.42 (95% CI=0.07 to 0.14; p≤0.001).

Conclusion
Women with BC may benefit from a holistic approach that integrates positive religious coping patterns. This approach should take into account the determinants identified in this study and identify any negative religious coping strategies that may have an adverse effect on patients’ mental health.

Objectives
To evaluate changes in oral corticosteroid (OCS) use after the publication of the 2014 Japanese clinical practice guidelines for myasthenia gravis (MG).

Design
Retrospective cohort study performed in three Japanese health insurance databases: the JMDC database between 2005 and 2021; the DeSC database covering the National Health Insurance (NHI) and the DeSC database covering the Late-Stage Elderly Healthcare Service (LSEHS) between 2014 and 2021. Achievement of OCS ≤5 mg/day was defined as ≥90 days of consecutive OCS ≤5 mg/day during follow-up, without any gap longer than 60 days between two consecutive claims. The time to achieve OCS ≤5 mg/day was estimated using Kaplan-Meier survival analysis.

Setting
Real-world treatment setting in Japan.

Participants
Patients aged ≥16 years with a record of MG (International Classification of Diseases 10th edition code: G70.0) with a serological test, who had baseline period ≥180 days before inclusion with no MG claim and who started immunotherapy (including OCS) within 90 days of MG diagnosis.

Outcome measures
Prescription of OCS and other therapies for MG.

Results
Overall, 811 patients were included. The mean age was 49 years in the JMDC, 61 years in the NHI and 80 years in the LSEHS. In the JMDC, the median time to achieve OCS ≤5 mg/day was significantly shorter (p=0.042; log-rank test) in patients included in 2015 or later (11.0 months) than in patients included before 2015 (17.9 months). The median time to achieve OCS ≤5 mg/day was shorter in the LSEHS (6.5 months) than in the JMDC (11.0 months) and the NHI (11.7 months).

Conclusions
Faster tapering of the OCS dose was observed in patients starting treatment after the publication of the 2014 guidelines, although use of higher-dose OCS remained widespread after this date. This highlights the need to improve awareness of guidelines by healthcare providers in order to decrease the burden of higher-dose OCS.

Trial registration number
Clinical Trials Registry (UMIN-CTR): UMIN000051155; Post-results.

Objectives
Due to numerous comorbidities, complicated medical regimens and age-related difficulties, older adults frequently confront substantial treatment burdens and poor medication adherence, which could result in poor health outcomes. This study assessed the treatment burden and medication adherence among older adults in comprehensive specialised hospitals in the Amhara Region in Ethiopia.

Design
A multicentre hospital-based cross-sectional study was conducted from 30 March to 30 July 2024.

Setting
The study was conducted at four comprehensive specialised hospitals in Northwest Ethiopia.

Participants
Patients were ≥65 years old, diagnosed with two chronic illnesses and were receiving medical attention for the relevant issue.

Outcome measures
This study employed the Multimorbidity Treatment Burden Questionnaire to assess treatment burden and the General Medication Adherence Scale to assess medication adherence. Data analysis was conducted using STATA version 17. Linear and binary logistic regressions were used to analyse the dependent variables of treatment burden and medication adherence to the determining factors, respectively.

Results
422 patients took part in this study. Regarding treatment burden, 75% report a high burden. Of the patients, 32.20% adhered well, whereas 67.80% did not. The medication regimen complexity index (MRCI; β=0.029, 95% CI 0.001 to 0.058; p=0.047), age (β=0.027, 95% CI 0.009 to 0.044; p=0.004) and number of medications (β=0.168, 95% CI 0.045 to 0.291; p=0.007) were associated with higher treatment burden. Variables associated with medication non-adherence included rural residence (adjusted OR 2.249, 95% CI, 1.356 to 3.732; p=0.002), care provided by relatives (1.744, 1.055 to 2.883; p=0.030), moderate Charlson comorbidity index (CCI; 2.241, 1.220 to 4.117; p=0.009), severe CCI (6.953, 3.526 to 13.715; p=0.000), polypharmacy (1.615, 1.055 to 3.230; p=0.044) and treatment burden (1.501, 1.023 to 3.090; p=0.015).

Conclusion
Of the older adult patients enrolled in this study, three-quarters had a high treatment burden, and more than two-thirds had poor adherence. A high treatment burden was associated with age, medication use and MRCI, whereas non-adherence was associated with self-management, residency, CCI, medication use, MRCI and treatment burden.

Objective
To explore the association between biological rhythm and internalising disorders among children and adolescents.

Design, setting and participants
This cross-sectional study used data from the Baoxing Youth Mental Health cohort and included 2119 children and adolescents recruited in December 2021 from 21 primary and secondary schools in Baoxing County, Sichuan Province, China.

Exposure
Biological rhythm was assessed across four domains—eating habits, physical activity, social interactions and sleep behaviours—using a 22-item, self-constructed questionnaire. Principal component analysis was performed to identify the patterns of biological rhythm.

Main outcome measures
The 7-item Generalised Anxiety Disorder scale and the 9-item Patient Health Questionnaire were used to assess internalising disorders. Logistic regression analyses were conducted to examine the association between individual items and patterns of biological rhythm and internalising disorders.

Results
Among the participants, 47.9% were girls and the mean (SD) age was 12.4 (2.69) years. Seven distinct patterns of biological rhythm have been identified. Compared with low adherence level group, a high level of physical exercise (OR 0.43 (95%CI 0.33 to 0.56)), family meals for breakfast (0.53 (0.41 to 0.69)) and nutritious diet (0.48 (0.37 to 0.62)) were associated with a lower risk of internalising disorders. While high level of sedentary lifestyle (2.00 (1.53 to 2.62)), daytime tiredness (2.09 (1.61 to 2.71)) and unhealthy bedtime snacks (3.38 (2.57 to 4.44)) were associated with an increased risk of internalising disorders. Null results were observed for the pattern of social interactions in school (0.89 (0.69 to 1.16)). These associations were maintained for children and adolescents who were exposed to adverse childhood experiences.

Conclusions
The results of this study highlight the potential protective effects of physical exercise, family meals for breakfast and nutritious diet on youth mental health. Well-designed longitudinal studies are needed to further clarify the relationship between patterns of biological rhythm and internalising disorders.

Stomaco – L’agopuntura si è dimostrata efficace nel recupero dei pazienti con gastrectomia: uno studio sul post-operatorio nel tumore allo stomaco.

Objectives
To assess the economic burden of premature mortality due to liver cancer in Spain over 10 years (2013–2022) using a retrospective economic analysis.

Design
A population-based retrospective study using the Human Capital approach.

Setting
We analysed national registry data from the Spanish National Institute of Statistics on mortality, employment and wage structure. Sensitivity analyses were conducted using discount rates of 0%, 3% and 6%.

Participants
All individuals who died from liver cancer between 2013 and 2022, with a focus on the working-age population under 65 years of age.

Primary and secondary outcome measures
Primary outcomes included years of potential life lost (YPLL), years of potential labour productive life lost (YPLPLL) and associated productivity losses due to premature liver cancer mortality. Secondary outcomes involved trend analyses of productivity loss and YPLL over time, and assessment of sex-specific and age-specific differences in productivity losses.

Results
Between 2013 and 2022, 36 635 individuals died from liver cancer, including 6622 individuals of working age. This led to 9924–12 068 YPLL annually. The cumulative productivity loss was 12.88 billion (range: 12.52–13.26 billion).

Conclusions
These findings highlight the substantial economic impact of liver cancer mortality in Spain and underscore the importance of targeted prevention and screening programmes for high-risk populations.

Objectives
To identify clustered trajectories of self-reported disability following the initiation of care by a physical therapist in outpatient orthopaedic settings and to determine baseline factors that distinguish between different trajectories.

Design
Retrospective cohort study using electronic health record and patient-reported outcome data.

Setting
Data were extracted from the ATI Patient Outcomes Registry, encompassing patient encounters from over 900 ATI outpatient physical therapy clinics in 26 states across the USA.

Participants
Patients receiving physical therapy after surgery were excluded. The final analytical sample included 597 245 unique patients initiating care between 1 January 2016 and 31 December 2021 for management of a spine, upper extremity or lower extremity musculoskeletal condition.

Interventions
Patients received treatments which could include strengthening and range of motion exercises, manual therapy, education, functional training and pain-relieving modalities.

Primary and secondary outcome measures
The primary outcome was trajectory of self-reported, joint-specific disability measure scores up to 6 months following initial evaluation.

Results
Three distinct disability trajectory clusters were identified (proportion of sample; beta coefficient (95% CI)): significant immediate worsening (3.4%; –1.31 (–1.33, –1.28)), significant gradual improvement (61.4%; (0.36 (0.35, 0.36)) and minimal change (35.2%; –0.20 (–0.21, –0.19)). Results were similar when stratified by primary diagnosis of upper extremity, lower extremity or spine conditions, with small differences in the relative proportion of trajectory class membership by body region. Predictive factors for less favourable disability trajectories included older age, lower physical and mental health scores, body region, higher social deprivation index, insurance type and certain comorbidities.

Conclusions
Most patients showed improvement in disability after exposure to treatment by a physical therapist, but a notable proportion experienced minimal change or worsening. Multiple demographic, physical, mental and social health factors differentiated trajectory class membership, highlighting opportunities to improve how and to whom this type of guideline-supported non-pharmacological care is delivered.

Objectives
To identify latent resilience profiles among older adults residing in nursing homes and to examine the mediating role of perceived social support in the relationship between resilience and social trust.

Design
A cross-sectional survey conducted between January and May 2023.

Setting
Three nursing homes in urban Guangzhou, China.

Participants
A total of 233 older adults aged 60 years or above living in nursing homes.

Primary and secondary outcome measures
Identification of latent profiles of resilience and the mediating effect of perceived social support on the relationship between resilience and social trust.

Results
Of the 254 participants, 233 (91.7%) completed the survey. The sample comprised 60% females, with 55% aged 80 or older. Three distinct latent profiles of resilience were identified: low resilience (55.8%), moderate resilience (12.0%) and high resilience (32.2%). Moreover, perceived social support significantly mediated the relationship between resilience and social trust (B=0.72, SE=0.23, 95% CI (0.3, 1.21)).

Conclusion
Perceived social support mediates the link between resilience and social trust in institutionalised older adults. Tailored care strategies based on individual resilience profiles may enhance social support and foster trust, contributing to active ageing in nursing home residents.

37 studi clinici attivi, 75.000 pazienti coinvolti nella ricerca