Dissertations / Theses on the topic 'Cohort study'

En raison du vieillissement de la population, les syndromes gériatriques sont devenus un enjeu majeur de santé publique, et le syndrome de fragilité une priorité notamment en France avec le programme PAERPA. La fragilité permet d’identifier des personnes âgées présentant des capacités de résistance diminuées face aux agents agresseurs. Elle a pour conséquence d’accroître chez l’individu le risque de survenu d’évènements de santé défavorables (de dépendance, de chutes, d’hospitalisations, d’entrée en institution et de mortalité). Plusieurs outils de mesure sont développés mais aucune mesure de référence ne fait consensus actuellement même si des progrès considérables ont été réalisés dans ce domaine depuis une dizaine d’années. Les données épidémiologiques sur la prévalence, l’incidence et les conséquences de la fragilité ont été abondamment publiées mais se caractérisent par une grande variabilité. Ces indicateurs sont variables en fonction de l’outil de mesure utilisé, de la population étudiée, de l’examinateur et également de l’évènement de santé que l’on veut prédire. De nombreux facteurs de risque de fragilité ont été également mis en évidence et certains ouvrent des voies crédibles de recherche aidant à la prévention. Une meilleure connaissance de l’épidémiologie du syndrome de fragilité est donc une nécessité incontournable pour apprécier l’importance du phénomène et mettre en place les moyens de le contrôler. Afin de mieux définir la fragilité sur le plan épidémiologique, il est indispensable de bien comprendre la notion d’études pronostiques en épidémiologie et les principaux domaines qui la constituent c’est-à-dire : décrire la population, prédire des évènements de santé, comprendre les liens de causalité et proposer des actions. Il est donc indispensable dans les études épidémiologiques, de définir et d’utiliser avec précision les principaux domaines des études pronostiques décrit ci-dessus. Le risque ici est un passage sans précaution de la prédiction à la compréhension du concept de fragilité qui sont deux domaines différents bien que complémentaires. La définition la plus utilisée de la fragilité reste encore celle proposée par Fried et collaborateurs. Elle est basée sur la prise en compte d’éléments essentiellement physiques. Cette définition a de nombreuses limites lorsque la population cible vit en EHPAD par exemple. D’autres composantes non physiques parmi lesquelles la cognition, les vulnérabilités sociales, les comorbidités sont actuellement débattue pour mieux définir le concept de fragilité et identifier ses biomarqueurs. Cette thèse aborde d’un point de vue épidémiologique la définition du syndrome de fragilité grâce aux données des cohortes PAQUID et 3C (deux études Françaises en population) et la cohorte INCUR (une étude Française en EHPAD). Les résultats présentés dans cette thèse nous permettent d’affirmer que la relation entre la fragilité et la prédiction d’évènements défavorables de santé prend en compte la population cible, l’outil de mesure de la fragilité et l’examinateur. Ce résultats ouvrent donc des perspectives intéressantes pour la recherche sur le syndrome fragilité quelques soit les caractéristiques des populations étudiées
Now-a-days, geriatric syndromes have become a major public health problem owing to the population aging. In this context, frailty syndrome represents particularly a public health priority in France through PAERPA program. Frailty is defined as an extreme vulnerability of the organism to endogenous and exogenous stressors. This syndrome exposes the individual at higher risk of negative health-related outcomes as well as a transition phase between successful aging and disability. The theoretical concept of frailty is largely agreed, its practical translation still presents some limitations due to the existence of multiple tools and operational definitions. The definition most widely used is the one proposed by Fried and collaborators which essentially includes physical elements. Nonetheless, the inclusion of other non-physical components, in particular cognitive function, social vulnerability state, morbidities is currently debated. Considerable progress has been made in this field over the past ten years. The prevalence and incidence of frailty are reported in several epidemiological studies and are well known, but are quite variable. Many risk factors of frailty have been highlighted, leaving a door open towards prevention. A better knowledge of frailty epidemiology is therefore essential if we are to assess its extent and the means of controlling it. To better define frailty from an epidemiological point of view, it is essential to describe and better understand the different components of epidemiological prognostic studies: describing, prediction of health events, explaining the causal relation and proposing the action. The aim of this thesis was to the study, from an epidemiological point of view, the definition of frailty using the data of three French cohorts: PAQUID, 3C and INCUR. The results are consistent with an association between frailty and negative health-related outcomes. This association depends on the target sample, tools used and investigators

Objective: To provide six-year cumulative incidence of visual impairment and blindness, diabetic retinopathy (DR), age related macular degeneration (AMD), visually impairing cataract and features of glaucoma in an older age Kenyan population and the risk factors for each. Design: Population based cohort study with six-year follow-up (n=2,171; 50% participation) Main outcome measures: Six-year cumulative incidence of visual impairment and blindness, DM, DR, AMD, visually impairing cataract and features of glaucoma, risk factors for incidence and population estimates. Results: The six-year cumulative incidence of visual impairment and blindness was 119.4 (103.1 - 137.9) and 15.1 (10.4 – 21.7) per 1000 of population respectively. The six-year cumulative incidence of DM and DR (in those with diabetes mellitus) was 61.0 (50.3 - 73.7) and 224.7 (116.9 - 388.2) per 1000 of population respectively. The six-year cumulative incidence of AMD was 164.2 (136.7 - 195.9) per 1000 of population and the six-year cumulative incidence of visually impairing cataract was 235.6 (213.5 – 259.3) per 1000 of population. Associations with incident cases were demonstrated for each with age and diabetes being the leading associations across the primary outcome measures. Conclusions: This six-year follow-up of a population-based cohort indicates a high incidence of visual impairment and blindness and provides data, for the first time, on the incidence of DR, AMD and cataract in Kenya. A large gap exists between provision and need for services and cataract control should remain the priority focus with work to strengthen health care systems as posterior segment eye diseases will become a greater issue as services improve and cataract comes under greater control.

BACKGROUND: Retaining participants in multi-year prospective cohort studies presents challenges, especially in urban settings. Early identification of participants at risk for attrition may enhance retention. We examine the validity of two risk for loss-to-follow-up assessments and early retention efforts in one Primary Sampling Unit during the National Children’s Study pilot. Our goal was to identify cases requiring additional attention. Retention challenges included high poverty, frequent moves, lack of spousal support, and mistrust of research. METHODS: Recruitment ended in 2012 and research activities shifted to retention. Data collectors (DC) completed subjective risk assignments (low, medium, high) based on knowledge of participants. Descriptive statistics compared risk assessments to socio-demographic characteristics, responses regarding participation, and missed appointments 11 months after risk assessment. RESULTS: We recruited approximately 100 participants. Higher perceived risk was associated with greater likelihood for mothers to be minorities, younger, and have lower education and income (X2=15.362, p<.01; X2=12.118, p<.05; X2=9.947. p<.01; and X2= 7.720, p<.05 respectively). Participants with income below federal poverty placed higher values on receiving incentives (X2= 6.011 p<.05). African American or “other” race participants placed a higher value on feeling comfortable with the interviewers than White respondents (X2=12.539 p<.01). Risk assignment and race were associated with number of missed appointments (X2=8.698 p<.01; X2 =4.307, p<.05). CONCLUSION: Results suggest DCs’ subjective assessment of risk predicts number of missed appointments. Future research might consider strategies to improve African American and “other” race participants’ comfort with interviewers. The ethics of dollar amounts for incentives among low-income participants remain a concern.

Pregnancy in women with hemoglobinopathy has been associated with an increased risk of adverse pregnancy outcomes. We conducted a historical cohort study using Discharge Abstract Database for the fiscal year 1991-1992 through 2007-2008. We estimated the frequency of pregnant women with hemoglobinopathy and examined their associations with adverse pregnancy outcomes. Women with sickle cell disease are more likely to develop pre-eclampsia and preterm labor, and to undergo cesarean delivery than women with nutritional deficiency anemia, suggesting that there are other mechanisms beyond anemia that may be responsible for an increased risk of adverse pregnancy outcomes. The data suggested a synergistic effect of hemoglobinopathy and pre-eclampsia on preterm labor and cesarean delivery. Prediction models for pre-eclampsia, preterm labor and cesarean delivery were created and internally validated for women with hemoglobinopathy, with satisfactory discrimination and calibration.

BACKGROUND Few high-quality observational studies have been conducted to examine clinically relevant features of emotional distress and Major Depressive Disorder (MDD) in adults with primary cerebral glioma. Our knowledge of these important complications of glioma is currently poor. AIMS This thesis aims to answer a series of relevant clinical questions. I have studied: [1] the frequency, independent clinical associations and course of general emotional distress measured using the NCCN Distress Thermometer (DT); [2] the utility of three depression screening tools for identifying MDD; [3] the frequency, independent clinical associations and course of MDD in glioma; [4] current patterns of practice, and the apparent tolerability of antidepressant treatment of depression in glioma; and [5] barriers to the effective management of MDD in glioma. METHODS I conducted a prospective, twin-centre, observational cohort study. Adults with a new histological diagnosis of primary supratentorial glioma were enrolled and interviewed three times: shortly after starting radiotherapy (T1), three months later (T2) and six months later (T3). At each time point participants completed the DT, the Hospital Anxiety and Depression Scale (Depression subscale, HAD-D), the Patient Health Questionnaire-9 (PHQ-9) and the Structured Clinical Interview for DSMIV MDD (SCID). Barriers to depression management were studied using questionnaires completed by the patient and their named GP. RESULTS During a two-year recruitment period, 223 patients were eligible and 155 provided useable data (57.4% male, mean age = 54.2 years, 85.8% high-grade glioma, 78.1% radical radiotherapy, 55.5% chemotherapy). [1] High distress (DT score ≥ 4/10) was consistently a frequent complication, occurring in between 36.4% ± 7.6% of patients at T1 to 33.7% ± 10.2% at T3. In a logistic regression analysis, high distress at T1 was independently associated with MDD, functional impairment and younger age (χ2 for model = 39.882, p < 0.001, R Square = 0.312). Patients who reported high distress at T1 (median DT score = 8; IQR 7 - 9) remained highly distressed on follow-up (T2 median score = 8, IQR 6 - 8; T3 median score = 7, IQR 5 - 8). [2] As screening tools, the HAD-D and PHQ-9 showed good internal consistency (α = 0.769 - 0.862 at any time point). The HAD-D displayed the best operating characteristics on ROC curve analysis. At a threshold of 7+, sensitivity = 0.933, specificity = 0.907 and Positive Predictive Value (PPV) = 0.56. A threshold of 8+ displayed similar PPV, however. [3] The cross-sectional prevalence of MDD was 13.5% ± 5.4% at T1, 14.8% ± 6.7% at T2 and 6.8% ± 5.8% at T3. Inter-rater diagnostic agreement was good (κ = 0.81, 95% CI 0.60 – 1.00). MDD was independently associated with a past history of depression (OR = 3.8, 95%CI 1.5 - 9.8), and with current functional impairment (OR = 3.6, 95%CI 1.4 - 9.4). MDD persisted for at least three months in 9/17 patients who could be followed up. [4] The frequency of antidepressant prescription was 8.4% ± 4.4% at T1, 7.4% ± 4.9% at T2 and 12.6% ± 6.9% at T3. Citalopram was the most frequent antidepressant choice. Antidepressant tolerability appeared to be good among patients who could be followed up. [5] Barriers to the management of depression included 78.4% of GPs regarding major depression as a normal reaction to having glioma, and 39.2% expressing a belief that major depression did not always require treatment. In addition, most patients expressed a degree of resistance to any kind of future depression treatment. DISCUSSION This is the largest cohort study of depression in consecutively presenting adults with glioma, and the first to utilise criterion standard structured interview diagnoses in a longitudinal design. There is a degree of theoretical uncertainty about the nosological validity of MDD in glioma, although the clinical relevance of this uncertainty can be debated. Methodological limitations to the presented study include an absence of alternative potential psychiatric diagnoses to MDD, the likelihood of selection bias in recruitment, and considerable attrition. Due to these and other limitations, findings from this study are tentative and should ideally be replicated. Clinicians should have a high index of suspicion for identifying low mood in glioma patients, particularly those with functional impairment or previous depressive episodes. The HAD-D (suggested threshold 8+) can reasonably be used to screen for depression, if desired. Caution is required when prescribing antidepressants. Clinicians should be educated about the frequency and consequences of MDD in glioma. Researchers interested in psychological neuro-oncology could convene a meeting to guide future projects, particularly since multi-centre studies may be necessary to recruit sufficient sample sizes in future.

Abstract Dental caries in toddlers was studied in relation to several risk factors which were also determined by salivary tests in a longitudinal design. Another specific aim was to reveal the effect of prolonged pacifier sucking on caries development. The study population consisted of 183 pre-school children. At the baseline, salivary microbiological tests were taken from children whose average age was 2.5 years. Risk factors for colonisation of salivary lactobacilli and yeasts were determined from a questionnaire filled in by the parents. At the 2-year follow-up, caries in primary teeth was studied against the possible risk factors recorded at the baseline. At the 7-year follow-up, the risk factors identified at the age of two were analysed against caries development in primary molars and in first permanent molars. Also the long-term predictive value of salivary microbiological tests was investigated. At the baseline, the use of pacifier and nocturnal use of nursing bottle were associated with colonisation of salivary lactobacilli and yeasts. Prolonged pacifier sucking and use of nursing bottle at nights were shown to be associated with caries development in children at the 2-year follow-up. Consumption of sweets, lack of daily tooth brushing and nocturnal use of nursing bottle at the age of two were associated with caries onset in both primary and permanent molars at the seven-year follow-up. The use of fluoride tablets reduced the risk of caries onset in primary molars. Children who were colonised by salivary lactobacilli or yeasts at the baseline were susceptible to caries in primary molars. Early colonisation of lactobacilli was associated with caries in permanent molars. The results suggest that the risk of caries is possible to assess in toddlers by identifying caries-related habits early, already at the age of two. Microbiological tests may also have some value. Assessment of caries risk in toddlers enables both prevention and early intervention, and thereby prevention of caries development in children
Tiivistelmä Tämän tutkimuksen tarkoituksena oli pitkäaikaisseurannassa selvittää taaperoikäisiltä lapsilta otettujen sylkitestien ja muiden määritettyjen riskitekijöiden mahdollista yhteyttä karieksen kehittymiseen. Erityisesti haluttiin myös tutkia pitkittyneen tutin käytön merkitystä. Tutkimusaineisto koostui 183:sta alle kouluikäisestä lapsesta. Aloitusvaiheessa otettiin mikrobiologiset sylkitestit lapsilta, joiden keski-ikä oli 2,5 vuotta, ja määritettiin anamnestisesti mahdolliset riskitekijät laktobasillien ja hiivasienten kolonisaatiolle. Kahden vuoden seurannan jälkeen tutkittiin riskin toteutumista maitohampaiden karioitumisessa. Seuraavassa seitsemän vuoden seurantatutkimuksessa tutkittiin karieskehitystä maitomolaareissa ja ensimmäisissä pysyvissä molaareissa kahden vuoden iässä määritetyissä riskiryhmissä. Myös syljen mikrobiologisten testien avulla määritetyn riskin toteutumista selvitettiin seitsemän vuoden seurannan päätyttyä. Tutkimuksen aloitusvaiheen sylkitestitulokset osoittivat, että tutin käyttö ja tuttipullon käyttö öisin olivat yhteydessä syljen kariekseen liittyviin mikrobeihin, ja ne voivat siten lisätä kariesaktiivisuutta maitohampaistossa. Kahden vuoden seurantatutkimuksessa todettiinkin, että karieskehitys oli yhteydessä aikaisemmin määritettyihin riskitekijöihin: pitkittyneeseen tutin käyttöön ja tuttipullon käyttöön öisin. Seitsemän vuoden seurantatutkimuksen tulokset osoittivat, että makeisten käyttö kaksivuotiaana, puutteellinen hampaiden harjaus ja tuttipullon käyttö öisin ovat riskitekijöitä sekä maitomolaarien että ensimmäisten pysyvien molaarien karieskehitykselle. Fluoritablettien käyttö vähensi maitomolaarien karioitumista. Myös varhain tehdyillä syljen mikrobiologisilla testeillä oli pitkäaikainen ennustusarvo. Tulokset osoittavat, että riskin määritys taaperoikäisten lasten karieskehitykselle voidaan tehdä varhaisessa vaiheessa sekä mikrobiologisten sylkitestien avulla että määrittelemällä muiden mahdollisten riskitekijöiden esiintyvyys. Varhaisen kariesriskin määrityksen avulla voidaan ehkäisevät hoitotoimenpiteet kohdistaa ajoissa riskiryhmille ja siten ehkäistä karieskehitystä ja korjaavan karieshoidon tarvetta lapsilla

In a prevalent cohort study with follow-up, the incidence process is not directly observed since only the onset times of prevalent cases can be ascertained. Several important consequences follow if one can establish stationarity of the incidence process: (1) The useful epidemiological relationship between prevalence, incidence, and mean duration holds, (2) There is improved efficiency when estimating the underlying survivor function from a prevalent cohort study with follow-up, (3) The constancy of the incidence rate is established, and (4) The constant incidence rate can be estimated using data from a prevalent cohort study.
We propose a formal test for stationarity using data from a prevalent cohort study with follow-up, and establish new characterizations of stationarity, and of useful types of departure from stationarity.
A dual to the problem of establishing stationarity by comparing the backward and forward recurrence times is addressed. Assuming stationarity of the underlying incidence process, we use the backward and forward recurrence times to verify whether the underlying survival distribution is independent of the date of onset. In doing so, we characterize specific types of dependence of the underlying survival distribution on calendar time.
If the data are consistent with stationarity of the incidence rate, then a natural next step is to estimate the (constant) incidence rate. We derive the nonparametric maximum likelihood estimator of the constant incidence rate, prove that the estimator is weakly consistent, and show how one may construct an asymptotic confidence interval for the incidence rate. One main advantage of our procedure is that it only requires the completion of a single prevalent cohort study with follow-up.
We apply our test for stationarity to data obtained as part of the Canadian Study of Health and Aging to verify that the incidence rate of dementia amongst the elderly in Canada has remained constant. Upon concluding that this constancy is, plausible, we estimate the incidence rate.

The aim of this research is to investigate the process of Internet adoption among a cohort of older people who reached their formative years historically prior to the public emergence of the Internet, and who have gained no previous exposure to the Internet in their educational and working lives. This research is based on an ethnographic research study of a number of participants who attended one-off, introductory Internet workshops. It is situated within an interpretive paradigm. The research involved a follow-up of research participants approximately six months after their workshop attendance. This research employs Everett Rogers' (2003) theory of the Diffusion of Innovations, and draws on diverse literatures from Information Systems, Sociology, Gerontology and Gerontechnology. It investigates why the aforementioned cohort of older people may be adopting (or rejecting) the Internet; how they are adopting; and how this process can occur over time. It also proposes a potential means for accelerating Internet adoption among older people. The results of this research reveal that the process of Internet adoption characterising this specific cohort can be long and complex, and can be shaped by social network ties. The influence of strong ties was most evident, but weak ties were also important. The influence of both strong and weak ties is emphasised in the proposal of community networks and of intra- and intergenerational partnerships, which are recommended as community-based, 'home-from-home' environments in which older people (and other social groups) can 'trial' the Internet and observe it in use by others.

A cohort of 578 of mothers and their infants from Western Saudi Arabia were followed for six months to document infant feeding practices. Breastfeeding was initiated by 80% of mothers, but only 48.6% were exclusively breastfeeding at discharge. The ‘any breastfeeding’ rate declined to 46% at six months. Most mothers (71.3%) introduced some infant formula before six weeks of age. Younger age, primi-parity, higher socio-economic status, obesity and depression were associated with lower breastfeeding rates.

Skin tears are common wounds found amongst older adults. A 6-month cohort study was conducted to investigate the reliability of non-invasive technologies to objectively quantify ageing skin properties, and to examine risk factors associated with 6-months incidents of skin tears, in an aged care population. Multivariable analysis developed a skin tear model with a receiver operator characteristic curve indicating the model provided very good discrimination for correctly classifying participants with and without skin tears.

Dogslife is the first large-scale, longitudinal cohort study of canine lifestyle, morphology and health. The project involves recruiting the owners of UK-based, Kennel Club registered Labrador Retrievers and asking them to submit data about their dogs via an online questionnaire repeatedly as the dogs age. In this thesis, I have analysed Dogslife data regarding the lifestyle, morphology and health of Labrador Retrievers up to four years of age. A validation study was initially undertaken in order to understand the quality of the Dogslife data because this would underlie all future investigations. Owners were visited and veterinary records scrutinised. It was determined that Dogslife illness reports were subject to recall decay and that minor changes would improve the usability of the questionnaire. Accelerometers were subsequently sent to a subset of the cohort and aspects of the Dogslife exercise questionnaire were found to be correlated to accelerometer readings indicative of sedentary, light and moderate to vigorous exercise. Overall, Dogslife dogs were exercised for over two hours each day with the time spent being dominated by time off lead and on other activities. Dogs in England spent less time exercising than those in Scotland and Wales and dogs in family households spent less time exercising than those in single adult households or households comprising more than one adult. Despite being pedigree animals, the males in the cohort were 2-3cm taller than the breed standard. On average, the females met the breed standard but there was wide variation for both sexes. Working dogs in the cohort were over 2kg lighter than household pets and chocolate coloured dogs were 1.4kg heavier than their black and yellow counterparts. Dogs in multi-dog households were 0.5kg lighter than those in households with no other dog. Heavier dogs spent less time fetching, chasing and retrieving and on other exercise. Over 6,000 signs of illness were reported to Dogslife in the first three and half years and approximately half of them did not involve a veterinary visit. Reported signs were dominated by vomiting and diarrhoea, both of which peaked when the dogs were between 3-6 months of age. For the first time, rates of diarrhoea were shown to be positively associated with human population density in the UK. Limber tail was found to be associated with swimming in the cohort and working dogs were more likely to develop the condition than pets. Genetic analyses identified regions of interest that might predispose the dogs to limber tail on chromosomes 6 and 30. Data from the Dogslife project provide a unique resource for investigating the epidemiology of Labrador Retrievers. This thesis creates a platform for all such future investigations.

Objectius: Determinar la prevalença de malaltia arterial subclínica mesurada per ecografia en el territori carotidi d’individus amb prediabetis sense antecedents previs de malaltia cardiovascular (CV) d’una regió mediterrània no urbana i comparar-la amb la de subjectes amb normoglucèmia; avaluar el perfil cardiometabòlic dels individus amb prediabetis i comparar-lo amb el dels individus amb normoglucèmia; determinar els factors associats a la malaltia ateroscleròtica carotídia subclínica. Metodologia: L’Estudi Mollerussa és un estudi de cohorts prospectiu de subjectes de 25 anys o més seleccionats de forma aleatòria de la població general. Es va definir la prediabetis com el fet de tenir una glucèmia basal (GB) entre 100 mg/dL i <126 mg/dL i/o un valor d’hemoglobina glucosilada (HbA1c) entre 5,7% i <6,5%. La malaltia arterial subclínica es va valorar per ecografia carotídia mesurant el gruix íntima-mitja (GIM), la presència/absència de placa i el nombre de plaques. També es van investigar altres factors associats a l’aterosclerosi subclínica. Resultats: Es van incloure 550 subjectes [58,4% dones; edat mitjana 50,1 anys; índex de massa corporal (IMC) 26,1 Kg/m2]. 224 subjectes (40,7%) tenien prediabetis. La mitjana de GIM i la prevalença de placa carotídia van ser significativament superiors en el grup amb prediabetis que en el de normoglucèmia (0,72 vs. 0,67; p<0,001 i 37,9% vs. 19,6%; p<0,001, respectivament), i també va ser així amb la proporció de subjectes amb una o múltiples plaques (19,6% i 18,3% vs. 10,1% i 9,5%, respectivament; p<0,001). Els individus amb prediabetis eren d’edat més avançada (p <0,001) i amb un pitjor perfil cardiometabòlic pel que fa a l’IMC (p<0,001) i al perímetre cintura (p<0,001), a la dislipèmia i a la hipertensió arterial (HTA) (p=0,002) i a l’exposició al tabac i a la funció renal (p<0,001). A més a més, el recompte de leucòcits també va ser més elevat en el grup amb prediabetis (p=0,033). L’edat i el sexe masculí (p<0,001) i la tensió arterial (TA) sistòlica (p=0,007) es van correlacionar positivament amb el GIM. D’altra banda, la prediabetis i el colesterol de lipoproteïnes de baixa densitat (LDL) es van associar a la presencia de placa [Odds ratio (OR)=1,64; interval de confiança (IC) 95%= 1,04-2,58; p=0,034 i OR=1,01; IC 95%=1,00-1,02; p=0,013, respectivament] juntament amb l’edat (p<0,001) i el sexe masculí (p=0,026) i l’exposició al tabac i el recompte de leucòcits (p=0,036 i p=0,022, respectivament). Conclusions: Les persones amb prediabetis tenen un GIM carotidi més elevat, més prevalença de placa carotídia, i més nombre de plaques en comparació amb els individus amb normoglucèmia. La prediabetis és un factor que s’ha associat a la presència de placa carotídia. En canvi, no ha mostrat associació amb el GIM, com sí que ho han fet el sexe masculí, l’edat i la TA sistòlica. El sexe masculí, l’edat, l’exposició al tabac, el colesterol LDL i el recompte de leucòcits s’han associat també a la presència de placa carotídia subclínica. Les persones amb prediabetis tenen un perfil cardiometabòlic més desfavorable que les que estan en situació de normoglucèmia, això és, són d’edat més avançada, tenen un grau d’adipositat més elevat, més prevalença de dislipèmia i d’HTA, més exposició al tabac i una funció renal més deteriorada.
Objetivos: Determinar la prevalencia de enfermedad arterial subclínica medida por ecografía en el territorio carotídeo de individuos con prediabetes sin antecedentes previos de enfermedad cardiovascular (CV) de una región mediterránea no urbana y compararla con la de individuos con normoglucemia; evaluar el perfil cardiometabólico de los sujetos con prediabetes y compararlo con el de los individuos con normoglucemia; determinar los factores asociados a la enfermedad aterosclerótica carotídea subclínica. Metodología: El Estudio Mollerussa es un estudio de cohortes prospectivo de sujetos de 25 años o más seleccionados de forma aleatoria de la población general. La prediabetes se definió como tener una glucemia basal (GB) entre 100 mg/dL y <126 mg/dL y/o un valor de hemoglobina glucosilada (HbA1c) entre 5,7% y <6,5%. La enfermedad arterial subclínica se valoró por ecografía carotídea midiendo el grosor íntima-media (GIM), la presencia/absencia de placa y el número de placas. También se investigaron otros factores asociados a la aterosclerosis subclínica. Resultados: Se incluyeron 550 sujetos [58,4% mujeres; edad media 50,1 años; índice de masa corporal (IMC) 26,1 Kg/m2]. 224 sujetos (40,7%) tenían prediabetes. La media de GIM y la prevalencia de placa carotídea fueron significativamente superiores en el grupo con prediabetes que en el de normoglucemia (0,72 vs. 0,67; p<0,001 y 37,9% vs. 19,6%; p<0,001, respectivamente), y también fue así con la proporción de sujetos con una o múltiples placas (19,6% y 18,3% vs. 10,1% y 9,5%, respectivamente; p<0,001). Los individuos con prediabetes eran de edad más avanzada (p <0,001) y con un peor perfil cardiometabólico respecto al IMC (p<0,001) y al perímetro cintura (p<0,001), a la dislipemia y a la hipertensión arterial (HTA) (p=0,002) y a la exposición al tabaco y a la función renal (p<0,001). Además, el recuento de leucocitos también fue más elevado en el grupo de prediabetes (p=0,033). La edad y el sexo masculino (p<0,001) y la tensión arterial (TA) sistólica (p=0,007) se correlacionaron positivamente con el GIM. Por otra parte, la prediabetes y el colesterol de lipoproteínas de baja densidad (LDL) se asociaron a la presencia de placa [Odds ratio (OR)=1,64; intervalo de confianza (IC) 95%= 1,04-2,58; p=0,034 y OR=1,01; IC 95%=1,00-1,02; p=0,013, respectivamente] junto con la edad (p<0,001) y el sexo masculino (p=0,026) y la exposición al tabaco y el recuento de leucocitos (p=0,036 i p=0,022, respectivamente). Conclusiones: Los individuos con prediabetes tienen un GIM carotídeo más elevado, más prevalencia de placa carotídea y más número de placas en comparación con los individuos con normoglucemia. La prediabetes es un factor asociado a la presencia de placa carotídea. En cambio, no es un factor asociado al GIM, como lo son el sexo masculino, la edad y la TA sistólica. El sexo masculino, la edad, la exposición al tabaco, el colesterol LDL y el recuento de leucocitos se han asociado también con la presencia de placa carotídea subclínica. Los individuos con prediabetes tienen un perfil cardiometabólico más desfavorable que los individuos con normoglucemia, es decir, son de edad más avanzada, tienen un grado de adiposidad más elevado, más prevalencia de dislipemia y de HTA, más exposición al tabaco y una función renal más deteriorada.
Objectives: To compare the prevalence of subclinical atherosclerosis as measured by carotid ultrasonography in a cohort of subjects from a non-urban Mediterranean population with prediabetes without prior cardiovascular (CV) disease vs. subjects with normal glucose tolerance; to evaluate the cardiometabolic profile of prediabetic subjects in comparison with normoglycemic subjects; to determine associated factors with subclinical carotid atherosclerosis. Methods: The Mollerussa Cohort Study was a prospective, observational study conducted in subjects aged 25 years or more randomly selected from the general population who had prediabetes, defined as fasting plasma glucose (GB) between 100 mg/dL and <126 mg/dL and/or glycated haemoglobin (HbA1c) between 5.7% and <6.5%. The burden of atherosclerosis was assessed through carotid ultrasonography to measure carotid intima-media thickness (GIM), the presence/absence of carotid plaques, and the plaque number. We also investigated clinical factors associated with the presence of subclinical atherosclerosis. Results: Among 550 subjects included [58.4% women, mean age 50.1 years, mean body mass index (IMC) of 26.1 Kg/m2], there were 224 (40.7%) subjects with prediabetes. The mean GIM was significantly higher in the prediabetes group compared to the normal glucose tolerance group (0.72 vs. 0.67, p<0.001). The prevalence of carotid plaque was higher in the prediabetic group than in the normal glucose tolerance group (37.9% vs. 19.6%; p<0.001), as it was the proportion of subjects with one or multiple plaques (19.6% and 18.3% vs. 10.1% and 9.5%, respectively; p<0.001). Prediabetic subjects were older (p <0.001) and also had a worse cardiometabolic profile concerning IMC (p<0.001) and waist circumference (p<0.001), dyslipidemia and hypertension (HTA) (p=0.002) and tobacco exposure and glomerular filtration (p<0.001). Moreover, leukocyte count was also higher in the prediabetic group (p=0.033). Older age and male gender (p<0.001) and increased systolic blood pressure (TA) (p=0.007) were positively correlated with GIM. In the other hand, prediabetes and low-density lipoprotein (LDL) cholesterol were associated with the presence of carotid plaque [Odds ratio (OR)=1.64; 95% confidence interval (IC)= 1.04-2.58; p=0.034 and OR=1.01; 95% IC=1.00-1.02; p=0.013, respectively) together with age (p<0.001) and male gender (p=0.026) and tobacco exposure and the leukocyte count (p=0.036 and p=0.022, respectively). Conclusions: Prediabetic subjects have and increased carotid GIM, more prevalence of carotid plaque and plaque number than normoglycemic subjects. Prediabetes is associated with the presence of carotid plaque. In contrast, it is not associated with GIM, as are male gender, age and systolic TA. Male gender, older age, tobacco exposure, LDL cholesterol and leukocyte count are also associated with the presence of subclinical carotid plaque. Prediabetic subjects have a worse cardiometabolic profile compared to normoglycemic subjects, this means older age, high adiposity, more prevalence of dyslipidemia and HTA, higher tobacco exposure and worse glomerular filtration.

Background: Missing data are an unavoidable feature in longitudinal studies and inad- equate handling can result in bias. The South London Stroke Register (SLSR) follows up participants at three months and annually after stroke. The majority of data collected are categorical in nature. Typically a third of survivors miss each follow-up and the impact of, and `best' methods for, dealing with these missing data are not clear. The aim of the thesis is to compare and determine the most appropriate methods for handling non-continuous missing data in the SLSR. Methods: Exploratory analyses identi ed predictors of incomplete follow-up and in- formed a simulation study in which the biases associated with prevalence rates of four indicators of poor outcome were estimated and analysis methods compared across four scenarios. Models making di ering assumptions about the missing data assessed the im- pact of missing data on associations between baseline characteristics and outcomes. Results: Missing data were strongly associated with disability and activity level after stroke and likely missing not at random (MNAR). Estimates of prevalence of poor out- comes from available case analyses were relatively unbiased apart from when a strong MNAR assumption was made and outcomes were strongly associated with dropout, with prevalence underestimated by up to 7% points. Bias was reduced after using multiple imputation (MI) with maximum bias of 5% points. There was no evidence that missing data in uenced associations between baseline characteristics and outcome. Conclusions: Some subgroups of the SLSR are at greater risk of non-participation than others but the resulting bias is likely to be minimal. When summarising population out- comes using rates MI should be used in addition to available case analysis. Future work will seek to further quantify potential biases using routinely collected data from GPs to compare responders and non-responders.

Abstract Personality disorders (PDs) are relatively common mental disorders associating with other psychiatric disorders and disability. The aim of the study was to determine the occurrence of PDs in a general population subsample and psychiatric hospital patients, the associations of PDs with childhood family structure, the co-occurrence of PD with common psychiatric disorders, and the associations between PDs and temperament. The study is part of the Northern Finland 1966 Birth Cohort Project (NFBC 1966), consisting of cohort members living in Oulu (N = 1,609) on 1st January 1997 (the Oulu Study). The study consisted of a two-stage psychiatric field survey with questionnaires and a structured clinical interview and analysis of the patient records in public outpatient care. Information concerning psychiatric illness of all cohort members (N = 12,058) was gathered from the Finnish Hospital Discharge register (FHDR). The best-estimate procedure was used for the assessment of psychiatric morbidity including PDs. Childhood family structure and other sociodemographic variables were drawn from questionnaires of the field study conducted during earlier follow-up studies. In this study PDs were classified into three clusters: Cluster A (paranoid, schizoid and schizotypal PD), Cluster B (antisocial, borderline, histrionic, and narcissistic PD), and Cluster C (avoidant, dependent, obsessive-compulsive, and passive-aggressive PD). The most common PDs in the Oulu Study sample were Cluster C PDs, whereas Cluster B PDs were most common in the hospital-treated sample. PDs were highly associated with mood, anxiety and substance use disorders. Single-parent family type in childhood was associated with PDs, especially Cluster B PDs in adulthood. PD clusters were associated with different profiles of temperament, but the temperament dimensions could not distinguish different PDs very well. These results indicated that it is important to recognize PDs and their comorbid psychiatric disorders. This will have implications in both general outpatient care and psychiatry. These results indicate the importance of recognition of childhood risk factors for PDs for the prevention of severe PDs. The results suggest a need for more studies about the aetiology and development of PDs
Tiivistelmä Persoonallisuushäiriöt ovat yleisiä mielenterveyden ongelmia, joihin liittyy usein psykiatrista oheissairastavuutta ja toimintakyvyn laskua. Tämän tutkimuksen tarkoituksena oli arvioida persoonallisuushäiriöiden yleisyyttä nuorilla aikuisilla. tehtävänä oli arvoida yhteyksiä lapsuuden perherakenteeseen ja yleisimpiin psykiatrisiin häiriöihin sekä arvioida persoonallisuushäiriöiden yhteyksiä temperamenttitekijöihin. Tutkimus on osa Pohjois-Suomen vuoden 1966 syntymäkohortin psykiatrista osaprojektia, Oulu Studyä. Tutkimusaineiston muodostivat Oulu Studyn otokseen kuuluvat kaikki 1. tammikuuta 1997 Oulussa asuneet kohortin jäsenet (N = 1 609) sekä sairaalahoidossa olleiden persoonallisuushäiriö- diagnoosin saaneiden osalta koko alkuperäisen syntymäkohortin (N = 12 058) jäsenet. Tutkimus koostui kaksivaiheisesta psykiatrisesta kenttätutkimuksesta, jossa tietoja tutkittavilta kerättiin sekä kyselylomakkeiden ja haastattelututkimuksen avulla. Lisäksi tutkittavilta kerättiin tiedot heidän elinaikanaan toteutuneesta julkisten psykiatristen sairaala- ja avohoitopalvelujen käytöstä sairauskertomustietojen perusteella. Niin kutsutun best-estimated -menetelmän avulla arvioitiin tutkittavien psykiatrista sairastavuutta mukaan lukien persoonallisuushäiriöt. Tutkittavien lapsuuden perherakennetta ja sosiodemografisia tekijöitä arvioitiin aiempien seurantatutkimusten tietojen avulla. Tutkimuksessa persoonallisuushäiriöt luokiteltiin DSM-III-R-diagnoosiluokituksen mukaisesti kolmeen eri pääryhmään ja niiden mukaisiin alaryhmiin: Ryhmä A (epävakaa, eristäytyvä ja psykoosipiirteinen persoonallisuus), ryhmä B (epäsosiaalinen, epävakaa, huomionhakuinen ja narsistinen persoonallisuus) ja ryhmä C (estynyt, riippuvainen, pakko-oireinen ja passiivis-aggressiivinen persoonallisuus). Oulu Studyn väestöotoksessa yleisimpiä näistä olivat ns. C-ryhmän persoonallisuushäiriöt, kun taas sairaalahoidetuilla henkilöillä B-ryhmän persoonallisuushäiriöt olivat yleisimpiä. Persoonallisuushäiriöiden todettiin liittyvän yleisesti masennus- ja ahdistuneisuushäiriöihin sekä päihteiden käyttöön. Vanhemman yksinhuoltajuuden todettiin liittyvän persoonallisuushäiriöihin, etenkin B-ryhmän persoonallisuushäiriöihin. Persoonallisuushäiriöryhmät erosivat toisistaan temperamenttiprofiilien perusteella. Eri persoonallisuushäiriöistä kärsivillä tutkittavilla ei todettu tyypillisiä temperamenttiprofiileja. Johtopäätöksenä voidaan todeta, että persoonallisuushäiriöiden ja niihin yleisesti liittyvän psykiatrisen oheissairastavuuden tunnistaminen on tärkeää. Havainnot korostavat perusterveydenhuollon ja erikoissairaanhoidon yhteistyön merkitystä persoonallisuushäiriöistä ja psykiatrisista häiriöistä kärsivien henkilöiden tutkimuksessa ja hoidossa. Persoonallisuushäiriöille altistavien lapsuuden tekijöiden tunnistaminen on tärkeää vaikeiden persoonallisuushäiriöiden ehkäisemiseksi. Persoonallisuushäiriöiden etiologian ja kehittymisen selvittämiseksi tarvitaan uusia tutkimuksia

Cardiovascular diseases (CVD) are the principal cause of mortality worldwide. Lifestyle plays a crucial role in preventing the development of CVD, and one of its key elements is diet, which directly affects cardiometabolic health and cardiovascular risk. Given the complexity of diet and also of cardiovascular disease etiology, a lot of recent research into the association between diet and disease have focused on dietary patterns, as this is currently the most holistic way to study dietary habits in the population. In this work, we examined dietary patterns and their components that are associated with cardiometabolic health. Data were obtained from two population-based cross-sectional surveys conducted in Girona (Spain) in 2000 and 2005. The first survey included 3,058 randomly selected free-living men and women aged 25 to 74 years. The second survey included 6,352 men and women aged 35 to 80 years. These cohorts were re-examined in 2010 and 2012, with a follow up rate of 80.6% and 78.0%, respectively. At baseline and follow-up, we collected data on diet, using a validated food frequency questionnaire (FFQ), and on cardiovascular risk. We performed validation studies of a priori and a posteriori dietary patterns. In the a priori analysis, we found that a Diet Quality Index derived from a short Diet Quality Screener had good ability to predict future cardiovascular health complications. The a posteriori analysis showed good reproducibility and modest validity of dietary patterns defined using cluster analysis of the FFQ data. In a further step, we analysed the impact of energy under-reporting on dietary patterns and secular trends in dietary patterns. We concluded that energy under-reporting is a serious problem in nutritional epidemiology, especially when developing dietary guidelines for the general population, and more solid research is urgently needed in this area. To explore the association between diet and cardiovascular risk factors and CVD, we focused on abdominal obesity, a risk factor that had received increasing interest in recent years. Adherence to the Mediterranean diet and substitution of soft drinks with other caloric beverages, such as milk and juice, was associated with decreased abdominal adiposity. Finally, we studied the association between dairy products and cardiovascular events, and concluded that consumption of dairy products does not have an adverse impact on CVD incidence, and that frequent intake of yogurt was negatively associated with CVD incidence, presumably due to its prebiotic properties. In conclusion, this PhD research shows a smaller increase in waist circumference among individuals with high adherence to the Mediterranean diet, and the opposite for soft drink consumption. Furthermore, the results support the hypothesis that yogurt consumption is cardioprotective. Finally, it underlines the need to control for energy misreporting in epidemiological studies, and to validate dietary patterns.
En este trabajo, hemos examinado qué patrones dietéticos y cuáles de sus componentes están asociados con la salud cardiometabólica. Los datos se han obtenido a partir de dos estudios transversales de base poblacional realizados en España en 2000 y 2005. El primer estudio incluyó 3.058 y el segundo - 6.352 hombres y mujeres de 25 a 80 años de edad. Estas dos cohortes fueron re-examinadas en el año 2010 y 2012. Al inicio y al final del estudio se recogieron los datos dietéticos y los datos sobre los factores de riesgo cardiovascular. En el análisis a priori, encontramos que el Índice de Calidad Alimentaria derivado de un Cuestionario corto de Calidad de la Dieta tenía buena capacidad para predecir acontecimientos relacionados con la salud cardiovascular. El análisis a posteriori mostró una buena reproducibilidad y una validez modesta de los patrones dietéticos definidos mediante análisis de clústers de los datos de un cuestionario de frecuencia de alimentos. En el análisis del impacto de la declaración inferior de los niveles reales de energía consumida sobre los patrones dietéticos y las tendencias seculares en los mismos, llegamos a la conclusión de que la energía declarada por debajo de valores reales es un problema grave en la epidemiología nutricional, sobre todo en el desarrollo de guías alimentarias para la población en general. El seguimiento de una dieta mediterránea y la substitución de las bebidas gaseosas por otras bebidas calóricas, se asoció con una disminución de la adiposidad abdominal, un factor de riesgo de enfermedades cardiovasculares (ECV). Por último, llegamos a la conclusión de que el consumo frecuente de yogur se asoció negativamente con la incidencia de ECV. En conclusión, esta investigación doctoral muestra un menor aumento de la circunferencia de la cintura entre los individuos que siguen una dieta mediterránea, y lo contrario para el consumo de bebidas gaseosas. Además, los resultados apoyan la hipótesis de que el consumo de yogur actúa como cardioprotector. Por último, subraya la necesidad de controlar la declaración errónea del consumo de energía en los estudios epidemiológicos, y de validar los patrones dietéticos.

Abstract Somatization is a widespread phenomenon causing subjective suffering and disability. The aim of the study was to assess somatization disorder (SD) and somatization symptoms among young adult population and their associations with sociodemographic factors, alexithymia and temperament as well as psychiatric comorbidity. Various suggestions have been presented to operationalize somatization but none of them has been shown to be superior to others. In this study two definitions were used: SD by DSM-III-R classification diagnostic criteria and "somatization" meaning four or more symptoms of the 35 symptoms of DSM-III-R SD criteria. The study population was a subsample of the Northern Finland Birth Cohort 1966 (NFBC 1966), consisting of cohort members living in Oulu (N = 1,609) on January 1st 1997. The NFBC 1966 is a general population birth cohort of 12,058 live-born children covering 96.3% of all deliveries in the catchment area. The best-estimated procedure was used for assessment of psychiatric morbidity including SD and somatization. Data were collected from the Finnish Hospital Discharge Register and from all available outpatient and inpatient records. Data on education were gathered from Statistics Finland. Other sociodemographic variables, alexithymia and temperament scores were drawn from questionnaires of the field study conducted in 1997 and from earlier follow-up studies. The prevalence of SD was 1.1% (N = 18). Of the subjects 6.1% (N = 97) had somatization. The female-to-male ratio was 5:1 and 6:1, respectively. SD was not recognized by any of the treating physicians, at least not documented in case notes. The observed occurrences of SD and somatization were at a level comparable with earlier international population studies. Somatization did not associate with depression or alexithymia, and neither could a characteristic temperament profile be recognized. Somatization was associated with psychological distress. These results indicate a need for training physicians to recognize SD and somatization and its comorbidity. This will have implications both for psychiatry and other medical specialties regarding collaboration and underlines the importance of liaison-psychiatry at general hospitals. The results suggest a need for more studies about the etiology and development of SD and somatization
Tiivistelmä Somatisaatio on yleinen ilmiö, josta aiheutuu subjektiivista kärsimystä ja toimintakyvyn laskua. Tämän tutkimuksen tarkoitus oli arvioida somatisaatiohäiriön ja somatisaatio-oireilun yleisyyttä nuorilla aikuisilla sekä näiden ilmiöiden yhteyttä sosiodemografisiin tekijöihin, aleksitymiaan, temperamenttiin ja psykiatriseen sairastavuuteen. Somatisaation käsitteellistämiseksi on esitetty useita vaihtoehtoja mutta mikään niistä ei ole osoittautunut muita paremmaksi. Tässä tutkimuksessa käytetiin kahta määritelmää: DSM-III-R -diagnoosiluokituksen mukaista somatisaatiohäiriön diagnoosia tai somatisaatio-oireilua, jossa esiintyy neljä tai useampia DSM-III-R:n 35 somatisaatiohäiriön oireesta. Tutkimusaineiston muodostivat Pohjois-Suomen vuoden 1966 syntymäkohortin ne jäsenet, jotka asuivat Oulussa 1. tammikuuta 1997 (N = 1,609). Alkuperäinen kohortti koostuu 12,058 elävänä syntyneestä tutkittavasta, mikä kattaa 96.3 % kaikista synnytyksistä Pohjois-Suomessa. Niin kutsutun best-estimated -menettelyn avulla arvioitiin tutkittavien psykiatrista sairastavuutta mukaan lukien somatisaatiohäiriö ja -oireilu. Tietoa kerättiin sairaaloiden poistoilmoitusrekisteristä. Avohoidon sairauskertomustieto koottiin kattavasti. Koulutusasteesta saatiin tieto Tilastokeskukselta. Muita sosiodemografisia tekijöitä, aleksitymiaa ja temperamenttia arvioitiin vuoden 1997 kenttätutkimuksen ja aiempien seurantatutkimusten tietojen avulla. Somatisaatiohäiriön esiintyvyys oli 1.1 % (N = 18). Somatisaatio-oireita todettiin 6.1 % (N = 97) tutkittavista. Naisten osuus oli somatisaatiohäiriössä 5:1 ja somatisaatio-oireilussa 6:1. Osoittautui, että lääkärit eivät tunnistaneet somatisaatiohäiriötä, ainakaan sitä ei oltu kirjattu sairauskertomuksiin. Havaitut somatisaatiohäiriön ja -oireilun esiintyvyydet ovat sopusoinnussa aiempien kansainvälisten tutkimusten kanssa. Somatisaatio-oireilu ei liittynyt masennukseen tai aleksitymiaan eikä somatisaatio-oireilusta kärsiville tutkittavilla todettu tyypillistä temperamenttiprofiilia. Somatisaatio liittyi psyykkiseen stressiin. Johtopäätöksenä voidaan todeta, että lääkäreille tulisi tarjota koulutusta somatisaatiohäiriön ja -oireilun tunnistamisessa. On tärkeää tunnistaa somatisaatio ja siihen liittyvä oheissairastavuus. Havainnot korostavat yleissairaaloiden yhteistyöpsykiatrian ja muiden erikoisalojen yhteistyön merkitystä somatisaatiosta kärsivien potilaiden tutkimuksessa ja hoidossa. Somatisaatiohäiriön ja -oireilun etiologian ja kehittymisen selvittämiseksi tarvitaan uusia tutkimuksia

Abstract Low back pain (LBP) is a common condition already in adolescence and seems to predict future symptoms. Most of the previous longitudinal studies on LBP have been conducted in adult populations. Among adolescents, LBP has been linked most convincingly to psychosocial factors and smoking. We are not aware of any previous studies on clustering of potential risk factors in adolescent LBP. The main objective of this study was to analyze the potential associations of mainly modifiable psychosocial and lifestyle factors with LBP in adolescence. The factors evaluated were overweight, smoking, physical workload, family’s socioeconomic status, and the co-occurrence of psychosocial and lifestyle factors. The present study used the database of the 16- to 18-year-old adolescent subcohort, Oulu Back Study (n=1,987), of the Northern Finland Birth Cohort 1986. Moreover, we evaluated whether the associations differ depending on the presence of LBP symptoms at baseline of the two-year follow-up period. LBP was common among cohort adolescents as, on average, every second adolescent reported LBP, girls reporting more symptoms. As a whole, more associations were found among girls than boys. Overweight was associated with new LBP in the follow-up, but the association was not strong. Prolonged habitual smoking was associated with LBP, particularly with symptoms at baseline and follow-up. High exposure to awkward trunk postures and an overall physically demanding job were especially associated with new LBP in the follow-up. Family’s socioeconomic status was not consistently associated with LBP. At 16 years, four latent class clusters of psychosocial and lifestyle factors were found in both genders. Clusters characterized by behavioural problems were associated with LBP among both genders. Especially girls with the combination of emotional and behavioural problems were at the greatest risk of seeking care for new LBP. The results of this study indicate that LBP in adolescence is associated with both psychosocial and lifestyle factors. The information obtained may be utilized for improving preventive measures and individual care for adolescent LBP
Tiivistelmä Alaselkäkipu on yleistä jo nuorilla, ja varhain koetut oireet ennustavat myöhempiä selkäkipuoireita. Suurin osa alaselkäkivun seurantatutkimuksista on tehty aikuisväestöllä. Nuorten alaselkäkivun on esitetty vakuuttavimmin liittyvän psykososiaalisiin ongelmiin ja tupakointiin. Alaselkäkipuun liittyvien tekijöiden mahdollista kasautumista ei ole nuorilla tutkittu aiemmin. Tämän väitöstutkimuksen tarkoituksena oli selvittää, ovatko pääasiassa muunneltavissa olevat psykososiaaliset ja elämäntapatekijät yhteydessä nuoruudessa esiintyvään alaselkäkipuun. Arvioitavina tekijöinä olivat ylipaino, tupakointi, fyysinen työkuormitus, sosioekonomiset tekijät, sekä psykososiaalisten ja elämäntapatekijöiden kasautuminen. Tutkimusaineisto koostui Pohjois-Suomen syntymäkohortti 1986:n osaotoksesta (Oulun selkätutkimus), johon kuului 1987 16–18-vuotiasta nuorta. Mahdollisia yhteyksiä arvioitiin erikseen sen mukaan, raportoivatko nuoret seurannan alussa alaselkäkipuoireita vai ei. Alaselkäkipu oli nuorilla yleistä, ja tytöillä yleisempää kuin pojilla. Keskimäärin joka toinen nuori raportoi oireita. Tutkittujen tekijöiden ja alaselkäkivun välisiä yhteyksiä todettiin selvemmin tytöillä. Ylipaino ennusti seurannassa ilmaantuvaa alaselkäkipua, mutta yhteys ei ollut vahva. Säännöllinen tupakointi oli yhteydessä alaselkäkipuun ja etenkin toistuviin oireisiin. Tutkituista työkuormitustekijöistä etenkin hankalat työasennot ja fyysisesti monella tapaa raskaaksi luokiteltava työ altistivat seurannassa uudelle alaselkäkivulle. Sosioekonomiset tekijät eivät olleet selkeästi yhteydessä alaselkäkipuun. Latenttien luokkien analyysi tunnisti seurannan alkuvaiheessa neljä erilaista ryhmää (klusteria) psykososiaalisten ja elämäntapatekijöiden perusteella molemmilla sukupuolilla. Sekä tytöillä että pojilla alaselkäkipua esiintyi erityisesti niissä ryhmissä, joissa esiintyi runsaasti käyttäytymishäiriöitä. Tunne-elämän ja käyttäytymisen ongelmat ennustivat alaselkäkivun vuoksi hoitoon hakeutumista tytöillä. Tulosten perusteella nuorten alaselkäkipuun liittyy sekä psykososiaalisia että elämäntapatekijöitä. Tuloksia voidaan hyödyntää alaselkäkivun ennaltaehkäisyn ja nuorten yksilöllisen hoidon suunnittelussa

UA Open Access Publishing Fund
Background: Current understanding of tuberculosis (TB) genotype clustering in the US is based on individual risk factors. This study sought to identify whether area-based socioeconomic status (SES) was associated with genotypic clustering among culture-confirmed TB cases. Methods: A retrospective cohort analysis was performed on data collected on persons with incident TB in King County, Washington, 2004–2008. Multilevel models were used to identify the relationship between area-level SES at the block group level and clustering utilizing a socioeconomic position index (SEP). Results: Of 519 patients with a known genotyping result and block group, 212 (41%) of isolates clustered genotypically. Analyses suggested an association between lower area-based SES and increased recent TB transmission, particularly among US-born populations. Models in which community characteristics were measured at the block group level demonstrated that lower area-based SEP was positively associated with genotypic clustering after controlling for individual covariates. However, the trend in higher clustering odds with lower SEP index quartile diminished when additional block-group covariates. Conclusions: Results stress the need for TB control interventions that take area-based measures into account, with particular focus on poor neighborhoods. Interventions based on area-based characteristics, such as improving case finding strategies, utilizing location-based screening and addressing social inequalities, could reduce recent rates of transmission.

Many authors suggest that low anthropometric levels are associated with higher mortality risk in adults, In developing countries however there have been few opportunities to test this hypothesis. In addition, there is increasing interest in the role of women's nutritional status in their own health and survival as distinct from its impact on infant outcomes. This thesis describes the results obtained from a longitudinal historical follow-up of a cohort of 2,314 rural Bangladeshi women over a period of 19 years (1975-1993). The demographic, socio-economic, and anthropometric characteristics of the study cohort are described with reference to the methods of data extraction, preparation and validation. The risk of mortality associated with different levels of the anthropometric indicators (height, weight, arm circumference and body mass index) were analysed using Cox's proportional hazards models. In addition to the basic survival models, the effects of confounding, early mortality, missing data, and young subjects, on the estimates are discussed. A significant association between BMI and mortality (p=0.009) was found in adjusted analyses which used categories that distinguished the women in the highest and lowest 10% of the cohort BMI distribution. Women with BMI levels between 10% and 90% and >90% had hazard ratios of 0.45 (95% confidence intervals 0.27,0.73) and 0.55 (0.25,1.22) respectively, when compared to women with BMI <10%. The strength of the association between BMI and mortality risk was reduced after adjusting the models for early mortality (<4 years), (p=0.068). No significant associations were found between height, arm circumference and mortality risk. In conclusion, these data provide no evidence that these anthropometric indicators would be useful in population-based screening programmes in rural Bangladesh to identify women at higher mortality risk. The findings are considered with respect to the study's methodological constraints and comparisons with other studies in order to produce recommendations for those working in research and health programmes in women's nutrition.

This thesis was part of a multi-center prospective-cohort study conducted in six hospitals in Vietnam. A total of 2030 pregnant women were recruited and interviewed face-to-face at 24-28 weeks of gestation, with four follow-up visits from discharge to six months postpartum. The aims of this thesis were to review the prevalence and major determinants of perinatal depression in Asia and to determine the prevalence of and factors associated with perinatal depressive symptoms among Vietnamese women.

T2DM continues to be a public health burden with its increasing incidence, prevalence, and mortality risks. The aim of this thesis was to examine a population-based cohort of 22,000 people with T2DM diagnosed between 1 January 2000 and 31 December 2010 within the Wirral Peninsula, UK with the aim of: Assessing factors relating to all-cause, cardivascular-, malignancy-, and non-cardiovascular mortality; evaluating the role of glycaemic control, socioeconomic status, smoking, dyslipidaemia, blood pressure, obesity, and nephropathy, as predicting risk factors for mortality; assessing the influence of age at diagnosis, duration of diabetes, year of diagnosis and gender on mortality; examining the life expectancy and mortality patterns and measuring the years of life lost as a result of a diagnosis of T2DM; applying Complexity Science to the dynamic interplay of the various factors in T2DM that lead to unpredictability in health outcomes.

The present thesis introduces the EPI-CT cohort study; a European collaborative effort aimed at quantifying the health risks of computed tomography (CT scan) radiation exposure during childhood and assesses the main epidemiological factors that could bias the risk estimates in similar studies. It confirms an increase in the CT scan usage among patients younger than 21 years in Catalonia during the period 1991-2013. Of importance is that, the results obtained within the Spanish branch of the EPI-CT study do not suggest that the number of CT scans per person differ among the socioeconomic spectrum. This thesis also includes a health risk assessment of the 2013 Spanish CT imaging practice in young population, which projects 0.2% additional cancer cases (over the spontaneously arising cancer cases) to occur in the expected lifespan of the CT scan exposed individuals. A very initial analysis quantifying the association between the cumulative organ-doses and leukaemia and brain cancer mortality is included, suggesting a dose-related increase in the risk of brain tumours and leukaemia mortality.
Aquesta tesi presenta l'estudi de cohort EPI-CT; un estudi Europeu adreçat a la quantificació dels riscos per a la salut associats a l'exposició a la radiació de la tomografia computaritzada (TC) durant la infància i avalua els principals factors epidemiològics que podrien esbiaixar les estimacions de risc en estudis similars. Aquesta tesi confirma un augment en l'ús de la TC en pacients menors de 21 anys a Catalunya durant el període 1991-2013 i alhora, conclou que el nombre de TCs per persona no difereix segons el nivell socioeconòmic del pacient, suggerint un ús similar en tota la població. Aquesta tesi inclou també una avaluació del risc per a la salut de totes les TCs que es van dur a terme al 2013 en població jove a Espanya, i projecta un increment d’un 0,2% de càncers respecte als que s’esperen que ocorrin de forma espontànea entre la població exposada. S’inclou també una anàlisi molt inicial en la que s’observa una associació entre dosi a nivell d’òrgan i mortalitat per leucèmia i càncer de cervell.

Background: Silicosis is an ancient and preventable occupational lung disease that has long been known to be caused by exposure to significant amounts of dust containing silica (1). Silica dust is now known to be made up of microscopic silicon dioxide (SiO2) crystals, termed respirable crystalline silica (RCS), which are small enough to be inhaled to the deep alveolar sections of the lungs where gas exchange occurs (2). Over time this exposure can lead to silicosis, which can significantly impact a person’s quality of life and lifespan (2). Recent attempts to understand the pathophysiology of this disease have been undertaken to better aid understanding of the disease process and potential targets for therapeutic interventions beyond prevention (3). Currently the only established intervention for silicosis is a lung transplant, though other therapies such as whole lung lavage are being trialed which could potentially slow down or halt the progression of disease (4). Aetiology: This condition has seen a sudden increase among young stonemasons (24-39 years old) in Australia since 2015 and even earlier in other developed nations such as Spain and Israel due to the recent and widespread use of artificial (or engineered) stone in kitchen and bathroom benchtops, which is a popular material due to its strength, affordability, water resistance and visual appeal (5, 6). An increased demand for artificial stone in new homes and renovations combined with a lack of effective workplace regulation of safe practices have led to a large number of stonemasons in Australia being exposed to dangerously high levels of silica dust, since the material contains much higher silica content than traditional stone (7). This has resulted in significant numbers of younger stonemasons contracting a form of silicosis which occurs after a shorter latency period than historical cases (8). These cases have been characterised by rapid deterioration in lung function and quality of life, sometimes leading to lung transplant or death (8, 9). Screening program: A large screening program in Queensland of all known stonemasons working in kitchen and bathroom benchtop workshops has been undertaken by the government agencies WorkCover Queensland (WCQ) and Workplace Health and Safety, commencing in late 2018. At the time of writing 1053 workers have been screened, 202 have been diagnosed with silicosis and an additional 33 with progressive massive fibrosis (PMF), a radiological finding indicative of the advanced stage of the disease (10). Most of these cases have been followed up in several specialist respiratory clinics in Brisbane and the Gold Coast. In Australia to date there have only been several published case reports of silicosis from artificial stone and to our knowledge there hasn’t yet been data published reflecting the true extent of this disease and its burden in Australia (11). Therefore, our research focus will be to thoroughly describe this cohort in order to understand who is affected, what background they have and how compromised by the disease they are.
Thesis (Masters)
Master of Medical Research (MMedRes)
School of Pharmacy & Med Sci
Griffith Health
Full Text

Abstract The objective of this study was to investigate intellectual disability (ID) in children, with focus on occurrence, associated biomedical and sociodemographic factors, probable psychiatric problems and temporal variations in the occurrence of ID and the associated factors in an interval of 20 years. The study population consisted of two birth cohorts of children born in northern Finland, the Northern Finland Birth Cohort 1986 (NFBC 1986, N = 9,432 live-born children) and the Northern Finland Birth Cohort 1966 (NFBC 1966, N = 12,058 live-born children). Temporal changes in ID were studied by comparing NFBC 1986 with NFBC 1966. The same definition of intellectual disability (intelligence quotient ≤70), time of follow-up (up to 11.5 years), case ascertainment methods and data sources were used. Data were collected from questionnaires, registers and records. In NFBC 1986 the incidence of ID was 12.62/1,000 by age 11.5 years and prevalence 11.23/1,000 live-born at age 11.5 years. Associated biomedical aetiology could be found in two thirds of the cases. Genetic disorders were the largest aetiological category (36.1%) associated with ID. Maternal disadvantage (unskilled worker, basic education only) had the largest impact on the incidence of ID, while among single independent factors, maternal prepregnancy obesity (body mass index ≥30) showed the highest risk for ID (OR 2.8, 95% CI 1.5, 5.3) in the offspring. According to the assessments by the teachers at school children with ID had 4.9 times more likely probable behavioural problems than their peers not having ID. In an interval of 20 years, there was no change in the incidence or in the prevalence of ID between NFBC 1986 and NFBC 1966. However, a shift occurred from more severe levels of ID towards mild ID, so that both the incidence and prevalence of mild ID increased by 50% whereas more severe ID decreased by 50%. Temporal changes appeared in the proportions of aetiological categories (NFBC 1986 vs. NFBC 1966) with a statistically significant decrease of Down syndrome and paranatally originating causes (traumas/asphyxia). The proportion of chromosomal disorders other than Down syndrome increased, as did malformations of the central nervous system. Among sociodemographic factors associated with ID, indicators of socio-economic disadvantage retained their status as having the largest impact on the incidence of ID. Over the 20 years, the mother being single, living in a remote area and mother's older age at time of delivery had lost their association with ID. Only one new maternal sociodemographic factor, prepregnancy obesity, had emerged as having an association with ID with a statistically significant difference between NFBC 1986 and NFBC 1966. In conclusion, these results indicate that although the occurrence of ID remained the same in northern Finland over a period of 20 years, temporal changes have taken place in the biomedical and sociodemographic factors contributing to the incidence and prevalence of ID. There are also factors that have retained their status as associated disadvantageous factors. Studies like this with repeatedly collected data in the same geographical area, describing the occurrence of ID, and analysing associated biomedical and sociodemographic factors, are valuable for evaluating developments in the health care and service system. They are also of value for future planning of services for individuals with ID
Tiivistelmä Tämän tutkimuksen tavoitteena oli selvittää kehitysvammaisuuden esiintyvyyttä lapsilla, siihen liittyviä lääketieteellisiä etiologisia ja sosiodemografisia tekijöitä, mahdollisia psykiatrisia ongelmia sekä kehitysvammaisuuden esiintyvyydessä ja siihen liittyvissä tekijöissä tapahtuneita muutoksia 20 vuoden aikana. Tutkimusjoukko muodostui kahden syntymäkohortin lapsista, jotka olivat syntyneet Pohjois-Suomessa, Pohjois-Suomen syntymäkohortti 1986 (NFBC 1986, N = 9432 elävänä syntynyttä lasta) ja Pohjois-Suomen syntymäkohortti 1966 (NFBC 1966, N = 12058 elävänä syntynyttä lasta). Kehitysvammaisuudessa tapahtuneita ajallisia muutoksia tutkittiin vertaamalla Pohjois-Suomen syntymäkohortti 1986:ta Pohjois-Suomen syntymäkohortti 1966:een. Tutkimuksessa käytettiin samaa kehitysvammaisuuden määritelmää (älykkyysosamäärä ≤70, seuranta-aika 11.5 vuoteen saakka), tiedonkeruun menetelmiä ja tietolähteitä. Tiedot kerättiin kyselylomakkeista, rekistereistä ja asiakirjoista. Pohjois-Suomen syntymäkohortti 1986:ssa kehitysvammaisuuden ilmaantuvuus oli 12.62/1000 11.5 vuoden ikään mennessä ja vallitsevuus 11.23/1000 11.5 vuoden iässä. Kehitysvammaisuuteen liittyvä lääketieteellinen etiologia pystyttiin selvittämään kahdessa kolmasosassa tapauksia. Geneettiset häiriöt muodostivat suurimman etiologisen luokan (36.1%). äitiin liittyvillä epäedullisilla sosiaalisilla tekijöillä (kouluttamaton työntekijä, vain peruskoulutus) oli suurin vaikutus kehitysvammaisuuden ilmaantuvuuteen, kun taas yksittäisistä sosiodemografisista tekijöistä korkein riski (vaarasuhde 2.8, luottamusväli 1.5, 5.3) oli äidin lihavuudella (painoindeksi ≥30) raskauden alussa. Koulussa opettajien arvioiden mukaan kehitysvammaisilla lapsilla esiintyi mahdollisia käytöshäiriöitä 4.9 kertaa useammin kuin ei-kehitysvammaisilla lapsilla. 20 vuoden aikana Pohjois-Suomen syntymäkohorttien 1986 ja 1966 välillä ei ollut tapahtunut muutoksia kehitysvammaisuuden kokonaisilmaantuvuudessa eikä -vallitsevuudessa. Kuitenkin tuli esiin siirtymä vaikeammasta lievempään asteeseen siten, etta lievän kehitysvammaisuuden ilmaantuvuus ja vallitsevuus lisääntyivät noin 50%, kun taas vaikeamman väheni 50%. Lääketieteellisten etiologisten luokkien osuuksissa tuli esiin ajallisia muutoksia (Pohjois-Suomen syntymäkohortti 1986 vs. Pohjois-Suomen syntymäkohortti 1966) siten, että Downin syndrooman sekä syntymän aikaan ajoittuvan vamman ja hapenpuutteen osuudet vähenivät tilastollisesti merkitsevästi. Keskushermoston epämuodostumien sekä muiden kromosomihäiriöiden kuin Downin syndrooman osuudet kasvoivat. Kehitysvammaisuuteen liittyvistä sosiodemografisista tekijöistä sosioekonomisen huono-osaisuuden osoittimet säilyttivät asemansa suurimpana ryhmänä. 20 vuoden aikana äidin naimattomuus, asuminen syrjäseudulla sekä korkeampi ikä lapsen syntymän aikaan olivat menettäneet yhteytensä kehitysvammaisuuteen. Pohjois-Suomen syntymäkohortti 1986:n ja Pohjois-Suomen syntymäkohortti 1966:n välillä tuli esiin vain yksi uusi kehitysvammaisuuteen tilastollisesti merkitsevästi liittyvä sosiodemografinen tekijä, äidin lihavuus raskauden alussa. Yhteevetona voidaan todeta, etta vaikka kehitysvammaisuuden kokonaisesiintyvyys oli pysynyt samana Pohjois-Suomessa 20 vuoden aikana niin esiintyvyyteen liittyvät etiologiset ja sosiodemografiset tekijät olivat osittain muuttuneet. Tämänkaltaiset tutkimukset, joissa peräkkäisinä ajanjaksoina kerätään tietoja samalla maantieteellisellä alueella ja jotka kuvaavat kehitysvammaisuuden esiintyvyyttä sekä analysoivat siihen liittyviä lääketieteellisiä ja sosiodemografisia tekijoitä, ovat hyödyllisiä arvioitaessa terveydenhoidossa ja palvelujärjestelmässä tapahtunutta kehitystä. Niitä voidaan hyödyntää myös suunniteltaessa tulevaisuudessa palveluja kehitysvammaisille henkilöille

This thesis describes a study undertaken between 1992 and 2001 to explore the possible health impacts of human exposure to pesticides. The study followed the health outcomes of approximately 4000 outdoor workers over a period of up to sixty-one years. These workers comprised two subcohorts of approximately even size, one composed of agricultural workers with high insecticide exposures, and the other made up of outdoor staff from local councils in the same area with little or no occupational exposure to insecticides. Mortality and morbidity were compared between the two groups, and with the general Australian community. The study identifies significantly increased mortality among both exposed and control subjects when compared to the Australian population. The major cause of this increase was mortality from smoking related diseases. The study also identifies significant increases in mortality among exposed subjects for a number of conditions that do not appear to be the result of smoking patterns, both when compared to the control group and the Australian population. These include pancreatic cancer in some DDT exposed subjects and asthma, diabetes, and leukaemia in subjects working with more modern chemicals. There was also an increase in self reported chronic illness and asthma, and lower neuropsychological functioning scores among surviving exposed subjects when compared to controls. Diabetes was also reported more commonly by subjects reporting occupational use of herbicides.

This thesis describes a study undertaken between 1992 and 2001 to explore the possible health impacts of human exposure to pesticides. The study followed the health outcomes of approximately 4000 outdoor workers over a period of up to sixty-one years. These workers comprised two subcohorts of approximately even size, one composed of agricultural workers with high insecticide exposures, and the other made up of outdoor staff from local councils in the same area with little or no occupational exposure to insecticides. Mortality and morbidity were compared between the two groups, and with the general Australian community. The study identifies significantly increased mortality among both exposed and control subjects when compared to the Australian population. The major cause of this increase was mortality from smoking related diseases. The study also identifies significant increases in mortality among exposed subjects for a number of conditions that do not appear to be the result of smoking patterns, both when compared to the control group and the Australian population. These include pancreatic cancer in some DDT exposed subjects and asthma, diabetes, and leukaemia in subjects working with more modern chemicals. There was also an increase in self reported chronic illness and asthma, and lower neuropsychological functioning scores among surviving exposed subjects when compared to controls. Diabetes was also reported more commonly by subjects reporting occupational use of herbicides.

L'exposition médicale diagnostique aux rayonnements ionisants représente environ 40% de l'exposition totale aux radiations en France. L'utilisation du scanner, beaucoup plus irradiant que l'imagerie conventionnelle, ne cesse de progresser, y compris chez les enfants, dont la radiosensibilité est supérieure à celle des adultes. Plusieurs études récentes sont en faveur d'une augmentation du risque de leucémie et de tumeur cérébrale après exposition au scanner dans l'enfance. Une cohorte nationale multicentrique a été mise en place à l'IRSN depuis 2009 incluant plus de 108 137 enfants soumis à un ou plusieurs scanners avant l'âge de 10 ans sur la période 2000-2010 dans 23 services de radiologie pédiatriques de CHU, répartis sur l'ensemble du territoire. L'estimation des doses reçues au niveau des principaux organes a été faite en fonction des protocoles utilisés. La grande variabilité des doses selon les services témoigne de la nécessité d'optimisation des protocoles. Près de 3% des enfants de la cohorte présentaient un facteur de prédisposition aux cancers étudiés. Le croisement de la cohorte avec le registre national des cancers pédiatriques a identifié 106 cas incidents de cancer, dont 22 tumeurs cérébrales et 17 leucémies. Chez les enfants sans facteur de prédisposition, un excès de risque positif mais non significatif était observé pour la leucémie et les tumeurs cérébrales en fonction de la dose, similaire à celui observé pour la population d'étude dans son ensemble. Chez les enfants avec un facteur de prédisposition au cancer, le risque diminuait, possiblement en lien avec une mortalité précoce augmentée entrainant un déficit de risque de cancer radio-induit à plus long terme. Le projet européen EPI-CT inclut 9 cohortes nationales, dont la cohorte française et regroupera plus d’un million d’enfants exposés au scanner. L’analyse conjointe de ces données permettra d’apporter prochainement des résultats complémentaires sur ce sujet
Medical diagnostic exposure to ionizing radiation represents about 40% of the total annual radiation exposure in France. The CT scans, which represent only 5% of the total number of X-rays examinations, account for half of the total collective dose associated with medical diagnostic exposure. However, its use continues to grow, including in children, for whom the radio sensitivity is known to be greater than in adults. Several recent studies support an increased risk of leukemia and brain tumors after exposure to CT scan in childhood. A national multicenter cohort was set up at the IRSN since 2009 including 108 137 children subjected to at least one CT scans before the age of 10 during the 2000 to 2013 period in 23 French University hospital’s pediatric radiology departments. Children's exposure was assessed based on radiological protocols. It was observed high variability of doses according to the participant departments, reflecting the need for protocol optimization. Moreover, children with predisposing factor for studied cancers represented 3% of the study population, a percentage well above that observed in the general population. The linkage of the cohort with the National Register of pediatric cancers identified 106 incident cases of cancer in the cohort, 22 brain tumors and 17 leukemias. For children without predisposing factor, it was observed a non-significant excess risk of cancer according to the received dose, similar to that observed for the whole study population. For children with predisposing factor to cancer, the risk decreased without reaching significance, possibly linked to earlier non-cancer mortality in this group and then to a lower risk to develop later radiation induced cancer. The European project EPI-CT, which includes 9 national cohorts (including the French cohort), will include more than one million children and then will bring further results on this topic

Abstract The Northern Finland 1966 Birth Cohort is an unselected, population-based sample of 12,058 live born children. The present study is based on 10,934 individuals living in Finland at the age of 16 years. Ninety-six research diagnoses fulfilling operational DSM-III-R criteria for schizophrenia by age 34 years were found in the reassessment of clinical diagnoses. Of these 96 cases, 55 (57%) had concordant diagnoses (both the clinical and research diagnosis was schizophrenia) and 41 (43%) had discordant diagnoses (the clinical diagnosis was other than schizophrenia). Diagnostic discordance was associated with low parental social class in 1980, later age at onset, comorbid diagnosis of mental retardation, shorter treatment periods and lower number of treatment episodes. Unwanted pregnancy and parental history of psychosis increased the risk for schizophrenia. The combination of unwantedness of pregnancy and parental history of psychosis elevated the risk of schizophrenia over 8-fold in offspring compared to those without either risk factor. Both low and high birth weight increased the risk of later schizophrenia. Both short and tall babies also had elevated risk. A reverse J-shape curve described the associations between birth weight, length and schizophrenia. The ages when cohort members learned to stand, walk and became potty-trained were related to subsequent incidence of schizophrenia and other psychoses. Earlier milestones reduced and later milestones increased the risk in a linear manner. In conclusion, these results indicate that schizophrenia has complex phenomenology and developmental pathways. Its multiple symptomatology with no single specific defining feature and no absolute validation criteria makes the phenomenological-based diagnosis of schizophrenia challenging. Unwanted pregnancy may act as an additive factor for subjects already vulnerable to schizophrenia and psychoses may have a developmental dimension expressed as deviant foetal development and delayed milestones. These results support the neurodevelopmental theory suggesting that schizophrenia results from small developmental deviances with origins very early in development
Tiivistelmä Tämän tutkimuksen tavoitteena oli tutkia skitsofrenian diagnostiikan osuvuuteen liittyviä tekijöitä sekä raskauden ei-toivottavuuden, lapsen syntymäpainon ja -pituuden ja skitsofrenian sekä varhaislapsuuden kehityksen ja skitsofrenian ja muiden psykoosien välistä yhteyttä. Pohjois-Suomen vuoden 1966 syntymäkohortti on prospektiivinen, epidemiologinen seurantatutkimus, johon kuuluu 12,058 vuonna1966 syntynyttä lasta. Prospektiivista tietoa on kerätty raskaudesta alkaen elinolosuhteista, elintavoista ja perheestä ja perimästä. Tämä tutkimus perustuu 10,934 henkilöön, jotka ovat asuneet 16-vuotiaana Suomessa eivätkä ole kieltäneet tietojensa käyttämistä tutkimukseen. Kliinisten diagnoosien uudelleen arvioinnissa DSM-III-R:n kriteerit täyttäviä skitsofreniatapauksia 34 ikävuoteen mennessä todettiin 96. Näistä 96 tapauksesta myös 55:n (57 %) kliininen diagnoosi oli skitsofrenia ja 41:n (43 %) kliininen diagnoosi oli muu kuin skitsofrenia. Diagnostiikan epätarkkuus liittyi matalaan sosiaaliluokkaan vuonna 1980, myöhäiseen sairastumisikään, samanaikaiseen kehitysvamma-diagnoosiin, lyhyisiin hoitoaikoihin ja vähäiseen hoitojaksojen määrään. Ei-toivottu raskaus yhdessä vanhemman psykoosisairauden kanssa lisäsi lapsen skitsofrenian riskiä yli 8-kertaiseksi. Matala ja korkea syntymäpaino lisäsivät skitsofrenian riskiä kaksinkertaiseksi ja samansuuruinen riskin kasvu havaittiin myös lapsilla, jotka olivat syntyessään lyhyitä tai pitkiä. J-muotoinen yhteys havaittiin syntymäpainon ja -pituuden sekä skitsofrenian riskin välillä. Ikä, jolloin lapsi oppi seisomaan, kävelemään ja kuivaksi, liittyi myöhempään skitsofreniaan ja sairastumiseen muihin psykooseihin. Varhainen oppiminen laski ja myöhäinen kehitys kohotti riskiä sairastua lineaarisesti. Tutkimuksen tulokset osoittivat, että skitsofrenia on monimuotoinen kliininen oireyhtymä, mikä tekee diagnostiikan haastavaksi. Raskauden ei-toivottavuus liittyneenä vanhemman psykoosisairauteen lisää lapsen skitsofrenian riskiä. Myös poikkeava syntymäpaino ja -pituus lisäävät skitsofrenian riskiä. Psykooseihin voi liittyä kehityksellinen dimensio, joka ilmenee viivästyneenä kehityksenä

ACC.15: American College of Cardiology Scientific Session 2015, developed at March 14, 2015 to March 16, 2015. Session Title: Young Investigator Awards Competition: Cardiovascular Health Outcomes and Population Genetics Abstract Category: Cardiovascular Health Outcomes and Population Genetics Presentation Number: 915-05. Oral Contributions Room 4 Monday, March 16, 2015, 11:00 a.m.-11:15 a.m.
Background: American Heart Association 2020 Impact Goal focuses on promotion of health and control of cardiovascular risk. We aimed to determine the prevalence of Ideal Cardiovascular Health in Peru. Methods: Ideal Cardiovascular Health is the presence of 3 ideal health factors (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/ <80 mm Hg, and untreated fasting plasma glucose <100 mg/dL) and 4 ideal health behaviors (never smoker, body mass index <25 kg/m2, high physical activity, and fruit and vegetable consumption >3 times/day). Data from the CRONICAS longitudinal study, an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings. Results: 3058 of 3618 (84.5%) of the CRONICAS cohort participants had complete information for analysis. Figure 1 shows the agestandardized prevalence estimates of ideal, intermediate and poor health metrics. No one had all 7 metrics; only 48 (15.7%) had 6 ideal health metrics and 650 (21.3%) had ≤ 1 ideal health metric. Compared to urban Lima, living in rural Puno was associated with more Ideal Cardiovascular Health (OR 2.09, 95% CI 1.49-2.91) and rural Tumbes was less ideal (OR 0.54, 95% CI 0.39-0.76) after adjusting for sex, age, education and wealth index. Conclusion: There is an alarmingly low prevalence of Ideal Cardiovascular Health in Peru and the metrics with the greatest potential for improvement are health behaviors, including diet quality, physical activity and body weight.
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