Multiple Sclerosis Progressive Courses: A Clinical Cohort Long-Term Disability Progression Study

ObjectivesImproving the understanding of multiple sclerosis (MS) mechanism and disability progression over time is essential to assess the value of healthcare interventions. Poor or no data on disability progression are available for progressive courses. This study aims to fill this gap.MethodsAn observational cohort study of patients with primary MS (PPMS) and secondary progressive MS (SPMS) was conducted on 2 Italian MS centers disease registries over an observational time of 34 years. Annual transition probabilities among Expanded Disability Status Scale (EDSS) states were estimated using continuous Markov models. A sensitivity analysis was performed in relation to clinical characteristic associated to disability progression.ResultsThe study cohort included 758 patients (274 PPMS and 434 SPMS) with a median follow-up of 8.2 years. Annual transition probability matrices of SPMS and PPMS reported different annual probabilities to move within EDSS levels. Excluding EDSS associated to relapse events or patient with relapses, the annual probability of staying stable in an EDSS level increased in both disease courses even not significantly.ConclusionsThis study provides estimates of annual disability progression as EDSS changes for PPMS and SPMS. These estimates could be a useful tool for healthcare decision makers and clinicians to properly assess impact of clinical interventions.     

Return-to-Work Outcomes Following Work Disability: Stakeholder Motivations,Interests and Concerns

Introduction: Satisfaction with return-to-work (RTW) outcomes is dependent on many factors, including a clear exposition of what people define as a “good outcome” and the information they use to determine if such an outcome has been achieved. This paper defines the key stakeholders involved in the RTW process and discusses the need to understand their motivations, interests, and concerns. Methods:A review of the literature and discussions with RTW researchers conducted by a multidisciplinary group of academic researchers. Results: Our analysis suggests that RTW stakeholders can share the goal of a successful RTW; however, this consensus has to be viewed in light of other, sometimes competing, goals and the environments in which stakeholders operate. Conclusions: It is suggested that more clearly articulating and operationalizing stakeholders' perspectives will allow researchers to advance the understanding of RTW interventions and outcomes.     

Sarcopenic Obesity and Risk of Disability in Community-Dwelling Japanese Older Adults: A 5-Year Longitudinal Study

ObjectivesPrevious studies have indicated that sarcopenic obesity is a risk factor for disability onset. However, these studies had disparities in terms of criteria for sarcopenia, study design, or study population. No longitudinal study has investigated the effect of sarcopenic obesity on disability onset in an Asian population using the Asian Working Group for Sarcopenia 2019 criteria for sarcopenia definition. Herein, we aimed to investigate the longitudinal effect of sarcopenic obesity on disability onset in Japanese older adults and extend the generalizability of results to other populations.DesignLongitudinal cohort study.Setting and ParticipantsA total of 4197 Japanese older adults (mean age 74.6 ± 5.0 years, 54.2% women) formed our study population.MeasurementsSarcopenia was identified using the Asian Working Group for Sarcopenia 2019 algorithm. Obesity was determined when body fat percentage was ≥25%, or when visceral fat content was ≥100 cm² for either sex. Disability onset was defined as a new case of long-term care insurance system certification for 5 years from baseline. Missing values were managed with multi-imputation. Cox proportional hazard regression analysis was used with disability onset as dependent variable and group (nonsarcopenia/nonobesity as a reference, nonsarcopenia/obesity, sarcopenia/non-obesity, possible sarcopenia/obesity, possible sarcopenia/non-obesity, sarcopenic obesity) as explanatory variable, and was adjusted for potential confounding factors.ResultsWhen the nonsarcopenia/nonobesity group was used as the reference category, other groups such as possible-sarcopenia/nonobesity [hazard ratio (HR) 1.38, 95% confidential interval (95% CI) 1.29‒1.47, P < .028], possible-sarcopenia/obesity (HR 1.54, 95% CI 1.46‒1.62 P < .001), sarcopenia/nonobesity (HR 2.09, 95% CI 1.96‒2.23, P < .001), and sarcopenic obesity (HR 2.48, 95% CI 2.24‒2.75, P < .001) showed significantly increased HRs.Conclusions and ImplicationsThe risk of disability onset because of sarcopenic obesity was exceedingly higher compared with sarcopenia alone among community-dwelling older adults in Japan The health providers should consider assessing the co-existence of sarcopenia and obesity to screen for the risk of disability onset in the community-dwelling population.     

Factors Associated With Hospital Presentation of Self-Harm Among Older Canadians in Long-Term Care: A 12-Year Cohort Study

ObjectivesThis study aimed to examine the incidence of, and factors associated with, hospital presentation for self-harm among older Canadians in long-term care (LTC).DesignRetrospective cohort study.Setting and ParticipantsThe LTC data were collected using Resident Assessment Instrument–Minimum Data Set (RAI-MDS) and Resident Assessment Instrument–Home Care (RAI-HC), and linked to the Discharge Abstract Database (DAD) with hospital records of self-harm diagnosis. Adults aged 60+ at first assessment between April 1, 2003, and March 31, 2015, were included.MethodsAdjusted hazard ratios (HRs) of self-harm for potentially relevant factors, including demographic, clinical, and psychosocial characteristics, were calculated using Fine & Gray competing risk models.ResultsRecords were collated of 465,870 people in long-term care facilities (LTCF), and 773,855 people receiving home care (HC). Self-harm incidence per 100,000 person-years was 20.76 [95% confidence interval (CI) 20.31–25.40] for LTCF and 46.64 (44.24–49.12) for HC. In LTCF, the strongest risks were younger age (60–74 years vs 90+: HR, 6.00; 95% CI, 3.24–11.12), psychiatric disorders (bipolar disorder: 3.46; 2.32–5.16; schizophrenia: 2.31; 1.47–3.62; depression: 2.29; 1.80–2.92), daily severe pain (2.01; 1.30–3.11), and daily tobacco consumption (1.78; 1.29–2.45). For those receiving HC, the strongest risk factors were younger age (60–74 years vs 90+: 2.54; 1.97–3.28), psychiatric disorders (2.20; 1.93–2.50), daily tobacco consumption (2.08; 1.81–2.39), and frequent falls (1.98; 1.46–2.68). All model interactions between setting and factors were significant.Conclusions and ImplicationsThere was lower incidence of hospital presentation for self-harm for LTCF residents than HC recipients. We found sizable risks of self-harm associated with several modifiable risk factors, some of which can be directly addressed by better treatment and care (psychiatric disorders and pain), whereas others require through more complex interventions that target underlying factors and causes (tobacco and falls). The findings highlight a need for setting- and risk-specific prevention strategies to address self-harm in the older populations.     

Gender Differences in Psychosocial Determinants of Adolescent Smoking

Because of the social meaning smoking has acquired and because of different trends in male and female initiation rates, it is reasonable to suspect that different psychosocial factors predict smoking in teen-age boys and girls. A literature review revealed external pressures such as peer and parental smoking are important for both boys and girls though their influence may be moderated differentially by age and type of smoking behavior assessed. Some data support the hypothesis that female smoking is associated with self-confidence, social experience, and rebellion, whereas male smoking is associated with social insecurity. Overall, group differences such as gender and socioeconomic status are well-documented in terms of smoking prevalence but underexplored in the area of psychosocial predictors. In this review, gender differences have been documented with sufficient frequency to warrant further attention to develop gender specific components of smoking prevention programs.     

Gender Differences in Work Modifications and Changed Job Characteristics During the Return-To-Work Process: A Prospective Cohort Study

Objectives To describe gender differences in work modifications and changed job characteristics during return-to-work after sickness absence. Methods A 13 month prospective cohort study was performed among 119 employees (54 women and 65 men) who had reported sick for more than 1 month due to mental or musculoskeletal disorders. Men and women were of comparable ages and educational levels, worked in similar sectors, at corresponding functional levels, and were experiencing the same types of health disorders. They were interviewed bi-monthly. Work modifications and job characteristics were assessed at return-to-work. Job characteristics were also assessed upon the employee’s inclusion in the study. Results Work modifications occurred in 77.4% of the return-to-work attempts (no gender differences); reduced working hours, reduced work pace, or task reassignments were most frequent. Compared to men, reduced hours and pace were more often used for women between 12 and 20 weeks of absence (P > 0.001 and 0.01 < P < 0.001 respectively) and reduced hours also during the whole period (0.01 < P < 0.001). Applying reduced hours related to type of disorder in men and applying different time-schedules in women. Upon return to work both women and men reported increased job autonomy and emotional demands (P < 0.001); women reported more job satisfaction (P < 0.001). Conclusions Work modifications were widely applied during the return-to-work process and predominantly aimed at reduction of pressure at work. Women had a few more work modifications. The marginal gender differences may be due to male and female respondents having similar characteristics. Upon return to work some job characteristics improved.     

Premarital Sexual Standards and Sociosexuality: Gender, Ethnicity, and Cohort Differences

In this article, we present results from a “cohort-longitudinal” analysis of sexual attitudes and behaviors based on a large sample of young adults (N = 7,777) obtained from a university setting over a 23-year period. We investigated gender, ethnicity, and cohort differences in sexual permissiveness, endorsement of the double standard, and sociosexuality. Compared to women, men had more permissive attitudes, particularly about sex in casual relationships, endorsed the double standard to a greater degree, and had a more unrestricted sociosexuality. Black men were generally more permissive than White, Hispanic, and Asian men, whereas ethnic differences were not found among women. Participants from the 1995–1999 cohort were slightly less permissive than those from the 1990–1994 and 2005–2012 cohorts. Although prior meta-analytic studies (e.g., Petersen & Hyde, 2010) found reduced gender differences in sexuality over time, our cohort analyses suggest that gender differences in sexual permissiveness have not changed over the past two decades among college students.     

Long Sleep Duration Is Associated With Higher Mortality in Older People Independent of Frailty: A 5-Year Cohort Study

ObjectivesAlthough general adult population studies show a U-shaped association between sleep duration and mortality, prolonged rather than short sleep duration was more consistently associated with higher mortality in older populations. Failing health or frailty is a possible mechanism. Thus, we examined the relationship among sleep duration, frailty status, and mortality in an elderly cohort.MethodsA total of 3427 community-living adults 65 years or older were examined for general health, mood, subjective sleep measures (insomnia, napping, sleep apnea, nighttime sleep duration, sleep medications), frailty, and 5-year mortality.ResultsAfter 5 years, 12.9% of men and 4.5% of women had died. Mean nighttime sleep duration was 7.3 hours. Proportion of participants who slept 10 or more hours increased with increasing frailty. Age-adjusted hazard ratio (HR) for 5-year mortality of long nighttime sleep (≥10 hours) was 2.10 (95% confidence interval [CI] 1.33–3.33) in men, and 2.70 (95% CI 0.98–7.46) in women. The HR in men was attenuated (HR 1.75; 95% CI 1.09–2.81) after adjustment for frailty and other covariates, whereas that of women strengthened (HR 2.88; 95% CI 1.01–8.18). Mortality increased sharply with nighttime sleep of 10 hours or more. Nighttime sleep of 10 or more hours (HR 1.75, men; HR 2.88, women) and frailty (HR 2.43, men; HR 2.08, P = .08 in women) were independently associated with 5-year mortality after full adjustment for covariates.ConclusionFrailty and long nighttime sleep duration of 10 or more hours were independently associated with 5-year mortality in older adults.     

Changes in Sedentary Behavior among Adolescent Girls: A 2.5-Year Prospective Cohort Study

PurposeTo describe longitudinal changes in leisure-time sedentary behavior among girls, during early to mid-adolescence.MethodsA 2.5-year prospective cohort study, comprising 5 data collections, 6 months apart, between 2000 and 2002. Girls aged 12–15 years (n = 200) from 8 high schools located in Sydney, Australia, self-reported the usual time spent each week in a comprehensive range of sedentary behaviors.ResultsRetention rate for the study was 82%. Girls aged 12.8 years spent approximately 45% of their discretionary time in sedentary behavior, which increased to 63% at age 14.9 years. Watching TV, videos, and playing video games (small screen recreation; SSR) was the most popular sedentary pastime, accounting for 33% of time spent in sedentariness, followed by homework and reading (25%). Sedentary behavior increased 1.4 and 3.3 hours on week and weekend days, respectively. On weekdays, increased time was spent on hobbies (27 min/day) and on weekend days, increased time was spent sitting around talking with friends (60 min/day), computer use (37 min/day), and television viewing (34 min/day).ConclusionsAmong girls, the transition between early and mid-adolescence was accompanied by a significant increase in leisure-time sedentary behavior. Interventions to reduce sedentariness among adolescent girls are best to focus on weekend behaviors. Studies seeking to examine the association between inactivity and the development of chronic health problems need to examine a diverse range of activities that comprehensively measure sedentariness. This information will provide a better understanding of inactivity patterns among adolescent girls.     

Physician Availability in Long-Term Care and Resident Hospital Transfer: A Retrospective Cohort Study

ObjectivesTo investigate whether same-day physician access in long-term care homes reduces resident emergency department (ED) visits and hospitalizations.DesignRetrospective cohort study.Setting and participants161 long-term care homes in Ontario, Canada, and 20,624 residents living in those homes.MethodsWe administered a survey to Ontario long-term care homes from March to May 2017 to collect their typical wait time for a physician visit. We linked the survey to administrative databases to capture other long-term care home characteristics, resident characteristics, hospitalizations, and ED visits. We defined a cohort of residents living in survey-respondent homes between January and May 2017 and followed each resident for 6 months or until discharge or death.We estimated negative binomial regression models on counts of hospitalizations and ED visits with random intercepts for long-term care homes. We controlled for residents' sociodemographic and illness characteristics, long-term care home size, chain status, rurality, and nurse practitioner access.ResultsFifty-two homes (32%) reported same-day physician access. Among residents of homes with same-day physician access, 9% had a hospitalization and 20% had an ED visit during follow-up. In contrast, among residents in homes without same-day access, 12% were hospitalized and 22% visited an ED.The adjusted hospitalization and ED rates among residents of homes with same-day physician access were 21% lower (rate ratio = 0.79, P = .02) and 14% lower (rate ratio = 0.86, P = .07), respectively, than residents of other homes. We estimate that nearly 1 in 6 resident hospitalizations could be prevented if all long-term care homes had same-day physician access.Conclusions and implicationsResidents of long-term care homes with same-day physician access experience lower hospitalization and ED visit rates than residents in homes that wait longer for physicians, even after adjusting for important resident and home characteristics. Improved on-demand access to physicians has the potential to reduce hospital transfer rates.     

Gender and Ethnic Differences in Survival in a Cohort of HIV Positive Clients

Objectives: The purpose of this study was to examine gender and ethnic differences in survival of persons receiving treatment for HIV infection to determine if differences existed, and if they did, to assess the possibility of explaining these differences by examining other factors, such as age, disease severity when beginning treatment, alcohol, illicit drugs, tobacco, educational level, living arrangements, antiretroviral treatment, PCP prophylaxis, sexually transmitted diseases, mode of transmission and opportunistic infections.

Design: A retrospective cohort study of all clients receiving treatment at an HIV only clinic from its opening in early 1988 until the end of May 1993. Statistical methods used to examine the data included incidence density ratios, Kaplan‐Meier survival curves, Breslow (generalized Wilcoxon) tests of equality of survival curves and Cox proportional hazards models both with and without time dependent covariates.

Results: In the cohort (37% African American, 7% Hispanic American and 25% female), 220 deaths occurred during 1223 person years of follow‐up. Compared to European American males, the following incidence density ratios were observed: European American females: 0.50, Hispanic American females: 0.70, Hispanic American males: 0.96, African American females: 1.28 and African American males: 2.38. The differences were noted above for gender/ethnicity groups were significant at the p < 0.0001 level. After adjusting for disease stage (as measured by laboratory testing of CD4 positive T‐lymphocytes), educational level, and age, no differences in survival by gender or ethnicity remained. Disease stage and educational level had the greatest prognostic significance.

Conclusions: European Americans entered treatment at a much earlier disease stage (as measured by CD4 positive T‐lymphocyte counts) and had higher educational levels (a surrogate for socioeconomic status) than African Americans. These factors may explain the longer survival in European Americans as compared to African Americans in this cohort.     

Long-Term Exposure to Road Traffic Noise and Incident Diabetes: A Cohort Study

Background: Road traffic noise at normal urban levels can lead to stress and sleep disturbances. Both excess of stress hormones and reduction in sleep quality and duration may lead to higher risk for type 2 diabetes.Objective: We investigated whether long-term exposure to residential road traffic noise is associated with an increased risk of diabetes.Methods: In the population-based Danish Diet, Cancer and Health cohort of 57,053 people 50–64 years of age at enrollment in 1993–1997, we identified 3,869 cases of incident diabetes in a national diabetes registry between enrollment and 2006. The mean follow-up time was 9.6 years. Present and historical residential addresses from 1988 through 2006 were identified using a national register, and exposure to road traffic noise was estimated for all addresses. Associations between exposure to road traffic noise and incident diabetes were analyzed in a Cox regression model.Results: A 10-dB higher level of average road traffic noise at diagnosis and during the 5 years preceding diagnosis was associated with an increased risk of incident diabetes, with incidence rate ratios (IRR) of 1.08 (95% CI: 1.02, 1.14) and 1.11 (95% CI: 1.05, 1.18), respectively, after adjusting for potential confounders including age, body mass index, waist circumference, education, air pollution (nitrogen oxides), and lifestyle characteristics. After applying a stricter definition of diabetes (2,752 cases), we found IRRs of 1.11 (95% CI: 1.03, 1.19) and 1.14 (95% CI: 1.06, 1.22) per 10-dB increase in road traffic noise at diagnosis and during the 5 years preceding diagnosis, respectively.Conclusion: Exposure to residential road traffic noise was associated with a higher risk of diabetes. This study provides further evidence that urban noise may adversely influence population health.     

Dairy Food Consumption and Health-Related Quality of Life in Boys: Preliminary Findings from a 5-Year Cohort Study

Objectives: There are few reported data on the relationship between dairy food consumption and health-related quality of life (QOL). In this cohort study, we aimed to assess the association between dairy food intake and QOL scores during adolescence.

Methods: Of the 1216 participants who were followed up over 5 years (i.e., from age 12 to 17), 858 participants had complete data on dietary intakes and information on QOL scores at the 5-year survey. Dairy consumption was assessed from validated semiquantitative food frequency questionnaires. Health-related QOL was assessed by the Pediatric Quality of Life Inventory (PedsQL).

Results: Among adolescent boys, after multivariable adjustment, those in the highest tertile of yogurt consumption compared to those in the lowest tertile of consumption had 4.7, 5.9, and 9.1 units higher for total score (p-trend = 0.03), and psychosocial health summary (p-trend = 0.02), and school functioning scores (p-trend = 0.01). Boys who remained in the highest tertile compared to the lowest tertile of yogurt consumption during adolescence from ages 12 to 17 had 7.4 and 12.4 units higher psychosocial health summary (p-trend = 0.04) and school functioning scores (p-trend = 0.02), respectively. Nonsignificant associations were observed among girls and with total dairy intake and milk and cheese consumption.

Conclusions: Yogurt consumption in boys could influence health-related QOL scores. Given that ours is an observational study we cannot establish a causal nature and direction of the relationship between yogurt intake and quality of life, our findings require further confirmation and clarification by other studies.     

The Association Between Self-Assessed Future Work Ability and Long-Term Sickness Absence,Disability Pension and Unemployment in a General Working Population: A 7-Year Follow-Up Study

Purpose Work ability is commonly measured with self-assessments, in the form of indices or single items. The validity of these assessments lies in their predictive ability. Prospective studies have reported associations between work ability and sickness absence and disability pension, but few examined why these associations exist. Several correlates of work ability have been reported, but their mechanistic role is largely unknown. This study aims to investigate to what extent individual’s own prognosis of work ability predicts labor market participation and whether this was due to individual characteristics and/or working conditions. Methods Self-assessed prognosis of work ability, 2 years from “now,” in the Stockholm Public Health Questionnaire (2002–2003) was linked to national registers on sickness absence, disability pension and unemployment up to year 2010. Effects were studied with Cox regression models. Results Of a total of 12,064 individuals 1466 reported poor work ability. There were 299 cases of disability pension, 1466 long-term sickness absence cases and 765 long-term unemployed during follow-up. Poor work ability increased the risk of long-term sickness absence (HR 2.25, CI 95 % 1.97–2.56), disability pension (HR 5.19, CI 95 % 4.07–6.62), and long-term unemployment (HR 2.18, CI 95 % 1.83–2.60). These associations were partially explained by baseline health conditions, physical and (less strongly) psychosocial aspects of working conditions. Conclusions Self-assessed poor ability predicted future long-term sickness absence, disability pension and long-term unemployment. Self-assessed poor work ability seems to be an indicator of future labor market exclusion of different kinds, and can be used in public health monitoring.     

A Prospective Cohort Study of the Impact of Return-to-Work Coordinators in Getting Injured Workers Back on the Job

Purpose To assess the impact of workplace-based return-to-work (RTW) Coordinators’ interpersonal and functional activities on RTW outcomes. Methods Multivariable logistic regression analyses of cross-sectional and longitudinal survey responses of 632 injured workers with at least 10 days of work absence in Victoria, Australia, adjusting for demographic and other workplace factors. Outcome was being back at work for at least 1 month, measured at both baseline and 6 month follow-up survey. Participant responses to stressfulness of Coordinator interactions were dichotomised into good and poor and evaluated as a proxy for Coordinators’ interpersonal activities, while having a RTW plan was evaluated as a proxy for functional activities. Results At baseline, RTW plans doubled the odds of RTW (OR 2.02; 95% CI 1.40–2.90) and attenuated the impact of good Coordinator interactions (1.14; 0.77–1.70). At 6-month follow-up, the opposite was observed: good interactions nearly doubled odds of RTW (1.90; 1.22–2.95) while RTW plans were non-significant (1.02; 0.68–1.54). Conclusions Differences between when the two Coordinator activities were effective may be due to the nature of claimants who RTW in each survey period. Length of shorter-duration claims are influenced by injury related factors, while psychosocial factors tend to be more important for longer-duration claims. Such factors may determine whether a claimant is more likely to respond to Coordinators’ functional or interpersonal activities. The findings have important implications for increasing Coordinator effectiveness.     

Recalled Parental Gender Preference in Chinese Culture: A Taiwan Birth Cohort Study

Archives of Sexual Behavior - Chinese culture has long favored sons over daughters. With the development of reproductive technology, the methods can be used not only in facilitation of conception,...