Determinants of Follow-Up Participation in the Internet-Based European Influenza Surveillance Platform Influenzanet

Background

“Influenzanet” is a network of Internet-based platforms aimed at collecting real-time data for influenza surveillance in several European countries. More than 30,000 European volunteers participate every year in the study, representing one of the largest existing Internet-based multicenter cohorts. Each week during the influenza season, participants are asked to report their symptoms (if any) along with a set of additional questions.

Objective

Focusing on the first influenza season of 2011-12, when the Influenzanet system was completely harmonized within a common framework in Sweden, the United Kingdom, the Netherlands, Belgium, France, Italy, and Portugal, we investigated the propensity of users to regularly come back to the platform to provide information about their health status. Our purpose was to investigate demographic and behavioral factors associated with participation in follow-up.

Methods

By means of a multilevel analysis, we evaluated the association between regular participation during the season and sociodemographic and behavioral characteristics as measured by a background questionnaire completed by participants on registration.

Results

We found that lower participation in follow-up was associated with lower educational status (odds ratio [OR] 0.80, 95% CI 0.75-0.85), smoking (OR 0.64, 95% CI 0.59-0.70), younger age (OR ranging from 0.30, 95% CI 0.26-0.33 to 0.70, 95% CI 0.64-0.77), not being vaccinated against seasonal influenza (OR 0.77, 95% CI 0.72-0.84), and living in a household with children (OR 0.69, 95% CI 0.65-0.74). Most of these results hold when single countries are analyzed separately.

Conclusions

Given the opportunistic enrollment of self-selected volunteers in the Influenzanet study, we have investigated how sociodemographic and behavioral characteristics may be associated with follow-up participation in the Influenzanet cohort. The study described in this paper shows that, overall, the most important determinants of participation are related to education and lifestyle: smoking, lower education level, younger age, people living with children, and people who have not been vaccinated against seasonal influenza tend to have a lower participation in follow-up. Despite the cross-country variation, the main findings are similar in the different national cohorts, and indeed the results are found to be valid also when performing a single-country analysis. Differences between countries do not seem to play a crucial role in determining the factors associated with participation in follow-up.     

CE: Continuing Education ArticleMANAGEMENT OF ANAEMIA IN CHRONIC KIDNEY DISEASE

Anaemia is an almost universal issue that develops in the later stages of chronic kidney disease (CKD) primarily due to a lack of erythropoietin (EPO) and the depressed EPO response in bone marrow. This can have a profound effect on the patient's lifestyle and quality of life. Knowledge of both the psychosocial and clinical areas of CKD is imperative for healthcare professionals so that they can be at the forefront of improvements of CKD patient care.     

Dyslipidaemia and statin use in individuals aged 10 to <40 years in the T1D Exchange clinic registry

For individuals aged 10 to <40 years with type 1 diabetes and dyslipidaemia, US national guidelines recommend consideration of statin therapy based on age, low-density lipoprotein cholesterol (LDL-C) level and other cardiovascular risk factors. We evaluated dyslipidaemia prevalence, statin therapy use, and associations between not meeting target LDL-C [<100 mg/dL (<5.55 mmol/L)] and other cardiovascular disease (CVD) risk factors in individuals aged 10 to <40 years in the T1D Exchange clinic registry. In 7223 participants, statin use was 2% in 10 to <18 year olds, 4% in 18 to <25 year olds, and 21% in 25 to <40 year olds. Individuals not on statin therapy with LDL-C above target were more likely to have ≥1 additional CVD risk factor(s) than those with LDL-C in the target range for all age groups (all P < 0.01). While most individuals not on statin therapy had LDL-C in the target range, those who did not were more likely to have ≥1 additional CVD risk factor(s), and therefore longitudinal study of lipid levels and statin use is needed to see if treatment of dyslipidaemia to target LDL-C levels may lower the risk of future CVD in individuals aged 10 to <40 years with type 1 diabetes.     

Inequities in Health Outcomes in Children and Adults With Type 1 Diabetes: Data From the T1D Exchange Quality Improvement Collaborative

Health care inequities among racial and ethnic groups remain prevalent. For people with type 1 diabetes who require increased medical access and care, disparities are seen in access to care and health outcomes. This article reports on a study by the T1D Exchange Quality Improvement Collaborative evaluating differences in A1C, diabetic ketoacidosis (DKA), severe hypoglycemia, and technology use among racial and ethnic groups. In a diverse cohort of nearly 20,000 children and adults with type 1 diabetes, A1C was found to differ significantly among racial and ethnic groups. Non-Hispanic Blacks had higher rates of DKA and severe hypoglycemia and the lowest rate of technology use. These results underscore the crucial need to study and overcome the barriers that lead to inequities in the care and outcomes of people with type 1 diabetes.

Health inequities among racial and ethnic groups persist in both children and adults. Individuals with chronic conditions such as type 1 diabetes require increased medical access and care. Yet, there are disparities in access to care and health outcomes (1). The incidence of type 1 diabetes is increasing in the United States across all populations, and most significantly among Hispanic youths, but despite the higher incidence, health disparities continue to worsen among specific racial and ethnic groups (2,3).Mean A1C levels were found to be higher in Hispanics and non-Hispanic Blacks with type 1 diabetes compared with non-Hispanic Whites in the largest U.S. study to date, which included ∼11,000 youths and young adults in the T1D Exchange clinic network and registry (4). Non-Hispanic Blacks and Hispanics have been reported to perform fewer blood glucose checks per day than Non-Hispanic Whites (5,6). One study evaluating A1C trajectories over time in ∼16,000 youths from Australia, Europe, and the United States found that minority groups were more likely to have increasing A1C levels over time compared with Non-Hispanic Whites, specifically in the T1D Exchange and Diabetes-Patienten-Verlaufsdokumentation registries (7).Disparities also exist in rates of acute complications such as diabetic ketoacidosis (DKA) and severe hypoglycemia, although literature in this area is more limited. One study found that Non-Hispanic Blacks were 2.5 times more likely to have at least one DKA episode in the previous 12 months compared with Non-Hispanic Whites. They were also 2.5 times more likely than Non-Hispanic Whites to have at least one severe hypoglycemic event in the previous 12 months (4). Rates of mortality in diabetes are also twice as high among Non-Hispanic Blacks compared with other racial groups (8).One area of diabetes care that has improved diabetes management is the advancement of technology, including insulin pumps and continuous glucose monitoring (CGM) systems. However, use of these advanced diabetes technologies varies by population. Both the T1D Exchange and the SEARCH for Diabetes in Youth registries reported that Non-Hispanic White youths are more likely to use an insulin pump than their Black and Hispanic counterparts (4,9,10). The T1D Exchange registry found that Non-Hispanic White youths were 1.9 times more likely than Non-Hispanic Black youths and 3.6 times more likely than Hispanic youths to use an insulin pump. This finding is particularly important because it is known that insulin pump therapy can contribute to lower A1C levels (11), and Non-Hispanic Black and Hispanic youths are more likely to have higher A1C levels (4,7). Agarwal et al. (12) recently found that insulin pump use was one variable that helped account for the difference in A1C levels between Black and White young adults with type 1 diabetes. Studies of CGM use among racial and ethnic groups are very limited. One study showed that, among youths <13 years of age, Non-Hispanic Whites were more likely than Hispanics to use CGM, but this difference was not seen in older children or adults (13).Although there have been multiple studies evaluating A1C differences among racial and ethnic groups, there are limited population studies, and none have examined inequities in acute complication rates and technology use. This study uses a dataset with a large cohort of individuals with type 1 diabetes in a real-world setting to examine racial and ethnic differences in glycemic control, acute complications rates, and technology use.     

EEG correlates of fatigue during administration of a neuropsychological test battery

ObjectiveMental fatigue, a poorly understood symptom of sports-related concussion, ideally requires assessment across multiple modalities. Our study aimed to examine mental fatigue effects among 10 neurologically normal, athletically active students undergoing typical concussion testing. It is our intention to ultimately address the question whether fatigue effects due to mild traumatic brain injury (mTBI) may become confounded with fatigue effects due to testing effort.MethodsFourteen athletically active and neurologically normal volunteers were initially recruited from Penn State University. Self-reported fatigue, neuropsychological performance, and electroencephalographic (EEG) activity were measured throughout the whole testing duration. EEG measures in frequency domain (e.g., relative power of theta, alpha, and beta bands) were examined over the course of neuropsychological (NP) test administration.ResultsPredicted fatigue effects over the course of testing included: (a) increased self-reported fatigue; (b) increased errors on the Stroop Interference Test; (c) significantly increased relative power of theta activity during the Stroop Interference Test in frontal–central and parietal regions; and (d) migration of alpha activation from the occipital to anterior (left parietal and pre-central) regions during the Stroop Interference task administered at the beginning compared with the end of testing.ConclusionsResults supported predictions related to subjective fatigue and cognitive performance and offered partial support for predictions related to EEG activation patterns over the course of administering the NP testing.SignificanceNeurologically intact and athletically active college students demonstrate effects related to fatigue after undergoing a typical sports concussion assessment battery, including an increase in subjectively experienced fatigue, a decrease in cognitive task performance accuracy and associated modulations in EEG activity. This finding should be considered by clinical practitioners while evaluating the symptoms of concussion and making a decision regarding the return-to-sport participation.     

Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate

Background:

The locking compression plate (LCP) with combination holes is a newer device in fracture fixation. We undertook a study comparing the LCP with limited contact dynamic compression plate (LC-DCP) in the treatment of diaphyseal fractures of both bones of the forearm.

Materials and Methods:

This is a prospective comparative study, 36 patients (18 in each group) with fractures of both the forearm bones (72 fractures) were treated with one of the two devices. The average age of the patients was 30.5 years (range 16–60 years) with mean followup of 2.1 years (range 1.5–2.8 years). The patients were assessed for fracture union and function and complications and by Disabilities of the Arm, Shoulder and Hand (DASH) score for patient related outcome at the latest followup.

Results:

There was no significant difference in two groups with respect to the range of movements or grip strength. One case had delayed union (LC-DCP group) and another had synostosis (LCP group). Plate removal was done in four cases within the study period with no refracture till the presentation of this report.

Conclusion:

LC plating is an effective treatment option for fractures of both bones of forearm. The present study could not prove its superiority over LC-DCP.     

Computed tomography features of recurrent ovarian carcinoma according to time to relapse

Background: Although the sites of recurrent ovarian cancer are individually described in the literature, patterns of recurrent disease are poorly understood.

Purpose: To describe CT patterns of disease in recurrent ovarian cancer. To emphasize common patterns, recognise subtle and unusual sites of recurrent disease.

Materials and Methods: We identified patients between 1981-2004 presenting with clinical recurrence or elevated CA 125 after complete primary clinical and radiological response. CT imaging at primary diagnosis, during and after treatment and at recurrence was retrospectively reviewed. Site, distribution, stage of disease and time to relapse was recorded.

Results: 400 patients were treated for ovarian cancer. 214(54%) achieved complete primary response. 161(75%) relapsed with complete imaging available in 67 patients. Of the 67 patients, 14 (21%) recurred within 1 year, 44 (66%) relapsed between 1-5 years. Therefore 87% of relapses occurred within 5 years following primary treatment. Five (8%) relapsed between 5-10 years and 4 (6%) relapsed after 10 years. Commonest pattern of relapse was pelvic mass in 35 (48%) patients, solitary in 15 (22%). 27 (45%) relapsed with peritoneal thickening, 27 (45%) had small or large bowel serosal disease, 22 (33%) had enlarged lymphadenopathy, 6 as sole manifestation of recurrence, 20 (30%) presented with unusual sites of recurrence: 6 splenic, 10 hepatic, 2 biliary, 3 brain and 2 muscle.

Conclusion: Our study is the first to describe common patterns of recurrence in ovarian cancer. Most frequent site is pelvis, followed by peritoneum, serosal surfaces and nodal disease. 30% presented with disease at 'unusual' sites.