Latest news with #cohortstudy
Medscape
5 days ago
- Health
- Medscape
Conception via ART Linked to Lower Cardiorespiratory Fitness
TOPLINE: Individuals conceived through assisted reproductive technologies (ART) had significantly lower cardiorespiratory fitness than those conceived spontaneously, with no difference in muscle strength, a cohort study showed. METHODOLOGY: Researchers conducted a single-centre observational cohort study in Germany between 2021 and 2022, including individuals aged 4-26 years without known cardiovascular conditions, who were conceived using ART (n = 67) or spontaneously (age- and sex-matched control individuals, n = 86). They analysed anthropometric measurements, diet quality, levels of physical activity, and sedentary behaviour. The analysis was adjusted for age, birth weight, and gestational age. Cardiorespiratory fitness was evaluated using the 6-minute walking test (6MWT) and 20-meter shuttle run test (20mSRT). The 6MWT distance, number of 20mSRT laps, estimated maximal oxygen uptake (VO2max), systolic blood pressure (SBP), and pulse rate recovery were analysed. Muscle strength was evaluated using hand grip strength (HGS) measurements. TAKEAWAY: Adherence to the Mediterranean diet, levels of physical activity, and sedentary behaviour were not significantly different between groups. The ART group showed significantly lower 6MWT distance (P = .02), number of 20mSRT laps (P < .001), estimated VO2max (P = .02), and pulse rate recovery at 5 (P = .01) and 10 (P = .02) minutes than the control group. In the adjusted analysis, the ART group showed significantly lower number of 20mSRT laps (P = .02), estimated VO2max (P = .04), pulse rate recovery at 5 minutes (P = .03), and SBP (P = .03) than the control group. Maximal HGS showed no significant differences between groups. IN PRACTICE: "This study indicates a significantly lower CRF [cardiorespiratory fitness] in ART participants compared to spontaneously conceived controls. Significant differences in muscle strength were not demonstrated between ART participants and controls," the authors wrote. "Future research should consider CPET [cardiopulmonary exercise testing] for direct VO 2max measurement. Larger multi-center follow-up studies are required for precise cardiorespiratory risk stratification of the ART cohort," they added. SOURCE: This study was led by Marie Kramer and Pengzhu Li, University Hospital, LMU Munich, Munich, Germany. It was published online on June 21 in the European Journal of Pediatrics. LIMITATIONS: This non-blinded, multi-investigator study was vulnerable to participation and assessor biases and inter-observer variability. Its wide age range and inclusion of adverse perinatal conditions may have affected the results, and key confounders such as ART modality, parental health, and socioeconomic status were not accounted for. Comorbidities among ART offspring may also have affected the fitness measures. DISCLOSURES: The study was funded by the Deutsche Forschungsgemeinschaft and the Munich Clinician Scientist Program of LMU Munich. One author reported receiving support from various sources. Details are provided in the original article. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
24-06-2025
- Health
- Medscape
Dementia Risk May Follow a Geographic Pattern
TOPLINE: Dementia incidence varied significantly by US region in a new study, with the Southeast showing a 25% higher risk and the Northwest and Rocky Mountains each showing a 23% higher risk compared to the Mid-Atlantic. Investigators said the findings highlight the need for a geographically tailored approach to address dementia risk factors and diagnostic services. METHODOLOGY: Researchers conducted a cohort study using data from the US Veterans Health Administration for more than 1.2 million older adults without dementia (mean age, 73.9 years; 98%% men) from 1999 to 2021. The average follow-up was 12.6 years. Ten geographical regions across the US were defined using the CDC National Center for Chronic Disease Prevention and Health Promotion definition. The diagnosis of dementia was made using International Classification of Diseases, Ninth and Tenth Revision codes from inpatient and outpatient visits. TAKEAWAY: Dementia incidence rates per 1000 person-years were lowest in the Mid-Atlantic (11.2; 95% CI, 11.1-11.4) and highest in the Southeast (14.0; 95% CI, 13.8-14.2). After adjusting for demographics, compared with the Mid-Atlantic region, dementia incidence was highest in the Southeast (rate ratio [RR], 1.25), followed by the Northwest and Rocky Mountains (RR for both, 1.23), South (RR, 1.18), Southwest (RR, 1.13), and Midwest and South Atlantic (RR for both, 1.12). The Great Lakes and Northeast regions had < a 10% difference in incidence. Results remained consistent after adjusting for rurality and cardiovascular comorbidities, and after accounting for competing risk for death. IN PRACTICE: 'This study provides valuable insights into the regional variation in dementia incidence among US veterans in that we observed more than 20% greater incidence in several regions compared with the Mid-Atlantic region,' the investigators wrote. 'By identifying areas with the highest incidence rates, resources can be better allocated and targeted interventions designed to mitigate the impact of dementia on vulnerable populations,' they added. SOURCE: This study was led by Christina S. Dintica, PhD, University of California, San Francisco. It was published online on June 9 in JAMA Neurology. LIMITATIONS: This study population was limited to US veterans, limiting the generalizability of the findings. Education level was defined using educational attainment rates in the participants' zip codes rather than individual data. Additionally, because residential history was limited to a single location per participant, migration patterns could not be tracked. DISCLOSURES: This study was supported by grants from the Alzheimer's Association, the National Institute on Aging, and the Department of Defense. One author reported serving on data and safety monitoring boards for studies sponsored by the National Institutes of Health, as well as holding advisory board membership and receiving personal fees from industry. Full details are listed in the original article. The other four investigators reported no relevant financial conflicts. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
09-06-2025
- Health
- Medscape
Early Illness Plus Sensitization May Spell Trouble for Lungs
Sensitization by age 2 years to an allergen such as cow's milk, egg white, peanut, cat dander, or dust mites may influence how early-life respiratory tract infections affect lung function in adulthood, new research showed. Among sensitized children, each additional month of respiratory tract infection in the first 2 years of life was associated with poorer lung function at age 25 years. METHODOLOGY: Researchers analyzed data from a prospective cohort study in Australia that recruited 620 infants (51.1% boys) born between 1990 and 1994 who had at least one parent or sibling with self-reported allergic disease, including asthma. Parents answered questions until the children were 2 years old about how often their child had had a cough, rattle, or wheeze in the past month. Skin prick testing was used to determine allergic sensitization at age 2 years. When participants were 18 and 25 years old, the researchers assessed lung function using spirometry. TAKEAWAY: At age 25 years among the participants with sensitization, each additional month of respiratory tract infection early in life was associated with a decrease in the forced expiratory volume in 1 second (Z-score, -0.06; P = .055). = .055). Among nonsensitized participants, each additional month of respiratory illness was associated with an increase in lung function (Z-score, 0.07; P = .012). = .012). Findings were similar at age 18 years and for other measures of lung function, but there was less evidence of an interaction at age 12 years. IN PRACTICE: 'Even in the absence of reported chronic respiratory symptoms, close monitoring and prevention of recurrent respiratory infections in children with sensitization may help minimize disease progression and functional impairment, and thereby enable attainment of optimal adult lung function,' the authors of the study wrote. SOURCE: Shyamali C. Dharmage, MD, PhD, with The University of Melbourne, Melbourne, Australia was the corresponding author of the study, which was published online on June 2 in Pediatric Allergy and Immunology. LIMITATIONS: The study relied on parent reports of respiratory tract infection. The researchers were unable to adjust for gestational age or birthweight because of missing data. Sensitization was assessed against a limited number of allergens. DISCLOSURES: The authors reported having no conflicts of interest.
Medscape
06-06-2025
- Health
- Medscape
‘Enormous Burden' Cataloged in Relapsing Polychondritis
A large multicenter prospective cohort study has expanded 'the understanding of the range of manifestations of disease in patients with relapsing polychondritis [RP]' — particularly involving the ear, nose, throat, and musculoskeletal systems — as well as a high prevalence of organ damage, near-universal use of glucocorticoids, and frequent use of additional nonbiologic or biologic immunomodulatory therapies. METHODOLOGY: Researchers conducted a multicenter cohort study between 2017 and 2023 to evaluate clinical manifestations, treatment approaches, and the association between them in 195 patients with RP (median age, 48 years; 85.6% women). A diagnosis of RP was confirmed using comprehensive laboratory, radiographic, and other tests; all participants tested negative for proteinase 3 and myeloperoxidase. Data on clinical manifestations, organ damage, and medication history were collected at baseline study visits using standardized case report forms. Patients were grouped by treatment: Group 1 received glucocorticoids or no drugs, group 2 received nonbiologic immunosuppressive drugs (excluding JAK inhibitors) with or without glucocorticoids, and group 3 received JAK inhibitors or biologic drugs with or without nonbiologic immunosuppressives or glucocorticoids. TAKEAWAY: All patients presented with at least three clinical manifestations of RP, with a median of 11 manifestations per patient; all showed ear, nose, or airway involvement, and 83% had musculoskeletal manifestations. A substantial portion of patients (41%) developed organ damage, including sensorineural hearing loss (25%), auricular and saddle nose deformities (12% each), and subglottic stenosis (9%); among those who underwent dynamic CT of the chest, 31% had tracheomalacia, and 20% had bronchomalacia. Treatment groups 1, 2, and 3 comprised 19%, 28%, and 53% of patients, respectively; most patients (95%) received glucocorticoids, and a substantial proportion (81%) received additional immunomodulatory treatments. Patients in treatment group 3 had the highest rate of organ damage (62% vs 22% in group 2 and 15% in group 1) and were more likely to have arthritis and stenosis, whereas those in group 1 were less likely to experience nose pain. IN PRACTICE: 'Standardized assessment of disease activity is warranted for patients with RP for early detection and timely initiation of treatment. These findings also highlight the absence of a consensus approach to treatment for patients with RP and underscore the need for clinical trials and treatment guidelines in this disease to help reduce the enormous burden of disease for patients,' the authors wrote. SOURCE: This study was led by Roger Yang, MD, University of Pennsylvania, Philadelphia, and University of Montreal, Montreal, Quebec, Canada. It was published online on May 20, 2025, in ACR Open Rheumatology . LIMITATIONS: This study did not capture data on dose and duration of immunomodulatory medications or clinical features at treatment decisions. Treatment choices were made independently by clinicians and may have been influenced by factors such as drug availability or insurance, introducing variability. Moreover, the academic referral setting may have contributed to selection bias. DISCLOSURES: Two authors reported receiving support from the Vasculitis Clinical Research Consortium, Association des médecins rhumatologues du Québec, Institute for Translational Medicine and Therapeutics, and other sources. This research was also supported by the Relapsing Polychondritis Foundation and other generous donors to the Penn Relapsing Polychondritis Program.
Medscape
16-05-2025
- Health
- Medscape
Age Matters in Gallbladder Surgery Success
Undergoing cholecystectomy at a younger age (< 40 years) was associated with higher long-term mortality, potentially influenced by higher alcohol use and smoking. METHODOLOGY: This nationwide Swedish cohort study examined the long-term mortality outcomes after cholecystectomy in 159,946 adults (62.2% men) aged 20-79 years who underwent the procedure between 1969 and 2016. The patients were matched with 764,681 (62% men) control individuals from the general population who did not have gallbladder disease or undergo cholecystectomy. Information on deaths and comorbidities was obtained from national registers. The participants were followed for a median of 12 years. TAKEAWAY: During the follow-up period, 38,401 deaths were reported in the cholecystectomy group, whereas 181,197 deaths occurred in the control group (adjusted hazard ratio [aHR], 0.91; 95% CI, 0.90-0.92), indicating a lower mortality risk after surgery. Cholecystectomy was associated with higher overall mortality in individuals aged 20-39 years (aHR, 1.42; 95% CI, 1.32-1.53) and those aged 40-49 years (aHR, 1.07; 95% CI, 1.02-1.13). Among the 1015 patients who underwent the surgery between the ages of 20 and 39 years and died during the follow-up period, alcohol-related diseases (12.2%) and smoking-related disorders (7.4%) were notably common. The risk for overall mortality was slightly reduced in patients older than 50 years at the time of cholecystectomy. IN PRACTICE: "Future studies are needed to investigate mechanisms of higher mortality among younger participants with cholecystectomy, and to identify measures to prevent these excess deaths in the population, our study suggests that obesity may be an important risk factor to target in this patient group," the authors wrote. SOURCE: This study was led by Louise Emilsson, Institute of Health and Society, University of Oslo, Oslo, Norway. It was published online on May 09, 2025, in Clinical Gastroenterology and Hepatology. LIMITATIONS: The study was limited by its inability to adjust for postmenopausal hormone use and potential residual confounding from factors such as body mass index, diet, and alcohol consumption. Additionally, it could not differentiate between gallstone types or classify surgeries as elective or acute. Furthermore, with a predominantly European ancestry among participants, the findings require validation in non-European populations. DISCLOSURES: The study was supported by grants from FORTE. One author disclosed receiving financial support, being involved in other research collaborations, and coordinating other studies, with ties to pharmaceutical companies. Another author declared being an employee and stockholder of a pharmaceutical company.
