Project description:Background and purposeA 1988 pilot study in Peru suggested an association between migraine and chronic exposure to high altitude. This study provides epidemiological evidence corroborating this.MethodsIn a cross-sectional nationwide population-based study, a representative sample of Nepali-speaking adults were recruited through stratified multistage cluster sampling. They were visited at home by trained interviewers using a culturally adapted questionnaire. The altitude of dwelling of each participant was recorded.ResultsOf 2100 participants, over half [1100 (52.4%)] were resident above 1000 m and almost one quarter [470 (22.4%)] at ≥2000 m. Age- and gender-standardized migraine prevalence increased from 27.9% to 45.5% with altitude between 0 and 2499 m and thereafter decreased to 37.9% at ≥2500 m. The likelihood of having migraine was greater (odds ratio, 1.5-2.2; P ≤ 0.007) at all higher altitudes compared with <500 m. In addition, all symptom indices increased with altitude across the range <500 m to 2000-2499 m, i.e. median attack frequency from 1.3 to 3.0 days/month (P < 0.001), median duration from 9 to 24 h (P < 0.001) and pain intensity [the proportion reporting 'bad pain' (highest intensity)] from 35.5% to 56.9% (P = 0.011). Each of these showed a downward trend above 2500 m.ConclusionsDwelling at high altitudes increases not only migraine prevalence but also the severity of its symptoms.
Project description:ObjectivesLiterature suggests an inconsistent, but largely inverse, association between asthma and risk of glioma, which is primarily due to methodological inconsistency in sampling frame and ascertainment of asthma. The objective of the study was to clarify the association between asthma and risk of glioma by minimising methodological biases (eg, recall and detection bias).DesignA population-based case-control study.SettingGeneral population in Olmsted County, Minnesota, USA.ParticipantsAll eligible biopsy-proven incident glioma cases (1995-2014) and two sets of controls among residents matched to age and sex (first set: community controls without glioma; second set: MRI-negative controls from the same community).MethodsThe predetermined asthma criteria via medical record review were applied to ascertain asthma status of cases and controls. History of asthma prior to index date was compared between glioma cases and their matched controls using conditional logistic regression models. Propensity score for asthma status was adjusted for multivariate analysis.ResultsWe enrolled 135 glioma cases (median age at index date: 53 years) and 270 controls. Of the cases, 21 had a history of asthma (16%), compared with 36 of MRI controls (27%) (OR (95% CI) 0.48 (0.26 to 0.91), p=0.03). With MRI controls, an inverse association between asthma and risk of glioma persisted after adjusting for the propensity score for asthma status, but did not reach statistical significance probably due to the lack of statistical power (OR (95% CI) 0.48 (0.21 to 1.09); p=0.08). Based on comparison of characteristics of controls and cases, community controls seem to be more susceptible to a detection bias.ConclusionsWhile differential detection might account for the association between asthma and risk of glioma, asthma may potentially pose a protective effect on risk of glioma. Our study results need to be replicated by a larger study.
Project description:(1) Background: Our aim was to determine changes in the prevalence of physical activity (PA) in adults with asthma between 2014 and 2020 in Spain, investigate sex differences and the effect of other variables on adherence to PA, and compare the prevalence of PA between individuals with and without asthma. (2) Methods: This study was a cross-sectional, population-based, matched, case-control study using European Health Interview Surveys for Spain (EHISS) for 2014 and 2020. (3) Results: We identified 1262 and 1103 patients with asthma in the 2014 and 2020 EHISS, respectively. The prevalence of PA remained stable (57.2% vs. 55.7%, respectively), while the percentage of persons who reported walking continuously for at least 2 days a week increased from 73.9% to 82.2% (p < 0.001). Male sex, younger age, better self-rated health, and lower body mass index (BMI) were significantly associated with greater PA. From 2014 to 2020, the number of walking days ≥2 increased by 64% (OR1.64 95%CI 1.34-2.00). Asthma was associated with less PA (OR0.87 95%CI 0.47-0.72) and a lower number of walking days ≥2 (OR0.84 95%0.72-0.97). (4) Conclusions: Walking frequency improved over time among people with asthma. Differences in PA were detected by age, sex, self-rated health status, and BMI. Asthma was associated with less LTPA and a lower number of walking days ≥2.
Project description:Mammographic breast cancer screening is effective in reducing breast cancer mortality. Nevertheless, several limitations are known. The objective of this study was to identify circulating microRNAs (miRs) ratios associated with BC in women attending mammography screening. A nested case-control study was conducted within the ANDROMEDA cohort (women of age 46-67 attending BC screening in northern Italy), where pre-diagnostic plasma samples, information on life-styles and common BC risk factors were collected. Small RNA sequencing was carried out on plasma samples from 65 cases and 66 controls. miR-ratios associated with BC were selected by two-sample Wilcoxon test and lasso logistic regression. Subsequent assessment by RT-qPCR of the miRs contained in the selected miR-ratios was carried out as a platform validation. Penalized logistic regression was further applied to candidate miR-ratios alone, or in combination with non-molecular factors, to build a diagnostic model.
Project description:Low back pain (lumbago) is a common health problem globally. It is related to age, modern lifestyle (no exercise etc), and injuries. Its treatment includes a very broad spectrum of methods and its prevention is still unclear.We present Aristides, a 52-year old male, who has been suffering from low back pain for 10 years, and discovered a preventive and therapeutic maneuver that has helped him to significantly decrease the acute and chronic attacks of low back pain that were haunting him. We present the "Bartzokas' maneuver", a very simple and effective therapeutic - as well as preventive - manipulation with no known adverse effects.
Project description:ObjectivesAsthmatics have increased risks of airway-related infections. Little is known about whether this is true for non-airway-related serious infections such as Escherichia coli bloodstream infection (BSI). We assessed whether asthma is associated with a risk of developing community-acquired E coli BSI.DesignThe study was designed as a population-based retrospective case-control study.SettingThis population-based study was conducted in Olmsted County, Minnesota.ParticipantsThe study included 259 all eligible community-acquired E coli BSI cases in Olmsted County, MN between 1998 and 2007 and 259 birthday-matched, gender-matched and residency-matched controls.Primary and secondary outcome measuresOnly community-acquired E coli BSI cases as the primary outcome was included. Asthma status as an exposure was ascertained by predetermined criteria. An adjusted OR and 95% CI for the association between asthma and risk of community-acquired E coli BSI was calculated using conditional logistic regression.ResultsOf 259 eligible cases, 179 (69%) were women and mean age was 61±22 years. Of the 259 cases 37 (14%) and 16 (6%) of 259 controls had a prior history of asthma (adjusted OR 2.74; 95% CI 1.11 to 6.76; p=0.029). The population attributable risk of asthma for community-acquired E coli BSI was 9%. Although not statistically significant, there was a borderline association between having a history of food allergy and increased risk of community-acquired E coli BSI (6% vs 2%; adjusted OR 3.51; 95% CI 0.94 to 13.11; p=0.062).ConclusionsBased on the findings of the current population-based, case-control investigation, a history of asthma may be associated with risk of community-acquired E coli BSI. The impact of asthma on risk of microbial infections may go beyond airways.
Project description:BackgroundCancer patients are at significant risk of developing sepsis due to underlying malignancy and necessary treatments. Little is known about the economic burden of sepsis in this high-risk population. We estimate the short- and long-term healthcare costs of care of cancer patients with and without sepsis using individual-level linked-administrative data.MethodsWe conducted a population-based matched cohort study of cancer patients aged ≥18, diagnosed between 2010 and 2017. Cases were identified if diagnosed with sepsis during the study period, and were matched 1:1 by age, sex, cancer type and other variables to controls without sepsis. Mean costs (2018 Canadian dollars) for patients with and without sepsis up to 5 years were estimated adjusted using survival probabilities at partitioned intervals. We estimated excess cost associated with sepsis presented as a cost difference between the two cohorts. Haematological and solid cancers were analysed separately.Results77,483 cancer patients with sepsis were identified and matched. 64.3% of the cohort were aged ≥65, 46.3% female and 17.8% with haematological malignancies. Among solid tumour patients, the excess cost of care among patients who developed sepsis was $29,081 (95%CI, $28,404-$29,757) in the first year, rising to $60,714 (95%CI, $59,729-$61,698) over 5 years. This was higher for haematology patients; $46,154 (95%CI, $45,505-$46,804) in year 1, increasing to $75,931 (95%CI, $74,895-$76,968).ConclusionsSepsis imposes substantial economic burden and can result in a doubling of cancer care costs, particularly during the first year of cancer diagnosis. These estimates are helpful in improving our understanding of burden of sepsis along the cancer pathway and to deploy targeted strategies to alleviate this burden.
Project description:Background and purposeData on the association between vertebral endplate changes and low back pain are contradictory. This study was designed to assess whether this association exists among Southern European subjects.Materials and methodsPatients in this study serving as cases were 35-50 years of age with low back pain lasting >90 days, for whom a lumbar MR imaging had been prescribed. Controls were subjects 35-50 years of age, having a cranial MR imaging for headache with normal findings, and no history of clinically relevant LBP. Two hundred forty cases and 64 controls were recruited consecutively in the radiology services across 6 cities in Spain. Imaging findings and subject characteristics were gathered through previously validated instruments. Radiologists who interpreted MRI were blinded to the subject characteristics. A multivariate logistic regression model was developed to assess the association of vertebral endplate changes with LBP, adjusting for sex, age, body mass index, lifetime exposure to smoking, physical activity, disk degeneration, and the interaction between disk degeneration and vertebral endplate changes.ResultsVertebral endplate changes were found in 80.4% of the cases and in 87.5% of the controls. In the regression model, disk degeneration was the only variable showing a confounding effect. Results showed that after adjusting for disk degeneration, the presence of vertebral endplate changes is associated with the absence of chronic LBP (OR for LBP: 0.31; 95% CI, 0.10-0.95).ConclusionsIn Southern European subjects, vertebral endplate changes are not associated with chronic LBP.
Project description:(1) Background: To assess the time trend in the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine or frequent headache (MFH) among people with diabetes in Spain from 2014 to 2020, this study identified sex differences and compared the prevalence of these pain sites between people with diabetes and age-sex-matched non-diabetic subjects. (2) Methods: The study design included a cross-sectional and a case-control study. The data were obtained from the European Health Interview Surveys for Spain conducted in 2014 and 2020. The presence of diabetes, CNP, CLBP, and MFH was self-reported. Study covariates included sociodemographic characteristics, comorbidities, lifestyles, and pain-related variables. (3) Results: Among people with diabetes, the prevalence of CNP, CLBP, and MFH did not improve from 2014 to 2020. Women with diabetes had a significantly higher prevalence of all the pain sites analyzed than men with diabetes. After matching by sex and age, the prevalence of CNP (26.0% vs. 21.1%; p < 0.001), CLBP (31.2% vs. 25.0%; p < 0.001), and MFH (7.7% vs. 6.5%; p = 0.028) was higher for people with diabetes than for those without diabetes. Self-reported mental disease was independently associated with reporting the three pain sites analyzed in people with diabetes. (4) Conclusions: The prevalence of CNP, CLBP, and MFH has remained stable over time. Remarkable sex differences were found, with a higher prevalence among women than men with diabetes. Diabetes was associated with reporting in all the pain sites analyzed. Self-reported mental disease was associated with reporting CNP, CLBP, and MFH.
Project description:Background/Objectives: Gamma-Aminobutyric Acid (GABA) and glutamate are the main inhibitory and excitatory neurochemicals of the central nervous system. Recently, increased GABA+ (GABA+ macromolecules) and Glx (glutamate and glutamine) levels have been reported in migraine. Conversely, decreased GABA+ and Glx levels have been reported in conditions such as chronic musculoskeletal pain and other chronic widespread pain conditions. This has led to the hypothesis that unique neurochemical profiles may underpin different headache and pain conditions. What is currently unknown is how neurochemical levels correlate with different clinical presentations of local and widespread pain sensitivity. The aims of this study were therefore to (i) explore the relationship between brain neurochemicals and clinical presentations of different headache and pain conditions and (ii) use a novel approach to explore how participants cluster based on their neurochemical profiles and explore the clinical characteristics of the participants in these neurochemical clusters. Methods: In this exploratory secondary analysis of a cross-sectional study, participants with migraine (n = 20), whiplash-headache (n = 20), and low back pain (n = 20), and healthy controls (n = 21) completed pain, disability and psychological distress questionnaires, received Magnetic Resonance Spectroscopy (MEGAPRESS), and underwent cervical musculoskeletal and quantitative sensory testing. Participants were classified based on cervical musculoskeletal impairment, increased cervical pain sensitivity, and central sensitization. Correlations between neurochemical levels and clinical classifications were explored. Cluster analysis was used to determine how participants grouped based on their neurochemical profiles. Pain, disability and psychological distress scores and clinical classifications were then compared between the resultant clusters. Post hoc testing explored increased cervical pain sensitivity within the clusters. Results: GABA+ levels moderately correlated with increased cervical pain sensitivity (r2 = 0.31, p = 0.006), with no other significant correlations. Cluster analysis revealed three neurochemical profiles, Cluster 1 (Low GABA+ levels) had moderate disability, Cluster 2 (highest Glx levels) had the lowest pain and disability, and Cluster 3 (highest GABA+ levels) had the highest pain and disability. Post hoc testing demonstrated that the cluster with the highest GABA+ levels (Cluster 3) had the most cervical pain sensitivity. Conclusions: This study suggests that considering the pain condition or presence of central sensitization alone is not sufficient to explain GABA+ and Glx levels. Our findings suggest that increased cervical pain sensitivity might be more reflective of GABA+ levels than pain condition or central sensitization and would benefit from further investigation to further elucidate the relationship between brain neurochemicals and clinical characteristics of pain sensitivity.