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Összefoglaló. Bevezetés: A munkavégzés fontos egészségprotektív tényező, de munkahelyi pszichoszociális kockázatokkal jár, amelyeknek az egészségi állapottal való összefüggéseire az elmúlt évtizedekben derült fény. Célkitűzés: A vizsgálat célja a munkahelyi beosztás és az egészségi állapot közti összefüggés vizsgálata volt olyan, viszonylag homogén mintában, amelynek tagjait közintézmények dolgozói adták. Módszer: Kérdőíves egészségfelmérés történt online adatgyűjtéssel, keresztmetszeti elrendezésben, egy megyeszékhely két közintézményében alkalmazottak körében. A kérdőív demográfiai, az egészségi állapotra, az egészségmagatartásra és a munkavégzésre, köztük a munkahelyi beosztásra vonatkozó, validált kérdéseket tartalmazott. Az adatelemzés beosztási kategóriák szerint két (vezető vs. beosztott), illetve három (vezető, diplomás beosztott, nem diplomás beosztott) rétegben történt. Eredmények: A vizsgált mutatók közül a szubjektív egészség, az élettel való elégedettség, a koherenciaérzés, a túlzott mértékű pszichés stressz, a munkahelyi hiányzás, a munkahelyi és magánéleti társas támogatottság a vezető beosztásban dolgozók körében volt a legkedvezőbb. A vizsgált indikátorok közül csak a munkaképesség nem különbözött beosztás szerint, és csak az alvásidő volt szignifikánsan kedvezőtlenebb (rövidebb) a vezetők körében a beosztottakhoz képest. A háromrétegű elemzés szerint a legkedvezőtlenebb mutatók a nem diplomás beosztottakra voltak jellemzőek. Eredményeink szerint a vezető beosztásban dolgozók egészségi állapota és mentális egészsége kedvezőbb, mint a beosztottaké. Következtetés: A munkahelyi beosztás az egyéni társadalmi-gazdasági helyzet mellett a munkahelyi pszichoszociális stressz mértékével is összefüggésben van, ezért a munkahelyi stressz vizsgálata során érdemes beosztás szerinti elemzést is végezni. A munkahelyi pszichoszociális stressz nyomon követése minden munkahelyen ajánlott, amelynek egyszerű módja az alkalmazási idő és a hiányzott napok számának létszámarányos és beosztásra stratifikált, idősoros nyomon követése. Orv Hetil. 2021; 162(29): 1172–1179. Summary. Introduction: Employment is an important health protective factor but also entails workplace psychosocial risks with multiple impacts on health. Objective: The present study aimed at examining the association between employment position and subjective health in a relatively homogenous sample of public servants with mostly tertiary degrees. Method: Online health survey was conducted among employees of two large public institutes in a large city in Hungary. The questionnaire contained items on demographic data, health status, mental health, health behaviour, and work-related questions including employment position (leadership). Data analysis was carried out by employment position in two (manager, subordinate) and three (manager, subordinate with college degree, subordinate with no college degree) strata. Results: Subjective health, satisfaction with life, sense of coherence, pathological stress, sickness absence, social support in the workplace and private life were most favourable among those in leadership position. Work ability did not differ by employment position, but sleep time was significantly less favourable (shorter) among leaders compared to subordinates. Subordinates with no college degree had the worst measures of health. Conclusion: Employment position is related to individual socioeconomic status and workplace psychosocial stress, therefore research on workplace stress should include employment level as a potential confounder. Psychosocial stress at workplaces should be monitored for which various recommendations are available. The simplest method is to monitor mid- and long-term turnover and sickness absence stratified for employment position and proportionate to the workforce. Orv Hetil. 2021; 162(29): 1172–1179.

Background/aimAn objective marker is needed to detect when corneal nerve abnormalities underlie neuropathic corneal pain (NCP), as symptoms often overlap with those of dry eye (DE). This study evaluated microneuroma (MN) frequency in various populations and investigated relationships between MN presence and DE clinical features in individuals with DE symptoms but without a history of refractive surgery, in order to eliminate refractive surgery as a potential confounder of nerve abnormalities.MethodsThis was a retrospective study that included individuals with and without DE symptoms who underwent a clinical evaluation for DE (symptom surveys and ocular surface evaluation) and in vivo confocal microscopy imaging. DE clinical features (including those suggestive of neuropathic pain) were compared based on MN presence using t-tests, χ2 analyses and Pearson’s correlation coefficients with 0.05 alpha level.ResultsMN frequencies did not significantly differ between individuals with DE symptoms (Dry Eye Questionnaire 5 score ≥6) and a history of refractive surgery (n=1/16, 6%), individuals with DE symptoms without a history of refractive surgery (n=26/119, 22%) and individuals without DE symptoms (n=2/18, 11%, p=0.22). Among individuals with DE symptoms without a history of refractive surgery, DE clinical features, including those indicative of NCP (burning sensation and sensitivity to light, wind and extreme temperatures), did not significantly differ based on MN presence (p>0.05).ConclusionMN frequencies did not significantly differ between individuals with and without DE symptoms. Their presence alone could not distinguish between DE subtypes, including features of NCP in our study population.

Total shoulder arthroplasty (TSA) is commonly performed for shoulder osteoarthritis (OA). Uncemented metal-backed (MB) glenoid components were introduced in an attempt to avoid glenoid loosening. New Zealand and Australian Joint Registry studies have shown significantly higher revision rates when uncemented MB glenoids are used. We used the New Zealand Joint Registry (NZJR) to compare all-cause revision rates and functional scores for TSA and investigated the trends of glenoid fixation used in New Zealand.The NZJR was accessed for all primary TSA undertaken for OA from January 2000 to December 2017. Patient demographics were collated. All-cause revision rates were reported as rate per 100 component-years. Analysis was repeated excluding the uncemented SMR L2 glenoid (LimaCorporate), as it was a potential confounder. Kaplan-Meier survival analysis was performed. Oxford Shoulder Scores at both 6 months and 5 years were analyzed.A total of 2613 TSAs were performed for OA during the study period, representing 85.0% of all TSAs in New Zealand. Overall, 62.1% of the patients were female. In addition, 69.6% of glenoids were cemented and 30.4% uncemented. The most common uncemented MB glenoid was SMR 86.6% (LimaCorporate), and cemented was Global (DePuy) 49.8%. The revision rate for TSA with uncemented glenoids was significantly higher at 2.03 compared with cemented at 0.41 per 100 component-years (P.001). Hazard ratio 5.0 for revision of uncemented glenoids. No significant difference was found in Oxford Scores at 6 months (39.7 vs. 40.3, P = .13) or 5 years (42.1 vs. 42.8, P = .22). The most common mode of failure was glenoid loosening in cemented glenoids (44.4%), and component failure in uncemented (34.8%). Revision for rotator cuff, deep infection, and instability were comparable between groups. When excluding SMR L2, uncemented MB glenoid all-cause revision rates remained significantly higher than cemented (1.42 vs. 0.41 per 100 component-years, P.001). SMR L1 uncemented MB glenoids had a higher revision rate than the non-SMR uncemented glenoids (1.61 vs. 0.18 per 100 component-years, P = .009). Uncemented glenoid use peaked in New Zealand in 2011 at 46.7% of TSAs but declined to 20.1% in 2017.In the NZJR, primary TSAs undertaken for OA have a significantly higher all-cause revision rate when the glenoid component is uncemented. Uncemented glenoids have a 5.0 times higher revision rate. Excluding SMR L2 glenoids from the analysis, the significantly higher revision rate remained for uncemented glenoids. These data reaffirm that uncemented MB glenoids are associated with higher revision rates.

This study assessed potential risk factors associated with introduction of Mycobacterium avium ssp. paratuberculosis (MAP) into dairy cattle herds in the Galicia region, northwestern Spain. The study was carried out with data collected from 93 dairies enrolled in a voluntary MAP control program. Information on potential risk factors was obtained through personal interviews with the farmers and veterinarians in charge of the control program of each farm. In addition, blood samples were taken annually over 2 years from cows on the farms in the program, and analyzed with a commercial ELISA to detect antibodies to MAP. Fecal samples of all ELISA-positive cows were analyzed using PCR. Based on χ2 test and Fisher's exact test, purchase practices, shared manure truck, shared materials, and visitors per month who contacted animals were found to be significantly associated with farm MAP infection status. Multiple logistic regression indicated that purchase practices and herd size (included as a potential confounder) are the variables that best predict MAP status.

The type of dwelling where a child lives is an important factor when considering residential exposure to environmental agents. In this paper, we explore its role when estimating the potential effects of magnetic fields (MF) on leukemia using data from the California Power Line Study (CAPS). In this context, dwelling type could be a risk factor, a proxy for other risk factors, a cause of MF exposure, a confounder, an effect-measure modifier, or some combination. We obtained information on type of dwelling at birth on over 2,000 subjects. Using multivariable-adjusted logistic regression, we assessed whether dwelling type was a risk factor for childhood leukemia, which covariates and MF exposures were associated with dwelling type, and whether dwelling type was a potential confounder or an effect-measure modifier in the MF-leukemia relationship under the assumption of no-uncontrolled confounding. A majority of children lived in single-family homes or duplexes (70%). Dwelling type was associated with race/ethnicity and socioeconomic status but not with childhood leukemia risk, after other adjustments, and did not alter the MF-leukemia relationship upon adjustment as a potential confounder. Stratification revealed potential effect-measure modification by dwelling type on the multiplicative scale. Dwelling type does not appear to play a significant role in the MF-leukemia relationship in the CAPS dataset as a leukemia risk factor or confounder. Future research should explore the role of dwelling as an effect-measure modifier of the MF-leukemia association.

Aim Despite numerous reports over three decades, the association between perioperative blood transfusion and long-term outcomes after resection of colorectal cancer remains controversial. This cohort study used competing risks statistical methods to examine the association between transfusion and recurrence and colorectal cancer-specific death after potentially curative and noncurative resection. Method A hospital database provided prospectively recorded clinical, operative and follow-up information. All surviving patients were followed for at least 5 years. Data were analysed by multivariable competing risks regression. Results From 2575 patients in the period 1995-2010 inclusive, after exclusions, 2334 remained for analysis. Among 1941 who had a potentially curative resection and 393 who had a noncurative resection the transfusion rates were 24.9% and 33.6%, respectively. After potentially curative resection there was no significant bivariate association between transfusion and recurrence (HR 0.93, CI 0.74-1.16, P = 0.499) or between transfusion and colorectal cancer-specific death (HR 1.04, CI 0.82-1.33, P = 0.753). After noncurative resection there was no significant association between transfusion and cancer-specific death (HR 0.93, CI 0.73-1.19, P = 0.560). Multivariable models showed no material effect of potential confounder variables on these results. Conclusion The competing risks findings in this study showed no significant association between perioperative transfusion and recurrence or colorectal cancer-specific death.

Purpose The purpose of this descriptive study was to define patterns of ossification and fusion of growth centers around the pediatric and adolescent glenoid as a function of age using 3-dimensional, frequency-selective, fat-suppressed spoiled gradient recalled echo magnetic resonance (MR) imaging sequences, with a particular focus on the anterior glenoid rim because of its clinical relevance as a potential confounder of glenohumeral instability. Methods Picture Archiving and Communication System records at an urban academic tertiary care orthopaedic facility from October 2005 to December 2018 were queried for shoulder MRI in patients aged 9 to 17 years. Patients were excluded if they had any diagnoses that could alter glenoid development. All images were independently evaluated by a musculoskeletal fellowship-trained radiologist. Secondary ossification centers were characterized as cartilage anlage, ossified, or fused at 3 anatomic sites: the anterior glenoid rim, coracoid, and superior glenoid rim. Results A total of 250 MR examinations (143 males, 107 females) were assessed in this study. The glenoid develops in a predictably sequential manner with ossification at the anterior glenoid rim lagging behind the coracoid and superior glenoid rim. The earliest age of anterior glenoid rim ossification was 11 years for both males (range 11-17) and females (range 11-12). Anterior glenoid rim ossification peaked at age 16 among males (34.8%, 8/23) and age 11 among females (27.3%, 3/11). Conclusions Glenoid ossification and fusion progress in a predictable and chronological manner. This pattern should be used as a guideline when interpreting pediatric shoulder MRI examinations. In particular, an anterior glenoid ossification center should not be confused with an anterior glenoid injury (e.g., Bankart lesion), particularly in males 11 to 17 years old and females 11 to 12 years old. Level of Evidence IV (case series).

Background and purpose — Intramedullary nails (IMN) have become increasingly common as treatment for trochanteric hip fractures (THF) although they are costlier, and without proven superiority compared with sliding hip screws (SHS). We investigated whether the 2 methods differ in terms of short-term mortality when used in fractures where both methods are suitable. Patients and methods — We extracted data from the Swedish Fracture Register (SFR) on 19,935 patients ≥ 60 years with trochanteric fractures AO type 31-A1 or -A2 who had been treated with either SHS or IMN. We assessed absolute mortality rates and the relative risks (RR) of death after 7, 30, 90, and 365 days using generalized linear models, adjusting for age, sex, and fracture type. We performed a sensitivity analysis on a subgroup of 3,673 patients with information on comorbidity to address this potential confounder. Results — 69% of the patients were women and mean age was 84 years (60–107). IMN was used in 35% of A1 and in 71% of A2 fractures. The use of IMN was associated with a slightly increased adjusted risk of death within 30 days compared with SHS (RR = 1.1, 95% CI 1.0–1.2) with no difference at any other time point. Interpretation — The slightly increased risk of death up to 30 days postoperatively does not support the use of IMN instead of SHS in stable THF.

Introduction Umbilical hernia repair, despite its perceived simplicity, is associated with recurrence between 2.7 and 27%, in mesh repair and non mesh repair respectively. Many factors are recognized contributors to recurrence however multiple defects in the linea alba, known to occur in up to 30% of patients, appear to have been overlooked by surgeons. Aims This systematic review assessed reporting of second or multiple linea alba defects in patients undergoing umbilical hernia repair to establish if these anatomical variations could contribute to recurrence along with other potential factors. Methods A systematic review of all published English language articles was undertaken using databases PubMed, Embase, Web of Science and Cochrane Library from January 2014 to 2019. The search terms ‘Umbilical hernia’ AND ‘repair’ AND ‘recurrence’ were used across all databases. Analysis was specified in advance to avoid selection bias, was registered with PROSPERO (154173) and adhered to PRISMA statement. Results Six hundred and forty-six initial papers were refined to 10 following article review and grading. The presence of multiple linea alba defects as a contributor to recurrence was not reported in the literature. One paper mentioned the exclusion of six participants from their study due multiple defects. In all 11 factors were significantly associated with umbilical hernia recurrence. These included: large defect, primary closure without mesh, high BMI in 5/10 publications; smoking, diabetes mellitus, surgical site Infection (SSI) and concurrent hernia in 3/10. In addition, the type of mesh, advanced age, liver disease and non-closure of the defect were identified in individual papers. Conclusion This study identified many factors already known to contribute to umbilical hernia recurrence in adults, but the existence of multiple defects in the linea, despite it prevalence, has evaded investigators. Surgeons need to be consider documentation of this potential confounder which may contribute to recurrence.

Purpose To analyse the association between intake of total dairy (TD) and types of dairy [liquid dairy (LD), solid dairy (SD), low-fat dairy (LFD), high-fat dairy (HFD), high sugar dairy (HSD), low-sugar dairy (LSD), not fermented dairy (NFD), as well as fermented dairy (FD)] and long-term changes in body weight status and composition among children and adolescents in Germany. Methods In total, 9999 3-day dietary records collected between 1985 and 2019 by 1126 participants (3.5–18.5 years; boys: 50.8%) of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were analysed. Polynomial mixed-effects regression models were used to examine whether changes (median follow-up: 9 years) in the intake of TD and dairy types (in 100 g/1000 kcal total energy intake) were associated with changes in body-mass-index-standard-deviation-score (BMI-SDS); fat mass index (FMI); fat-free mass index (FFMI) over time. Results An individual increase in TD intake was slightly but significantly associated with an increase in BMI-SDS (β = 0.0092; p = 0.0371), FMI (β = 0.022; p = 0.0162), and FFMI (β = 0.0156; p = 0.0417) after adjustment for potential confounder. Analyses for LD (BMI-SDS: β = 0.0139; p = 0.0052; FMI: β = 0.0258; p = 0.0125; FFMI: β = 0.0239; p = 0.0052) and LSD intake (BMI-SDS: β = 0.0132; p = 0.0041, FMI: β = 0.02; p = 0.0316, FFMI: β = 0.0183; p = 0.0189) showed similar results to TD. Both processing method and fat content showed no association with body composition in our analyses. Conclusion Increases in TD, LD, and LSD intake showed small but significant increases in BMI and concomitant increases in fat mass and lean mass. However, the observed changes were too small to expect biological or physiological meaningful effects. Overall, our results showed that policies to promote dairy intake in childhood are to be welcomed, as no negative effects on body composition are expected, while the intake of important nutrients for growth is ensured. The type of dairy does not seem to matter.

OBJECTIVE Smoking is a potential confounder in studies of workplace exposures and smoking-related disease, but little data exist to quantitatively adjust for smoking in statistical models. METHODS We estimated smoking prevalence trends between 1950 and 1999 for 12,299 female and 43,307 male hourly and salaried petrochemical workers using company physical examination data. RESULTS Nearly half of hourly male and female employees smoked during the study period, compared with 38% of salaried males and 29% of females. Smoking prevalence in the 1950s reached 80% and 66% among female and male hourly workers, respectively, significantly higher than the US general population. CONCLUSIONS As hourly workers typically comprise higher exposure groups and expected case counts are typically generated from the US general population, biased risk estimates may result from standardized mortality ratio analyses if smoking rate differences are not accounted for.

Objectives There is a growing body of evidence linking ambient air temperature and adverse health effects, in the form of hospitalization or even increased mortality mainly due to respiratory and cardio/cerebro-vascular illnesses. In the present study, we examine the association between high ambient air temperature and cardiovascular as well as respiratory mortality for the population of the greater area of Thessaloniki, Greece, taking into account the role of particulate pollution as a potential confounder. Methods A mixed Poisson regression model, using a quasi-likelihood function to account for potential over-dispersion in the outcome distribution given covariates, was combined with distributed lag non-linear models, to estimate the non-linear and lag patterns in the association between mortality and daily mean temperature from 1999 to 2012. Results A direct heat effect was found, as the mortality risk increased sharply above the temperature threshold of 33 °C, suggesting a significant effect of high temperatures on mortality on the same and next day of the heat events (lags 0–1) which was retained for a week, whereas a harvesting effect was noticed for the following days. Cardiovascular and respiratory mortality risk increased by 4.4% (95% CI 2.7%–6.1%) and 5.9% (95% CI 1.8%–10.3%) respectively on the same and following day of a heat event, whereas the risk dropped steeply in the following days. Particulate matter did not confound the association between high temperature and mortality in this population. Conclusion There is a significant association between mortality and hot temperatures in Thessaloniki, Greece. Reduction in exposure to increased temperatures, as part of prevention measures and strategies, should be considered for vulnerable subpopulations.

ObjectiveObservational studies have linked occupational standing or walking to musculoskeletal pain. These prior studies, however, are flawed as few accounted for physical exertion; a potential confounder that accompanies many standing-based occupations. The purpose of this study was to examine the individual and joint associations of occupational standing/walking and exertion with musculoskeletal symptoms.MethodsData for this analysis come from the 2015 National Health Interview Survey, a US nationally representative survey. Occupational standing/walking and exertion were assessed by self-report on a 5-point Likert scale. The presence of musculoskeletal symptoms (pain, aching and stiffness) for upper extremities (neck, shoulders, elbows, wrists and fingers), lower extremities (hips, knees, ankles and toes) and lower back was also assessed.ResultsOccupational standing/walking was associated with a greater likelihood of upper extremity, lower extremity and lower back musculoskeletal symptoms; however, associations were attenuated and no longer significant with adjustment for exertion. When stratified by levels of occupational exertion, occupational standing/walking was associated with musculoskeletal symptoms only among the group with high exertion (eg, OR=1.69 (95% CI: 1.48 to 1.94) for lower back symptoms comparing high/high for standing or walking/exertion vs low/low). Among groups with low exertion, occupational standing/walking was not associated with musculoskeletal symptoms (eg, OR=1.00 (95% CI: 0.85 to 1.16) for lower back symptoms comparing high/low for standing or walking/exertion vs low/low).ConclusionResults from this US representative survey suggest that the association between occupational standing/walking and musculoskeletal symptoms is largely driven by the co-occurrence of occupational exertion and does not provide evidence that standing or walking incurs adverse musculoskeletal symptoms.

ObjectivesThe percentage of athletes with Therapeutic Use Exemptions (TUEs) competing in elite sport and the association with winning medals has been a matter of speculation in the absence of validated competitor numbers. We used International Olympic Committee (IOC) and World Anti-Doping Agency (WADA) data to identify athletes competing with TUEs at five Olympic Games (Games) and a possible association between having a TUE and winning an Olympic medal.MethodsWe used the IOC’s competition results and WADA’s TUE database to identify the number of TUEs for athlete competitions (ACs, defined as one athlete competing in one event) and any associations with medals among athletes competing in individual competitions. We calculated risk ratios (RR) for the probability of winning a medal among athletes with a TUE compared with that of athletes without a TUE. We also reported adjusted RR (RRadj) controlling for country resources, which is a potential confounder.ResultsDuring the Games from 2010 to 2018, there were 20 139 ACs and 2062 medals awarded. Athletes competed with a TUE in 0.9% (181/20 139) of ACs. There were 21/2062 medals won by athletes with a TUE. The RR for winning a medal with a TUE was 1.13 (95% CI: 0.73 to 1.65; p=0.54), and the RRadj was 1.07 (95% CI: 0.69 to 1.56; p=0.73).ConclusionThe number of athletes competing with valid TUEs at Games is

Contains fulltext : 244790.pdf (Publisher’s version ) (Open Access) INTRODUCTION: The StartReact (SR) effect is the accelerated release of a prepared movement when a startling acoustic stimulus is presented at the time of the imperative stimulus (IS). SR paradigms have been used to study defective control of balance and gait in people with neurological conditions, but differences in emotional state (e.g. fear of failure) may be a potential confounder when comparing patients to healthy subjects. In this study, we aimed to gain insight in the effects of postural threat on the SR effect by manipulating surface height during a postural (lateral step) task and a non-postural (wrist extension) task. METHODS: Eleven healthy participants performed a lateral step perpendicular to the platform edge, and 19 participants performed a wrist extension task while standing at the platform edge. Participants initiated the movement as fast as possible in response to an IS that varied in intensity across trials (80 dB to 121 dB) at both low and high platform height (3.2 m). For the lateral step task, we determined anticipatory postural adjustments (APA) and step onset latencies. For the wrist extension task, muscle onset latencies were determined. We used Wilcoxon signed-rank tests on the relative onset latencies between both heights, to identify whether the effect of height was different for IS intensities between 103 and 118 dB compared to 121 dB. RESULTS: For both tasks, onset latencies were significantly shortened at 121 dB compared to 80 dB, regardless of height. In the lateral step task, the effect of height was larger at 112 dB compared to 121 dB. The absolute onset latencies showed that at 112 dB there was no such stimulus intensity effect at high as seen at low surface height. In the wrist extension task, no differential effects of height could be demonstrated across IS intensities. CONCLUSIONS: Postural threat had a significant, yet modest effect on shortening of RTs induced by a loud IS, with a mere 3 dB difference between standing on high versus low surface height. Interestingly, this effect of height was specific to the postural (i.e. lateral stepping) task, as no such differences could be demonstrated in the wrist extension task. This presumably reflects more cautious execution of the lateral step task when standing on height. The present findings suggest that applying stimuli of sufficiently high intensity (≥115 dB) appears to neutralize potential differences in emotional state when studying SR effects.

That social desirability might be a confounder of people's survey responses regarding environmental actions has been discussed for a long time. To produce evidence for or against this assumption, we conducted meta-analyses of correlations between social desirability scales and self-reports of environmentally relevant behaviors, intentions, and (broadly defined) attitudes, based on data from 29 previously published papers. The pooled correlations with social desirability are generally small, ranging from 0.06 to 0.11 (0.08–0.13 when correcting for measurement error attenuation). However, our results do not lead to the conclusion that social desirability can be completely disregarded by environmental psychologists as a potential confounder. For example, we found evidence of substantial heterogeneity across studies, so the effect of social desirability may be more pronounced in specific cases. Continued attention to social desirability bias is needed to fully understand its possible subtle effects. Copyright © 2020 Vesely and Klöckner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

PURPOSE: To determine whether disorganization of retinal inner layers (DRIL) on optical coherence tomography (OCT) is associated with ischemia on ultra-widefield fluorescein angiography (UWFFA) and with visual outcomes in eyes with acute, treatment-naïve central retinal vein occlusion (CRVO). DESIGN: Retrospective, single-institution, longitudinal cohort study. PARTICIPANTS: Twenty-five consecutive patients with treatment-naïve CRVO and ≥ 1 year follow-up. METHODS: Two independent masked graders evaluated the extent of DRIL, ellipsoid zone disruption, external limiting membrane disruption, and other OCT parameters at the baseline, 6- month, 12-month, and final visits. Baseline UWFFA images were assessed for ischemic index values and foveal avascular zone (FAZ) enlargement. MAIN OUTCOME MEASURES: Associations of DRIL with UWFFA findings and clinical outcomes including corrected visual acuity (VA). RESULTS: The median time to final follow-up was 24 months (range 12.1 – 43.9 months). Median DRIL extent at baseline was 765 µm (range 0 – 1000 µm). Eighteen of 25 eyes (72%) had some degree of DRIL at baseline, and 20 of 25 eyes (80%) had cystoid macular edema (CME). Neither the presence nor extent of DRIL at baseline was associated with presenting VA. In a cross-sectional analysis of each visit, extent of DRIL correlated with worse VA at both the 6-month (ρ = 0.656; p = 0.001) and final (ρ = 0.509; p = 0.016) visits. At final follow-up, DRIL extent was the OCT parameter most strongly correlated with baseline ischemic index (ρ = 0.418; p = 0.047) and baseline enlarged FAZ (p = 0.057) on UWFFA. On multivariate regression analysis, DRIL extent at final follow-up was the only OCT parameter associated with worse VA (p = 0.013) and remained significant when accounting for CME as a potential confounder. CONCLUSIONS: Extent of DRIL was not associated with presenting VA in treatment-naïve eyes with acute CRVO. Following six months of follow-up however, DRIL extent correlated with worse VA and was predictive of worse VA throughout more than 2 years of follow-up. Ischemic features on UWFFA at baseline are predictive of the extent of DRIL development at final follow-up.

Doxofylline is an effective bronchodilator for relieving airway obstruction in patients with asthma or chronic obstructive pulmonary disease (COPD), and displays a better safety profile with respect to theophylline. Herein, we performed a pair-wise meta-analysis of the currently available data to provide consistent and homogeneous findings on the impact of this xanthine in COPD patients. Results obtained from 820 patients were selected from 20 clinical trials. Meta-regression was performed to examine the source of heterogeneity between-studies and identify potential confounder covariates. The quality of the evidence was assessed by the GRADE system. Doxofylline induced a significant (P

Our study looked at the relationship between insulin use and clinical outcomes in COVID-19. A response to our article, written by Dr. Chia Sing Kow and Dr. Syed Shahzad Hasan raised a few questions. They mentioned our use of hemoglobin A1c may be inaccurate as the patients in our study had high rates of CKD or ESRD which could alter the hemoglobin A1c levels. However due to the limitations of our patient population and perhaps in a lot of other sample populations in the real-world setting, it was the most feasible way to represent glucose control.The writers also suggested that the use of metformin, a potential confounder, was also not adjusted for. This should be considered in future research but addition of too many variables in a regression model may lead to less reliability of results for our study.The letter writers also suggested that the results of our paper may lead to misinterpretation by readers and may influence providers to not use insulin therapy for their patients when necessary due to fear of worse outcomes in the setting of COVID-19. We reiterated that it is very important that the data not be misinterpreted, and that nowhere in our paper did we imply or suggest that patients who need insulin therapy to treat their diabetes should not receive proper therapy due to the association we delineated in our paper. Instead, more careful surveillance of patients with advanced diabetes is needed especially when admitted with COVID-19.

Background Current South American populations trace their origins mainly to three continental ancestries, i.e. European, Amerindian and African. Individual variation in relative proportions of each of these ancestries may be confounded with socio-economic factors due to population stratification. Therefore, ancestry is a potential confounder variable that should be considered in epidemiologic studies and in public health plans. However, there are few studies that have assessed the ancestry of the current admixed Chilean population. This is partly due to the high cost of genome-scale technologies commonly used to estimate ancestry. In this study we have designed a small panel of SNPs to accurately assess ancestry in the largest sampling to date of the Chilean mestizo population (n = 3349) from eight cities. Our panel is also able to distinguish between the two main Amerindian components of Chileans: Aymara from the north and Mapuche from the south. Results A panel of 150 ancestry-informative markers (AIMs) of SNP type was selected to maximize ancestry informativeness and genome coverage. Of these, 147 were successfully genotyped by KASPar assays in 2843 samples, with an average missing rate of 0.012, and a 0.95 concordance with microarray data. The ancestries estimated with the panel of AIMs had relative high correlations (0.88 for European, 0.91 for Amerindian, 0.70 for Aymara, and 0.68 for Mapuche components) with those obtained with AXIOM LAT1 array. The country’s average ancestry was 0.53 ± 0.14 European, 0.04 ± 0.04 African, and 0.42 ± 0.14 Amerindian, disaggregated into 0.18 ± 0.15 Aymara and 0.25 ± 0.13 Mapuche. However, Mapuche ancestry was highest in the south (40.03%) and Aymara in the north (35.61%) as expected from the historical location of these ethnic groups. We make our results available through an online app and demonstrate how it can be used to adjust for ancestry when testing association between incidence of a disease and nongenetic risk factors. Conclusions We have conducted the most extensive sampling, across many different cities, of current Chilean population. Ancestry varied significantly by latitude and human development. The panel of AIMs is available to the community for estimating ancestry at low cost in Chileans and other populations with similar ancestry.

Background Multicenter studies reveal that diagnostic efficacy of lupus anticoagulant (LA) assays is enhanced if cut-offs are locally generated. However, a potential confounder is the inevitable use of separate normal donor populations. Objectives Generate cut-offs for multiple LA reagents with the same analyzer and normal donor plasmas. Methods Cut-offs for screen ratio, confirm ratio, percent correction of screen ratio by confirm ratio, and normalized screen/confirm ratio (NSCR) were derived from the same 50 normal donor plasmas for screen and confirm pairs for two dilute Russell's viper venom time reagents, LA1/LA2 and HEMOCLOT™ LA-S/LA-C, and two APTTs, Actin FSL/FS and Cephen LS/Cephen. The cut-offs were challenged with plasmas from 20 triple-positive APS patients and 25 plasmas from LA-negative, thrombotic patients. Results Cut-offs for screen ratio, confirm ratio, percent correction, and NSCR, respectively, were 1.12/1.08/8.3/1.09 for LA1/LA2; 1.17/1.10/13.6/1.13 for HEMOCLOT™ LA-S/LA-C; 1.12/1.13/9.7/1.10 for Actin FSL/FS; 1.09/1.13/11.0/1.11 for Cephen LS/Cephen. LA1 and LA-S screens were elevated in 19/20 and 16/20 triple-positive plasmas, respectively, while 20/20 were detected with both via integrated interpretation ie, percent correction or NSCR irrespective of screen elevation. Actin FSL and Cephen LS screens were elevated in 17/20 and 19/20 triple-positive plasmas, respectively, while one more LA was detected with Actin FSL via integrated interpretation, but not for Cephen LS. Integrated interpretation suggested 5/25 LA-negative plasmas contained weak LA (two with Actin FSL/FS, two with LA1/LA2, one with LA-S/LA-R). Conclusions Employing the same normal donor plasmas and analytical platform does not compensate for between-reagent differences when generating LA assay cut-offs.

Ternidens deminutus, the false hookworm of humans and non-human primates, represents a truly neglected intestinal helminth infection. The similarity of the eggs of this nematode to those of hookworm both presents a diagnostic challenge and a potential confounder in prevalence surveys of soil transmitted helminths (STH) in regions where T. deminutus is found. The helminth infects non-human primates throughout Africa and Asia, but reports of human infection are almost exclusively found in eastern and southern Africa. Historically, an infection prevalence up to 87% has been reported from some parts of Zimbabwe. Scarce reports of ternidensiasis have also been made in individuals in Suriname and one from Thailand. Little work has been performed on this parasite since the 1970s and it not known why human infection has not been reported more widely or what the current prevalence in humans from historically endemic areas is. This review serves to revisit this enigmatic parasite and provide detail to a modern audience of parasitologists on its history, clinical presentation, geographic distribution, life cycle, biology, morphology, diagnosis and treatment.

Background:There is overlap between pathological mitral regurgitation seen in borderline rheumatic heart disease using World Heart Federation echocardiography criteria and physiologic regurgitation found in normal children. One possible contributing factor is higher rates of anaemia in endemic countries.Objective:To investigate the contribution of anaemia as a potential confounder in the diagnosis of rheumatic heart disease detected in echocardiographic screening.Method/Design:A novel Server 2012 data warehouse tool was used to incorporate haematology and echocardiography databases. The study included a convenience sample of patients from 5 to 18 years old without structural or functional heart disease that had a haemoglobin value within 1 month prior to an echocardiogram. Echocardiogram images were reviewed to determine presence or absence of World Heart Federation criteria for rheumatic heart disease. The rate of rheumatic heart disease among anaemic and non-anaemic children according to gender- and age-based norms groups was compared.Results:Of the 935 patients who met the study inclusion criteria, 406 were classified as anaemic. There was no difference in the rate of echocardiograms meeting criteria for borderline rheumatic heart disease in anaemic (2.0%, 95% CI 0.6–3.3%) and non-anaemic children (1.3%, 95% CI 0.3–2.3%). However, there was a statistically significant increase in rates of mitral regurgitation of unclear significance among anaemic versus non-anaemic patients (8.6 versus 3.6%; p = 0.0012).Conclusion:Anaemia does not increase the likelihood of meeting echocardiographic criteria for borderline rheumatic heart disease. Future studies should evaluate for the correlation between anaemia and mitral regurgitation in endemic settings.

Background Tofacitinib (TOFA), a targeted synthetic DMARD, has been approved for the treatment of rheumatoid arthritis (RA) in Canada since April 2014. This oral agent preferentially inhibits signalling by cytokine receptors associated with JAK1 and JAK3 subunits. It is now indicated for the treatment of psoriatic arthritis (PsA) and ulcerative colitis (UC) since October 2018. Clinical experience with this molecule has been increasing, and questions relating to its efficacy and long-term safety are of interest. Data collection through RHUMADATA®, a Quebec based clinical database and registry, allows comparison of various advanced treatment options including TOFA and non-TNFi biologic agents (i.e., agents with other modes of action - OMA) such as fusion proteins (abatacept), and IL-6 (sarilumab, tocilizumab) and CD20 inhibitors (rituximab). Objectives This analysis compares TOFA and OMAs used with and without methotrexate (MTX). Methods Data collected since January 1, 2014 (since TOFA became available in Canada) at the Institut de Recherche en Rhumatologie de Montreal (IRRM) and the Centre de l’Osteoporose et de Rhumatologie de Quebec (CORQ) was extracted from the Rhumadata® on January 7, 2019. The selected patients had initiated therapy with either TOFA or OMA (either without or in combination with MTX). The collected data include baseline characteristics (socio-demographic variables, concomitant and past medication, comorbidities and the Charlson comorbidity index (CCI)), variables measured over time (laboratory test results, patient and physician-reported outcomes, and disease activity measures such as CDAI and DAS28(4)-ESR) and persistence data (treatment duration, reason for cessation). The groups were compared to identify potential confounder, and persistence data were analyzed using Kaplan-Meier and proportional hazard methods. Results A total of 483 patients were initiated on TOFA (n=162) or an OMA (n=321) since January 1, 2014. Of those, 57% (n=92) and 59% (n=191) were treated with MTX in the TOFA and OMA group respectively. These represent the first treatment following csDMARD inadequate response for 33%(TOFA) and 29%(OMA) of these patients. These patients had a mean disease duration of 12.1 (standard deviation=11.0) and 11.1 (10.3) years. In the TOFA group, 84% were women, 15% were smokers, and the mean age at treatment initiation was 57.7 (11.5). In the OMA group, 75% were women, 18% were smokers, and the mean age at treatment initiation was 57.3 (12.0) years. Patient global, pain and fatigue assessments, made on a visual analogue scale ranging from 1 to 10, were 5.6 (2.5), 5.9 (2.7) and 5.7 (2.9) in the TOFA group and 5.7 (2.5), 6.1 (2.7) and 6.0 (2.8) in the OMA group. Disease activity was assessed as moderate or high/severe in 85.9% and 88.3% of patients (DAS28(4)-ESR criteria). Among the 56 (35%) TOFA and 149 (46%) OMA patients ceasing therapy, reasons for cessation were “inefficacy” (TOFA: 64% vs OMA: 59%) and “adverse events” (TOFA: 16% vs TNFi: 17%). Patients remaining on TOFA and OMA therapy at last follow-up had an average treatment duration of 1.7 (1.1) and 2.6 (1.4) years. No difference in retention was observed between TOFA and OMA treated patients (log-rank p=0.6138). Patients treated with an OMA+/-MTX had similar retention (log-rank p=0.2640) as did patients treated with TOFA+/-MTX (log-rank p=0.9553). These results remain unchanged when we adjust for age at treatment initiation, gender, disease duration, and comorbidities (CCI) using Cox models. Conclusion OMA and TOFA have similar retention as do subjects treated with OMA or TOFA with or without MTX. Disclosure of Interests Denis Choquette Grant/research support from: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Consultant for: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Speakers bureau: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant for: AbbVie, Celgene, Eli Lilly, Novartis, Pfizer Inc, Loic Choquette Sauvageau: None declared, Isabelle Ferdinand Consultant for: AbbVie, Amgen, Novartis, Pfizer, Speakers bureau: Amgen, Pfizer, Paul Haraoui Grant/research support from: Abbvie, Amgen, Pfizer, UCB, Consultant for: Abbvie, Amgen, Lilly, Pfizer, Sandoz, UCB, Speakers bureau: Pfizer, Frederic Massicotte Consultant for: AbbVie, Pfizer, Janssen, Eli Lilly, Speakers bureau: Janssen, Jean-Pierre Pelletier Shareholder of: Shareholder in ArthroLab Inc., Grant/research support from: Study funded by TRB Chemedica SA, Consultant for: TRB Chemedica SA, Jean-Pierre Raynauld Consultant for: ArthroLab Inc., Marie-Anais Remillard Consultant for: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Paid instructor for: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Speakers bureau: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Diane Sauvageau: None declared, Edith Villeneuve Consultant for: AbbVie, UCB, Celgene, Roche, Pfizer, Amgen, BMS, Sanofi-Genzyme, Paid instructor for: AbbVie, Speakers bureau: AbbVie, Pfizer, BMS, Roche, Louis Coupal: None declared

Background: Anemia is a common feature of RA. Prior to the appearance of biologic treatments, improvement of hemoglobin (Hb) levels was unusual and inconsistent. With better control of the inflammatory process with cytokine inhibitors, it has been shown that Hb levels can improve substantially. Recently in the development of IL-6 receptor antagonists (sarilumab (SARI) and tocilizumab (TOCI)) data have shown improvement in Hb levels related to the down-regulation of hepcidin. No direct comparison of Hb levels between TNF and IL-6 inhibition has been explored in observational data (1). Objectives: This analysis compares the impact of TNF and IL-6 inhibitors on Hb levels over time. Methods: Data collected since January 1, 2015 (when TOCI and SARI were available in Canada) at the Institut de Recherche en Rhumatologie de Montreal (IRRM) and the Centre de l’Osteoporose et de Rhumatologie de Quebec (CORQ) was extracted from the Rhumadata® clinical database and registry on January 7, 2019. Selected patients were those initiated on an IL-6 antagonist or a TNFi (adalimumab, certolizumab, etanercept, golimumab or infliximab) and had been treated for at least one year. Furthermore, patients were cancer free and had no diagnosis of Crohn’s disease or ulcerative colitis and had creatinine (Cr) and ALT levels within the normal sex-specific range. IL-6 patients were matched (ratio 1:2) to TNFi patients based on age at treatment initiation, gender and baseline Hb. The collected data include baseline characteristics (socio-demographic variables, concomitant and past medication, comorbidities and the Charlson comorbidity index (CCI)), variables measured over time (Hb and other laboratory test results, patient and physician-reported outcomes, and disease activity measures such as CDAI and DAS28(4)-ESR. The groups were compared to identify potential confounder. Results: A total of 145 patients initiating an IL-6 antagonist since January 1, 2015 were matched with 286 patients prescribed a TNF inhibitor during the same time-period. Most patients were women (86%), the mean age at treatment initiation was 54.1 (standard deviation=11.7) years, and 16% were smokers. Baseline patient global, pain and fatigue assessments, made on a visual analogue scale ranging from 1 to 10, were 5.4 (2.5), 6.1 (2.5) and 5.5 (3.0) in the IL6 group and 5.1 (2.7), 5.5 (3.0) and 5.0 (3.2) in the TNFi group. Baseline disease activity was assessed as moderate or high/severe in 85.5% (IL6) and 85.9% (TNFi) of patients (DAS28(4)-ESR criteria). At treatment initiation, mean Hb level was 126.6 (12.4) g/L, and Cr and ALT levels were 66.2 (11.5) umol/L and 18.7 (6.5) U/L in the IL6 group and 67.0 (12.0) umol/L and 19.3 (6.8) U/L in the TNFi group. At three months, Hb had increased by 5.4 (10.2) g/L in the IL6 group and by 1.8 (13.9) g/L in the TNFi group (p-value=0.024). These respective changes at 12 months were 8.7 (11.4) g/L and 5.4 (9.2) g/L (p-value=0.042). Conclusion: This analysis confirms that IL-6 inhibition provides a numerically and statistically superior increase in Hb over TNFi. Reference: [1] Song, et al. Arthritis Research & Therapy 2013, 15:R141 Disclosure of Interests: Denis Choquette Grant/research support from: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Consultant for: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Speakers bureau: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant for: AbbVie, Celgene, Eli Lilly, Novartis, Pfizer Inc, Loic Choquette Sauvageau: None declared, Isabelle Ferdinand Consultant for: AbbVie, Amgen, Novartis, Pfizer, Speakers bureau: Amgen, Pfizer, Paul Haraoui Grant/research support from: Abbvie, Amgen, Pfizer, UCB, Consultant for: Abbvie, Amgen, Lilly, Pfizer, Sandoz, UCB, Speakers bureau: Pfizer, Frederic Massicotte Consultant for: AbbVie, Pfizer, Janssen, Eli Lilly, Speakers bureau: Janssen, Jean-Pierre Pelletier Shareholder of: Shareholder in ArthroLab Inc., Grant/research support from: Study funded by TRB Chemedica SA, Consultant for: TRB Chemedica SA, Jean-Pierre Raynauld Consultant for: ArthroLab Inc., Marie-Anais Remillard Consultant for: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Paid instructor for: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Speakers bureau: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Diane Sauvageau: None declared, Edith Villeneuve Consultant for: AbbVie, UCB, Celgene, Roche, Pfizer, Amgen, BMS, Sanofi-Genzyme, Paid instructor for: AbbVie, Speakers bureau: AbbVie, Pfizer, BMS, Roche, Louis Coupal: None declared

Background Secukinumab (SECU) is a human IgG1κ monoclonal antibody that binds to the protein interleukin-17A approved for the treatment of psoriasis, ankylosing spondylitis, and psoriatic arthritis (PsA). Recently presented data suggest that combination with methotrexate (MTX) in patients with PsA may not be as necessary as in rheumatoid arthritis as it improves neither efficacity nor sustainability (1,2,3,4). Objectives This analysis describes the use of SECU with or without MTX. Methods The data of patients with psoriatic arthritis seen since January 1, 2015 (date at which SECU appeared in the Canadian market) at the Institut de Recherche en Rhumatologie de Montreal (IRRM) and the Centre de l’Osteoporose et de Rhumatologie de Quebec (CORQ) was extracted from the Rhumadata® clinical database and registry on January 7, 2019. Selected patients initiated SECU either without (MTX-) or with MTX (MTX+). The collected data include baseline characteristics (socio-demographic variables, concomitant and past medication, comorbidities and the Charlson comorbidity index (CCI)), variables measured over time (laboratory test results, patient and physician-reported outcomes, and disease activity measures such as minimal disease activity (MDA), CDAI and DAS28(4)-ESR) and persistence data (treatment duration, reason for cessation). The groups were compared to identify potential confounder, and persistence data were analyzed using Kaplan-Meier and proportional hazard methods. Results A total of 96 patients were prescribed SECU since January 1, 2015. Of those, 49% (n=47) treated with MTX. No significant differences in baseline (at treatment initiation) were observed between the MTX+ and MTX- groups. Average age at treatment initiation was 52.4 (standard deviation=11.3) and 53.7 (13.4) in the MTX+ and MTX- groups respectively. Women represent 45% and 55% of these groups, and the average body mass index was 29.9 (6.2) and 28.1 (6.0) kg/m2. Patient global, pain and fatigue assessments, made on a visual analogue scale ranging from 1 to 10, were 4.9 (2.6), 5.3 (2.9) and 4.3 (2.9) in the MTX+ group and 6.3 (2.2), 6.9 (2.1) and 6.5 (2.9) in the MTX- group. Among the 38 (40%) patients ceasing therapy, the principal reason for cessation was “inefficacy” (MTX+: 15/17 (88%) vs MTX-: 15/21 (71%)). Patients remaining on treatment at last follow-up had an average treatment duration of 1.7 (0.8) and 1.5 (0.7) years. The improvement in CDAI, HAQ and the percentage of patients reaching MDA are similar for both groups. No difference in retention was observed between the MTX+ and MTX- groups (log-rank p=0.4867). These results remain unchanged when we adjust for age at treatment initiation, gender, disease duration, and comorbidities (Charlson comorbidity index). Conclusion Combining MTX to SECU does not improve its sustainability over time. Efficacy was also the same for both cohorts. References [1] Mease PJ, et al. Arthritis Rheumatol. 2018; 70 (suppl 10). Abstract L11 [2] Benryane O, et al. Arthritis Rheumatol. 2018; 70 (suppl 10). Abstracts 693 and 694 [3] Benryane O, et al. CRA-2019, Montreal, Canada. Disclosure of interests Denis Choquette Grant/research support from: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Consultant for: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Speakers bureau: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Louis Bessette Grant/research support from: abbVie, amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer inc, Roche, Sanofi, UCB, Consultant for: abbVie, Celgene, Eli Lilly, Novartis, Pfizer inc, Loic Choquette Sauvageau: None declared, Isabelle Ferdinand Consultant for: abbVie, amgen, Novartis, Pfizer, Speakers bureau: amgen, Pfizer, Paul Haraoui Grant/research support from: abbvie, amgen, Pfizer, UCB, Consultant for: abbvie, amgen, Lilly, Pfizer, Sandoz, UCB, Speakers bureau: Pfizer, Frederic Massicotte Consultant for: abbVie, Pfizer, Janssen, Eli Lilly, Speakers bureau: Janssen, Jean-Pierre Pelletier Shareholder of: Shareholder in arthroLab inc., Grant/research support from: Study funded by TRB Chemedica SA, Consultant for: TRB Chemedica SA, Jean-Pierre Raynauld Consultant for: arthroLab inc., Marie-Anais Remillard Consultant for: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Paid instructor for: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Speakers bureau: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Diane Sauvageau: None declared, Edith Villeneuve Consultant for: abbVie, UCB, Celgene, Roche, Pfizer, amgen, BMS, Sanofi-Genzyme, Paid instructor for: abbVie, Speakers bureau: abbVie, Pfizer, BMS, Roche, Louis Coupal: None declared

We thank Drs. Morfeld and Erren for conveying their agreement of our consideration of chronoytpe as a potential effect modifier, and not as a potential confounder, in the relationship between shift work and ovarian cancer ([1][1]). Their proposition to consider chronodisruption as a single time

BACKGROUND: Multi-mode data collection is widely used in surveys. Since several modes of data collection are successively applied in such design (e.g. self-administered questionnaire after face-to-face interview), partial nonresponse occurs if participants fail to complete all stages of the data collection. Although such nonresponse might seriously impact estimates, it remains currently unexplored. This study investigates the determinants of nonresponse to a self-administered questionnaire after having participated in a face-to-face interview. METHODS: Data from the Belgian Health Interview Survey 2013 were used to identify determinants of nonresponse to self-administered questionnaire (n = 1,464) among those who had completed the face-to-face interview (n = 8,133). The association between partial nonresponse and potential determinants was explored through multilevel logistic regression models, encompassing a random interviewer effect. RESULTS: Significant interviewer effects were found. Almost half (46.6%) of the variability in nonresponse was attributable to the interviewers, even in the analyses controlling for the area as potential confounder. Partial nonresponse was higher among youngsters, non-Belgian participants, people with a lower educational levels and those belonging to a lower income household, residents of Brussels and Wallonia, and people with poor perceived health. Higher odds of nonresponse were found for interviews done in the last quarters of the survey-year. Regarding interviewer characteristics, only the total number of interviews carried out throughout the survey was significantly associated with nonresponse to the self-administered questionnaire. CONCLUSIONS: The results indicate that interviewers play a crucial role in nonresponse to the self-administered questionnaire. Participant characteristics, interview circumstances and interviewer characteristics only partly explain the interviewer variability. Future research should examine further interviewer characteristics that impact nonresponse. The current study emphasises the importance of training and motivating interviewers to reduce nonresponse in multi-mode data collection. ispartof: PLOS ONE vol:14 issue:4 ispartof: location:United States status: published

Single-incision laparoscopic surgery (SILS) places multiple instruments in close, parallel proximity, an orientation that may have implications in the production of stray current from the monopolar “Bovie” instrument. The purpose of this study was to compare the energy transferred during SILS compared to traditional four-port laparoscopic surgery (TRD). In a laparoscopic simulator, instruments were inserted via SILS or TRD setup. The monopolar generator delivered energy to a laparoscopic L-hook instrument for 5-s activations on 30-Watts coag mode. The primary outcome (stray current) was quantified by measuring the heat of liver tissue held adjacent to the non-electrically active 10-mm telescope tip and Maryland grasper in both the SILS and TRD setups. To control for the potential confounder of stray energy coupling via wires outside the surgical field, the camera cord and active electrode wires were oriented parallel or completely separated. SILS and TRD setups create similar amounts of stray current as measured by increased tissue temperature at the non-electrically active telescope tip (41 ± 12 vs. 39 ± 10 °C; p = 0.71). Stray current was greater in SILS compared to TRD at the tip of the non-electrically active Maryland forceps (38 ± 9 vs. 20 ± 10 °C; p

Background: Evidence linking inflammation and depression is marred by several methodological inconsistencies. Further, varying information is present on the role of gender as a potential confounder in this association. Aims: To assess systemic inflammation in drug naοve depression by measuring selected pro-inflammatory (tumor necrosis factor-alpha [TNF-α], interleukin-6 [IL-6]) and anti-inflammatory cytokines (transforming growth factor-beta [TGF-β]) and comparing them with a matched control group. We also aimed at exploring the differences in these markers between genders. Setting and Design: The study was a cross-sectional one carried out a teaching cum Tertiary Care Hospital. Materials and Methods: We recruited 55 drug naοve cases diagnosed with major depression and compared them for inflammatory markers with a matched apparently healthy control group (n = 42) at baseline. The inflammatory markers were also compared between the genders. Baseline depression and stress levels were assessed using standard measures. Statistical Analysis Used: Mann-Whitney U-test. Results: In comparison with healthy controls, drug naοve depressed individuals demonstrated significantly raised baseline levels of TNF-α and IL-6 (P < 0.001 for both) but no difference in levels of TGF-β (P = 0.433). Neither the baseline depression nor the stress scores correlated with any of the inflammatory markers (P = 0.955 and 0.816 for TNF-α respectively). Males and females were comparable on the levels of markers studied (P = 0.986, 0.415, and 0.430 for TNF-α, IL-6 and TGF-β respectively). Conclusion: There is evidence for higher baseline inflammation in depression prior to starting anti-depressant therapy. Gender does not mediate this observed link between inflammation and depression.

Background Previous results from the Diesel Exhaust in Miners Study (DEMS) demonstrated a positive exposure–response relation between lung cancer and respirable elemental carbon (REC), a key surrogate for diesel exhaust exposure. Two issues have been raised regarding DEMS: (i) the use of historical carbon monoxide (CO) measurements to calibrate models used for estimating historical exposures to REC in the DEMS exposure assessment; and (ii) potential confounding by radon. Methods We developed alternative REC estimates using models that did not rely on CO for calibration, but instead relied on estimated use of diesel equipment, mine ventilation rates and changes in diesel engine emission rates over time. These new REC estimates were used to quantify cumulative REC exposure for each subject in the nested case-control study. We conducted conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals for lung cancer. To evaluate the impact of including radon as a potential confounder, we estimated ORs for average REC intensity adjusted for cumulative radon exposure in underground miners. Results Validation of the new REC exposure estimates indicated that they overestimated historical REC by 200–400%, compared with only 10% for the original estimates. Effect estimates for lung cancer using these alternative REC exposures or adjusting for radon typically changed by Conclusions These results emphasize the robustness of the DEMS findings, support the use of CO for model calibration and confirm that radon did not confound the DEMS estimates of the effect of diesel exposure on lung cancer mortality.

Background: Delegating ear and hearing care (EHC) tasks to frontline health workers may help to improve muchneeded access to this specialized care. Primary healthcare workers (PHCWs) need to acquire relevant knowledge and skill to recognize, refer, and/or treat simple ear problems. This study aims to evaluate the effectiveness of an EHC training program for PHCWs. Methodology: The training intervention was a 2day course based on an adapted WHO training resource in EHC for frontline workers. A pre and posttest study design was undertaken with the assessment of EHC at two time points using the same questionnaire at baseline and at completion of the training. Results: One hundred and ninety PHCWs were recruited for the study. Overall, there was a statistically significant improvement from baseline to course completion. However, participants’ scores in the domain of knowledge for risk factors were slightly low compared to other domains (54.3%, 95% confidence interval [CI]: 52.0%–56.6%), and this improved significantly following the training (72.7%, 95% CI: 71.0%–74.0%). A potential confounder in this evaluation may be that of the scores recorded at pretest, which may change in the posttest due to regression to the mean phenomenon. Conclusion: The findings from this study indicate that the training program demonstrated the potential to be an effective way to improve knowledge of EHC, and we suggest the inclusion of “primary ear care” as a component of primary health care.

Nonalcoholic fatty liver disease (NAFLD) is considered to be a risk factor for the onset of type 2 diabetes mellitus (T2D), but no studies have considered the role of visceral fat (VF), which is strongly linked to both NAFLD and T2D, as a potential confounder. Therefore, it is not fully understood how NAFLD and T2D are associated. We previously reported that the risk of T2D onset and NAFLD were associated via VF accumulation. In this study, we further investigated the association between liver fat accumulation or NAFLD and T2D comorbidity, focusing on the presence or absence of visceral obesity (VO). The subjects were 367 individuals (179 men, 48.8%; mean age, 56.3 years), who received health check-ups at our medical examination center, MedCity21. In all subjects, quantitative live fat accumulation was evaluated by controlled attenuation parameter (CAP) value using Fibroscan®, and VF area at umbilical level (VFA) by abdominal CT scan as an index of VF accumulation. Those who habitually drank > 30 g/day of alcohol and those with confirmed liver diseases were excluded. CAP value ≥ 236 dB/m was defined as NAFLD, and VFA > 100 cm2 as VO. The association of CAP values or existence of NAFLD with T2D comorbidity was examined in the subgroups with and without VO (n = 101 and n = 266, respectively) by multivariate logistic analysis, with other factors adjusted. NAFLD was found 33.8% of subjects in non-VO group and 75.2% in VO group, respectively. In non-VO group, neither CAP value nor NAFLD showed significant association with T2D. In contrast, in VO group, the odds of T2D comorbidity were higher by 12.7% for each 10 dB/m higher CAP value, and NAFLD raised the odds of T2D comorbidity 5.2 times compared to non-NAFLD. These findings suggest that liver fat accumulation is associated with T2D via interaction with VF accumulation. In conclusion, both liver fat accumulation and NAFLD are associated with T2D comorbidity only in individuals with VO. Disclosure S. Fukumoto: Speaker's Bureau; Self; Astellas Pharma US, Inc.. Research Support; Self; Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi K.K.. Research Support; Self; Takeda Pharmaceuticals U.S.A., Inc., Taisho Toyama Pharmaceutical Co., Ltd. M. Emoto: Speaker's Bureau; Self; Eli Lilly and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Astellas Pharma Inc, Ono Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Kowa Pharmaceutical Company Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation. K. Motoyama: None. T. Morioka: Consultant; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., MSD K.K., Eli Lilly and Company, Sanofi K.K., Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Takeda Pharmaceuticals U.S.A., Inc., Novo Nordisk Inc., Kowa Pharmaceuticals America, Inc., Astellas Pharma US, Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Sumitomo Dainippon Pharma Co., Ltd. T. Shoji: Speaker's Bureau; Self; Astellas Pharma Inc, Bayer Yakuhin Ltd. Research Support; Self; Bayer Yakuhin Ltd. Speaker's Bureau; Self; Kowa Pharamaceutical Co Ltd, Daiichi Sankyo Company, Limited, MSD K.K., Chugai Pharmaceutical Co., Ltd.. Research Support; Self; Chugai Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Kyowa Hakko Kirin Co., Ltd., Kissei Pharmaceutical Co., Ltd. K. Hirata: Speaker's Bureau; Self; AstraZeneca, Astellas Pharma Inc., Eisai Co., Ltd., KYORIN Pharmaceutical Co.,Ltd., Daiichi Sankyo Company, Limited, Sumitomo Dainippon Pharma Co., Ltd., TAIHO PHARMACEUTICAL Co.,Ltd., Chugai Pharmaceutical Co., Ltd., TEIJIN HOME HEALTHCARE LIMITED, Eli Lilly Japan K.K, Nippon Shinyaku Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Pfizer Japan Inc.. Research Support; Self; KYORIN Pharmaceutical Co.,Ltd., Daiichi Sankyo Company, Limited, Chugai Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., MSD K.K.. Other Relationship; Self; AstraZeneca, GlaxoSmithKline K.K., Chugai Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Santen Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Eli Lilly Japan K.K. M. Inaba: None.

Evidence on the relation between the threat of nuclear war and mental health among adolescents is conflicting. We studied 1493 adolescents in the 10th to 12th grades in school, who completed self-administered questionnaires 1–43 days before the Persian Gulf war broke out. Regression analyses controlled for several potential confounders. After this, the frequency of thinking about nuclear war and the frequency of fearing nuclear war were positively related to perceived present state anxiety among both boys and girls. Among boys, both thinking and fearing were positively related to the psychosomatic symptom score. Among girls, estimates on deaths due to nuclear war associated significantly with psychosomatic symptoms. Long-term effects of the threat of nuclear war on mental health of adolescents merit further study.

Epidemiological miner cohort data used to estimate lung cancer risks related to occupational radon exposure often lack cohort-wide information on exposure to tobacco smoke, a potential confounder and important effect modifier. We have developed a method to project data on smoking habits from a case-control study onto an entire cohort by means of a Monte Carlo resampling technique. As a proof of principle, this method is tested on a subcohort of 35,084 former uranium miners employed at the WISMUT company (Germany), with 461 lung cancer deaths in the follow-up period 1955-1998. After applying the proposed imputation technique, a biologically-based carcinogenesis model is employed to analyze the cohort's lung cancer mortality data. A sensitivity analysis based on a set of 200 independent projections with subsequent model analyses yields narrow distributions of the free model parameters, indicating that parameter values are relatively stable and independent of individual projections. This technique thus offers a possibility to account for unknown smoking habits, enabling us to unravel risks related to radon, to smoking, and to the combination of both.

Alterations in scapular muscle activity have been theorized to contribute to abnormal scapular motion and shoulder pain, but pose challenges to quantify in the clinic. Rehabilitative Ultrasound Imaging (RUSI) has proved useful identifying dysfunction of lumbar regional stabilizing muscle activity, specifically contractile behavior. Although, recent examinations of scapular stabilizing trapezius muscle function using RUSI did not detect alterations individuals with shoulder pain or differences in muscle thickness between varying external loads in asymptomatic individuals, a potential confounder to prior results, scapular dyskinesis has not been controlled. It is unknown if dyskinesis alters scapular muscle thickness during activation measured with RUSI. Thus, the purpose of this study was to compare change in scapular muscle thickness between individuals with and without scapular dyskinesis. Thirty-nine asymptomatic adults with (n = 19) and without (n = 20) scapular dyskinesis, defined with a reliable and validated method, participated. Two separate ultrasound images of the serratus anterior (SA) and lower trapezius (LT) were captured under two randomized conditions, rest and isometric contraction against gravity, and saved for blinded measurement. Change in thickness with contraction was calculated and expressed as a percentage. The dyskinesis group demonstrated a greater increase (p = 0.005) in LT thickness with the isometric contraction than the group without (mean difference = 31.6%; 95%CI = 10.3, 53.0). No differences in SA or resting thickness of either muscle were found between groups. The presence of scapular dyskinesis alters thickness changes of the lower trapezius during activation. Furthermore, potential underlying reasons beyond muscle contractile behavior must be considered.

Background The technical hypothesis of Motivational Interviewing (MI) proposes that: (a) client talk favoring behavior change, or Change Talk (CT) is associated with better behavior change outcomes, whereas client talk against change, or Sustain Talk (ST) is associated with less favorable outcomes, and (b) specific therapist verbal behaviors influence whether client CT or ST occurs. MI consistent (MICO) therapist behaviors are hypothesized to be positively associated with more client CT and MI inconsistent (MIIN) behaviors with more ST. Previous studies typically examine session-level frequency counts or immediate lag sequential associations between these variables. However, research has found that the strongest determinant of CT or ST is the client's previous CT or ST statement. Therefore, the objective of this paper was to examine the association between therapist MI skills and subsequent client talk, while accounting for prior client talk. Methods We analyzed data from a manualized MI intervention targeting both alcohol misuse and sexual risk behavior in 132 adults seen in two hospital emergency departments. Transcripts of encounters were coded using the Motivational Interviewing Skills Code (MISC 2.5) and an additional measure, the Generalized Behavioral Intervention Analysis System (GBIAS). Using these measures, we analyzed the association between client talk following specific classifications of MICO skills, with the client's prior statement as a potential confounder or effect modifier. Results With closed questions as the reference category, therapist simple reflections and paraphrasing reflections were associated with significantly greater odds of maintaining client talk as CT or ST. Open questions and complex reflections were associated with significantly greater odds of CT following ST, were not associated significantly with more ST following ST, and were associated with more ST following CT (i.e., through an association with less Follow Neutral). Conclusions Simple and paraphrasing reflections appear to maintain client CT but are not associated with transitioning client ST to CT. By contrast, complex reflections and open questions appeared to be more strongly associated with clients moving from ST to CT than other techniques. These results suggest that counselors may differentially employ certain MICO technical skills to elicit continued CT and move participants toward ST within the MI dialogue.

We read with interest the thought provoking study by Anand et al. [(1)][1] in which patients with heart failure with a preserved ejection fraction (HFpEF) and low levels of natriuretic peptides were at lower risk of adverse outcome but benefited from spironolactone, whereas patients with higher