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AIM: We investigated the associations between motor performance and IQ at 5 years of age and school difficulties and grade point averages (GPAs) at 18 years of age. Additionally, the accuracy of preschool IQ in predicting school difficulties was examined. METHODS: A nationwide follow-up study of children born in 1994-1995 who were <28 weeks of gestation or had a birthweight <1000 g. The Danish personal identification number was used to merge data from a national cohort study with population-based registries. Logistic regression analyses examined the associations between motor performance/IQ and school difficulties. Linear regression analyses and the area under the receiver operator curve (AUC) were used to examine the relationship between IQ and GPAs. RESULTS: The study population comprised 248 children, 37% were classified with school difficulties. Motor performance and IQ were associated with school difficulties. The odds of having school difficulties increased as IQ decreased, and the same pattern was observed for GPAs. IQ predicted school difficulties, with an AUC of 0.80 (confidence interval: 0.74-0.86). CONCLUSION: Preschool motor performance and IQ were associated with school difficulties. Additionally, IQ was linked to GPAs. As a screening tool, the predictive ability of preschool IQ for academic difficulties was moderate/high in this cohort.

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BACKGROUND: Leakage of fire-fighting foam from an airfield caused contamination of the drinking water supplied to a third of the population in Ronneby, resulting in very high serum levels of predominantly perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS). The results of studies investigating the association between exposure to perfluorinated alkyl substances (PFAS) and pregnancy complications are inconsistent, and studies at high exposures of PFOS and PFHxS are lacking. OBJECTIVES: To investigate the association between exposure to high levels of PFAS and gestational hypertension and preeclampsia, and gestational diabetes mellitus. METHODS: We retrieved data on 27 292 childbirths between 1995 and 2013 from the National Medical Birth Register for women that had a residential address in Blekinge county for at least one year before delivery. Residential history was used as a proxy for exposure by categorizing women into high-, intermediate-, or background exposed based on their residential address during the five-year period before childbirth. Data on confounders were retrieved from administrative registers. The outcomes were defined based on International Classification of Diseases codes. We used logistic regression to estimate odds ratios (OR) for gestational hypertension and preeclampsia, and gestational diabetes mellitus. We also investigated effect modification by fetal sex. RESULTS: We found no evidence of increased risk of gestational hypertension and preeclampsia (OR 0.80; CI 0.63-1.03), nor gestational diabetes (OR 1.03; CI 0.67-1.58) after high PFAS exposure. There was no effect modification by fetal sex. DISCUSSION: This was the first study to investigate the association between high exposure to PFOS and PFHxS and pregnancy complications. The results from this study add important knowledge to public health management as new hotspots with high levels of PFAS are continuously discovered.

Asunto(s)

Diabetes Gestacional , Agua Potable , Fluorocarburos , Hipertensión Inducida en el Embarazo , Preeclampsia , Embarazo , Femenino , Humanos , Hipertensión Inducida en el Embarazo/inducido químicamente , Hipertensión Inducida en el Embarazo/epidemiología , Preeclampsia/inducido químicamente , Preeclampsia/epidemiología , Diabetes Gestacional/inducido químicamente , Diabetes Gestacional/epidemiología , Suecia/epidemiología , Alcanosulfonatos , Fluorocarburos/toxicidad

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There are indications that early-life exposure to perfluoroalkyl substances (PFAS) can impact neurodevelopment, but results are inconclusive. The objective was to investigate if high early-life exposure to primarily perfluorohexanesulfonic acid (PFHxS) and perfluorooctanesulfonic acid (PFOS) increases the risk of developmental language disorder in children up to seven years of age. Methods: A register-based cohort of all children born 1998-2013 in Blekinge county, Sweden, was studied. Maternal residential history, that is, with or without highly PFAS-contaminated drinking water, during the 5-year period before childbirth was used as a proxy for early-life exposure. Exposure was categorized as high (n = 646), intermediate (n = 1,650), or background (n = 9,599). We used Cox proportional hazards regression to estimate hazard ratios (HR) for (1) referral to a speech- and language pathologist after routine screening at Child Health Services, and (2) subsequent language disorder diagnosis after clinical assessment. Models were adjusted for parity, maternal age, education level, and smoking, and explored effect modification by sex. Results: In children from the high-exposed area, the adjusted HR for referral was 1.23 (95% CI = 1.03, 1.47) and 1.13 (95% CI = 0.97, 1.56) for subsequent diagnosis. There was no increased risk in the intermediate exposure category. Conclusion: Children, particularly girls, with high exposure had an increased risk of both referral and confirmed developmental language disorder. Further research is needed on PFAS in the context of general neurodevelopment, for which language development is a proxy.

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We aimed to provide a detailed description of the use of melatonin in Danish children, adolescents, and young adults during 2012-2019. We identified melatonin users 0-24 years of age (n = 43,652; median age 16 years) via the Danish nationwide health registers. Melatonin is a prescription drug in Denmark. The incidence of melatonin use increased from 2.4 to 3.9/1000 person-years during 2012 to 2019. Among 6,557 incident users in 2019, 53% filled only a single prescription within the first 6 months. Long-term use was most common among the younger age groups, with 17% of 5-9-year-olds and 14% of 10-13-year-olds being in continued treatment (no treatment breaks) 12 months after their first melatonin prescription. Disregarding treatment breaks, 3 in 10 were using melatonin 12 months after their first melatonin prescription and this proportion was also highest among 5-9-year-olds (63%) and 10-13-year-olds (51%). Psychopathology was common among melatonin users with 75% registered with either a psychiatric disorder diagnosis (54%), a filled prescription for another psychotropic (58%), or a contact to a private practice psychiatrist (15%) within ± 12 months of treatment initiation. General practitioners authorized melatonin prescriptions to almost half of all new users (48%), while psychiatric specialists authorized 37% of first prescriptions. In conclusion, the incidence of melatonin use increased in Denmark from 2012 to 2019. A substantial proportion of users had concurrent psychopathology most likely explaining their use of melatonin. Long-term melatonin use was more common among the youngest age groups, which should be a focus of interest due to limited safety data.

Asunto(s)

Melatonina , Medicamentos bajo Prescripción , Humanos , Niño , Adolescente , Adulto Joven , Lactante , Melatonina/uso terapéutico , Sistema de Registros , Utilización de Medicamentos , Dinamarca/epidemiología , Prescripciones de Medicamentos

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OBJECTIVE: Many psychiatric diseases have a strong familial aggregation, but it is unknown whether postpartum depression (PPD) without prior psychiatric history aggregates in families. METHODS: Based on Danish national registers, we constructed a cohort with information on 848,544 singleton deliveries (1996-2017). Women with an episode of PPD were defined as having used antidepressant medication and/or had a hospital contact for depression within 6 months after delivery. Those with psychiatric history prior to the delivery were excluded. We estimated relative risk (RR) of PPD, comparing women with female relatives with and without PPD history, respectively. RESULTS: Overall, women with a PPD history in female blood relatives had themselves a higher risk of PPD (RR = 1.64, 95% CI 1.16-2.34). Having the first-degree female relative with PPD history was associated with a more than 2.5 times (RR = 2.65, 95% CI 1.79-3.91) increased risk of PPD. However, having the second/third-degree female relative and/or a female non-blood relative with PPD history did not increase the woman's own risk of PPD (RR = 0.58, 95% CI 0.26-1.28, RR = 1.09, 95% CI 0.83-1.44). CONCLUSION: Postpartum depression aggregates in families with no other psychiatric history, but the findings do not support a strong genetic trait as a major cause. Other possible mechanisms are shared environment and/or health-seeking behavior in close relationships.

Asunto(s)

Depresión Posparto , Antidepresivos/uso terapéutico , Estudios de Cohortes , Depresión Posparto/epidemiología , Femenino , Predisposición Genética a la Enfermedad , Humanos , Periodo Posparto , Factores de Riesgo

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AIM: Low socioeconomic status is associated with higher risk of major adverse cardiovascular events (MACE) among patients with incident acute coronary syndrome (ACS). We examined whether non-persistence with antiplatelet and statin therapy mediated the income- and educational-related inequality in risk of MACE. METHODS: Using national registers, all Danish patients diagnosed with incident ACS from 2010 to 2017 were identified. The primary outcome (MACE) comprised all-cause death, cardiac death and cardiac readmission. Risk of MACE was handled by discrete time analyses using inverse probability of treatment weights. The mediator variable comprised non-persistence to a combined 2-dimensional measure of statin and antiplatelet treatment. The mediation analysis was evaluated by population average effects. RESULTS: The study population was 45,874 patients, of whom 16,958 (37.0%) were non-persistent with medication and 16,365 (35.7%) suffered MACE during the median follow-up of 3.5 years. Compared to patients with low income, the adjusted hazard ratio of MACE was lowered by 33% (HR: 0.67, 95% CI: 0.61-0.72) in men and by 34% (HR: 0.66, 95% CI: 0.61-0.72) in women with high income, respectively. Similar results were observed according to level of education. A socioeconomic difference in risk of non-persistence was found in men but not women and only in relation to income. The lower risk of non-persistence observed in high-income men mediated the lower risk of MACE by 12.6% (95% CI: 11.1-14.1%) compared with low-income men. CONCLUSION: Non-persistence with medication mediated some of the income-related inequality in risk of MACE in men, but not women, with incident ACS.

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To estimate the cost of illness in adult patients with moderate-to-severe atopic dermatitis (AD) a cohort study was conducted identifying Danish citizens (≥ 18 years) diagnosed with AD between 1997 and 2018 in the Danish National Patient Register. Moderate-to-severe AD was defined as ≥3 hospital contacts regarding AD the first year after diagnosis. Each patient with AD was matched to 3 reference individuals through the Central Person Registry. Societal costs included the direct costs for primary-sector visits, inpatient hospitalizations, outpatient contacts, prescription medicine and indirect costs of lost productivity 3 years before and 5 years after the index date (the study period). A total of 5,245 patients with moderate-to-severe AD were identified. The mean attributable healthcare costs for patients with moderate-to-severe AD were EUR 10,835 (p < 0.0001) during the study period. Moderate-to-severe AD among adults inferred substantial economic burden compared with a group of matched reference individuals.

Asunto(s)

Dermatitis Atópica , Adulto , Estudios de Cohortes , Costo de Enfermedad , Dinamarca/epidemiología , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/epidemiología , Dermatitis Atópica/terapia , Costos de la Atención en Salud , Humanos

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OBJECTIVE: To investigate (1) if antidepressant use among women in assisted reproductive technology (ART) treatment and among women without ART treatment influences cumulative live birth rates (CLBR) and number of initiated treatment cycles per woman, (2) whether women undergoing ART treatment are at higher risk of initiating use of antidepressants compared to women not having undergone ART, (3) if mothers after ART treatment have higher risk for postpartum use of antidepressants after ART treatment compared to mothers not having used ART treatment. STUDY DESIGN: A Danish nation-wide register-based cohort study including all women in ART treatment between 1995 through 2009 and an age-matched comparison group of women not having initiated ART treatment. In both groups, women had no previous children before study entry. The women were followed from time of initiating first ART treatment until time of permanent emigration (> 6 months), date of death, or end of follow-up by 31st of December 2009. Chi-square test was used to assess whether observed differences in CLBR between groups were significant. Adjusted incidence rates (IR) and incidence rate ratio (IRR) with 95 % confidence interval (CI) were calculated using Poisson regression analysis. The main outcome measures were: CLBR, number of initiated ART treatment cycles and IRR of initiating antidepressant use. RESULTS: Women using antidepressants before, during or after ART treatment were significantly older, had a lower CLBR and a lower mean number of initiated ART treatment cycles compared to women in ART treatment with no use of antidepressants. No significant difference was found in the incidence of initiating antidepressant use between women in ART treatment and the comparison group. However, when comparing only women with a live birth, significantly more women in ART treatment initiated antidepressant use in the postpartum period (adjusted incidence rate ratio (IRR) = 2.56 (95 % CI 1.98-3.30; p < 0.001)). CONCLUSION: Generally, women undergoing ART treatment are not at higher risk of initiating use of antidepressants compared with an age-matched comparison group not treated with ART. However, women with antidepressant medication use prior to ART initiate fewer ART treatments and have lower CLBR. Even though it has not been possible to adjust for all relevant confounders and our follow-up period only runs until the end of 2009, we still believe the results of this study to be highly relevant. According to our study, clinicians should be aware that women conceiving after ART treatment might experience an increased level of psychological strain during the postpartum period compared to mothers who conceived without ART.

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Antidepresivos , Técnicas Reproductivas Asistidas , Antidepresivos/efectos adversos , Niño , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Humanos , Embarazo , Sistema de Registros

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PURPOSE: To characterize pre- and perioperative factors associated with treatment for wet age-related macular degeneration (wet AMD) after cataract surgery. METHODS: This register-based cohort study with data from the Swedish National Cataract Register (NCR) and the Swedish Macula Register (SMR) from 2010 to 2017 compared eyes with and without preoperative AMD that had undergone cataract surgery and was subsequently treated for wet AMD to eyes not treated within the study period. All first-eye surgeries registered in the NCR from 2010 to 2017 and matching eyes found in the SMR that had undergone treatment for wet AMD ≥ 1 year after the cataract procedure were included. Data for cataract surgery date, age and gender, use of a blue-blocking IOL, preoperative visual acuity, ocular comorbidities, posterior capsule rupture and date of AMD treatment initiation were extracted. RESULTS: The only independent factor associated with postoperative treatment of wet AMD in both groups was female gender (67.3% vs. 58.8%, p < 0.001 and 66.4% vs. 60.6%, p = 0.001, respectively). Older age was an independent factor in eyes without preoperative AMD (78.4 ± 6.5 vs. 73.4 ± 9.6 years, p < 0.001). A blue-blocking IOL appeared to decrease the likelihood of subsequent wet AMD treatment slightly but not statistically significant in eyes with preoperative AMD (52.7% vs. 56.8%, p = 0.110). CONCLUSIONS: Some factors (female gender, high age) are associated with undergoing subsequent treatment for wet AMD to a higher extent. If the use of a blue-blocking IOL offers any protection from undergoing AMD treatment after cataract surgery, such an effect must be very small.

Asunto(s)

Extracción de Catarata , Catarata/complicaciones , Manejo de la Enfermedad , Cuidados Posoperatorios/métodos , Sistema de Registros , Agudeza Visual , Degeneración Macular Húmeda/terapia , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Suecia , Degeneración Macular Húmeda/complicaciones , Degeneración Macular Húmeda/diagnóstico

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Background: ß-adrenergic signaling has been implicated in the pathology of hepatocellular carcinoma (HCC), but the evidence from clinical studies is limited. In this national population-based cohort study, we investigated the possible association of ß-adrenergic receptor blockers and cancer-specific mortality among patients with primary HCC diagnosed in Sweden between 2006 and 2014.Methods: Patients were identified from the Swedish Cancer Register (n = 2104) and followed until 31 December 2015. We used Cox regression to evaluate the association of ß-blockers dispensed within 90 days prior to cancer diagnosis, ascertained from the national Prescribed Drug Register, with liver cancer mortality identified from the Cause of Death Register, while controlling for socio-demographic factors, tumor characteristics, comorbidity, other medications and treatment procedures.Results: Over a median follow-up of 9.9 months, 1601 patients died (of whom 1309 from liver cancer). Compared with non-use, ß-blocker use at cancer diagnosis [n = 714 (predominantly prevalent use, 93%)] was associated with lower liver cancer mortality [0.82 (0.72-0.94); p = .005]. Statistically significant associations were observed for non-selective [0.71 (0.55-0.91); p = .006], ß1-receptor selective [0.86 [0.75-1.00); p = .049] and lipophilic [0.78 (0.67-0.90); p = .001] ß-blockers. No association was observed for hydrophilic ß-blockers [1.01 (0.80-1.28); p = .906] or other antihypertensive medications. Further analysis suggested that the observed lower liver cancer mortality rate was limited to patients with localized disease at diagnosis [0.82 (0.67-1.01); p = .062].Conclusion: ß-blocker use was associated with lower liver cancer mortality rate in this national cohort of patients with HCC. A higher-magnitude inverse association was observed in relation to non-selective ß-blocker use.

Asunto(s)

Antagonistas Adrenérgicos beta/uso terapéutico , Carcinoma Hepatocelular/mortalidad , Hipertensión/tratamiento farmacológico , Neoplasias Hepáticas/mortalidad , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/tratamiento farmacológico , Causas de Muerte , Femenino , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Suecia/epidemiología , Resultado del Tratamiento

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BACKGROUND: The focus of emergency room (ER) treatment is on acute medical crises, but frequent users of ER services often present with various needs. The objectives of this study were to obtain information on persistent frequent ER service users and to determine reasons for their ER service use. We also sought to determine whether psychiatric diagnoses or ongoing use of psychiatric or substance use disorder treatment services were associated with persistent frequent ER visits. METHODS: A cohort (n = 138) of persistent frequent ER service users with a total of 2585 ER visits during a two-year-period was identified. A content analysis was performed for 10% of these visits. Register data including International Classification of Primary Care 2 (ICPC-2) -codes and diagnoses were analyzed and multivariable models were created in order to determine whether psychiatric diagnoses and psychosocial reasons for ER service use were associated with the number of ER visits after adjusting for covariates. RESULTS: Patients who were younger, had a psychiatric diagnosis and engaged in ongoing psychiatric and other health services, had more ER visits than those who were not. Having a psychiatric diagnosis was associated with the frequency of ER visits in the multivariable models after adjusting for age, gender and ongoing use of psychiatric or substance use disorder treatment services. Reasons for ER-service use according to ICPC-2 -codes were inadequately documented. CONCLUSIONS: Patients with psychiatric diagnoses are overrepresented in this cohort of persistent frequent ER service users. More efficient treatments paths are needed for patients to have their medical needs met through regular appointments.

Asunto(s)

Servicio de Urgencia en Hospital/estadística & datos numéricos , Trastornos Mentales/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Estudios de Cohortes , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Finlandia , Humanos , Masculino , Análisis Multivariante , Distribución de Poisson , Sistema de Registros , Trastornos Relacionados con Sustancias/epidemiología , Adulto Joven

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STUDY QUESTION: Is female infertility predictive of a woman's future risk of early cardiovascular disease (CVD)? SUMMARY ANSWER: Female infertility does not seem to be predictive of early CVD during a mean follow-up of 9 years. WHAT IS KNOWN ALREADY: Associations between infertility and comorbidity have been found in several studies, but data on the association between female infertility and risk of CVD are scarce and inconclusive. STUDY DESIGN, SIZE, DURATION: In this nationwide cohort study, we included 87 221 women registered in the Danish National IVF register, undergoing medically assisted reproduction (MAR) between 1st of January 1994 and 31st of December 2015. The cohort was followed for incident hospitalization due to CVD in the Danish National Patient Register from enrollment to 31 December 2015. Women with a history of CVD prior to enrollment were excluded. Cox proportional hazard models with age as the underlying time scale were used to estimate hazard ratios (HR) with 95% CI of CVD among women with an infertility diagnosis, compared to women without an infertility diagnosis. All analyses were adjusted for educational attainment. PARTICIPANTS/MATERIALS, SETTING, METHODS: Female infertility and the reason for infertility was diagnosed and registered in the IVF register by specialists in Danish public and private fertility clinics since 1st of January 1994. In our cohort, 53 806 women (61.7%) were diagnosed with female factor infertility, while 33 415 (38.3%) did not have a female factor infertility diagnosis and made up the reference group. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 686 (1.3%) infertile women were hospitalized for CVD compared to 250 (0.7%) among women without an infertility diagnosis during a mean follow-up time of 9 years. We found no increased risk of early CVD in our analyses (adjusted HR 0.98, 95% CI: 0.85;1.14). Likewise, analyses stratified by specific infertility diagnosis, showed no risk difference. LIMITATIONS, REASONS FOR CAUTION: We were unable to adjust for confounding parameters such as body mass index, cigarette smoking or alcohol consumption. These results may not be generalizable to infertile women who do not seek out fertility treatment, or infertile women with other lifestyle characteristics than Danish women. WIDER IMPLICATIONS OF THE FINDINGS: Diagnosing female infertility or the time of MAR does not seem to be a window of opportunity where early screening for cardiovascular disease risk factors can have a prophylactic potential. STUDY FUNDING/COMPETING INTEREST(S): This study is part of the ReproUnion collaborative study, co-financed by the European Union, Interreg V ÖKS. None of the authors declare any conflict of interest.

Asunto(s)

Enfermedades Cardiovasculares/epidemiología , Hospitalización , Infertilidad Femenina/epidemiología , Sistema de Registros , Adulto , Enfermedades Cardiovasculares/complicaciones , Estudios de Cohortes , Comorbilidad , Dinamarca/epidemiología , Femenino , Fertilidad , Fertilización In Vitro , Humanos , Infertilidad Femenina/complicaciones , Modelos de Riesgos Proporcionales , Riesgo

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BACKGROUND: A bivalent HPV vaccine (Cervarix®; HPV2, GlaxoSmithKline) was introduced into the Finnish national vaccination programme (NVP) in November 2013 for girls aged 11-13 years with a catch-up for 14-15 year-olds. We evaluated the association between HPV2 and selected autoimmune diseases and clinical syndromes by conducting a nation-wide retrospective register-based cohort study. METHODS: First life-time occurrences of the relevant ICD-10 codes in girls aged 11-15 years between Nov-2013 and Dec-2016 were obtained from the national hospital discharge register. Population denominators were obtained from the Population Information System and vaccination records from the National Vaccination Register. Registers were linked using unique personal identity codes. Association between HPV2 and 38 selected outcomes were studied using Cox regression, with age as the main time-scale and the first vaccination dose as the time-dependent exposure. The hazard ratios (HR) with 95%CI were assessed according to the time since exposure (entire follow-up, 0-180/181-365/>365 days). RESULTS: Of 240 605 girls eligible for HPV2 vaccination, 134 615 (56%) were vaccinated. After adjustment for geographical area (6 hospital districts), country of origin (Finnish-born/not) and number of hospital contacts from 9 through 10 years of age, HRs ranged from 0.34 (95%CI 0.11-1.05) to 8.37 (95%CI 0.85-82.54) and HPV2 vaccination was not statistically significantly associated with a higher risk of any outcome during the entire follow-up. CONCLUSIONS: This study found no significantly increased risk for the selected outcomes after the HPV vaccination in girls 11-15 years of age. These results provide valid evidence to counterbalance public scepticism, fears of adverse events and possible opposition to HPV vaccination and consequently can contribute to increase HPV vaccination coverage in Finland as well as elsewhere.

Asunto(s)

Sistemas de Registro de Reacción Adversa a Medicamentos/estadística & datos numéricos , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/efectos adversos , Sistema de Registros , Neoplasias del Cuello Uterino/prevención & control , Adolescente , Enfermedades Autoinmunes/epidemiología , Enfermedades Autoinmunes/etiología , Niño , Estudios de Cohortes , Femenino , Finlandia/epidemiología , Papillomavirus Humano 16 , Papillomavirus Humano 18 , Humanos , Programas de Inmunización , Vacunas contra Papillomavirus/administración & dosificación , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Neoplasias del Cuello Uterino/virología , Cobertura de Vacunación/estadística & datos numéricos

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OBJECTIVE: To study whether male childlessness is associated with an increased risk of metabolic disorders such as metabolic syndrome (MetS) and diabetes. DESIGN: A population-based cohort study. SETTING: Not applicable. PARTICIPANTS: 2572 men from the population-based Malmö Diet and Cancer Cardiovascular Cohort. INTERVENTIONS: None. MAIN OUTCOME MEASURES: From cross-sectional analyses, main outcome measures were ORs and 95% CIs for MetS and diabetes among childless men. In prospective analyses, HRs and 95% CI for diabetes among childless men. RESULTS: At baseline, in men with a mean age of 57 years, the prevalence of MetS was 26% and 22% among childless men and fathers, respectively. Similarly, we observed a higher prevalence of diabetes of 11% among childless men compared with 5% among fathers. In the cross-sectional adjusted analyses, childless men had a higher risk of MetS and diabetes, with ORs of 1.22 (95% CI 0.87 to 1.72) and 2.12 (95% CI 1.34 to 3.36) compared with fathers. In the prospective analysis, during a mean follow-up of 18.3 years, we did not see any increase in diabetes risk among childless men (HR 1.02 (0.76 to 1.37)). CONCLUSION: This study provides evidence of an association between male childlessness and a higher risk of MetS and diabetes. However, as these associations were found in cross-sectional analyses, reverse causation cannot be excluded.

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Diabetes Mellitus/epidemiología , Síndrome Metabólico/epidemiología , Estudios de Cohortes , Estudios Transversales , Padre , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Suecia/epidemiología

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BACKGROUND: Homelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland. METHODS: The study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs. RESULTS: During the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9-20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5-9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4-10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3-31.2) and SUDs (11.5, 95% CI 5.7-23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes. CONCLUSIONS: Dual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.

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Servicio de Urgencia en Hospital/estadística & datos numéricos , Personas con Mala Vivienda/psicología , Trastornos Mentales/epidemiología , Atención Primaria de Salud/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Anciano , Enfermedad Crónica/epidemiología , Estudios de Cohortes , Diagnóstico Dual (Psiquiatría)/estadística & datos numéricos , Femenino , Finlandia/epidemiología , Personas con Mala Vivienda/estadística & datos numéricos , Vivienda , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven

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The objective was to assess the potential association between female and male alcohol consumption and probability of achieving a live birth after assisted reproductive treatment. From a nationwide Danish register-based cohort information on alcohol consumption at assisted reproductive treatment initiation was linked to information on births and abortions. From 1 January 2006 to 30 September 2010, 12,981 women and their partners went through 29,834 treatment cycles. Of these, 22.4% and 20.4% led to a live birth for female abstainers and heavy consumers (>7 drinks/week), respectively. Concerning men, 22.6% and 20.2% of cycles resulted in a live birth for abstainers and heavy consumers (>14 drinks/week), respectively. No statistically significant associations between alcohol consumption and live birth were observed. Adjusted odds ratios from trend analyses were 1.00 (95% confidence interval (CI) 0.99-1.01) and 0.99 (95% CI 0.97-1.01) for every one-unit increase in female and male weekly alcohol consumption at assisted reproductive treatment initiation, respectively. In conclusion, this study did not show significant associations between male or female alcohol consumption and odds of live birth after assisted reproductive treatment.

Asunto(s)

Consumo de Bebidas Alcohólicas , Resultado del Embarazo , Sistema de Registros , Técnicas Reproductivas Asistidas , Adulto , Dinamarca , Femenino , Humanos , Masculino , Embarazo , Adulto Joven

RESUMEN

STUDY QUESTION: Is male factor infertility associated with an increased risk of developing diabetes? SUMMARY ANSWER: The study provides evidence that male factor infertility may predict later occurrence of diabetes mellitus with the risk being related to the severity of the underlying fertility problem. WHAT IS KNOWN ALREADY: Previous cross-sectional studies have shown an increased prevalence of comorbidities among infertile men when compared to controls. STUDY DESIGN, SIZE, DURATION: In this prospective cohort study, 39 516 men who had since 1994 undergone fertility treatment with their female partner were identified from the Danish national IVF register, which includes data on assumed cause of couple infertility (male/female factor, mixed and unexplained infertility) and type of fertility treatment. With a median follow-up time of 5.6 years, each man was followed for diabetes occurrence from enrollment until 31 December 2012 using the National Diabetes Register (NDR). Men with a history of diabetes prior to their fertility diagnosis were excluded. Hazard ratios (HR) were estimated by Cox proportional hazard models with age as the underlying time scale. In addition to analyzing the data for the entire IVF registration period (1994-2012), separate analyses were performed for men identified from the first (1994-2005) and second (2006-2012) IVF registration period owing to heterogeneity in the reporting of male factor infertility in these two time periods, because the reason for male factor infertility was not available from the first register. PARTICIPANTS/MATERIALS, SETTING, METHODS: Male factor infertility was identified from the variable 'yes' or 'no' from the first IVF register and through a diagnosis code (e.g. oligospermia, azoospermia) from the second IVF register. The reference group was men with male factor infertility (='no') and those with normal semen quality or sterilized men. Of the included men, 18 499 (46.8%) had male factor infertility and 21 017 (53.2%) made up the reference group. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 651 (1.6%) diabetes cases were identified during the follow-up period. The adjusted HR's for diabetes risk among men with male factor infertility when compared to the reference group were HR = 1.08 (95% CI: 0.89, 1.31) and HR = 1.45 (95% CI: 1.06, 1.97) for the first and second IVF registration period, respectively. When assessing the effects of individual causes of male factor infertility, the adjusted HR's for men with oligospermia, azoospermia and aspermia were HR = 1.44 (95% CI: 1.01, 2.06), HR = 2.10 (95% 1.25, 3.56) and HR = 3.20 (95% CI 1.00, 10.31), respectively. LIMITATIONS, REASONS FOR CAUTION: We found no increased risk among men identified from the first IVF register, which may be related to exposure misclassification as the reason for male factor infertility was not available from this time period. The NDR does not distinguish between type 1 and type 2 diabetes. WIDER IMPLICATIONS OF THE FINDINGS: These findings support previous studies that a man's reproductive and somatic health are closely intertwined and highlight the importance for further monitoring of these men. Further, implementation of diabetes screening may be especially relevant among aspermic and azoospermic men. STUDY FUNDING/COMPETING INTERESTS: This article is part of the ReproUnion collaborative study, co-financed by the European Union, Intereg V Öresund-Kattegat-Skagerrak. None of the authors declare any conflict of interest. TRIAL REGISTRATION NUMBER: None.

Asunto(s)

Diabetes Mellitus/etiología , Infertilidad Masculina/fisiopatología , Adulto , Aspermia/epidemiología , Aspermia/fisiopatología , Aspermia/terapia , Azoospermia/epidemiología , Azoospermia/fisiopatología , Azoospermia/terapia , Estudios de Cohortes , Comorbilidad , Estudios Transversales , Dinamarca/epidemiología , Diabetes Mellitus/epidemiología , Composición Familiar , Fertilización In Vitro , Estudios de Seguimiento , Humanos , Incidencia , Infertilidad Masculina/epidemiología , Infertilidad Masculina/terapia , Masculino , Persona de Mediana Edad , Prevalencia , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Sistema de Registros , Riesgo , Índice de Severidad de la Enfermedad

RESUMEN

It is unclear whether psychological resilience to stress in adolescence represents a persistent characteristic relevant to the subsequent risk for depression and anxiety in later adulthood. We aimed to test whether low psychological stress resilience assessed in adolescence is associated with an increased risk of receiving medication for depression and anxiety in middle age. We utilized Swedish register-based cohort study. Men born between 1952 and 1956 (n = 175,699), who underwent compulsory assessment for military conscription in late adolescence were followed to examine subsequent risk of pharmaceutically-treated depression and anxiety in middle age, from 2006 to 2009 corresponding to ages between 50 and 58 years, using Cox regression. The associations of stress resilience with prescription of antidepressant and anxiolytics medication through potential mediating factors cognitive and physical function and adult socioeconomic factors were calculated. Low stress resilience was associated with elevated risks for antidepressant (hazard ratio (HR):1.5 (95% CI 1.4 1.6)) and anxiolytics (HR:2.4 (CI 2.0 2.7)) medication. Adjustment for measures of childhood living circumstances attenuated the associations somewhat. Around a third of association with low stress resilience, and a half of that with moderate resilience, was mediated through cognitive and physical function in adolescence and adult socioeconomic factors. The magnitude of the inverse association of higher cognitive function with antidepressant medication was eliminated among those with low stress resilience. These results indicate that low stress resilience in adolescence is associated with an increased risk for antidepressant and anxiolytics medication over 30 years later, in part mediated through developmental factors in adolescence and socioeconomic circumstances in adulthood, and low stress resilience can diminish or eliminate the inverse association of higher cognitive function with antidepressant medication.

Asunto(s)

Ansiolíticos/uso terapéutico , Antidepresivos/uso terapéutico , Resiliencia Psicológica , Adolescente , Adulto , Factores de Edad , Anciano , Ansiedad/psicología , Cognición , Estudios de Cohortes , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Personal Militar/psicología , Factores Socioeconómicos , Estrés Psicológico/psicología , Suecia , Adulto Joven

RESUMEN

OBJECTIVES: To determine the prevalence rate of women with a diagnosis of schizophrenia or related psychotic disorder in assisted reproductive technology (ART) treatment and to study these women's fertility treatment outcome in comparison to women with no psychotic disorders. STUDY DESIGN: We used a national register-based cohort of 42,915 Danish women in ART treatment from 1.1.1994 to 30.9.2009. All women with a diagnosis of schizophrenia or related psychotic disorders before, during or after their ART treatment were identified by individual-level linkage of nationwide registers of ART treatment, psychiatric admission, birth and socio-demographic status. The comparison group (N=42,671) consisted of all women in the study cohort never diagnosed with psychotic disorders. Conventional descriptive methods were used for the statistical analyses. RESULTS: Two hundred and forty-four (0.6%) women in the study cohort received a diagnosis of psychotic disorder before (N=135-55.3%), during (N=7-2.9%) or after (N=102-41.8%) ART treatment. The mean time from last diagnosis of psychotic disorder to their first ART treatment in the 135 women with a psychiatric diagnosis prior to their first ART treatment was 7.1 ± 5.6 years (25-75% percentile: ±2.8-10.4 years). The most frequent diagnoses were acute and transient psychotic disorder. Women with a diagnosis of schizophrenia or related psychotic disorder before their first ART treatment had a lower ART treatment success rate as significantly fewer women obtained a live birth (40.0% vs. 51.9%, P<0.01). However, we found no statistical differences in perinatal outcomes for the children born by women in the study population and comparison group. CONCLUSIONS: The prevalence of women with a psychotic diagnosis in fertility treatment is lower than the prevalence in the general population. Women with a psychotic disorder prior to ART treatment have a lower fertility treatment success rate compared to women without psychotic disorder. Women with a psychotic disorder achieving delivery show similar obstetric outcomes to women with no psychotic disorder.

Asunto(s)

Infertilidad/terapia , Índice de Embarazo , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Esquizofrenia/epidemiología , Adulto , Dinamarca/epidemiología , Femenino , Humanos , Infertilidad/complicaciones , Embarazo , Complicaciones del Embarazo/psicología , Prevalencia , Sistema de Registros , Estudios Retrospectivos , Esquizofrenia/complicaciones , Esquizofrenia/diagnóstico , Factores de Tiempo , Adulto Joven