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The American Journal of Sports Medicine Oct 2016Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effective at improving postoperative outcomes at least in the short term. Less is known... (Comparative Study)
Comparative Study
Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts.
BACKGROUND
Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effective at improving postoperative outcomes at least in the short term. Less is known about the effects of preoperative rehabilitation on functional outcomes and return-to-sport (RTS) rates 2 years after reconstruction.
PURPOSE/HYPOTHESIS
The purpose of this study was to compare functional outcomes 2 years after ACLR in a cohort that underwent additional preoperative rehabilitation, including progressive strengthening and neuromuscular training after impairments were resolved, compared with a nonexperimental cohort. We hypothesized that the cohort treated with extended preoperative rehabilitation would have superior functional outcomes 2 years after ACLR.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
This study compared outcomes after an ACL rupture in an international cohort (Delaware-Oslo ACL Cohort [DOC]) treated with extended preoperative rehabilitation, including neuromuscular training, to data from the Multicenter Orthopaedic Outcomes Network (MOON) cohort, which did not undergo extended preoperative rehabilitation. Inclusion and exclusion criteria from the DOC were applied to the MOON database to extract a homogeneous sample for comparison. Patients achieved knee impairment resolution before ACLR, and postoperative rehabilitation followed each cohort's respective criterion-based protocol. Patients completed the International Knee Documentation Committee (IKDC) subjective knee form and Knee injury and Osteoarthritis Outcome Score (KOOS) at enrollment and again 2 years after ACLR. RTS rates were calculated for each cohort at 2 years.
RESULTS
After adjusting for baseline IKDC and KOOS scores, the DOC patients showed significant and clinically meaningful differences in IKDC and KOOS scores 2 years after ACLR. There was a significantly higher (P < .001) percentage of DOC patients returning to preinjury sports (72%) compared with those in the MOON cohort (63%).
CONCLUSION
The cohort treated with additional preoperative rehabilitation consisting of progressive strengthening and neuromuscular training, followed by a criterion-based postoperative rehabilitation program, had greater functional outcomes and RTS rates 2 years after ACLR. Preoperative rehabilitation should be considered as an addition to the standard of care to maximize functional outcomes after ACLR.
Topics: Adolescent; Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Cohort Studies; Female; Humans; Knee Injuries; Knee Joint; Male; Orthopedics; Osteoarthritis, Knee; Sports; Treatment Outcome; Young Adult
PubMed: 27416993
DOI: 10.1177/0363546516652594 -
JAMA Network Open Apr 2023Type 2 diabetes increases the risk of progressive diabetic kidney disease, but reliable prediction tools that can be used in clinical practice and aid in patients'...
IMPORTANCE
Type 2 diabetes increases the risk of progressive diabetic kidney disease, but reliable prediction tools that can be used in clinical practice and aid in patients' understanding of disease progression are currently lacking.
OBJECTIVE
To develop and externally validate a model to predict future trajectories in estimated glomerular filtration rate (eGFR) in adults with type 2 diabetes and chronic kidney disease using data from 3 European multinational cohorts.
DESIGN, SETTING, AND PARTICIPANTS
This prognostic study used baseline and follow-up information collected between February 2010 and December 2019 from 3 prospective multinational cohort studies: PROVALID (Prospective Cohort Study in Patients with Type 2 Diabetes Mellitus for Validation of Biomarkers), GCKD (German Chronic Kidney Disease), and DIACORE (Diabetes Cohorte). A total of 4637 adult participants (aged 18-75 years) with type 2 diabetes and mildly to moderately impaired kidney function (baseline eGFR of ≥30 mL/min/1.73 m2) were included. Data were analyzed between June 30, 2021, and January 31, 2023.
MAIN OUTCOMES AND MEASURES
Thirteen variables readily available from routine clinical care visits (age, sex, body mass index; smoking status; hemoglobin A1c [mmol/mol and percentage]; hemoglobin, and serum cholesterol levels; mean arterial pressure, urinary albumin-creatinine ratio, and intake of glucose-lowering, blood-pressure lowering, or lipid-lowering medication) were selected as predictors. Repeated eGFR measurements at baseline and follow-up visits were used as the outcome. A linear mixed-effects model for repeated eGFR measurements at study entry up to the last recorded follow-up visit (up to 5 years after baseline) was fit and externally validated.
RESULTS
Among 4637 adults with type 2 diabetes and chronic kidney disease (mean [SD] age at baseline, 63.5 [9.1] years; 2680 men [57.8%]; all of White race), 3323 participants from the PROVALID and GCKD studies (mean [SD] age at baseline, 63.2 [9.3] years; 1864 men [56.1%]) were included in the model development cohort, and 1314 participants from the DIACORE study (mean [SD] age at baseline, 64.5 [8.3] years; 816 men [62.1%]) were included in the external validation cohort, with a mean (SD) follow-up of 5.0 (0.6) years. Updating the random coefficient estimates with baseline eGFR values yielded improved predictive performance, which was particularly evident in the visual inspection of the calibration curve (calibration slope at 5 years: 1.09; 95% CI, 1.04-1.15). The prediction model had good discrimination in the validation cohort, with the lowest C statistic at 5 years after baseline (0.79; 95% CI, 0.77-0.80). The model also had predictive accuracy, with an R2 ranging from 0.70 (95% CI, 0.63-0.76) at year 1 to 0.58 (95% CI, 0.53-0.63) at year 5.
CONCLUSIONS AND RELEVANCE
In this prognostic study, a reliable prediction model was developed and externally validated; the robust model was well calibrated and capable of predicting kidney function decline up to 5 years after baseline. The results and prediction model are publicly available in an accompanying web-based application, which may open the way for improved prediction of individual eGFR trajectories and disease progression.
Topics: Male; Adult; Humans; Diabetes Mellitus, Type 2; Glomerular Filtration Rate; Prospective Studies; Renal Insufficiency, Chronic; Disease Progression
PubMed: 37017968
DOI: 10.1001/jamanetworkopen.2023.1870 -
Bundesgesundheitsblatt,... Oct 2021The worldwide development of twin cohorts began after World War II. These cohorts now include around 1.5 million twins, and more than 2748 twin studies have been... (Review)
Review
The worldwide development of twin cohorts began after World War II. These cohorts now include around 1.5 million twins, and more than 2748 twin studies have been published between 1950 and 2012. Each year, the number of twin publications increases by another 500 to 1000. The underrepresentation of German twin studies cannot be solely explained by the abuse of medical research under National Socialism. Developing and expanding large twin cohorts is a challenge in terms of both ethics and data protection. However, twin cohorts enable long-term and real-time research on many medical issues and contribute to answer the question of predisposition or environment as possible disease triggers - even after the sequencing of the human genome.There are currently two German twin cohorts: the biomedical cohort HealthTwiSt, with around 1500 pairs of twins, and TwinLife, a sociological-psychological cohort with around 4000 pairs of twins. There are also disease-specific cohorts. The TwinHealth Consortium in the Faculty of Medicine at the University of Tübingen was established in 2016 with the aim of enabling open-ended and sustainable twin research in Tübingen to answer various scientific questions.With the help of systematic literature research and medical history, this article gives an overview of the worldwide development of twin studies and databases over the last 100 years. The example of the Tübingen TwinHealth Initiative illuminates the structure of a twin cohort and its legal, ethical, and data protection aspects.
Topics: Biomedical Research; Cohort Studies; Diseases in Twins; Germany; Humans
PubMed: 34524474
DOI: 10.1007/s00103-021-03400-2 -
Alcoholism, Clinical and Experimental... Dec 2011Alcohol consumption has demonstrated substantial temporal trends, with some evidence suggesting strong birth cohort effects. The identification of at-risk birth cohorts... (Review)
Review
BACKGROUND
Alcohol consumption has demonstrated substantial temporal trends, with some evidence suggesting strong birth cohort effects. The identification of at-risk birth cohorts can inform the interpretation of alcohol trends across age, time, and demographic characteristics such as gender. The present literature review has 2 objectives. First, we conduct a cross-national review of the literature on birth cohort differences in alcohol consumption, disorder, and mortality. Second, we determine the consistency of evidence for birth cohort effects on gender differences.
METHODS
A search was conducted and key data on population characteristics, presence and direction of cohort effects, and interactions with gender compiled. Thirty-one articles were included.
RESULTS
Evidence suggests that younger birth cohorts in North America, especially those born after World War II, are more likely than older cohorts to engage in heavy episodic drinking and develop alcohol disorders, but this cohort effect is not found in Australia and western Europe. Cross-nationally, substantial evidence indicates that women in younger cohorts are at especially high risk for heavy episodic drinking and alcohol disorders.
DISCUSSION
Younger birth cohorts in North America and Europe are engaging in more episodic and problem drinking. The gender gap in alcohol problems is narrowing in many countries, suggesting shifting social norms surrounding gender and alcohol consumption. These trends suggest that public health efforts to specifically target heavy drinking in women are necessary.
Topics: Alcohol Drinking; Alcoholism; Australia; Cohort Effect; Europe; Female; Humans; Male; North America; Sex Factors
PubMed: 21919918
DOI: 10.1111/j.1530-0277.2011.01562.x -
Environmental Science & Technology Jun 2023Contemporary environmental health sciences draw on large-scale longitudinal studies to understand the impact of environmental exposures and behavior factors on the risk...
Contemporary environmental health sciences draw on large-scale longitudinal studies to understand the impact of environmental exposures and behavior factors on the risk of disease and identify potential underlying mechanisms. In such studies, cohorts of individuals are assembled and followed up over time. Each cohort generates hundreds of publications, which are typically neither coherently organized nor summarized, hence limiting knowledge-driven dissemination. Hence, we propose a Cohort Network, a multilayer knowledge graph approach to extract exposures, outcomes, and their connections. We applied the Cohort Network on 121 peer-reviewed papers published over the past 10 years from the Veterans Affairs (VA) Normative Aging Study (NAS). The Cohort Network visualized connections between exposures and outcomes across different publications and identified key exposures and outcomes, such as air pollution, DNA methylation, and lung function. We demonstrated the utility of the Cohort Network for new hypothesis generation, e.g., identification of potential mediators of exposure-outcome associations. The Cohort Network can be used by investigators to summarize the cohort's research and facilitate knowledge-driven discovery and dissemination.
Topics: Humans; Air Pollutants; Pattern Recognition, Automated; Environmental Exposure; Air Pollution; Cohort Studies
PubMed: 37224396
DOI: 10.1021/acs.est.2c08174 -
BMC Cancer Aug 2023To improve prediction, the AJCC staging system was revised to be consistent with upfront surgery (UFS) and neoadjuvant therapy (NAT) for PDAC.
OBJECTIVE
To improve prediction, the AJCC staging system was revised to be consistent with upfront surgery (UFS) and neoadjuvant therapy (NAT) for PDAC.
BACKGROUND
The AJCC staging system was designed for patients who have had UFS for PDAC, and it has limited predictive power for patients receiving NAT.
METHODS
We examined 146 PDAC patients who had resection after NAT and 1771 who had UFS at Changhai Hospital between 2012 and 2021. The clinicopathological factors were identified using Cox proportional regression analysis, and the Neoadjuvant Therapy Compatible Prognostic (NATCP) staging was developed based on these variables. Validation was carried out in the prospective NAT cohort and the SEER database. The staging approach was compared to the AJCC staging system regarding predictive accuracy.
RESULTS
The NAT cohort's multivariate analysis showed that tumor differentiation and the number of positive lymph nodes independently predicted OS. The NATCP staging simplified the AJCC stages, added tumor differentiation, and restaged the disease based on the Kaplan-Meier curve survival differences. The median OS for NATCP stages IA, IB, II, and III was 31.7 months, 25.0 months, and 15.8 months in the NAT cohort and 30.1 months, 22.8 months, 18.3 months, and 14.1 months in the UFS cohort. Compared to the AJCC staging method, the NATCP staging system performed better and was verified in the validation cohort.
CONCLUSIONS
Regardless of the use of NAT, NATCP staging demonstrated greater predictive abilities than the existing AJCC staging approach for resected PDAC and may facilitate clinical decision-making based on accurate prediction of patients' OS.
Topics: Humans; Neoadjuvant Therapy; Prognosis; Prospective Studies; Pancreatic Neoplasms; Carcinoma, Pancreatic Ductal
PubMed: 37612635
DOI: 10.1186/s12885-023-11181-x -
International Journal of Environmental... Apr 2020Many birth cohorts have been carried out. We performed a review of European birth cohorts to see the countries involved, provide a panorama of the current research...
Many birth cohorts have been carried out. We performed a review of European birth cohorts to see the countries involved, provide a panorama of the current research topics and design, and, more generally, provide input for those creating collaborations and laying out guidelines aimed at unifying cohort methodologies to enable data merging and maximize knowledge acquisition. We searched PubMed and Embase for articles referring to longitudinal, prospective European birth cohorts and searched online cohort inventories. We found references to 111 birth cohorts, 45 of which began enrolment at birth. These cohorts began between 1921 and 2015 and represented 19 countries, with varying sample sizes (236 to 21,000 children). As of 5 January 2020, were still recruiting. The main areas addressed were allergic diseases (14 cohorts) and environmental exposure (f12 cohorts) and most cohorts were publicly funded. Given the large costs of running cohorts and the importance of long follow-up periods in identifying the risk factors for disorders thought to have a perinatal/early life etiology, current cohorts must be designed to answer research questions considering several aspects, from genetic ones to psychological, social, and environmental ones. Furthermore, universally recognized methodological aspects are needed to permit the comparison and merging of cohort data.
Topics: Adolescent; Adult; Child; Child, Preschool; Cohort Studies; Environmental Exposure; Female; Humans; Infant; Infant, Newborn; Pregnancy; Prospective Studies; Risk Factors
PubMed: 32354101
DOI: 10.3390/ijerph17093071 -
Biochemistry. Biokhimiia Nov 2023Aging rate is an important characteristic of human aging. Attempts to measure aging rates through the Gompertz slope parameter lead to a conclusion that actuarial aging...
Aging rate is an important characteristic of human aging. Attempts to measure aging rates through the Gompertz slope parameter lead to a conclusion that actuarial aging rates were stable during the most of the 20th century, but recently demonstrate an increase over time in the majority of studied populations. These findings were made using cross-sectional mortality data rather than by the analysis of mortality of real birth cohorts. In this study we analyzed historical changes of actuarial aging rates in human cohorts. The Gompertz parameters were estimated in the age interval 50-80 years using data on one-year cohort age-specific death rates from the Human Mortality Database (HMD). Totally, data for 2,294 cohorts of men and women from 76 populations were analyzed. Changes of the Gompertz slope parameter in the studied cohorts revealed two distinct patterns for actuarial aging rate. In higher mortality Eastern European countries actuarial aging rates showed continuous decline from the 1910 to 1940 birth cohort. In lower mortality Western European countries, Australia, Canada, Japan, New Zealand, and USA actuarial aging rates declined from the 1910th to approximately 1930th cohort and then increased. Overall, in 50 out of 76 populations (68%) actuarial aging rate demonstrated decreasing pattern of change over time. Compensation effect of mortality (CEM) was tested for the first time in human cohorts and the cohort species-specific lifespan was estimated. CEM was confirmed using cohort data and human cohort species-specific lifespan estimates were similar to the estimates obtained for the cross-sectional data published earlier.
Topics: Male; Humans; Female; Middle Aged; Aged; Aged, 80 and over; Cross-Sectional Studies; Aging; Longevity; Japan; Mortality
PubMed: 38105198
DOI: 10.1134/S0006297923110093 -
PloS One 2022Medical schools are challenged to guard student wellbeing given the potential negative impact of the COVID-19 outbreak combined with an already high prevalence of mental...
BACKGROUND
Medical schools are challenged to guard student wellbeing given the potential negative impact of the COVID-19 outbreak combined with an already high prevalence of mental distress. Although social support is generally associated with less crisis-induced stress, it is unknown whether this applies to medical students during the COVID-19 outbreak.
OBJECTIVES
The impact of the COVID-19 outbreak on perceived stress of medical students was assessed by comparing their perceived stress levels during the outbreak to both their own baseline and the previous cohort's pre-COVID-19 stress levels. Then, the association between social support and stress during the COVID-19 outbreak was assessed.
METHODS
Dutch Year-1 medical students of cohort 2019 (n = 99) completed the 14-item Perceived Stress Scale (PSS-14) at two time points: baseline (pre-COVID-19) and final measurement (COVID-19). Social support-emotional-informational support and club membership-was assessed during the final measurement. PSS and social support scores were compared to similar measurements of cohort 2018 (n = 196). Students' baseline stress levels, gender, and study performance were controlled for when comparing final stress levels.
RESULTS
In cohort 2018 (pre-COVID-19), students' perceived stress levels did not differ significantly between the baseline and final measurements. Additionally, baseline stress levels of the two cohorts (2018 and 2019) were not found to be significantly different. Cohort 2019's final stress levels (COVID-19) were significantly higher compared to their baseline stress levels (paired t-test: t = 6.07, p < .001) and cohort 2018's final stress levels (linear regression: B = 4.186, p < .001). Only during the COVID-19 outbreak higher social support levels-i.e., emotional-informational support (B = -0.75, p < .001) and club membership (B = -3.68, p < .01)-were associated with lower stress levels.
CONCLUSIONS
During the COVID-19 outbreak, medical students' perceived stress levels were higher-especially for students with lower social support levels. Our results suggest that medical schools should optimize social support to minimize crisis-induced stress.
Topics: Humans; Students, Medical; COVID-19; Social Support; Schools, Medical; Disease Outbreaks
PubMed: 36454995
DOI: 10.1371/journal.pone.0278577 -
Environmental Health Perspectives Jan 2012Many pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data... (Review)
Review
BACKGROUND
Many pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data is needed to improve collaboration, harmonization, and future project planning.
OBJECTIVES
Our goal was to create a comprehensive overview of European birth cohorts with environmental exposure data.
METHODS
Birth cohort studies were included if they a) collected data on at least one environmental exposure, b) started enrollment during pregnancy or at birth, c) included at least one follow-up point after birth, d) included at least 200 mother-child pairs, and e) were based in a European country. A questionnaire collected information on basic protocol details and exposure and health outcome assessments, including specific contaminants, methods and samples, timing, and number of subjects. A full inventory can be searched on www.birthcohortsenrieco.net.
RESULTS
Questionnaires were completed by 37 cohort studies of > 350,000 mother-child pairs in 19 European countries. Only three cohorts did not participate. All cohorts collected biological specimens of children or parents. Many cohorts collected information on passive smoking (n = 36), maternal occupation (n = 33), outdoor air pollution (n = 27), and allergens/biological organisms (n = 27). Fewer cohorts (n = 12-19) collected information on water contamination, ionizing or nonionizing radiation exposures, noise, metals, persistent organic pollutants, or other pollutants. All cohorts have information on birth outcomes; nearly all on asthma, allergies, childhood growth and obesity; and 26 collected information on child neurodevelopment.
CONCLUSION
Combining forces in this field will yield more efficient and conclusive studies and ultimately improve causal inference. This impressive resource of existing birth cohort data could form the basis for longer-term and worldwide coordination of research on environment and child health.
Topics: Child; Child, Preschool; Cohort Studies; Databases, Factual; Environmental Exposure; Environmental Health; Europe; Female; Humans; Infant; Infant, Newborn; Internet; Maternal Exposure; Pregnancy
PubMed: 21878421
DOI: 10.1289/ehp.1103823