Association between Computed Tomography-Determined Loss of Muscle Mass and Impaired Three-Month Survival in Frail Older Adults with Cancer

As patients with solid (non-hematological) cancers and a life expectancy of <3 months rarely benefit from oncological treatment, we examined whether the CT-determined loss of muscle mass is associated with an impaired 3-month overall survival (OS) in frail ≥75-year-old patients with cancer. Frailty was assessed with G8-screening and comprehensive geriatric assessment in older adults at risk of frailty. The L3-level skeletal (SMI) and psoas (PMI) muscle indexes were determined from routine CT scans. Established and optimized SMI and PMI cut-offs were used. In the non-curative treatment group (n = 58), 3-month OS rates for normal and low SMI were 95% and 64% (HR 9.28; 95% CI 1.2-71) and for PMI 88%, and 60%, respectively (HR 4.10; 1.3-13). A Cox multivariable 3-month OS model showed an HR of 10.7 (1.0-110) for low SMI, 2.34 (0.6-9.8) for ECOG performance status 3-4, 2.11 (0.5-8.6) for clinical frailty scale 5-9, and 0.57 (0.1-2.8) for males. The 24-month OS rates in the curative intent group (n = 21) were 91% and 38% for the normal and low SMI groups, respectively. In conclusion, CT-determined low muscle mass is independently associated with an impaired 3-month OS and, alongside geriatric assessment, could aid in oncological versus best supportive care decision-making in frail patients with non-curable cancers.

Trajectories of working hours in later careers and their association with social and health-related factors: a follow-up study

BACKGROUND

The aim was to identify working hours' trajectories in later work careers over a follow-up of 15-17 years and to examine their association with social factors and health.

METHODS

A subsample from the Helsinki Health Study was extracted comprising employees of the City of Helsinki, Finland. Growth mixture modelling was used to identify different working hour trajectories. Age, gender, occupational class, marital status, health behaviour, physical and mental functioning and current pain were associated with trajectory membership. Relative risks (RRs) and their 95% confidence intervals (CIs) were estimated.

RESULTS

A two-trajectory model was selected: 'Stable regular working hours' (90%) and 'Shorter and varying working hours' (10%). Women (RR 1.40, 95% CI 1.09-1.78), the oldest employees (RR 2.71, 95% CI 2.06-3.57), managers and professionals (RR 1.56, 95% CI 1.20-2.02), those reporting non-drinker (RR 1.66, 95% CI 1.32-2.10), those reporting sleeping more than 8 h per night (RR 1.74 95% CI 1.25-2.42) and those reporting poor mental functioning (RR 1.39 95% CI 1.15-1.68) had higher likelihood of belonging to the trajectory 'Shorter and varying working hours'. There were no differences between the trajectories in marital status, smoking, body mass index, current pain or physical functioning. However, routine non-manual workers (RR 0.74, 95% CI 0.55-0.98), and semi-professionals (RR 0.70, 95% CI 0.50-0.96) had lower likelihood of belonging to this trajectory.

CONCLUSIONS

Trajectories of working hours in later work career differ by age, gender and occupational class but also by health behaviours and mental health functioning.

Weekend effect on mortality by medical specialty in six secondary hospitals in the Helsinki metropolitan area over a 14-year period

BACKGROUND

The weekend effect is the phenomenon of a patient's day of admission affecting their risk for mortality. Our study reviews the situation at six secondary hospitals in the greater Helsinki area over a 14-year period by specialty, in order to examine the effect of centralization of services on the weekend effect.

METHODS

Of the 28,591,840 patient visits from the years 2000-2013 in our hospital district, we extracted in-patients treated only in secondary hospitals who died during their hospital stay or within 30 days of discharge. We categorized patients based on the type of each admission, namely elective versus emergency, and according to the specialty of their clinical service provider and main diagnosis.

RESULTS

A total of 456,676 in-patients (292,399 emergency in-patients) were included in the study, with 17,231 deaths in-hospital or within 30 days of discharge. A statistically significant weekend effect was observed for in-hospital and 30-day post-discharge mortality among emergency patients for 1 of 7 specialties. For elective patients, a statistically significant weekend effect was visible in in-hospital mortality for 4 of 8 specialties and in 30-day post-discharge mortality for 3 of 8 specialties. Surgery, internal medicine, and gynecology and obstetrics were most susceptible to this phenomenon.

CONCLUSIONS

A weekend effect was present for the majority of specialties for elective patients, indicating a need for guidelines for these admissions. More disease-specific research is necessary to find the diagnoses, which suffer most from the weekend effect and adjust staffing accordingly.

Register-based study of the incidence, comorbidities and demographics of obsessive-compulsive disorder in specialist healthcare

BACKGROUND

Incidence of obsessive-compulsive disorder (OCD) has been suspected to increase but nationwide epidemiological studies are limited. This study aims to examine sex-specific incidence time trends and characterize psychiatric and neurodevelopmental comorbidities and sociodemographic risk factors of OCD in specialist healthcare in Finland.

METHODS

A nationwide register-based study using data from four Finnish registers identified 3372 OCD cases and 13,372 matched controls (1:4). Cumulative incidence in subjects born between 1987 and 2001 was estimated at ages of 10, 15, 20 and 23 years. Conditional logistic regression was used to examine the sociodemographic factors.

RESULTS

The cumulative incidence of OCD was 0.4% by age 23. Incidence by age 15 among three cohorts increased from 12.4 to 23.7 /10000 live born males and 8.5 to 28.0 /10000 live born females. 73% of the sample had a comorbid condition. Males were significantly more comorbid with psychotic and developmental disorders; females were more comorbid with depressive and anxiety disorders (p <0.001). Higher maternal SES was associated with an increased risk of OCD (OR 1.4; 95% CI 1.1-1.6).

CONCLUSIONS

These findings suggest that incidence of treated OCD in specialist healthcare has increased. The reason may be increased awareness and rate of referrals but a true increase cannot be ruled out. Further research on risk factors of OCD is warranted.