Novel Psychiatric Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents

OBJECTIVE

To investigate the factors predictive of novel psychiatric disorders in the interval 0-6 months following traumatic brain injury (TBI).

METHODS

Children ages 5-14 years consecutively hospitalized for mild to severe TBI at five hospitals were recruited. Participants were evaluated at baseline (soon after injury) for pre-injury characteristics including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, family function, family psychiatric history, and adaptive function. In addition to the psychosocial variables, injury severity and lesion location detected with acquisition of a research MRI were measured to develop a biopsychosocial predictive model for development of novel psychiatric disorders. Psychiatric outcome, including occurrence of a novel psychiatric disorder, was assessed 6 months after the injury.

RESULTS

The recruited sample numbered 177 children, and 141 children (80%) returned for the six-month assessment. Of the 141 children, 58 (41%) developed a novel psychiatric disorder. In univariable analyses, novel psychiatric disorder was significantly associated with lower SES, higher psychosocial adversity, and lesions in frontal lobe locations, such as frontal white matter, superior frontal gyrus, inferior frontal gyrus, and orbital gyrus. Multivariable analyses found that novel psychiatric disorder was independently and significantly associated with frontal-lobe white matter, superior frontal gyrus, and orbital gyrus lesions.

CONCLUSION

The results demonstrate that occurrence of novel psychiatric disorders following pediatric TBI requiring hospitalization is common and has identifiable psychosocial and specific biological predictors. However, only the lesion predictors were independently related to this adverse psychiatric outcome.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

POS0559 COMPLIANCE WITH RECOMMENDATIONS OF LOW INTAKE OF RED MEAT AND HIGH FIBER INTAKE IS ASSOCIATED WITH A REDUCED RISK OF RHEUMATOID ARTHRITIS

Background

Diet has received much attention as a factor that may contribute to the development of rheumatoid arthritis (RA). Several different nutrients, food components and dietary patterns have been studied in different populations. There is limited information on the importance of compliance with diet recommendations in this context.

Objectives

The aim of this study was to investigate the relation between overall dietary quality, diet components, and the risk of RA.

Methods

Participants in a population-based survey conducted in 1991-1996 who were subsequently diagnosed with RA (from inclusion until December 2004) were identified through register linkage and validated in a structured process. Four controls for each case, matched for sex, year of birth, and year of inclusion, were selected from the study cohort. The controls were alive and RA-free when the index person was diagnosed with RA. At inclusion, diet was assessed using a modified diet history method, consisting of a seven-day food record, a food questionnaire, and a supplementary interview.

The New Diet Score (NDS) reflects the recommendations in the Swedish dietary guidelines (SDG) from 2015, produced developed by the Swedish Food Agency, which in turn are based on the Nordic Nutrition Recommendations from 2012. According to the SDG, it is recommended to eat more fiber, vegetables and fruits and fish, and less red meat and added sugars. The mentioned dietary components are all included in the NDS, with a range 0-5. A score of 1 was assigned to each component where the individual complied with the recommendation. Non-compliance was assigned a score of 0. The cutoff values for the recommendations are based on a previously validated Diet Quality Index, except for red meat (based on SDG) and added sugars (based on World Health Organization guidelines from 2015 for sugar intake).

We used conditional logistic regression analysis to study the relation between NDS, its components, and RA. The NDS was divided into categories, defined as low (0–1), moderate (2–3) and high (4-5), with “low” as reference, and also assessed as a continuous variable. All models were adjusted for reported total energy intake, and potential misreporters of total energy intake were excluded.

We designed multivariable-adjusted models in which we included covariates that had been associated with diet and RA (smoking, alcohol and leisure time physical activity).

Results

In the study population, 172 RA cases were identified. Low red meat intake (<500 g/week) was significantly associated with a decreased risk of RA (Table 1). Compliance with the recommendations for intake of fiber and vegetables and fruit were inversely associated with RA, with a similar trend for the total NDS (Table). In additional multivariable analysis, including both variables and relevant confounders, compliance with recommendations for red meat intake (odds ratio (OR) 0.43; 95% CI 0.22-0.85) and for fiber intake (OR 0.53; 95% CI 0.30-0.94) were both associated with a reduced risk of RA.

Table 1.

Multivariable-adjusted odds ratios (ORs) describing the relation between New Diet Score (NDS) and its components and the risk of developing rheumatoid arthritis

Adjusted for reported energy intake, smoking, alcohol, leisure time physical activityNDS componentsRecommendationOR95% CI Fibre≥2.4 g/MJ0.510.29–0.90 Vegetables and fruits≥400 g/day0.550.32–0.95 Fish≥300 g/week1.250.76–2.05 Added sugar≤10 E%1.100.68–1.78 Red meat<500 g/week0.420.22–0.81NDS 0–11.00(Ref) 2–30.650.38–1.10 4–50.670.30–1.46 Per point increment0.820.67–1.00

Conclusion

These preliminary results indicate that low intake of red meat and higher fiber intake, in line with current recommendations, are independently associated with reduced risk of developing RA, suggesting that components found in meat and fiber-rich foods may affect very early disease mechanisms.

Disclosure of Interests

None declared.

Meal patterns across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study

OBJECTIVE

To characterize meal patterns across ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study.

DESIGN

Cross-sectional study utilizing dietary data collected through a standardized 24 h diet recall during 1995-2000. Eleven predefined intake occasions across a 24 h period were assessed during the interview. In the present descriptive report, meal patterns were analysed in terms of daily number of intake occasions, the proportion reporting each intake occasion and the energy contributions from each intake occasion.

SETTING

Twenty-seven centres across ten European countries.

SUBJECTS

Women (64 %) and men (36 %) aged 35-74 years (n 36 020).

RESULTS

Pronounced differences in meal patterns emerged both across centres within the same country and across different countries, with a trend for fewer intake occasions per day in Mediterranean countries compared with central and northern Europe. Differences were also found for daily energy intake provided by lunch, with 38-43 % for women and 41-45 % for men within Mediterranean countries compared with 16-27 % for women and 20-26 % for men in central and northern European countries. Likewise, a south-north gradient was found for daily energy intake from snacks, with 13-20 % (women) and 10-17 % (men) in Mediterranean countries compared with 24-34 % (women) and 23-35 % (men) in central/northern Europe.

CONCLUSIONS

We found distinct differences in meal patterns with marked diversity for intake frequency and lunch and snack consumption between Mediterranean and central/northern European countries. Monitoring of meal patterns across various cultures and populations could provide critical context to the research efforts to characterize relationships between dietary intake and health.

Dietary intakes and food sources of phytoestrogens in the European Prospective Investigation into Cancer and Nutrition (EPIC) 24-hour dietary recall cohort

BACKGROUND/OBJECTIVES

Phytoestrogens are estradiol-like natural compounds found in plants that have been associated with protective effects against chronic diseases, including some cancers, cardiovascular diseases and osteoporosis. The purpose of this study was to estimate the dietary intake of phytoestrogens, identify their food sources and their association with lifestyle factors in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

SUBJECTS/METHODS

Single 24-hour dietary recalls were collected from 36,037 individuals from 10 European countries, aged 35-74 years using a standardized computerized interview programe (EPIC-Soft). An ad hoc food composition database on phytoestrogens (isoflavones, lignans, coumestans, enterolignans and equol) was compiled using data from available databases, in order to obtain and describe phytoestrogen intakes and their food sources across 27 redefined EPIC centres.

RESULTS

Mean total phytoestrogen intake was the highest in the UK health-conscious group (24.9 mg/day in men and 21.1 mg/day in women) whereas lowest in Greece (1.3 mg/day) in men and Spain-Granada (1.0 mg/day) in women. Northern European countries had higher intakes than southern countries. The main phytoestrogen contributors were isoflavones in both UK centres and lignans in the other EPIC cohorts. Age, body mass index, educational level, smoking status and physical activity were related to increased intakes of lignans, enterolignans and equol, but not to total phytoestrogen, isoflavone or coumestan intakes. In the UK cohorts, the major food sources of phytoestrogens were soy products. In the other EPIC cohorts the dietary sources were more distributed, among fruits, vegetables, soy products, cereal products, non-alcoholic and alcoholic beverages.

CONCLUSIONS

There was a high variability in the dietary intake of total and phytoestrogen subclasses and their food sources across European regions.

Food patterns, inflammation markers and incidence of cardiovascular disease: the Malmö Diet and Cancer study

OBJECTIVES

To examine the associations between food patterns constructed using cluster analysis and markers of systemic and vascular inflammation, and incident cardiovascular disease (CVD) after 13 years of follow-up.

DESIGN

Population-based, prospective cohort study.

SETTING AND SUBJECTS

Cluster analysis identified six food patterns from 43 food group variables among 4999 subjects, aged 45-68 years, who participated in the Malmö Diet and Cancer cardiovascular programme between 1991 and 1994. Lipoprotein-associated phospholipase A(2) (Lp-PLA(2) ), C-reactive protein concentration and white blood cell (WBC) count were measured using blood samples at baseline. Incidence of CVD (coronary events and ischaemic stroke) was monitored over 13 years of follow-up.

RESULTS

The fibre-rich bread pattern was associated with favourable effects on WBC count in women, and the low-fat and high-fibre pattern with favourable effects on Lp-PLA(2) mass in women, and on Lp-PLA(2) activity in men. However, the milk fat and sweets and cakes patterns were both associated with adverse effects; the former on WBC count in women and on Lp-PLA(2) mass in men, and the latter on WBC count and Lp-PLA(2) mass in women. The milk fat and sweets and cakes patterns were associated with increased CVD risk in women.

CONCLUSIONS

The results of this study support the present Nordic dietary recommendations indicating that diets rich in high-fibre, low-fat and low-sugar foods are favourably associated with markers of inflammation and, potentially, with CVD risk.

Bronchospasm induced by intravenous adenosine

1. Adenosine is well known to cause bronchoconstriction when inhaled, but to date, there has been only one report following the intravenous route. 2. Adenosine caused bronchoconstriction in two patients (the only two with asthma) out of 26 treated with the drug. In one subject the duration of response was much longer than previously reported following inhalation. 3. We suggest that adenosine may aggravate bronchospasm in some asthmatics and alternative treatments for supraventricular tachycardia should be considered in this group.