No abstract

Background Data on comorbidities in children on kidney replacement therapy (KRT) is scarce. Considering their high relevance for prognosis and treatment, this study aims to analyse the prevalence and implications of comorbidities in European children on KRT. Methods We included data from patients aged < 20 years when commencing KRT from 2007 to 2017 from 22 European countries within the ESPN/ERA Registry. Differences between patients with or without comorbidities in access to kidney transplantation (KT), patient and graft survival were estimated using Cox regression. Results Comorbidities were present in 33% of the 4127 children commencing KRT, and the prevalence steadily increased by 5% annually since 2007. Comorbidities were most frequent in high-income countries (43% vs. 24% in low-income and 33% in middle-income countries). Patients with comorbidities had a lower access to transplantation (aHR 0.67, 95% CI: 0.61–0.74), and a higher risk of death (aHR 1.79; 95% CI: 1.38–2.32). The increased mortality was only seen in dialysis patients (aHR 1.60; 95% CI: 1.21–2.13), and not after KT. For both outcomes, the impact of comorbidities was stronger in low-income countries. Graft survival was not affected by presence of comorbidities (aHR for 5-year graft failure: 1.18, 95% CI: 0.84–1.65). Conclusions Comorbidities have become more frequent in children on KRT and reduce their access to transplantation and survival, especially when remaining on dialysis. KT should be considered as an option in all paediatric KRT patients and efforts should be made to identify modifiable barriers to KT for children with comorbidities.

Background Emotional stress in police officers has been recognized as a modifiable risk factor for cardiovascular disease (CVD). The impact of stress on health, however, is determined by characteristics of the stress stimulus. For example, distinct responses may be induced by acute vs. chronic aversive stimuli. A systematic review of literature has so far not addressed the problem. Methods Studies published in English between January and December 2016 reported by PubMed, Isi Web of Science, CINAHL and PsychInfo were retrieved according to the PRISMA statement. Results The search resulted in 752 records. 16 studies fulfilled the inclusion criteria and were retrieved. The epidemiological design was cross-sectional (12 studies), or longitudinal (4 studies). Studies were of medium (7) or low (9) quality according the Newcastle Ottawa Scale. Small sample size, lack of controls and selection bias were the most common weaknesses. An association between chronic psychosocial stress and the development of CV risk factors was generally supported. In particular, cross-sectional studies supported the association of perceived stress with hypertension, hypertriglyceridemia, and obesity. Studies on work-related stress, however, showed conflicting results. Results were generally inconsistent with regard to definitions and measurement of perceived or work-related stress, features of individual study design, study conduct and conclusions drawn. Conclusions Due to the lack of longitudinal studies, and the heterogeneity of cross-sectional observations, the evidence of the association between stress and CV disease or CV risk factors in police officers is limited. A sound precautionary principle would be to adopt worksite health promotion programs designed to implement stress management strategies and improve the lifestyle and eating habits of this category of workers.

The aim of the study was to investigate the body weight models among adolescents school students. Overweight

Background: Highly active antiretroviral therapy (HAART) treatments, particularly those comprising protease inhibitors have been demonstrated to cause, in a majority of HIV-infected individuals