Clinical Review of Hereditary Angioedema: Diagnosis and Management

Hereditary Angioedema (HAE) is caused by a deficiency in C1 esterase inhibitor and is characterized by sudden attacks of edema associated with discomfort and pain. The disease places patients at risk for disability and death if left untreated. Symptom severity and frequency can be extremely variable even among affected members of the same family. Attacks are not associated with inflammation or allergy, with most occurring secondary to trauma or stress. Swelling can affect any part of the body or multiple sites at once. Commonly affected areas include the extremities, genitalia, trunk, gastrointestinal tract, face, and larynx. Swelling typically worsens over 24 to 36 hours and resolves within 48 hours in less severe cases. Attacks result in 15 000 to 30 000 emergency department visits each year. Many of these emergency cases will undergo unnecessary surgeries or medical procedures due to misdiagnosis. The hallmarks of HAE recurrent episodes of swelling without urticaria, a family history of HAE, first attack in childhood, and worsening at puberty can be identified by a thorough family history, and the diagnosis can be confirmed by laboratory studies. Nevertheless, diagnosis may be delayed by 2 decades. We review available therapies and clinical characteristics that will both help clinicians diagnose HAE and distinguish among emergencies and nonemergency cases.

Retraso incrementado desde el diagnóstico hasta el tratamiento en pacientes venezolanos con artritis reumatoide.

Despite a decrease in time from disease onset to diagnosis, patients of a recent cohort had increased delay in initiation of first DMARD compared with patients from an earlier cohort, increasing the risk for disability in Venezuelan RA patients.

Different diagnostic groups and labour market marginalization among refugee youths

Background Refugees are at increased risk of labor market marginalization (LMM), which is of high Public Health importance. However, little is known whether specific multimorbidity patterns increase the risk of LMM in this group. We sought to examine whether different diagnostic groups associate with subsequent unemployment and disability pension in refugee youth as compared to their counterparts born in Sweden. Methodology We analyzed 249,245 individuals between the age of 16 and 26 at 31.12.2011 from a combined Swedish registry. Refugees were matched to five second-generation-native-born Swedes. LMM was defined as disability pension or > 180 days of unemployment, 2012-2015. Relative risks (RR) were calculated for 114 diagnostic groups (2009-11) with regard to the two outcome measures. Results The mean age was 23±1.7 years, 2,841 (1.1%) received disability pension and 16,323 (6.5%) individuals experienced unemployment. The majority of diagnostic groups was associated with a higher risk for unemployment and a lower risk for disability pension in refugees. Hypertensive diseases and external causes of morbidity showed higher risk ratios of unemployment for refugees compared to Swedish-born: RRs (95% Confidence Interval) 6.8 (3.16, 14.6) and 6.31 (4.45, 8.94), respectively. Diabetes and mental disorders were associated with higher risk estimates for disability pension in refugees: RRs (95% CI) 2.4 (1.02, 5.6) and 1.8 (0.80, 3.9), respectively. Conclusions Diagnoses are differentially associated with LMM in refugee youth as compared to Swedish-born individuals. In order to prevent LMM in refugees, early intervention for the identified diseases is important. Key message The importance of diagnostic groups for subsequent LMM differs for young refugees and Swedish-born individuals. Findings are also divergent regarding the measure of LMM.

Mobility Improvements Are Found in Older Veterans After 6 Months of Gerofit Regardless of Body Mass Index Classification

Veterans represent a unique population of older adults, as they are more likely to self-report a disability and be overweight or obese compared with the general population. We sought to compare changes in mobility function across the obesity spectrum in older veterans participating in 6 months of Gerofit, a clinical exercise program. A total of 270 veterans (mean age: 74 years) completed baseline, 3-, and 6-month mobility assessments and were divided post hoc into groups: normal weight, overweight, and obese. The mobility assessments included 10-m walk time, 6-min walk distance, 30-s chair stands, and 8-foot up-and-go time. No significant weight × time interactions were found for any measure. However, clinically significant improvements of 7–20% were found for all mobility measures from baseline to 3 months and maintained at 6 months (all ps < .05). Six months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility in older veterans at high risk for disability, regardless of weight status.

Company-level determinants of disability retirement: a multilevel study of Finnish private sector workplaces

Background We examined whether the risk for disability retirement varies between companies over and above the individual-level characteristics of their employees and which company-level characteristics are associated with the risk for any, full or partial disability retirement. Methods A 30% random sample of Finnish private sector companies with at least 10 employees was used (5567 companies and 301 313 employees). The risk for disability retirement over 6 years was analyzed using multilevel logistic regression. Company size and industry, as well as gender, age, education and social class measured both at the individual- and the company-level were used as explanatory variables. Results 3.8% of the variance in the risk for disability retirement was attributed to the company level after controlling for individual-level characteristics of the employees. Company-level variance was much larger in partial (11.7%) than in full (4.2%) disability retirement. After controlling for all individual- and company-level characteristics, those working in health and social work activities had increased risk for both full and partial disability retirement. The risk for full disability retirement increased by decreasing educational level of the company. The risk for partial disability retirement increased by increasing company size and was elevated in companies with the highest proportion of women. Conclusions After controlling for the individual-level characteristics, variation in the risk for disability retirement between companies was modest. The more substantial variation in partial disability pension suggests that companies have a marked role in advancing working with partial disabilities.