Validity of self-reports of reasons for hospitalization by young adults and risk factors for discordance with medical records: the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Reasons for Hospitalization while Receiving Dementia Care Coordination through Maximizing Independence at Home

OBJECTIVES

Persons living with dementia (PLWD), particularly those with higher levels of functional impairment, are at increased risk of hospitalization and higher hospital-associated health care costs. Our objective was to provide a nuanced description of reasons for hospitalizations over a 12-month period among community-living persons with dementia taking part in a dementia care coordination study using caregiver-reported data and to describe how reasons varied by disease stage.

DESIGN

Retrospective descriptive analysis of pooled data from 2 concurrent studies of PLWD receiving the MIND at Home dementia care coordination program.

SETTING AND PARTICIPANTS

Four hundred ninety-four community-dwelling PLWD with a family caregiver in the Greater Baltimore and Central Maryland region, 2015‒2019.

METHODS

PLWD sociodemographic, clinical, functional, cognitive, and behavioral characteristics were assessed during an in-home baseline visit. Caregiver-reported hospitalizations and primary reasons for events were recorded every 4.5 months by research staff and by memory care coordinators during program delivery for a 12-month period. Hospitalization event data were subsequently reviewed, reconciled, and coded by a trained investigator.

RESULTS

One hundred seventy PLWD (34.4%) had at least 1 hospitalization within 12 months of enrollment, with 316 separate events. The most common primary reason for hospitalization according to caregivers was infection (22.4%), falls (16.5%), and cardiovascular/pulmonary (12.4%). Top reasons for hospitalization were falls among persons with mild and moderate functional impairment (17.7% and 21.9% respectively) and infection among PLWD with severe impairment (30.3%).

CONCLUSIONS AND IMPLICATIONS

Infections and falls were the most common caregiver-reported reasons for hospitalization in PLWD receiving dementia care coordination. Reasons for hospitalization varied based on severity of functional impairment. Greater understanding of reasons for hospitalization among PLWD receiving dementia care management interventions, from multiple important perspectives, may help programs more effectively address and prevent hospitalization.

Relationship Between Obesity and Risk of Major Osteoporotic Fracture in Postmenopausal Women: Taking Frailty Into Consideration

The role of obesity in fracture risk remains uncertain and inconclusive in postmenopausal women. Our study aimed to assess the relationship between obesity and risk of major osteoporotic fracture (MOF; ie, a clinical fracture of upper arm or shoulder, hip, spine, or wrist) in postmenopausal women, after taking frailty into consideration. We used the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 5-year Hamilton cohort for this study. Frailty was measured by a frailty index (FI) of deficit accumulation at baseline. We incorporated an interaction term (obesity × FI) in the Cox proportional hazards regression model. We included 3985 women (mean age 69.4 years) for analyses, among which 29% were obese (n = 1118). There were 200 (5.02%) MOF events documented during follow-up: 48 (4.29%) in obese women and 152 (5.65%) in the nonobese group. Significant relationships between obesity, frailty, and MOF risk were found: hazard ratio (HR) = 0.72 (95% confidence interval [CI] 0.67-0.78) for those with an FI of zero regarding MOF risk among obese women, and HR = 1.34 (95% CI 1.11-1.62) per SD increase in the FI among nonobese women. The interaction term was also significant: HR = 1.16 (95% CI 1.02-1.34) per SD increase in the FI among obese women. Increased HRs were found with higher FIs regarding the relationship between obesity and MOF risk, indicating increasing frailty attenuated the protective effect of obesity. For example, although the HR for obesity and MOF risk among those who were not frail (FI = 0) was 0.72 (95% CI 0.67-0.78), among those who were very frail (FI = 0.70), the HR was 0.91 (95% CI 0.85-0.98). To conclude, after taking frailty into consideration, obesity was significantly associated with decreased risk of MOF in postmenopausal women among those who were not frail; however, increasing frailty attenuated this protective effect of obesity. Evaluating frailty status may aid in understanding of the complex relationship between obesity and fracture risk. © 2020 American Society for Bone and Mineral Research (ASBMR).

Enduring Cognitive and Linguistic Deficits in Individuals With a History of Concussion

Purpose The purpose of this research is to determine whether individuals with a history of concussion retain enduring differences in narrative writing tasks, which necessitate rapid and complex integration of both cognitive and linguistic faculties. Method Participants aged 12-40 years old, who did or did not have a remote history of concussion, were recruited to take an online survey that included writing both a familiar and a novel narrative. They also were asked to complete multiple tasks targeting word-level and domain general cognitive skills, so that their performance could be interpreted across these dimensions. Results Participants with a concussion history were largely similar to participants with no history of brain injury across tasks that targeted a single skill in isolation. However, participants with prior concussions demonstrated difficulty in providing both key content and details when presented with a novel video and asked to provide a summary of what they had just seen. Number of lifetime concussions predicted the inclusion of key content when summarizing the video. Thus, differences in cognitive and linguistic skills required for written narrative language may continue to be present far after concussion, despite average normative levels of performance on tasks targeting these skills in isolation. Conclusions These findings suggest that individuals with a concussion history, particularly a history of multiple concussions, may continue to experience difficulties for a long period after injury and are likely to benefit from more complex and ecologically valid assessment prior to discharge. Individuals with a concussion history who return to full participation in work, school, and recreational activities may continue to benefit from assistance when asked to rapidly acquire and distill novel information, as is often required in academic and professional environments.

Influence of Gender on Associations of Obstructive Sleep Apnea Symptoms with Chronic Conditions and Quality of Life

Women are less likely than men to be diagnosed with obstructive sleep apnea (OSA). We examined contemporary gender differences in symptoms, health status, and quality of life associated with diagnosed OSA and OSA symptoms in a population-based sample. A 2015 postal/on-line questionnaire of 2889 active participants of The North West Adelaide Health Study (response rate = 54%, male n = 704; female n = 856; age 30–100 years) assessed previously diagnosed OSA, OSA symptoms, insomnia, doctor-diagnosed medical conditions, and the SF-36. In weighted analyses, self-reported diagnosed OSA (men: 12.6%, n = 95; women: 3.3%, n = 27) and OSA symptoms (men: 17.1%; women: 9.7%) were more common in men. Diagnosed OSA showed stronger adjusted associations with typical OSA features in women, including obesity (women-odds ratio (OR), 95% CI: 5.7, 1.9–17.1, men: 2.2, 1.2–4.0), daytime sleepiness (women: 6.4, 2.7–15.6, men: 3.3, 2.1–5.4), and loud snoring (women: 25.4, 9.4–69.1, men: 8.7, 5.2–14.4). Diagnosed OSA was independently associated with cardiovascular disease (CVD) in men, and in women with high cholesterol, respiratory disease, insomnia, and reduced SF-36 Physical Component Summary score. In both sexes, OSA symptoms were significantly associated with depression, insomnia, and moderate to severe impairments in SF-36 physical and mental component summary scores. Diagnosed women showed clinical characteristics overtly related to OSA. A higher index of clinical suspicion of OSA may be required in women for a condition regarded as male-predominant to increase equity in health outcomes.

Modifying the Phenotypic Frailty Model in Predicting Risk of Major Osteoporotic Fracture in the Elderly

INTRODUCTION

The phenotypic frailty (PF) model (including slow walking, low physical activity, exhaustion, weakness, and unintentional weight loss) has been widely used to quantify the degree of frailty and predict risks of adverse health outcomes for the elderly. However, evidence has shown that not all the components included in the PF model contribute equally, and low predictive accuracy of the PF model has been reported in predicting risks of outcomes. We aimed to improve predictive accuracy of the PF model in risk of major osteoporotic fracture (MOF) in the elderly by modifying its weighting of individual components.

METHODS

Data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort were used for this study. We used the multivariable Cox regression model to identify the updated weighting for components in the original PF model. The goodness of fit and discrimination were assessed for model performances.

RESULTS

There were 3985 women included for analyses (mean age: 69.4 years). In the modified PF model, the updated weighting was 3 points for slowness and weakness, 2 points for weight loss, 1 point for poor endurance and exhaustion, and 1 point for low physical activity, respectively. The modified PF model could capture and categorize the future risk of MOF more accurately than the original model. Significant relationship between risks of MOF, falls, and death and the modified PF model was found. Compared with the original model, the modified PF model was a better fit to the data and with improved predictive accuracy.

CONCLUSION

Based on a simple and practical rescoring and recategorizing algorithm, the modified PF model could predict risks of adverse outcomes more accurately than the original model, reflecting a cost-effective way. More evidence is needed to validate the modified PF model and support its application in geriatric practice.

Frailty Change and Major Osteoporotic Fracture in the Elderly: Data from the Global Longitudinal Study of Osteoporosis in Women 3-Year Hamilton Cohort

Investigating the cumulative rate of deficits and the change of a frailty index (FI) chronologically is helpful in clinical and research settings in the elderly. However, limited evidence for the change of frailty before and after some nonfatal adverse health event such as a major osteoporotic fracture (MOF) is available. Data from the Global Longitudinal Study of Osteoporosis in Women 3-Year Hamilton cohort were used in this study. The changes of FI before and after onset of MOF were compared between the women with and without incident MOF. We also evaluated the relationship between risk of MOF, falls, and death and the change of FI and the absolute FI measures. There were 3985 women included in this study (mean age 69.4 years). The change of FI was significantly larger in the women with MOF than those without MOF at year 1 (0.085 versus 0.067, p = 0.036) and year 2 (0.080 versus 0.052, p = 0.042) post-baseline. The FI change was not significantly related with risk of MOF independently of age. However, the absolute FI measures were significantly associated with increased risk of MOF, falls, and death independently of age. In summary, the increase of the FI is significantly larger in the elderly women experiencing a MOF than their peer controls, indicating their worsening frailty and greater deficit accumulation after a MOF. Measures of the FI change may aid in the understanding of cumulative aging nature in the elderly and serve as an instrument for intervention planning and assessment.

How Reliable are Patient-Reported Rehospitalizations? Implications for the Design of Future Practical Clinical Studies

Background

Longitudinal clinical investigations often rely on patient reports to screen for postdischarge adverse outcomes events, yet few studies have examined the accuracy of such patient reports.

Methods and Results

Patients with acute myocardial infarction (MI) in the TRANSLATE‐ACS study were asked during structured interviews at 6 weeks, 6 months, and 12 months postdischarge to report any rehospitalizations. The accuracy of patient‐reported rehospitalizations within 1 year of postdischarge was determined using claims‐based medical bill validation as the reference standard. The cumulative incidence of rehospitalizations was compared when identified by patient report versus medical bills. Patients were categorized by the accuracy in reporting events (accurate, under‐, or over‐ reporters) and characteristics were compared between groups. Among 10 643 MI patients, 4565 (43%) reported 7734 rehospitalizations. The sensitivity and positive predictive value of patient‐reported rehospitalizations were low at 67% and 59%, respectively. A higher cumulative incidence of rehospitalization was observed when identified by patient report versus medical bills (43% vs 37%; P<0.001). Overall, 18% of patients over‐reported and 10% under‐reported the number of hospitalizations. Compared with accurate reporters, under‐reporters were more likely to be older, female, African American, unemployed, or a non‐high‐school graduate, and had greater prevalence of clinical comorbidities such as diabetes and past cardiovascular disease.

Conclusions

The accuracy of patient‐reported rehospitalizations was low with patients both under‐ and over‐reporting events. Longitudinal clinical research studies need additional mechanisms beyond patient report to accurately identify rehospitalization events.

Clinical Trial Registration

URL: https://clinicaltrials.gov. Unique identifier: NCT01088503.

Health Behavior Change after Blood Pressure Feedback

Better understanding is needed for antihypertensive medication initiation and lifestyle modification among younger populations with elevated blood pressure. This study aimed to assess health behavior change after receiving a report of elevated blood pressure among African Americans and Caucasians younger than 50 years old. We used the Coronary Artery Risk Development in Young Adults (CARDIA) repository dataset. By examination year twenty, 424 out of 2,478 Caucasian and 2,637 African American participants had received feedback from the CARDIA study due to elevated blood pressure readings. Blood pressure was measured by trained CARDIA researchers at the participant's home and was repeatedly recorded at seven examinations over twenty years. A feedback/referral letter was sent to participants with an elevated blood pressure reading. On average, participants first had an elevated blood pressure reading at the age of 34. After receiving the feedback letter, 44% of the previously undiagnosed participants received a formal diagnosis. In addition, 23% initiated the use of antihypertensive medication if they had not received medication treatment before. Among the participants with at-risk lifestyle behaviors, 40% reduced alcohol consumption, 14% increased exercise level, 11% stopped smoking, and 8% reached normal weight. While none of the studied patient factors were associated with lifestyle modification, age had a positive impact on antihypertensive medication initiation (p<0.05). We found no evidence of differences in health behavior change between African American and Caucasian participants after receiving the feedback letter. This research is one of the first to study what followed after receiving a feedback letter about elevated blood pressure outside of healthcare settings. Although additional referral care and behavior interventions are needed to facilitate medication initiation and lifestyle modification, our observations suggest that providing blood pressure feedback may have promise as part of a multi-method approach involving blood pressure screening and follow up.

Excess non-psychiatric hospitalizations among employees with mental disorders: a 10-year prospective study of the GAZEL cohort

OBJECTIVE

To examine whether non-psychiatric hospitalizations rates were higher in those with mental disorders.

METHOD

In a cohort of 15,811 employees, aged 35-50 years in 1989, mental disorder status was defined from 1989 to 2000. Hospitalizations for all-causes, myocardial infarction (MI), stroke, and cancer, were recorded yearly from 2001 to 2011. Negative binomial regression models were used to estimate hospitalization rates over the follow-up.

RESULTS

After controlling for baseline sociodemographic factors, health-related behaviors, self-rated health, and self-reported medical conditions, participants with a mental disorder had significantly higher rates of all-cause hospitalization [incidence rate ratio, IRR=1.20 (95%, 1.14-1.26)], as well as hospitalization due to MI [IRR=1.44 (95%, 1.12-1.85)]. For stroke, the IRR did not reach statistical significance [IRR=1.37 (95%, 0.95-1.99)] and there was no association with cancer [IRR=1.01 (95%, 0.86-1.19)]. A similar trend was observed when mental disorders groups were considered (no mental disorder, depressive disorder, mental disorders due to psychoactive substance use, other mental disorders, mixed mental disorders, and severe mental disorder).

CONCLUSION

In this prospective cohort of employees with stable employment as well as universal access to healthcare, we found participants with mental disorders to have higher rates of non-psychiatric hospitalizations.

Comparison between frailty index of deficit accumulation and phenotypic model to predict risk of falls: data from the global longitudinal study of osteoporosis in women (GLOW) Hamilton cohort

OBJECTIVES

To compare the predictive accuracy of the frailty index (FI) of deficit accumulation and the phenotypic frailty (PF) model in predicting risks of future falls, fractures and death in women aged ≥55 years.

METHODS

Based on the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort (n = 3,985), we compared the predictive accuracy of the FI and PF in risks of falls, fractures and death using three strategies: (1) investigated the relationship with adverse health outcomes by increasing per one-fifth (i.e., 20%) of the FI and PF; (2) trichotomized the FI based on the overlap in the density distribution of the FI by the three groups (robust, pre-frail and frail) which were defined by the PF; (3) categorized the women according to a predicted probability function of falls during the third year of follow-up predicted by the FI. Logistic regression models were used for falls and death, while survival analyses were conducted for fractures.

RESULTS

The FI and PF agreed with each other at a good level of consensus (correlation coefficients ≥ 0.56) in all the three strategies. Both the FI and PF approaches predicted adverse health outcomes significantly. The FI quantified the risks of future falls, fractures and death more precisely than the PF. Both the FI and PF discriminated risks of adverse outcomes in multivariable models with acceptable and comparable area under the curve (AUCs) for falls (AUCs ≥ 0.68) and death (AUCs ≥ 0.79), and c-indices for fractures (c-indices ≥ 0.69) respectively.

CONCLUSIONS

The FI is comparable with the PF in predicting risks of adverse health outcomes. These findings may indicate the flexibility in the choice of frailty model for the elderly in the population-based settings.

Change in physical activity after smoking cessation: the Coronary Artery Risk Development in Young Adults (CARDIA) study

AIMS

To estimate physical activity trajectories for people who quit smoking, and compare them to what would have been expected had smoking continued.

DESIGN, SETTING AND PARTICIPANTS

A total of 5115 participants in the Coronary Artery Risk Development in Young Adults Study (CARDIA) study, a population-based study of African American and European American people recruited at age 18-30 years in 1985/6 and followed over 25 years.

MEASUREMENTS

Physical activity was self-reported during clinical examinations at baseline (1985/6) and at years 2, 5, 7, 10, 15, 20 and 25 (2010/11); smoking status was reported each year (at examinations or by telephone, and imputed where missing). We used mixed linear models to estimate trajectories of physical activity under varying smoking conditions, with adjustment for participant characteristics and secular trends.

FINDINGS

We found significant interactions by race/sex (P = 0.02 for the interaction with cumulative years of smoking), hence we investigated the subgroups separately. Increasing years of smoking were associated with a decline in physical activity in black and white women and black men [e.g. coefficient for 10 years of smoking: -0.14; 95% confidence interval (CI) = -0.20 to -0.07, P < 0.001 for white women]. An increase in physical activity was associated with years since smoking cessation in white men (coefficient 0.06; 95% CI = 0 to 0.13, P = 0.05). The physical activity trajectory for people who quit diverged progressively towards higher physical activity from the expected trajectory had smoking continued. For example, physical activity was 34% higher (95% CI = 18 to 52%; P < 0.001) for white women 10 years after stopping compared with continuing smoking for those 10 years (P = 0.21 for race/sex differences).

CONCLUSIONS

Smokers who quit have progressively higher levels of physical activity in the years after quitting compared with continuing smokers.

Frailty index of deficit accumulation and falls: data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton cohort

Background

To investigate the association between frailty index (FI) of deficit accumulation and risk of falls, fractures, death and overnight hospitalizations in women aged 55 years and older.

Methods

The data were from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton Cohort. In this 3-year longitudinal, observational cohort study, women (N = 3,985) aged ≥55 years were enrolled between May 2008 and March 2009 in Hamilton, Canada. A FI including co-morbidities, activities of daily living, symptoms and signs, and healthcare utilization was constructed using 34 health deficits at baseline. Relationship between the FI and falls, fractures, death and overnight hospitalizations was examined.

Results

The FI was significantly associated with age, with a mean rate of deficit accumulation across baseline age of 0.004 or 0.021 (on a log scale) per year. During the third year of follow-up, 1,068 (31.89%) women reported at least one fall. Each increment of 0.01 on the FI was associated with a significantly increased risk of falls during the third year of follow-up (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.02-1.03). The area under the curve (AUC) of the predictive model was 0.69 (95% CI: 0.67-0.71). Results of subgroup and sensitivity analyses indicated the relationship between the FI and risk of falls was robust, while bootstrap analysis judged its internal validation. The FI was significantly related to fractures (hazard ratio [HR]: 1.02, 95% CI: 1.01-1.03), death (OR: 1.05, 95% CI: 1.03-1.06) during the 3-year follow-up period and overnight hospitalizations (incidence rate ratio [IRR]: 1.02, 95% CI: 1.02-1.03) for an increase of 0.01 on the FI during the third year of follow-up. Measured by per standard deviation (SD) increment of the FI, the ORs were 1.21 and 1.40 for falls and death respectively, while the HR was 1.17 for fractures and the IRR was 1.18 for overnight hospitalizations respectively.

Conclusion

The FI of deficit accumulation increased with chronological age significantly. The FI was associated with and predicted increased risk of falls, fractures, death and overnight hospitalizations significantly.

Asthma is associated with cardiovascular disease in a representative population sample

SUMMARY

RATIONALE

People with asthma may have an increased risk of cardiovascular disease (CVD) and metabolic disorders due to the direct involvement of common inflammatory mediators in the pathogenesis of CVD and insulin resistance. The aim of this study was to determine whether asthma was associated with an increased prevalence of CVD/stroke, and diabetes in a cross-sectional population study and whether the relationship was modified by obesity.

METHODS

The North West Adelaide Health Study (NWAHS) (n = 4060, age ≥18 years) clinical assessment included spirometry, anthropometry, blood pressure, fasting lipids, glucose and HbA1c. Questionnaires assessed doctor diagnosed asthma, diabetes, CVD (myocardial infarction, angina)/stroke, smoking status, and demographics. Asthma was identified by self-report or significant bronchodilator reversibility of lung function.

RESULTS

After adjustment for known risk factors and confounders, asthma was not associated with diabetes (odds ratio (OR) = 1.06, 95% confidence interval (CI): 0.45-2.49, p = .91) yet remained positively associated with CVD/stroke (OR = 1.82, 95% CI: 1.20-2.73, p < 0.01) independent of the level of BMI (p for interaction between asthma and BMI = .22), smoking and lung function. Asthma was not positively associated with CVD risk factors or the metabolic syndrome.

CONCLUSIONS

In a representative population sample, asthma was associated with CVD/stroke after adjustment for traditional risk factors and lung function. Asthma may lead to CVD events via pathways unrelated to traditional risk factors and this requires further investigation. No significant effect modification by BMI was observed in relation to CVD, or diabetes.

Five-factor model personality traits as predictors of incident coronary heart disease in the community: a 10.5-year cohort study based on the Baltimore epidemiologic catchment area follow-up study

OBJECTIVE

Certain personality and behavioral traits (e.g., type A and type D) have been reported to be associated with development and progression of coronary heart disease (CHD), but few have examined the relationship using a comprehensive assessment of personality along with a structured assessment of psychiatric disorders.

METHODS

Based on participants (age: 47.3 ± 12.8; female: 62.6%) of the Baltimore Epidemiologic Catchment Area follow-up study, we examined the relationship between the 5 major domains of personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and incident CHD between Wave III (1993-1996) and Wave IV (2004-2005).

RESULTS

Incident CHD developed in 65 participants during the follow-up. Those with incident CHD had lower on openness (44.06 ± 9.29 vs. 47.18 ± 8.80; p = 0.007) and extraversion (45.98 ± 9.25 vs. 49.12 ± 8.92; p = 0.007) scores than those without. Logistic regression models revealed an inverse association (OR = 0.73; 95% CI = 0.54-0.98) between openness factor z-scores and incident CHD after adjusting for putative confounding factors, including DSM III-R Major Depressive Disorder.

CONCLUSION

High openness appears to be an independent protective factor for incident CHD in the community. Future studies should examine behavioral and pathophysiologic mechanisms underlying this association.

Attempts at the practical on-road driving test and the hazard perception test and the risk of traffic crashes in young drivers

OBJECTIVE

This study separately examined the impact of the outcomes of a practical on-road driving test and a hazard perception test on the likelihood of traffic crashes among a cohort of newly licensed young drivers in New South Wales (NSW), Australia.

METHODS

The DRIVE study is a prospective cohort study of drivers aged 17 to 24 years holding their first-year provisional driver license in NSW. Information obtained from 20,822 participants in a detailed baseline questionnaire was linked to information on the number of attempts at a mandatory practical on-road driving test and hazard perception test as well as police-reported traffic crashes.

RESULTS

After controlling for a number of sociodemographic and behavioral factors as well as factors related to driver learning experiences, multivariate analysis showed that those who failed the practical on-road test at least 4 times had an increased risk of involvement in a traffic crash compared to those who passed the test at first attempt (relative risk [RR]: 1.79, 95% confidence interval [CI]: 1.20-2.65). The crash risk among those who failed the practical on-road test at least 4 times was particularly high in females (RR: 2.10, 95% CI: 1.20-3.68). Similarly, those who failed the hazard perception test at least twice had an increased risk of involvement in a traffic crash (RR: 1.83, 95% CI: 1.27-2.63) compared to those who passed the test on the first attempt. The crash risk of those who failed the hazard perception test at least twice was particularly high in males (RR: 2.5, 95% CI: 1.5-4.1) and among those from rural and remote areas (RR: 5.53, 95% CI: 1.63-18.71).

CONCLUSIONS

The findings have implications on licensing practices and suggest the need for adequate strategies to assist young drivers with multiple failures in the driving and hazard perception tests.

A survey of acute self-reported infections in pregnancy

OBJECTIVE

The objective of this study was to estimate the weekly prevalence of self-reported recently acquired infections in women at least 20 weeks pregnant.

DESIGN

We conducted a cross-sectional survey of pregnant women in a hospital antenatal clinic in Sydney, Australia between August 2008 and April 2009. Women were asked to report whether they had onset of a new infection in the 7 days before completing the questionnaire, and were asked for details of symptoms and medication taken.

RESULTS

737 women at least 20 weeks pregnant completed the survey (94% of women approached). Five per cent of the completed questionnaires reported the onset of an infection in the 7 days prior to survey completion. When symptoms were analysed, 3.5% of women were classified as having a moderate or severe infection in the past 7 days. The most common infection reported was a cold/upper respiratory tract infection followed by gastroenteritis. Women pregnant with their first child had a lower rate of self-reported infection than women who had other children (2.9% vs 7.2%).

CONCLUSIONS

These results can be used to inform future research examining acute infection as a trigger for pregnancy complications.

Cardiovascular disease risk associated with asthma and respiratory morbidity might be mediated by short-acting beta2-agonists

BACKGROUND

Studies examining the asthma-related risks of cardiovascular disease (CVD) events have generally used selected samples or did not control for the effects of beta(2)-agonist use, itself associated with CVD events.

OBJECTIVES

We assessed the relationship between incident CVD/stroke and asthma and the effect of atopy while controlling for beta(2)-agonist use in a representative adult population cohort free of CVD at baseline.

METHODS

The North West Adelaide Health Study (stage 1, n = 3812; stage 2, n = 3113) assessed spirometry, anthropometry, atopy, blood pressure, and lipid levels. Questionnaires assessed doctor-diagnosed asthma and CVD (myocardial infarction and angina)/stroke, smoking status, and demographics. Asthma was defined by self-report or FEV(1) reversibility. Current short- and long-acting beta(2)-agonist use was identified at follow-up.

RESULTS

Results are expressed as odds ratios (ORs) and 95% CIs. By using multivariable logistic regression, after adjustment for risk factors, in female subjects incident CVD/stroke events were associated with asthma (OR, 3.24; 95% CI, 1.55-6.78), with no effect modification by atopy (P for interaction = .61), and with as-required short-acting beta(2)-agonist use (OR, 2.66; 95% CI, 1.06-6.61). In male subjects events were associated with daily cough/sputum (OR, 1.92; 95% CI, 1.05-3.50) and FEV(1) of less than 80% of predicted value but an FEV(1)/forced vital capacity ratio of greater than 0.70 (OR, 2.15; 95% CI, 0.91-5.09; P = .08). Although few CVD/stroke events occurred in male subjects with asthma, a significant interaction with atopic status was found (P = .05).

CONCLUSIONS

Studies are required to elucidate how asthma exposes older women to excess macrovascular risk and prospectively determine the short-acting beta(2)-agonist-related risk in persons without existing CVD. CVD risk in relation to atopic status of asthma also requires further investigation.

Challenges of self-reported medical conditions and electronic medical records among members of a large military cohort

Background

Self-reported medical history data are frequently used in epidemiological studies. Self-reported diagnoses may differ from medical record diagnoses due to poor patient-clinician communication, self-diagnosis in the absence of a satisfactory explanation for symptoms, or the "health literacy" of the patient.

Methods

The US Department of Defense military health system offers a unique opportunity to evaluate electronic medical records with near complete ascertainment while on active duty. This study compared 38 self-reported medical conditions to electronic medical record data in a large population-based US military cohort. The objective of this study was to better understand challenges and strengths in self-reporting of medical conditions.

Results

Using positive and negative agreement statistics for less-prevalent conditions, near-perfect negative agreement and moderate positive agreement were found for the 38 diagnoses.

Conclusion

This report highlights the challenges of using self-reported medical data and electronic medical records data, but illustrates that agreement between the two data sources increases with increased surveillance period of medical records. Self-reported medical data may be sufficient for ruling out history of a particular condition whereas prevalence studies may be best served by using an objective measure of medical conditions found in electronic healthcare records. Defining medical conditions from multiple sources in large, long-term prospective cohorts will reinforce the value of the study, particularly during the initial years when prevalence for many conditions may still be low.