Patient-Physician Agreement in Reporting and Prioritizing Existing Chronic Conditions

Restricted linear association between night sleep duration and diabetes risk in middle-aged and older adults: a 7-year follow-up analysis from the China health and retirement longitudinal study

Background

A rapid increase in the prevalence of diabetes is an urgent public health concern among older adults, especially in developing countries such as China. Despite several studies on lifestyle factors causing diabetes, sleep, a key contributor, is understudied. Our study investigates the association between night sleep duration and diabetes onset over a 7-year follow-up to fill information gaps.

Method

A population-based cohort study with 5437 respondents used 2011-2018 China Health and Retirement Longitudinal Study data. Using self-reported night sleep duration from the 2011 baseline survey, information on new-onset diabetes was collected in follow-up surveys. Baseline characteristics of participants with vs. without new-onset diabetes were compared using Chi-square and Mann-Whitney U tests. Multivariable Cox regression models estimated the independent relationship between night sleep and new-onset diabetes. The addictive Cox regression model approach and piece-wise regression described the nonlinear relationship between night sleep and new-onset diabetes. Subgroup analysis was also performed by age, gender, body measurement index, dyslipidemia, drinking status, smoking, hypertension, and afternoon napping duration.

Result

549 respondents acquired diabetes during a median follow-up of 84 months. After controlling for confounders, night sleep duration was substantially linked with new-onset diabetes in the multivariable Cox regression model. The risk of diabetes is lower for respondents who sleep longer than 5 hours, except for those who sleep over 8 hours [5.1-6h Hazard ratios (HR) [95% confidence intervals (CI)] = 0.71 (0.55, 0.91); 6.1-7h HR = 0.69 (0.53, 0.89); 7.1-8h HR = 0.58 (0.45, 0.76)]. Nonlinear connections were delineated by significant inflection points at 3.5 and 7.5 hours, with a negative correlation observed only between these thresholds. With one hour more night sleep, the risk of diabetes drops 15%. BMI and dyslipidemia were identified as modifiers when only consider the stand linear effect of sleep duration on diabetes.

Conclusion

This study establishes a robust association between night sleep and new-onset diabetes in middle-aged and older Chinese individuals within the 3.5-7.5-hour range, offering a foundation for early glycemic management interventions in this demographic. The findings also underscore the pivotal role of moderate night sleep in preventing diabetes, marking a crucial juncture in community medical research.

Drug-related problems reported by patients with rheumatic diseases: an observational study

BACKGROUND

Drug-related problems can negatively influence treatment outcome and well-being for patients with rheumatic diseases. Thus, it is important to support patients in preventing or resolving drug-related problems as quickly as possible. To effectively develop interventions for this purpose, knowledge on the frequency and character of drug-related problems is needed. Therefore, this study aims to quantify and characterize drug-related problems reported by patients with inflammatory rheumatic diseases along their treatment process.

METHODS

A prospective observational study was conducted in a Dutch outpatient pharmacy. Adult patients with rheumatic diseases that were prescribed medication by a rheumatologist were questioned about experienced DRPs by telephone 4 times in 8 weeks using a structured interview-guide. Patient-reported DRPs were scored on uniqueness (i.e., if a specific DRP was reported in multiple interviews by one individual, this was counted as one unique DRP) and were categorized using a classification for patient-reported DRPs and analysed descriptively.

RESULTS

In total, 52 participants (median age 68 years (interquartile range (IQR) 62-74), 52% male) completed 192 interviews with 45 (87%) participants completing all 4 interviews. The majority of patients (65%) were diagnosed with rheumatoid arthritis. Patients reported a median number of 3 (IQR 2-5) unique DRPs during interview 1. In subsequent interviews, patients reported median numbers of 1 (IQR 0-2), 1 (IQR 0-2) and 0 (IQR 0-1) unique DRPs for interviews 2-4 respectively. Participants reported a median number of 5 (IQR 3-9) unique DRPs over all completed interviews. Unique patient-reported DRPs were most frequently categorized into (suspected) side effects (28%), medication management (e.g., medication administering or adherence) (26%), medication concerns (e.g., concerns regarding long-term side-effects or effectiveness) (19%) and medication effectiveness (17%).

CONCLUSIONS

Patients with rheumatic diseases report various unique DRPs with intervals as short as two weeks. These patients might therefore benefit from more continuous support in-between contact moments with their healthcare provider.

Risk of thyroid disorders in adult and childhood Hodgkin lymphoma survivors 40 years after treatment

Thyroid abnormalities are well reported following childhood treatment for Hodgkin Lymphoma (HL). Limited information exists for adult patients and after modern treatments. We analyzed risks of thyroid disorders in 237 female participants treated at the Royal Marsden Hospital 1970-2015. Multivariable analyses of risk according to treatment and time-related factors, survival analyses, and Cox regression modeling were undertaken. Overall, 33.8% of patients reported thyroid disorders (hypothyroidism 30.0% and thyroid nodules 6.8%). Cumulative prevalence was 42.9% by 40 years follow-up. Risks were greatest after supradiaphragmatic radiotherapy (RR = 5.0, p < 0.001), and increasing dose (RR = 1.03/Gy, p < 0.001). There was no association with a chemotherapy agent. Risks of thyroid disease were as raised following adult as childhood treatment. There was no trend in risk by decade of supradiaphragmatic radiotherapy treatment. Risks of thyroid disease after supradiaphragmatic radiotherapy are as great after adult as childhood treatment and persist after more recent treatment periods.

Electronic Health Records As a Platform for Audiological Research: Data Validity, Patient Characteristics, and Hearing-Aid Use Persistence Among 731,213 U.S. Veterans

OBJECTIVES

This article presents a summary of audiological, general health, and hearing aid (HA) outcome data in a large sample of U.S. Veterans receiving HAs. The current article also provides the foundation for a series of papers that will explore relationships between a wide range of factors and HA outcomes.

DESIGN

The patient sample is all (n = 731,213) patients for whom HAs were ordered between April 2012 and October 2014 through the U.S. Veterans Health Administration Remote Order Entry System. For these patients, Veterans Affairs electronic health records (EHRs) stored in various databases provided data on demographics, received diagnostic and procedure codes (2007 to 2017), audiometry, self-reported outcomes up to 6 months postfitting, and HA battery orders (to 2017). Data cleaning and preparation was carried out and is discussed with reference to insights that provide potential value to other researchers pursuing similar studies. HA battery order data over time was used to derive a measure of long-term HA use persistence. Descriptive statistics were used to characterize the sample, comparative analyses against other data supported basic validity assessment, and bivariate analyses probed novel associations between patient characteristics and HA use persistence at 2 years postfitting.

RESULTS

Following extensive cleaning and data preparation, the data show plausible characteristics on diverse metrics and exhibit adequate validity based on comparisons with other published data. Further, rates of HA use persistence are favorable when compared against therapy persistence data for other major chronic conditions. The data also show that the presence of certain comorbid conditions (Parkinson's disease, diabetes, arthritis, and visual impairment) are associated with significantly lower HA use persistence, as are prior inpatient admissions (especially among new HA recipients), and that increasing levels of multimorbidity, in general, are associated with decreasing HA use persistence. This is all despite the fact that deriving relevant audiological care-process variables from the available records was not straightforward, especially concerning the definition of the date of HA fitting, and the use of battery ordering data to determine long-term HA use persistence.

CONCLUSIONS

We have shown that utilizing EHRs in audiology has the potential to provide novel insights into clinical practice patterns, audiologic outcomes, and relations between factors pertaining to hearing and to other health conditions in clinical populations, despite the potential pitfalls regarding the lack of control over the variables available and limitations on how the data are entered. We thus conclude that research using EHRs has the potential to be an integral supplement to population-based and epidemiologic research in the field of audiology.