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Okazaki T, Nabeshima T, Santanda T, Hoshina Y, Kondo Y, Yaegashi Y, Nakazawa T, Tokuda Y, Norisue Y. Association of Relative Dysglycemia With Hospital Mortality in Critically Ill Patients: A Retrospective Study. Crit Care Med 2024:00003246-990000000-00329. [PMID: 38656278 DOI: 10.1097/ccm.0000000000006313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Relative dysglycemia has been proposed as a clinical entity among critically ill patients in the ICU, but is not well studied. This study aimed to clarify associations of relative hyperglycemia and hypoglycemia during the first 24 hours after ICU admission with in-hospital mortality and the respective thresholds. DESIGN A single-center retrospective study. SETTING An urban tertiary hospital ICU. PATIENTS Adult critically ill patients admitted urgently between January 2016 and March 2022. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Maximum and minimum glycemic ratio (GR) was defined as maximum and minimum blood glucose values during the first 24 hours after ICU admission divided by hemoglobin A1c-derived average glucose, respectively. Of 1700 patients included, in-hospital mortality was 16.9%. Nonsurvivors had a higher maximum GR, with no significant difference in minimum GR. Maximum GR during the first 24 hours after ICU admission showed a J-shaped association with in-hospital mortality, and a mortality trough at a maximum GR of approximately 1.12; threshold for increased adjusted odds ratio for mortality was 1.25. Minimum GR during the first 24 hours after ICU admission showed a U-shaped relationship with in-hospital mortality and a mortality trough at a minimum GR of approximately 0.81 with a lower threshold for increased adjusted odds ratio for mortality at 0.69. CONCLUSIONS Mortality significantly increased when GR during the first 24 hours after ICU admission deviated from between 0.69 and 1.25. Further evaluation will necessarily validate the superiority of personalized glycemic management over conventional management.
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Affiliation(s)
- Tomoya Okazaki
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Tadanori Nabeshima
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Takushi Santanda
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Yuiko Hoshina
- Strategic Planning and Analysis Division, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Yuki Kondo
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Yu Yaegashi
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Taichi Nakazawa
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Project for Okinawa Residency Programs, Urasoe, Okinawa, Japan
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
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Santos DAM, Siciliano RF, Besen BAMP, Strabelli TMV, Sambo CT, Milczwski VDM, Goldemberg F, Tarasoutchi F, Vieira MLC, Paixão MR, Gualandro DM, Accorsi TAD, Pomerantzeff PMA, Mansur AJ. Changing trends in clinical characteristics and in-hospital mortality of patients with infective endocarditis over four decades. J Infect Public Health 2024; 17:712-718. [PMID: 38484416 DOI: 10.1016/j.jiph.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Infective endocarditis continues to be a significant concern and may be undergoing an epidemiological transition. METHODS Were studied 1804 consecutive episodes of infective endocarditis between 1978 and 2022. The mean age was 48 ( ± 19), and 1162 (64%) patients were male. Temporal trends in demographic data, comorbidities, predisposing conditions, microorganisms, complications and in-hospital death have been studied over the decades (1978-1988, 1989-1999, 2000-2010 and 2011-2022). The outcomes and clinical characteristics were modeled using nonlinear cubic spline functions. FINDINGS Valve surgery was performed in 50% of the patients and overall in-hospital mortality was 30%. From the first to the fourth decade studied, the average age of patients increased from 29 to 57 years (p < 0.001), with significant declines in the occurrence of rheumatic valvular heart disease (15% to 6%; p < 0.001) and streptococcal infections (46% to 33%; p < 0.001). Healthcare-associated infections have increased (9% to 21%; p < 0.001), as have prosthetic valve endocarditis (26% to 53%; p < 0.001), coagulase-negative staphylococcal infections (4% to 11%; p < 0.001), and related-complications (heart failure, embolic events, and perivalvular abscess; p < 0.001). These changes were associated with a decline in adjusted in-hospital mortality from 34% to 25% (p = 0.019). INTERPRETATION In the 44 years studied, there was an increase in the mean age of patients, healthcare-related, prosthetic valve, coagulase-negative staphylococci/MRSA infections, and related complications. Notably, these epidemiological changes were associated with a decline in the adjusted in-hospital mortality.
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Affiliation(s)
- Diego Augusto Medeiros Santos
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Rinaldo Focaccia Siciliano
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Tania Mara Varejão Strabelli
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caio Trevelin Sambo
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vitor de Medeiros Milczwski
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flora Goldemberg
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flavio Tarasoutchi
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Milena Ribeiro Paixão
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Danielle Menosi Gualandro
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tarso Augusto Duenhas Accorsi
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alfredo José Mansur
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Onyszkiewicz M, Hilmers J, Rejdak R, Zrenner E, Straßer T. Effects of Miosis on the Visual Acuity Space under Varying Conditions of Contrast and Ambient Luminance in Presbyopia. J Clin Med 2024; 13:1209. [PMID: 38592033 PMCID: PMC10931829 DOI: 10.3390/jcm13051209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Presbyopia is an age-related ocular condition, typically affecting individuals aged over 40 years, characterized by a gradual and irreversible decline in the eye's ability to focus on nearby objects. Correction methods for presbyopia encompass the use of corrective lenses, surgical interventions (corneal or lens based), and, more recently, the FDA-approved topical administration of 1.25% pilocarpine. While prior research has demonstrated the efficacy of daily pilocarpine eye drop application in enhancing near visual acuity by increasing the depth of focus leveraging the pinhole effect, limited knowledge exists regarding its influence on visual acuity under varying conditions of contrast and ambient luminance. Methods: This study aims to investigate the impact of these variables on visual acuity, employing the VA-CAL test, among 11 emmetropic and 11 presbyopic volunteers who reported subjective difficulties with near vision. This study includes evaluations under natural conditions with a pinhole occluder (diameter of 2 mm), and subsequent administration of 1% pilocarpine (Pilomann, Bausch + Lomb, Laval, Canada). Results: The VA-CAL results demonstrate the expected, statistically significant effects of contrast and ambient luminance on visual acuity in both emmetropic and presbyopic volunteers. Furthermore, in emmetropic individuals, the application of pilocarpine resulted in a statistically significant reduction in visual acuity. In contrast, presbyopes did not exhibit statistically significant differences in the visual acuity space under either the pinhole or pilocarpine conditions when compared to natural conditions. Conclusions: The pharmacological treatment of presbyopia with pilocarpine eye drops, intended to enhance near vision, does not adversely affect visual acuity in presbyopes. This suggests that pilocarpine may offer a viable alternative for individuals averse to wearing corrective eyewear.
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Affiliation(s)
- Maksymilian Onyszkiewicz
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Julian Hilmers
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- STZ Eyetrial, University Eye Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Robert Rejdak
- STZ Eyetrial, University Eye Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Eberhart Zrenner
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- University Eye Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Torsten Straßer
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (M.O.); (E.Z.)
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland
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Olderbak S, Möckl J, Manthey J, Lee S, Rehm J, Hoch E, Kraus L. Trends and projection in the proportion of (heavy) cannabis use in Germany from 1995 to 2021. Addiction 2024; 119:311-321. [PMID: 37816631 DOI: 10.1111/add.16356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 08/07/2023] [Indexed: 10/12/2023]
Abstract
AIMS To measure the current trends of cannabis use in Germany, measure trends in the proportion of heavy cannabis users and estimate future cannabis use rates. DESIGN Repeated waves of the Epidemiological Survey on Substance Abuse, a cross-sectional survey conducted between 1995 and 2021 with a two-stage participant selection strategy where respondents completed a survey on substance use delivered through the post, over the telephone or on-line. SETTING Germany. PARTICIPANTS/CASES German-speaking participants aged between 18 and 59 years living in Germany who self-reported on their cannabis use in the past 12 months (n = 78 678). With the application of a weighting scheme, the data are nationally representative. MEASUREMENTS Questions on the frequency of cannabis use in the past 12 months and self-reported changes in frequency of use due to the COVID-19 pandemic. FINDINGS The prevalence of past 12-month cannabis users increased from 4.4% [95% confidence interval (CI) = 3.7, 5.1] in 1995 to 10.0% (95% CI = 8.9, 11.3) in 2021. Modeling these trends revealed a significant increase that accelerated over the past decade. The proportion of heavy cannabis users [cannabis use (almost) daily or at least 200 times per year] among past-year users has remained steady from 1995 (11.4%, 95% CI = 7.7, 16.5) to 2018 (9.5%, 95% CI = 7.6, 11.9), but significantly increased to 15.7% (95% CI = 13.1, 18.8) in 2021 during the COVID-19 pandemic. Extrapolating from these models, the prevalence of 12-month cannabis users in 2024 is expected to range between 10.4 and 15.0%, while the proportion of heavy cannabis users is unclear. CONCLUSIONS Trends from 1995 to 2021 suggest that the prevalence of past 12-month cannabis users in Germany will continue to increase, with expected rates between 10.4 and 15.0% for the German-speaking adult population, and that at least one in 10 cannabis users will continue to use cannabis heavily (almost daily or 200 + times in the past year).
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Affiliation(s)
| | - Justin Möckl
- IFT Institut für Therapieforschung, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Jakob Manthey
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Sara Lee
- IFT Institut für Therapieforschung, Munich, Germany
| | - Jürgen Rehm
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Program on Substance Abuse and WHO CC, Public Health Agency of Catalonia, Barcelona, Spain
| | - Eva Hoch
- IFT Institut für Therapieforschung, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Lin YS, DeClercq JJ, Ayers GD, Gilmor RJ, Collett G, Jain NB. Incidence and Clinical Risk Factors of Post-Operative Complications following Primary Total Hip Arthroplasty: A 10-Year Population-Based Cohort Study. J Clin Med 2023; 13:160. [PMID: 38202167 PMCID: PMC10780046 DOI: 10.3390/jcm13010160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Background: Total hip arthroplasty (THA) has become a growing treatment procedure for debilitating hip pathologies. Patients experienced post-operative complications and revision surgeries according to large THA registries. To fully understand the short-term and long-term post-operative outcomes following THA, the purpose of this study is to examine the incidence of post-operative complications following primary THA and to examine how this trend has changed over 10 years within community hospitals in the US using large databases. Methods: This study queried the State Inpatient Database (SID) for primary THA between 2006 and 2015. Individual patients were followed forward in time until the first instance of a post-operative complication. The multivariable logistic regression analyses were computed to examine which post-operative complications were independent predictors of pre-operative comorbidities. Results: Median age of patients was 67 years, and 56% of patients were female. Females with avascular necrosis (AVN) as an indication for THA had a 27% higher risk of complication. Females with osteoarthritis (OA) as an indication for THA had a 6% higher risk of complication. Post-operative complications occurred with higher frequencies in the first two months of THA and the highest risks of THA complications within the first 6 months. Conclusion: The most common indication is OA in elders with primary THA. Females and those of black ethnicity showed the greatest risks of THA complications. Data from our large study can be used to understand post-operative complications and readmissions after THA. Our study also provides data on risk factors associated with these complications.
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Affiliation(s)
- Yen-Sheng Lin
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Joshua J. DeClercq
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
| | - Gregory D. Ayers
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
| | | | - Garen Collett
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
| | - Nitin B. Jain
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
- Department of Population & Data Sciences, University of Texas Southwestern, Dallas, TX 75390, USA
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Burns RD, Byun W, Bai Y, de Castro Silveira JF, Reuter CP. Dose-response associations of Monitor-Independent Movement Summary with health-related fitness in youth. Scand J Med Sci Sports 2023; 33:2286-2298. [PMID: 37403707 DOI: 10.1111/sms.14448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
The purpose of this study was to determine the dose-response associations between Monitor-Independent Movement Summary (MIMS) units and health-related fitness in youth. The sample comprised US children and adolescents who participated in the 2012 National Youth Fitness Survey (NNYFS; N = 1158, 48.9% female). Health-related fitness domains were assessed using tests of cardiorespiratory endurance (timed maximal and graded treadmill tests), muscular strength (modified pull-up and grip tests), and muscular endurance (plank test). Movement data were collected using wrist-worn ActiGraph accelerometers with raw data processed using MIMS and the calculated metrics of average MIMS/day, Peak 60-min MIMS, and Peak 30-min MIMS. Weighted regression models examined linear associations between MIMS metrics and fitness test scores. Nonlinear associations were examined using weighted spline models with knots placed at the 10th, 50th, and 90th percentiles. Models were adjusted for covariates and fit was examined using the coefficient of determination (R2 ). The strongest adjusted linear relationships included a positive association between MIMS/day (per every 1000 units) and maximal endurance times (b = 5.5 s, p < 0.001) and between Peak 60-min MIMS (per every 10 units) and estimated aerobic capacity (b = 1.7 mL/kg/min, p < 0.001), modified pull-ups (b = 0.7 reps, p < 0.001), and plank test scores (b = 5.0 s, p < 0.001). Linear spline models had slightly higher R2 values (R2 range = 16.9%-74.8%) compared to linear models (R2 range = 15.0%-74.5%). The relationship between MIMS metrics and fitness test scores was best modeled as piecewise linear functions. Although all MIMS metrics associated with cardiorespiratory endurance, Peak 60-min MIMS showed stronger associations with tests of muscular strength and endurance.
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Affiliation(s)
- Ryan Donald Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Wonwoo Byun
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Yang Bai
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - João Francisco de Castro Silveira
- Graduate Program in Health Promotion, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
- Graduate Program in Human Movement Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Cézane Priscila Reuter
- Graduate Program in Health Promotion, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
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Fitzpatrick D, Lannon R, Laird E, Ward M, Hoey L, Hughes CF, Strain JJ, Cunningham C, McNulty H, Molloy AM, McCarroll K. The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture-results of a large observational cohort study. Osteoporos Int 2023; 34:1917-1926. [PMID: 37530847 PMCID: PMC10579148 DOI: 10.1007/s00198-023-06867-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
Proton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture; however, the mechanism is unclear. PPI users taking calcium supplements were more likely to have hyperparathyroidism compared to non-users (OR 1.56, CI 1.08-2.23, p = 0.018). This highlights the importance of monitoring PPI use, especially in older adults. PURPOSE Proton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture. Hyperparathyroidism may be implicated, but few studies have considered this relationship. This study evaluated the relationship between PPI use and hyperparathyroidism in older adults. METHODS Participants were from the TUDA study, a large cross-sectional cohort of older Irish adults. Participants with an estimated glomerular filtration rate (eGFR) < 30 ml/min and serum calcium > 2.5 mmol/l were excluded to avoid hyperparathyroidism due to chronic renal disease and primary hyperparathyroidism. Hyperparathyroidism was defined as a parathyroid hormone (PTH) > 65 pg/ml. Multivariate regression models were used to analyse the relationship between PPI use and hyperparathyroidism. RESULTS A total of 4139 participants met the inclusion criteria, of whom 37.8% (n = 1563) were taking PPI medication. PPI use was identified in 41.4% of calcium supplement users and 35.4% of non-calcium supplement users. Overall, compared to non-users of PPIs, those taking PPIs were older (74.8 vs 72.9 years, p < 0.001) and had a higher prevalence of hyperparathyroidism (17.8 vs 11.0%, p < 0.001). In those taking calcium supplements (but not in non-users), PPI use was significantly associated with hyperparathyroidism (OR 1.56, CI 1.08-2.23, p = 0.018) after adjusting for age, sex, body mass index, serum vitamin D, eGFR, timed-up-and-go, dairy intake, medications, and comorbidities. DISCUSSION The results are consistent with the hypothesis of PPIs reducing calcium absorption, leading to a rise in PTH which could mediate increased fracture risk. No relationship of PPI use with hyperparathyroidism was observed in non-users of calcium supplements, possibly owing to lower dietary calcium intake. These results highlight the importance of monitoring PPI use, especially in older adults at risk of fracture.
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Affiliation(s)
- Donal Fitzpatrick
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland.
| | - Rosaleen Lannon
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
| | - Eamon Laird
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - J J Strain
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Conal Cunningham
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College, Dublin, Ireland
| | - Kevin McCarroll
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
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Park S, Kim J. Gender differences in the association between food costs and obesity in Korean adults: an analysis of a population-based cohort. Nutr Res Pract 2023; 17:984-996. [PMID: 37780224 PMCID: PMC10522812 DOI: 10.4162/nrp.2023.17.5.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/29/2023] [Accepted: 07/18/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND/OBJECTIVES Prior studies, mostly conducted in Western countries, have suggested that the low cost of energy-dense foods is associated with an increased risk of obesity. This study aimed to investigate the association between food costs and obesity risk among Koreans who may have different food cost and dietary patterns than those of Western populations. SUBJECTS/METHODS We used baseline data from a cohort of 45,193 men and 83,172 women aged 40-79 years (in 2006-2013). Dietary intake information was collected using a validated food frequency questionnaire. Prudent and Western dietary patterns extracted via principal component analysis. Food cost was calculated based on Korean government data and market prices. Logistic regression analyses were performed to investigate the association of daily total, prudent, and Western food cost per calorie with obesity. RESULTS Men in the highest total food cost quintile had 15% higher odds of obesity, after adjusting for demographic characteristics and lifestyle factors (adjusted odds ratio, 1.15; 95% confidence interval, 1.08-1.22; P-trend < 0.001); however, this association was not clear in women (P-trend = 0.765). While both men and women showed positive associations between prudent food cost and obesity (P-trends < 0.001), the association between Western food cost and obesity was only significant in men (P-trend < 0.001). CONCLUSIONS In countries in which consumption of Western foods is associated with higher food costs, higher food costs are associated with an increased risk of obesity; however, this association differs between men and women.
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Affiliation(s)
- Soim Park
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Jihye Kim
- Department of Genetics and Biotechnology, College of Life Sciences, Kyung Hee University, Yongin 17104, Korea
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Nakatochi M, Sugishita A, Watanabe C, Fuchita E, Mizuno M. U-shaped link of health checkup data and need for care using a time-dependent cox regression model with a restricted cubic spline. Sci Rep 2023; 13:7537. [PMID: 37217488 DOI: 10.1038/s41598-023-33865-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
We explored risk indicators likely to result in older adults needing certified long-term care in Japan and ascertained whether this relationship forms a U-shaped link. We analyzed a community-based cohort of residents in Kitanagoya City, Aichi Prefecture, Japan. Participants were 3718 individuals aged 65 years and above who underwent health examinations between April 1, 2011 and March 31, 2012. For continuous clinical variables, we applied a time-dependent Cox regression model. Two types of models were applied-a linear and nonlinear model with restricted cubic splines-to assess the U-shaped association. Statistical significance (set at 0.05) for the nonlinearity was tested by comparing the spline and linear models. Among the participants, 701 were certified as needing Level 1 care or higher during a follow-up. Among the continuous clinical variables, the nonlinear model for body mass index, systolic blood pressure, high-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, and γ-glutamyl transpeptidase revealed significant U-shaped associations as compared with the linear model in which the outcome was a certification of the need for nursing care. These results provide an important insight into the usefulness of nonlinear models for predicting the risk of such certification.
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Affiliation(s)
- Masahiro Nakatochi
- Public Health Informatics Unit, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, 461-8673, Japan.
| | - Akitaka Sugishita
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, 466-8560, Japan
| | - Chihiro Watanabe
- Public Health Informatics Unit, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, 461-8673, Japan
- Department of Nursing, Nagoya University School of Health Sciences, Nagoya, 461-8673, Japan
| | - Etsuko Fuchita
- Gerontological Nursing, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, 461-8673, Japan
- Gerontological Nursing, Faculty of Nursing, Department of Nursing, Kawasaki City College of Nursing, Kawasaki, 212-0054, Japan
| | - Masaaki Mizuno
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, 466-8560, Japan.
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10
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Phillips OW, Kunicki Z, Jones R, Belanger E, Shireman TI, Friedman JH, Kim DS, Kluger B, Akbar U. Inpatient Mortality in Parkinson's Disease. Neurohospitalist 2023; 13:144-152. [PMID: 37064936 PMCID: PMC10091425 DOI: 10.1177/19418744231153477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Introduction Although a majority of the American public prefer to die at home, a large percentage of Parkinson's disease patients die in acute care hospitals. We examine trends in the clinical and demographic characteristics of Parkinson's disease patients who die in a hospital to identify populations potentially vulnerable to unwanted inpatient mortality. Methods Patients with Parkinson's disease admitted to a hospital from 2002-2016 were identified from the National Inpatient Sample (n = 710,013) along with their associated clinical and demographic characteristics. The main outcome examined was mortality during inpatient admission. From these data, logistic regression models were estimated to obtain the odds ratios of inpatient mortality among clinical and demographic attributes, and their change over time. Results Characteristics significantly associated with increased odds of inpatient mortality included increased age (OR = 1.70 for 55-65, 2.52 for 66-75, 3.99 for 76-85, 5.72 for 86+, all P < 0.001), length of stay ≤5 days (reference; 6 + days OR = 0.37, P < 0.001), white race or ethnicity (reference; Black OR = .84 P < .001, Hispanic OR = 0.91 P = 0.01), male (reference; female OR = 0.93 P < 0.001), hospitalization in Northeast (reference; Midwest OR = 0.78, South 0.84, West OR = 0.82; all P < 0.001), higher severity of illness (moderate OR = 1.50, major OR = 2.32, extreme OR = 5.57; all P < 0.001), and mortality risk (moderate OR = 2.88, major OR = 10.92, extreme OR = 52.30; all P < 0.001). Fitted probabilities overall declined over time. Conclusion Differences exist among PD patient populations regarding likelihood of in-hospital mortality that are changing with time. Insight into which PD patients are most at risk for inpatient mortality may enable clinicians to better meet end-of-life care needs.
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Affiliation(s)
- Oliver W. Phillips
- Cleveland Clinic Center for
Neurological Restoration, Cleveland, OH, USA
| | - Zachary Kunicki
- Department of Psychiatry and Human
Behavior, Brown University, Providence, RI, USA
| | - Richard Jones
- Department of Psychiatry and Human
Behavior, Brown University, Providence, RI, USA
| | - Emmanuelle Belanger
- Department of Health Services,
Policy and Practice, Center for Gerontology and Health Care Research, Brown University, Providence, RI, USA
| | - Theresa I. Shireman
- Department of Health Services,
Policy and Practice, Center for Gerontology and Health Care Research, Brown University, Providence, RI, USA
| | | | - Duk Soo Kim
- Department of Neurology, Brown University, Providence, RI, USA
| | - Benzi Kluger
- Department of Neurology, University of Rochester Medical
Center, Rochester, NY, USA
| | - Umer Akbar
- Department of Neurology, Brown University, Providence, RI, USA
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11
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Schuster NA, Rijnhart JJM, Bosman LC, Twisk JWR, Klausch T, Heymans MW. Misspecification of confounder-exposure and confounder-outcome associations leads to bias in effect estimates. BMC Med Res Methodol 2023; 23:11. [PMID: 36635655 PMCID: PMC9835340 DOI: 10.1186/s12874-022-01817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 12/08/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Confounding is a common issue in epidemiological research. Commonly used confounder-adjustment methods include multivariable regression analysis and propensity score methods. Although it is common practice to assess the linearity assumption for the exposure-outcome effect, most researchers do not assess linearity of the relationship between the confounder and the exposure and between the confounder and the outcome before adjusting for the confounder in the analysis. Failing to take the true non-linear functional form of the confounder-exposure and confounder-outcome associations into account may result in an under- or overestimation of the true exposure effect. Therefore, this paper aims to demonstrate the importance of assessing the linearity assumption for confounder-exposure and confounder-outcome associations and the importance of correctly specifying these associations when the linearity assumption is violated. METHODS A Monte Carlo simulation study was used to assess and compare the performance of confounder-adjustment methods when the functional form of the confounder-exposure and confounder-outcome associations were misspecified (i.e., linearity was wrongly assumed) and correctly specified (i.e., linearity was rightly assumed) under multiple sample sizes. An empirical data example was used to illustrate that the misspecification of confounder-exposure and confounder-outcome associations leads to bias. RESULTS The simulation study illustrated that the exposure effect estimate will be biased when for propensity score (PS) methods the confounder-exposure association is misspecified. For methods in which the outcome is regressed on the confounder or the PS, the exposure effect estimate will be biased if the confounder-outcome association is misspecified. In the empirical data example, correct specification of the confounder-exposure and confounder-outcome associations resulted in smaller exposure effect estimates. CONCLUSION When attempting to remove bias by adjusting for confounding, misspecification of the confounder-exposure and confounder-outcome associations might actually introduce bias. It is therefore important that researchers not only assess the linearity of the exposure-outcome effect, but also of the confounder-exposure or confounder-outcome associations depending on the confounder-adjustment method used.
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Affiliation(s)
- Noah A. Schuster
- grid.12380.380000 0004 1754 9227Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Judith J. M. Rijnhart
- grid.170693.a0000 0001 2353 285XCollege of Public Health, University of South Florida, Tampa, FL USA
| | - Lisa C. Bosman
- grid.12380.380000 0004 1754 9227Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- grid.12380.380000 0004 1754 9227Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Thomas Klausch
- grid.12380.380000 0004 1754 9227Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Martijn W. Heymans
- grid.12380.380000 0004 1754 9227Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands
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