Diabetes screening among immigrants: a population-based urban cohort study

OBJECTIVE

To examine diabetes screening, predictors of screening, and the burden of undiagnosed diabetes in the immigrant population and whether these estimates differ by ethnicity.

RESEARCH DESIGN AND METHODS

A population-based retrospective cohort linking administrative health data to immigration files was used to follow the entire diabetes-free population aged 40 years and up in Ontario, Canada (N = 3,484,222) for 3 years (2004–2007) to determine whether individuals were screened for diabetes. Multivariate regression was used to determine predictors of having a diabetes test.

RESULTS

Screening rates were slightly higher in the immigrant versus the general population (76.0 and 74.4%, respectively; P < 0.001), with the highest rates in people born in South Asia, Mexico, Latin America, and the Caribbean. Immigrant seniors (age ≥65 years) were screened less than nonimmigrant seniors. Percent yield of new diabetes subjects among those screened was high for certain countries of birth (South Asia, 13.0%; Mexico and Latin America, 12.1%; Caribbean, 9.5%) and low among others (Europe, Central Asia, U.S., 5.1–5.2%). The number of physician visits was the single most important predictor of screening, and many high-risk ethnic groups required numerous visits before a test was administered. The proportion of diabetes that remained undiagnosed was estimated to be 9.7% in the general population and 9.0% in immigrants.

CONCLUSIONS

Overall diabetes-screening rates are high in Canada’s universal health care setting, including among high-risk ethnic groups. Despite this finding, disparities in screening rates between immigrant subgroups persist and multiple physician visits are often required to achieve recommended screening levels.Diabetes is a serious chronic disease that is associated with substantial increases in morbidity and mortality and imposes a huge economic burden on society. Although screening for diabetes is increasing in Canada (1), up to one-third of all diabetes subjects are thought to be undiagnosed in the general population in Canada and the U.S., an estimate that may now be out of date (2,3). One significant factor that is likely contributing to increased screening is the rising prevalence of obesity in the population.Early detection and control of diabetes can potentially reduce the heightened risk of cardiovascular morbidity and mortality associated with this disease. People with screen-detected diabetes have an increased risk of heart disease as compared with the general population, and this risk is modifiable with treatment (4–6). In addition, timely screening can prevent the onset of common diabetes-related complications that could be avoided through early detection and treatment (e.g., retinopathy, peripheral neuropathy, and peripheral vascular disease) (7).National guidelines in both the U.S. and Canada recommend that diabetes screening should be performed on those aged 45 years (U.S.) or 40 (Canada) years and over every 3 years, with more frequent or earlier screening for those with additional risk factors, including belonging to a high-risk ethnic group (8,9). Ethnic groups that have been shown to display an elevated risk for diabetes include people of South Asian (10–12), Aboriginal (13), and African-Caribbean descent (2,11). Many of the 250,000 immigrants to Canada every year (14) belong to ethnicities that experience higher rates of diabetes (11) and who therefore should be screened regularly and beginning at a younger age. There is evidence, however, that immigrants may have lower health care utilization (15), which may predispose this group to have lower rates of screening than the Canadian-born population. An important and currently unanswered question, therefore, is whether some ethnic or migrant groups are more likely to be underdiagnosed than others. In this study, we describe the pattern of diabetes screening among recent immigrants to Ontario by looking at screening rates, screening efficiency/yield, predictors of screening, and the burden of undiagnosed diabetes in this population by region of origin.     

The modifying effect of positive emotion on the relationship between cognitive impairment and disability among older Mexican Americans: a cohort study

Objective: To determine if positive emotion modifies the relationship between cognitive impairment and activities of daily living disability status over 10?years in Mexican American adults aged 75 years and older.

Methods: A retrospective cohort design using data from the Hispanic established populations for the epidemiologic studies of the elderly. About 2674 participants aged 75 years and older were included and followed over 10 years. Cognition was measured using the mini-mental state examination, positive emotion was measured using four questions from the Center for Epidemiologic Studies Depression Scale, and disability was measured using seven activities of daily living items. A series of generalized estimating equations models were used, with the initial analysis including those with disability at baseline and subsequent analyses excluding disability at baseline.

Results: Positive emotion and cognitive impairment consistently decreased and increased risk for activities of daily living disability, respectively. Positive emotion was a significant modifier in the cross-sectional analysis, and was not a statistically significant modifier in the longitudinal or predictive series analysis.

Conclusions: Positive emotion and cognitive impairment differentially affect the risk of developing activities of daily living disability. Further research is needed to explore the interaction of positive emotion and cognitive impairment, and to identify appropriate interventions that address the specific cognitive and emotional needs of older Mexican Americans.

• Implications for rehabilitation

• Promoting emotional well-being may be protective against incident disability for older adults.

• Cognitive impairment significantly predicts incident disability in activities of daily living and should be considered an early indicator of impending disability for older adults.

     

Social support as a predictor of health status among older adults living alone in Japan

The purpose of this study was to determine social support as a predictor of health status among older adults living alone, based on a 2-year longitudinal study in a rural area of Japan. The self-reported questionnaires were distributed to 624 older adults living alone and were collected during home visits by welfare commissioners as baseline survey. After the follow-up survey of 493 respondents as the baseline survey, we analyzed 340 persons who lived alone over the last 2 years. Women had significantly higher emotional and instrumental support scores than men. Receiving positive support from the neighborhood had a significant effect on retaining activities of daily living for older women living alone. Our results suggest that receiving social support from the neighborhood brought an improvement in the health status of older adults, particularly women living alone.     

Loneliness as a predictor of quality of life among older caregivers

AIM: This paper reports a study investigating quality of life in relation to loneliness, caregiving, social network, gender, age and economic status among caregiving men and women in a population-based sample aged 75 years or older. BACKGROUND: Because of demographic changes, in the future more care for older people will be given by informal caregivers who are themselves older. Being old and caring for another older person may affect various aspects of life, such as physical and emotional health and decreased time for respite, which may affect social life and quality of life. METHOD: A postal questionnaire including the Short Form Health Survey was used. The sample consisted of 4278 people, aged 75 years and over, living in Sweden. Of these, 783 (18%) were caregivers. FINDINGS: Caregivers had a larger social network and reported feelings of loneliness less often than non-caregivers. Forty per cent of caregivers helped every day. There were gender differences in experiences of loneliness during the last year, with the frequency of intense feelings of loneliness being higher among women. Loneliness and a small or non-existent network were significantly associated with low quality of life among caregivers, as well as in the total sample. The results showed significant association between loneliness, weak social network and low mental quality of life. CONCLUSIONS: The fact that loneliness was the most important factor predicting low quality of life among caregivers, as well as older people in general, indicates that it is crucial in the care of older people. From a nursing perspective, the findings indicate the advantage of helping older people to keep up and develop their social networks. Nursing care should involve steps to maintain the social network before an older person becomes too weak, since decreased health status makes social contacts more difficult.     

Cardiovascular Risk Attributable to Diabetes in Southern Brazil: A population-based cohort study

OBJECTIVE

To analyze the effect of diabetes on general and cardiovascular disease (CVD) mortality and morbidity in southern Brazil.

RESEARCH DESIGN AND METHODS

A population-based cohort study of 1,091 individuals was conducted. Diabetes was ascertained by medical history. The vital status of 982 individuals and the incidence of events were ascertained during another visit and through hospital records, death certificates, and verbal necropsy with relatives.

RESULTS

The mean ± SD age of participants was 43.1 ± 17 years, and 55.7% were women. The prevalence of diabetes was 4.2%, and the mean follow-up time was 5.3 ± 0.07 years. Mortality was 36.3% and 6.6% in participants with or without diabetes, respectively; the incidence of CVD was 20.8% and 3.0%, with an adjusted hazard ratio of 4.4 (95% CI 2.4–7.9). Diabetic population-attributable risk (PAR) for CVD mortality was 10.1% and 13.1% for total CVD.

CONCLUSIONS

Diabetes is responsible for a large PAR for overall mortality and cardiovascular events in Brazil.Approximately 2.2 million deaths worldwide from ischemic heart disease and stroke were attributed to high levels of blood glucose in 2001 (1). We describe the effect of diabetes on cardiovascular disease (CVD) morbidity and mortality in southern Brazil.     

Long-term fracture risk among women with anorexia nervosa: a population-based cohort study

OBJECTIVE: To determine if fractures represent an important problem for women with anorexia nervosa who may fail to achieve peak bone mass and may experience premature bone loss from decreased estrogen levels. PATIENTS AND METHODS: In this population-based retrospective cohort study, we identified 208 Rochester, Minn, residents that were first diagnosed as having anorexia nervosa between 1935 and 1989, whose subsequent fractures were documented in contemporary medical records and compared with expected numbers of fractures (standardized incidence ratios [SIRs]). RESULTS: Subjects were followed up for 2689 person-years during which time 45 patients suffered 88 fractures. Fracture risk was increased among the 193 women (SIR, 2.9; 95% confidence interval, 2.0-3.9) as well as the 15 men (SIR, 3.4; 95% confidence interval, 1.1-7.9). The cumulative incidence of any fracture at 40 years after the diagnosis of anorexia nervosa was 57%. Fractures of the hip, spine, and forearm were late complications, occurring on average 38, 25, and 24 years, respectively, after diagnosis. CONCLUSION: Young women with anorexia nervosa are at increased risk of fractures later in life. Greater attention should be paid to the skeletal health of these individuals.     

Frailty as a predictor of disabilities among community-dwelling older people: a systematic review and meta-analysis

Background: Frailty has been shown to be associated with disability in the previous studies. However, it is not clear how consistently or to how much degree frailty is actually associated with the future disability risks.

Methods: A systematic review of the literature was conducted using Embase, MEDLINE, CINAHL, PsycINFO, and the Cochrane Library for any prospective studies published from 2010 to September 2015 examining associations between baseline frailty status and subsequent risk of developing or worsening disabilities among community-dwelling older people. A meta-analysis was performed to synthesize pooled estimates.

Results: Of 7012 studies identified through the systematic review, 20 studies were included in the meta-analysis. Twelve studies examined activities of daily living (ADL) disability risks, two studies examined instrumental activities of daily living (IADL) disability risks, and six studies examined both ADL and IADL disability risks. Overall, frail older people were more likely to develop or worsen disabilities in ADL (12 studies, pooled OR?=?2.76, 95% CI?=?2.23–3.44, p?p?p?p?=?0.08). Prefrailty was also associated with incident or worsening disability risks to a lesser degree in most pooled analyses. High heterogeneity observed among 12 studies with OR of ADL disability risks for frailty was explored using subgroup analyses, which suggested methodological quality and mean age of the cohort were the possible causes.

Conclusion: This systematic review meta-analysis quantitatively showed that frail older people are at higher risks of disabilities. These results are important for all related parties given population aging worldwide. Interventions for frailty are important to prevent disability and preserve physical functions, autonomy, and quality of life.

• Implications for Rehabilitation

• Although frailty has been shown to be associated with disability and considered as a precursor of disability, it is not clear how consistently or to how much degree frailty is actually associated with the future disability risks.

• This systematic review and meta-analysis quantitatively shows frailty is a significant predictor of incident and worsening ADL and IADL disabilities.

• It is a pressing priority to develop interventions for frailty to prevent disability and preserve older people’s physical functions, autonomy, and quality of life.

     

Dementia as a mortality predictor among older adults with COVID-19: A systematic review and meta-analysis of observational study

The purpose of this study was to systematically examine the association between dementia and mortality among older adults with COVID-19. To do so, we conducted a search of 7 databases for relevant full-text articles. A cohort study and case-control study were included. A meta-analysis was performed to synthesize the pooled odds ratio with a random-effects model. We identified studies that reported mortality among older adults with dementia and non-dementia who have COVID-19. The pooled mortality rates of dementia and non-dementia older adults infected with COVID-19 were 39% (95% CI: 0.23–0.54%, I² = 83.48%) and 20% (95% CI: 0.16–0.25%, I² = 83.48%), respectively. Overall, dementia was the main factor influencing poor health outcomes and high rates of mortality in older adults with COVID-19 infection (odds ratio 2.96; 95% CI 2.00–4.38, I² = 29.7%), respectively. Our results show that older adults with dementia with COVID-19 infection have a higher risk of mortality compared with older adults without dementia. This current study further highlights the need to provide focused care to the older adults with dementia or cognitive impairment who have COVID-19.     

Dual-task as a predictor of falls in older people with mild cognitive impairment and mild Alzheimer's disease: a prospective cohort study

Background

A dual-task tool with a challenging and daily secondary task, which involves executive functions, could facilitate the screening for risk of falls in older people with mild cognitive impairment or mild Alzheimer's disease.

Arm motor control as predictor for hypertonia after stroke: a prospective cohort study

de Jong LD, Hoonhorst MH, Stuive I, Dijkstra PU. Arm motor control as predictor for hypertonia after stroke: a prospective cohort study.

Objectives

To analyze the development of hypertonia in the hemiparetic elbow flexors, and to explore the predictive value of arm motor control on hypertonia in a cohort of first-ever stroke survivors in the first 6 months poststroke.

Design

A prospective cohort study.

Setting

A cohort of stroke survivors from a large, university-affilliated hospital in The Netherlands.

Participants

Patients (N=50) with first-time ischemic strokes and initial arm paralysis who were admitted to a stroke unit.

Interventions

Not applicable.

Main Outcome Measures

At 48 hours, 10 to 12 days, 3 and 6 months poststroke, hypertonia and arm motor control were assessed using the Modified Ashworth Scale and the Fugl-Meyer Assessment arm score.

Results

The incidence rate of hypertonia reached its maximum before the third month poststroke (30%). Prevalence was 42% at 3 and 6 months. Participants with poor arm motor control at 48 hours poststroke were 13 times more likely to develop hypertonia in the first 6 months poststroke than those with moderate to good arm motor control. These results were not confounded by the amount of arm function training received.

Conclusions

Hypertonia develops in a large proportion of patients with stroke, predominantly within the first 3 months poststroke. Poor arm motor control is a risk factor for the development of hypertonia.     

Asthma status is an independent risk factor for herpes zoster in children: a population-based cohort study

Backgrounds: Literatures regarding the effects of childhood asthma on the risk of herpes zoster (HZ) is very limited. The aim of this study is to investigate the risks of children developing HZ with asthma.

Methods: From the National Health Insurance Research Database, we identified 300,649 patients who had asthma between 2000 and 2007 as an asthma cohort. We identified another matched non-asthma cohort. All subjects were followed until the end of 2008. A Cox model was used to estimate the association of asthma on the risk of HZ.

Results: Asthma cohort had significantly higher risk of developing HZ than the comparison cohort (HR=1.15; 95 % CI =1.06-1.26). However, compared to those without regular controller, asthma cohort with regular inhaled corticosteroid (ICS) treatment had slightly increased risk for HZ (HR=1.14; 95% CI=1.01-1.27) but decreased risk for HZ in those with regular combined ICS and Montelukast (HR=0.83; 95% CI=0.69-0.98). Uncontrolled asthma with more than 3-4 times ED visits and admissions per year had 3.72 (CI =1.86-7.47) and 20.5 (CI =10.2-41.2) greater risks for HZ than those without asthma, respectively.

Conclusions: Asthma poses an increased risk of zoster, therefore control of asthma is important to minimize risk of HZ.     

Association among measures of mobility-related disability and self-perceived fatigue among older people: a population-based study

Objective:

To investigate the relationship between self-perceived fatigue with different physical functioning tests and functional performance scales used for evaluating mobility-related disability among community-dwelling older persons.

Method:

This is a cross-sectional, population-based study. The sample was composed of older persons with 65 years of age or more living in Cuiabá, MT, and Barueri, SP, Brazil. The data for this study is from the FIBRA Network Study. The presence of self-perceived fatigue was assessed using self-reports based on the Center for Epidemiologic Studies-Depression Scale. The Lawton instrumental activities of daily living scale (IADL) and the advanced activities of daily living scale (AADL) were used to assess performance and participation restriction. The following physical functioning tests were used: five-step test (FST), the Short Physical Performance Battery (SPPB), and usual gait speed (UGS). Three models of logistic regression analysis were conducted, and a significance level of α<0.05 was adopted.

Results:

The sample was composed of 776 older adults with a mean age (SD) of 71.9 (5.9) years, of whom the majority were women (74%). The prevalence of self-perceived fatigue within the participants was 20%. After adjusting for covariates, SPPB, UGS, IADL, and AADL remained associated with self-perceived fatigue in the final multivariate regression model.

Conclusion:

Our results suggest that there is an association between self-perceived fatigue and lower extremity function, usual gait speed and activity limitation and participation restriction in older adults. Further cohort studies are needed to investigate which physical performance measure may be able to predict the negative impact of fatigue in older adults.     

Where older people die: a retrospective population-based study

BACKGROUND: Palliative medicine services have invested in the community to support people dying at home. To develop end-of-life care for older people, we need to know where they die. AIM: To examine trends in age and location of death over the last 20 years. DESIGN: Retrospective death certificate review. METHOD: All Wales death certificates from 1981 to 2001 were examined. Place of death and age were noted. RESULTS: Total deaths decreased from 35,015 in 1981 to 32,966 in 2001, and mortality decreased from 12.45 per 1000 population in 1981 to 11.33 in 2001. Deaths in the community decreased from 37.6% (n = 13,155) to 22.1% (n = 7293) (p < 0.001); deaths increased in hospital from 56.7% (n = 19,871) to 61.7% (n = 20,334) (p < 0.001) and in care homes from 5.7% (n = 1989) to 16.2% (n = 5339) (p < 0.001). Between 1981 and 2001, deaths in those aged 65-74 years dropped from 9752 to 6361, but increased in the over-85s from 5661 to 9779. Deaths amongst 75-84-year-olds remained stable at around 11,000. The biggest rise in hospital and care-home deaths was in those over 85: hospital deaths increased from 2928 in 1981, to 5438 in 2001; care-home deaths increased from 941 to 3141. DISCUSSION: The last 20 years have seen a significant shift in location of death from the community to hospitals and care homes. Those aged over 85 years account for the biggest rise in hospital and care-home deaths. End-of-life needs for older people need to be addressed in hospital and care homes, not just in the community.     

Delirium as a predictor of sepsis in post-coronary artery bypass grafting patients: a retrospective cohort study

Introduction  

Delirium is the most common neurological complication following cardiac surgery. Much research has focused on potential causes of delirium; however, the sequelae of delirium have not been well investigated. The objective of this study was to investigate the relationship between delirium and sepsis post coronary artery bypass grafting (CABG) and to determine if delirium is a predictor of sepsis.