Association Between Muscular Strength and Mortality in Clinical Populations: A Systematic Review and Meta-Analysis

ObjectivesTo assess the relationship between muscular strength measures and mortality in outpatient populations with chronic diseases such as cancer, chronic obstructive pulmonary disease, renal disease, and metabolic and vascular diseases, and in critically ill hospitalized patients.DesignA systematic review and random-effects meta-analysis of prospective cohort studies was performed.Setting and participantsThe databases Medline, Embase, Clinical Trial Register, and Cochrane Trial Register were searched from inception until September 30, 2018. The systematic literature review yielded 39 studies with a total of 39,852 participants.ResultsLowest vs highest category of muscular strength revealed a statistically significant increased risk of all-cause mortality with a hazard ratio (HR) and 95% confidence intervals (CI) of 1.80 (95% CI 1.54–2.10). Lower muscular strength was associated with enhanced mortality in patients with cancer (HR 2.40; 95% CI 1.57–3.69), critical illness (HR 2.06; 95% CI 1.33–3.21), renal disease (HR 1.84; 95% CI 1.37–2.47), metabolic and vascular diseases (HR 1.64; 95% CI 1.26–2.14), and chronic obstructive pulmonary disease (HR 1.36; 95% CI 1.16–1.61). Conversely, a 5-kg higher level of muscular strength conferred a reduced risk of overall mortality (HR 0.72; 95% CI 0.59–0.89) and was accompanied by a reduction in mortality in patients with metabolic and vascular diseases (HR 0.52; 95% CI 0.29–0.91), critical illness (HR 0.78; 95% CI 0.61–0.99), and renal disease (HR 0.82; 95% CI 0.73–0.91).Conclusions and implicationsMuscular strength is inversely associated with mortality risk in various acute and chronic conditions. Future trials should focus on developing validated cut-points for diagnosing low muscular strength and their predictive value for hard end-points.     

Men with nonapnea sleep disorders have a high risk of developing subsequent epilepsy: A nationwide population-based cohort study

ObjectiveThis nationwide population-based cohort study evaluated the effects of nonapnea sleep disorders (NSDs) on the development of epilepsy.MethodsWe identified 63,865 patients aged ≥ 20 years, diagnosed with NSDs (ICD-9-CM: 307.4 or 780.5), and without coding for apnea-related sleep disorders (ICD-9-CM: 780.51, 780.53, or 780.57) during 2000–2003 as the NSD cohort. In addition, we enrolled a comparison cohort of 127,728 patients. We calculated the adjusted hazard ratio (aHR) for developing epilepsy (ICD-9-CM: 345) after adjustment for age, sex, comorbidities, and drug use. A Kaplan–Meier analysis was used to measure the cumulative incidence of epilepsy between the 2 groups until the end of 2011.ResultsThe cumulative incidence of epilepsy was significantly higher in the NSD cohort than in the comparison cohort. The aHR for developing epilepsy in the NSD cohort was 1.52 (95% CI = 1.37–1.69). The risk of developing epilepsy was higher among males (aHR = 1.41) than among females. The age-stratified effects of NSDs on developing epilepsy were the highest among patients aged ≥ 65 years. When comorbidities and NSDs coexisted, the risk of epilepsy was specifically increased in patients having an NSD and stroke (aHR: 8.61, 95% CI: 7.43–9.98) in addition to brain tumors (aHR: 7.66, 95% CI: 5.06–11.6).ConclusionThis study indicated that patients with NSDs have a higher risk of developing epilepsy and that the risk is much higher among men and older patients. These findings suggest that NSDs constitute a predisposing, possibly independent factor for developing subsequent epilepsy in adulthood.     

Fracturas de cadera en pacientes tratados con fármacos antipsicóticos. Estudio de cohortes históricas en Cataluña

ObjectiveTo evaluate the incidence of hip fracture in patients with antipsychotic treatment, comparing it with that of individuals who have not been treated with antipsychotics.DesignRetrospective cohort study of patients treated with antipsychotic drugs (TAP) and patients without known treatment (non-TAP). The observation period was 2006–2014.SiteAll primary care teams in Catalonia of the Catalan Health Institute (ICS).ParticipantsPatients older than 44 years with TAP lasting at least 3 months. Control cohort: random selection of non-TAP patients matching for baseline comorbidities and other variables. A total of 22,010 are analyzed.Main measurements Incidence rate (1000× person-years: PY) of hip fracture in each group (TAP and non-TAP). Cox regression models to estimate adjusted risks (hazard ratio: HR).ResultsThe hip fracture incidence rate was higher in TAP patients (5.83 vs 3.58 fractures per 1000 PY), and is higher in all strata according to sex, age and type of diagnosis. The risk of suffering a hip fracture was 60% higher (HR: 1.60 95% CI: 1.34–1.92) in the TAP group than in the non-TAP group. The risk was higher in the group with schizophrenia (HR: 3.57 95% CI: 1.75–7.30), followed by bipolar disorder (HR: 2.61; 95% CI: 1.39–4.92) and depression (HR: 1.51; 95% CI: 1.21–1.88).ConclusionsPatients with antipsychotic treatment have a higher risk of hip fracture than those who have not been treated with antipsychotics.     

Initial BMI and Weight Loss over Time Predict Mortality in Parkinson Disease

ObjectivesAlthough weight loss is a frequent symptom in Parkinson disease (PD), there have been few studies on the association between body mass index (BMI) and mortality. The objective of this study was to investigate the association between BMI and change in BMI at diagnosis in patients with PD and all-cause mortality.DesignCohort study using Korean National Health Insurance Service–Elderly Cohort data.Setting and ParticipantsPatients with new-onset PD were selected using the International Classification of Diseases 10th edition code (G20). Then, patients who were diagnosed more than 3 times with PD and had been prescribed anti-parkinsonian medication for ≥30 days were included. Those with a combined diagnosis of atypical parkinsonism and secondary parkinsonism were excluded.MethodsThe primary outcome was all-cause mortality. Anthropometric data, including height and weight, were obtained from the health screening data to calculate BMI. The Cox proportional hazards model was used to assess mortality risk by BMI.ResultsAmong the 2703 patients with PD, 492 (18.20%) died during the 11-year follow-up period. There was a significant inverse dose-response relationship between baseline BMI and mortality [<18.5 kg/m²: hazard ratio (HR), 1.872, 95% CI, 1.338–2.494; 23–25 kg/m²: HR, 0.695, 95% CI, 0.546–0.886; 25–30 kg/m²: HR, 0.644, 95% CI, 0.476–0.869; ≥30 kg/m²: HR, 0.396, 95% CI, 0.165–0.950]. Change in BMI of 10% revealed a significant association with mortality. Subgroup analyses by sex showed a significant inverse dose-response relationship between BMI and all-cause mortality only in women.Conclusions and ImplicationsWe demonstrated an inverse dose-response association between BMI at diagnosis and mortality in patients with PD, especially in women. Early detection of PD before weight loss progression and proper management might improve mortality. The small number of obese PD participants in our study should be considered when interpreting and generalizing results.     

Frailty in Older Persons: Multisystem Risk Factors and the Frailty Risk Index (FRI)

ImportanceCurrently there is no risk factor scale that identifies older persons at risk of frailty.ObjectivesIn this study, we identified significant multisystem risk factors of frailty, developed a simple frailty risk index, and evaluated it for use in primary care on an external validation cohort of community-living older persons.Design, Setting, and ParticipantsWe used cross-sectional data of 1685 older adults aged 55 and older in the Singapore Longitudinal Ageing Studies (SLAS) to identify 13 salient risk factors among 40 known and putative risk factors of the frailty phenotype (weakness, slowness, low physical activity, weight loss, and exhaustion). In a validation cohort (n = 2478) followed for 2 years, we evaluated the validity of Frailty Risk Index (FRI).Main Outcomes and MeasuresFrailty at baseline and functional dependency, hospitalization, and SF12 physical component summary (PCS) scores at 2-year follow-up were measured among people in the validation cohort.ResultsThe components (weighted scores) of the FRI are age older than 75 (2), no education (1), heart failure (1), respiratory disorders (2), stroke (2), depressive symptoms (3), hearing impairment (3), visual impairment (1), FEV₁/FVC lower than 0.7 (1), eGFR lower than 60 mL/min/1.73m² (1), nutritional risk score of 3 or higher (2), anemia (1), and white cell counts (× 10⁹/L) of 6.5 or more (1). In the validation cohort, the FRI (0 to 12) was significantly associated with prefrailty (OR, 1.20 per unit; 95% CI 1.19–1.27) and frailty (OR 1.80 per unit; 95% CI 1.65–1.95). The FRI predicted subsequent IADL-ADL dependency (OR1.19; 95% CI 1.11–1.27), hospitalization (OR .14; 95% CI 1.05–1.24), lowest quintile of SF12-PCS (OR 1.17; 95% CI 1.11–1.25), and combined adverse health outcomes (OR 1.16; 95% CI 1.09–1.22).Conclusions and RelevanceThe FRI is a validated instrument for assessing frailty risk in community-living older persons. FRI may be a useful rapid assessment tool to identify vital body system deficits underlying the frailty syndrome.     

Comorbidity of hospital-treated psychiatric and physical disorders with special reference to schizophrenia: a 28 year follow-up of the 1966 Northern Finland general population birth cohort

We studied the comorbidity of psychiatric and physical disorders in a sample (n = 11017) from the unselected, general population, Northern Finland 1966 Birth Cohort. During the period 1982–1994, hospital-treated psychiatric patients were more likely than people without psychiatric diagnoses to have been treated for physical disease in hospital wards, 298 out of 387 (77.0%) vs 6687 out of 10 630 (62.9%) (OR = 2.0, 95% CI = 1.6−2.5). Injuries, poisonings and indefinite symptoms were a more common reason for hospital treatment in people with schizophrenia or other psychiatric disorder as compared with people without a psychiatric disorder. Men with psychiatric disorder had more than a 50-fold risk for poisoning by psychotropic drugs (OR = 52.6, 95% CI = 27.7−99.8), women with psychiatric disorder a 20-fold risk (OR = 19.0, 95% CI = 9.5–38.1) and schizophrenics more than a 30-fold risk (OR = 37.5, 95% CI = 19.1–73.8). Men with psychiatric disorders were more commonly hospitalised for a variety of gastrointestinal disorders and circulatory diseases (OR = 2.3, 95% CI = 1.2–4.4), as compared with men with no psychiatric disorder. Respiratory diseases (OR = 2.2, 95% CI = 1.2–4.2), vertebral column disorders (OR = 4.2, 95% CI = 1.8–9.9), gynaecological disorders (OR = 2.1, 95% CI = 1.2–3.6) and induced abortions (OR = 1.8, 95% CI = 1.2–2.7) were more prevalent in women with psychiatric disorder than in other women. Epilepsy was strongly associated with schizophrenia (OR = 11.1, 95% CI = 4.0–31.6). Nervous and sensory organ diseases in general (OR = 2.5, 95% CI = 1.1–5.8) and inflammatory diseases of the bowel (OR = 12.8, 95% CI = 3.8–42.7) were also overrepresented in schizophrenia when compared with people without a psychiatric disorder. Our results indicate that physicians must be alert for psychiatric disorder, and mental health professionals must be aware of the considerable physical morbidity in their patients.     

Vaccine safety in HIV-infected adults within the Vaccine Safety Datalink Project

ObjectivesWe evaluate safety of routine vaccination among adults infected with human immunodeficiency virus (HIV) in five healthcare organizations in the United States.MethodsWe conducted a retrospective cohort study of HIV-infected adults who received inactivated influenza vaccines, hepatitis B vaccines, pneumococcal vaccines, or tetanus, diphtheria, and acellular pertussis vaccines between 2002 and 2013. We conducted self-controlled case series analysis to estimate the relative risk (RR) for 11 pre-specified adverse events (AEs) requiring medical attention.ResultsAmong 20,417 HIV-infected adults (90.2% male), a total of 137,674 vaccine doses were administered. Based on ICD-9 codes, we detected an increased risk of cellulitis and infection (RR: 1.18, 95% CI: 1.03–1.35) among all patients, and an increased risk of stroke/cerebrovascular diseases among patients with an HIV viral load >10,000 copies/ml (adjusted RR: 3.94, 95% CI: 1.32–11.72). Further analyses on chart confirmed cases of stroke/cerebrovascular diseases indicated no statistically significant increased risk (adjusted RR: 1.72, 95% CI: 0.41–7.24). There was no evidence of increased risk for other AEs following routine vaccination in HIV-infected adults.ConclusionsRoutinely administered vaccines are generally safe for HIV-infected adults.     

Risk Factors for Vertebral,Hip, and Femoral Fractures Among Patients With Parkinson's Disease: A 5-Year Follow-up in Korea

ObjectivesTo investigate the prevalence and incidence of Parkinson's disease (PD) and provide evidence for preventive strategy of vertebral, hip, and femoral fractures (VF, HF, and FF) in PD patients.DesignRetrospective cohort study.Setting and ParticipantsUsing a nationwide medical service utility database from 2009 to 2014, we enrolled PD patients with diagnosis of G20 as per ICD-10 who used medical services. Overall, the number of PD patients was 97,311, 106,072, 115,762, 127,647, 137,782, and 144,757 through 2009-2014, respectively. We followed 35,663 patients diagnosed with PD in 2010 without prior fracture.MeasuresWe estimated the annual PD prevalence and incidence and used Cox proportional hazards model to estimate the hazards ratio (HR) for factures based on demographic characteristics, underlying disease, and socioeconomic status according to fracture type (osteoporosis-related fracture, VF, HF/FF). Furthermore, we investigated the cumulative incidence of those fractures by month during the 5-year follow-up.ResultsThe standardized PD prevalence increased from 238 to 279 between 2009 and 2014, and its incidence decreased from 86 to 72 between 2010 and 2014 per 100,000 population based on 2015 census data. We followed 35,663 PD patients: women, 20,732 (58.1%); aged ≥60 years, 29,264 (82.1%); with osteoporosis, 6542 (18.3%); VF experience, 4242 (11.9%); and HF/FF experience, 2112 (5.9%). Osteoporosis was a significant risk factor for VF [HR 1.75, 95% confidence interval (CI) 1.64-1.87] and HF/FF (HR 1.37, 95% CI 1.24-1.51). The cumulative incidence of VF and HF/FF was the highest at 6 months and increased more than half in the coming 2 years after PD diagnosis.Conclusions/ImplicationsVF and HF/FF are common among PD patients. VF and HF/FF risks were high for female PD patients aged ≥60 years with osteoporosis. Fracture prevention strategies should be focused on older, women, and osteoporosis patients within 3 years of PD diagnosis.     

The Association Between Eye Disease and Incidence of Dementia: Systematic Review and Meta-Analysis

ObjectivesTo better demonstrate the relationship between common eye diseases and the risk of dementia, we conducted a systematic review and meta-analysis of cohort studies to investigate the relationship between common eye diseases and dementia.DesignSystematic review and meta-analysis.Setting and ParticipantsPatients with common eye diseases.MethodsWe conducted a systematic search of articles published up to August 25, 2022, of online databases including PubMed, EMBASE, and Web of Science. We included cohort studies that evaluated the association of glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), and cataracts with all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD). Relative risks (RRs) and 95% CIs were pooled using random effects model, and heterogeneity was assessed by the I² statistic. Subgroup analysis and sensitivity analysis were also performed.ResultsIn total, 25 studies were included in the meta-analysis, with a total of 11,410,709 participants. Pooled estimates suggested an increased risk of all-cause dementia associated with AMD (RR, 1.29; 95% CI, 1.13–1.48), glaucoma (RR, 1.16; 95% CI, 1.03–1.32), DR (RR, 1.40; 95% CI, 1.21–1.63), and cataract (RR,1.23; 95% CI, 1.09–1.40); an increased risk of AD associated with AMD (RR, 1.27; 95% CI, 1.06–1.52), glaucoma (RR, 1.18; 95% CI, 1.02–1.38), DR (RR, 1.21; 95% CI, 1.04–1.41), and cataracts (RR,1.22; 95% CI, 1.07–1.38). No association was observed between incident VaD and any eye diseases. The results of subgroup analyses were consistent with those in meta-analysis of DR and risk of all-cause dementia. Meta-regressions suggested geographic regions as potential sources of heterogeneity for the association between AMD and all-cause dementia, AMD and AD, glaucoma and dementia, glaucoma, and AD, respectively.Conclusions and ImplicationsAMD, glaucoma, DR, and cataract may be associated with an increased risk of all-cause dementia and AD, but not VaD. However, the results should be interpreted cautiously because of the high heterogeneity and unstable findings in some subgroup analyses.     

Factors Associated With Hospital Presentation of Self-Harm Among Older Canadians in Long-Term Care: A 12-Year Cohort Study

ObjectivesThis study aimed to examine the incidence of, and factors associated with, hospital presentation for self-harm among older Canadians in long-term care (LTC).DesignRetrospective cohort study.Setting and ParticipantsThe LTC data were collected using Resident Assessment Instrument–Minimum Data Set (RAI-MDS) and Resident Assessment Instrument–Home Care (RAI-HC), and linked to the Discharge Abstract Database (DAD) with hospital records of self-harm diagnosis. Adults aged 60+ at first assessment between April 1, 2003, and March 31, 2015, were included.MethodsAdjusted hazard ratios (HRs) of self-harm for potentially relevant factors, including demographic, clinical, and psychosocial characteristics, were calculated using Fine & Gray competing risk models.ResultsRecords were collated of 465,870 people in long-term care facilities (LTCF), and 773,855 people receiving home care (HC). Self-harm incidence per 100,000 person-years was 20.76 [95% confidence interval (CI) 20.31–25.40] for LTCF and 46.64 (44.24–49.12) for HC. In LTCF, the strongest risks were younger age (60–74 years vs 90+: HR, 6.00; 95% CI, 3.24–11.12), psychiatric disorders (bipolar disorder: 3.46; 2.32–5.16; schizophrenia: 2.31; 1.47–3.62; depression: 2.29; 1.80–2.92), daily severe pain (2.01; 1.30–3.11), and daily tobacco consumption (1.78; 1.29–2.45). For those receiving HC, the strongest risk factors were younger age (60–74 years vs 90+: 2.54; 1.97–3.28), psychiatric disorders (2.20; 1.93–2.50), daily tobacco consumption (2.08; 1.81–2.39), and frequent falls (1.98; 1.46–2.68). All model interactions between setting and factors were significant.Conclusions and ImplicationsThere was lower incidence of hospital presentation for self-harm for LTCF residents than HC recipients. We found sizable risks of self-harm associated with several modifiable risk factors, some of which can be directly addressed by better treatment and care (psychiatric disorders and pain), whereas others require through more complex interventions that target underlying factors and causes (tobacco and falls). The findings highlight a need for setting- and risk-specific prevention strategies to address self-harm in the older populations.     

Risk of intussusception following rotavirus vaccination: An evidence based meta-analysis of cohort and case-control studies

BackgroundInternational post-licensure studies on rotavirus vaccines have identified an increased risk of intussusception in infants after administration. The first developed rotavirus vaccine (Rotashield (RRV-TV)) was suspended post-licensure in 1999 after an association with intussusception was found. The currently available second-generation rotavirus vaccines (Rotateq (RV5) and Rotarix (RV1)), are recommended as a routine vaccine by the World Health Organisation (WHO). Post-licensure studies of these vaccines have shown a smaller but temporal increased risk for developing intussusception.MethodsA meta-analysis was performed to summarise available evidence and to give an overall risk of developing intussusception from case-control and cohort studies for all rotavirus vaccines that have been manufactured up to date. A search was conducted on MEDLINE, PubMed, EMBASE and Google Scholar up to May 2017. Eligible studies assessed the relationship between the rotavirus vaccine administration and subsequent development of intussusception both after receiving the first dose and after receiving all doses combined. Data was extracted on study characteristics, methods and outcomes. Results were pooled using the random-effect model.ResultsSix cohort studies involving 4506265 total first doses and five case-control studies involving a total sample of 9643 children were included in this analysis. The cohort data revealed that there was an associated increased risk of intussusception after the first 7 days post first dose of the vaccine (RR:3.71, 95% CI:1.08–12.69) and after receiving all doses of the rotavirus vaccine (RR:3.47, 95% CI:1.23–9.78). Similarly, the case-control data found an increased risk of intussusception following the first dose (OR: 8.45, 95% CI: 4.08–17.50) and following all doses (OR: 1.59, 95% CI: 1.11–2.27).ConclusionsFindings of this meta-analysis suggest that the rotavirus vaccine is associated with an increased risk on the development of intussusception, principally seen after administration of the first dose of vaccine.     

External Causes of Death From Death Certificates in Patients With Dementia

ObjectivesWe aim to analyze the risk of death from specific external causes, including falls, complications of medical and surgical care, unintentional injuries, and suicide, in dementia patients.DesignSwedish nationwide cohort study integrating 6 registers from May 1, 2007, through December 31, 2018, including the Swedish Registry for Cognitive/Dementia Disorders (SveDem).Setting and ParticipantsPopulation-based study. Patients diagnosed with dementia from 2007 to 2018 and up to 4 controls matched on year of birth (±3 years), sex, and region of residence.MethodsThe exposures of this study were diagnosis of dementia and dementia subtypes. Number of deaths and causes of mortality were obtained from death certificates compiled into the Cause of Death Register. Hazard ratios (HRs) and 95% CIs were estimated using Cox and flexible models, adjusted for sociodemographics, medical and psychiatric disorders.ResultsThe study population included 235,085 patients with dementia [96,760 men (41.2%); mean age 81.5 (SD 8.5) years] and 771,019 control participants [341,994 men (44.4%); mean age 79.9 (SD 8.6) years], over 3,721,687 person-years. Compared with control participants, patients with dementia presented increased risk for unintentional injuries (HR 3.30, 95% CI 3.19-3.40) and falls (HR 2.67, 95% CI 2.54-2.80) during old age (≥75 y), and suicide (HR 1.56, 95% CI 1.02-2.39) in middle age (<65 y). Suicide risk was 5.04 times higher (HR 6.04, 95% CI 4.22-8.66) in patients with both dementia and 2 or more psychiatric disorders relative to controls (incidence rate per person-years, 1.6 vs 0.3). For dementia subtypes, frontotemporal dementia had the highest risks of unintentional injuries (HR 4.28, 95% CI 2.80-6.52) and falls (HR 3.83, 95% CI 1.98-7.41), whereas subjects with mixed dementia were less likely to die from suicide (HR 0.11, 95% CI 0.03-0.46) and complications of medical and surgical care (HR 0.53, 95% CI 0.40-0.70) compared to controls.Conclusions and ImplicationsSuicide risk screening and psychiatric disorders management in early-onset dementia and early interventions for unintentional injuries and falls prevention in older dementia patients should be provided.     

Determinants of unsuccessful tuberculosis treatment outcomes in Malaysian HIV-infected patients

ObjectivesTo determine predictors of unsuccessful treatment in HIV-infected tuberculosis (TB) patients.MethodsWe reviewed medical records at the time of TB diagnosis and subsequent follow-up of all registered TB patients with HIV co-infection at TB clinics in the Institute of Respiratory Medicine and three public hospitals in Malaysia between January 2010 and September 2010. We reviewed these medical records again twelve months after their initial diagnosis to determine treatment outcomes. Multiple logistic regression was conducted to identify risk factors for unsuccessful TB treatment.ResultsAmong the 219 patients analyzed, 53.4% achieved successful outcomes (cure, completed treatment) while 46.6% of patients had unsuccessful outcomes (default, treatment failure, died). After adjusting for other factors, unsuccessful outcome was associated with intravenous drug use (OR 2.72; 95% CI 1.44–5.16), not receiving antiretroviral therapy (OR 5.10; 95% CI 2.69–9.69), lymphadenopathy (OR 2.01; 95% CI 1.09–3.72) and low serum albumin (OR 4.61; 95% CI 1.73–12.27).ConclusionAnti-retroviral treatment must be provided to all HIV-infected tuberculosis patients. Good immune and nutritional status needs to be assured in all HIV-infected tuberculosis patients. More studies are required in intravenous drug users to understand why tuberculosis treatment outcomes are poor in this group.     

Paraquat exposure and Parkinson’s disease: A systematic review and meta-analysis

Abstract

To reconcile and unify available results regarding paraquat exposure and Parkinson’s disease (PD), we conducted a systematic review and meta-analysis to provide a quantitative estimate of the risk of PD associated with paraquat exposure. Six scientific databases including PubMed, Cochrane libraries, EMBASE, Scopus, ISI Web of Knowledge, and TOXLINE were systematically searched. The overall odds ratios (ORs) with corresponding 95% CIs were calculated using a random-effects model. Of 7,309 articles identified, 13 case control studies with 3,231 patients and 4,901 controls were included into our analysis. Whereas, one prospective cohort studies was included into our systematic review. A subsequent meta-analysis showed an association between PD and paraquat exposure (odds ratio?=?1.64 (95% CI: 1.27–2.13; I²?=?24.8%). There is a statistically significant association between paraquat exposure and PD. Thus, future studies regarding paraquat and Parkinson’s disease are warranted.     

Risk factors for infection/colonization caused by resistant Gram negative bacilli in critically ill patients (An observational study of 1633 critically ill patients)

ObjectiveThe objective of this study is to identify risk factors associated with multi-resistant Gram negative (RGNB) infection and colonization among critically ill patients.MethodsA prospective cohort study of all patients aged 21–90 admitted for more than 24 hours in Medical and Surgical intensive care units (ICU) at a large teaching hospital in Singapore for the period of Aug '07–Dec '09 was conducted. Patient demographics, comorbidities, antibiotics, invasive devices, and culture results were collected. Forward stepwise logistic regression analyses were done to identify risk factors associated with RGNB infection and colonization.ResultsOf the 1373 patients included in the analysis, 13.5% developed RGNB infection. A logistic regression analysis including variables with a p value of < 0.2 in the univariate analysis showed that recent surgery (OR 2.1, 95% CI 1.2–3.6), renal impairment (OR 2.9, 95% CI 1.5–5.4), liver disease (OR: 3.8, 95% CI 1.7–8.8), central line (OR 1.8, 95% CI 1.01–3.4) were independently associated with RGNB infection in the ICU. Surgery (OR 3.9, 95% CI 2.7–5.7), third-line antibiotics (carbapenem, vancomycin, linezolid) (OR 1.8, 95% CI 1.2–2.9) were independently associated with RGNB infection during their hospitalization.ConclusionThe major risk factors identified for RGNB infection and colonization in the ICU were mainly patient dependent. However, broad spectrum initial antibiotic treatment remains an important independent modifiable risk factor. Interventions aimed at reducing initial broad spectrum antibiotics are clearly needed to help control the spread of these difficult to treat infections.     

Prevalence of Diagnosed Depression in Adolescents With History of Concussion

PurposePrevious studies in adults have suggested concussion and other brain injury presents a risk factor for depression. The goal of our study was to analyze the association between previous concussion and current depression diagnosis in a large nationally representative adolescent data set.MethodsRetrospective cohort study using the National Survey of Children's Health 2007–2008, a nationally representative survey conducted via random digit dialing. Data were obtained by parental report. We included youth 12–17 years old without a current concussion (N = 36,060), and evaluated the association between previous concussion (binary) and current depression diagnosis (binary) using multiple logistic regression to control for age, sex, parental mental health, and socioeconomic status.ResultsAfter controlling for age, sex, parental mental health, and socioeconomic status, history of concussion was associated with a 3.3-fold greater risk for depression diagnosis (95% CI: 2.0–5.5). Other factors significantly associated with depression diagnosis included poor or fair parental mental health (OR: 3.7, 95% CI: 2.8–4.9), and older age (15–17 years vs. 12–14 years, OR: 1.4, 95% CI: 1.1–1.8). Sex of the subject was not significantly related to depression diagnosis. Being above 200% of the poverty level was associated with approximately a 50% decreased risk of depression diagnosis (95% CI: 35%–70%).ConclusionsHistory of concussion was associated with a higher prevalence of diagnosed depression in a large nationally representative adolescent data set. Clinicians should screen for depression in their adolescent patients with concussion. Future studies should confirm this association using prospective methodology and examine potential treatment approaches.     

Impact of Body Mass Index on the Incidence of Cardiometabolic Risk Factors in Ambulatory Care Settings over 5 Years or More

ObjectiveThis study was performed to evaluate the association of body mass index (BMI) with the incidence of cardiometabolic risk factors in ambulatory care electronic medical records (EMRs) over 5 years or more.DesignA retrospective cohort of normal versus obese patients.SubjectsSubjects ≥18 years were identified between 1996 and 2005.MeasurementsPatients were categorized as either normal weight (18 kg/m² < BMI ≤ 27 kg/m²) or obese (BMI > 27 kg/m²) based on baseline BMI (measured 395 days or more after first EMR activity). Outcomes included development, at least 180 days after the first BMI reading date, of four cardiometabolic risk factors (elevated triglycerides, low high-density lipoprotein cholesterol [HDL-C], hypertension, or type 2 diabetes) determined from ICD-9 code, prescribed drug, or biometric reading. Logistic regression estimated the odds of developing cardiometabolic risk factors, alone and combined for normal versus obese patients forward for at least 5 years.ResultsSeventy-one percent were female, mean age was 43.5 years, and 37.6% had a baseline BMI > 27 kg/m². Comparing obese versus normal weight patients, adjusted odds ratios for the incidence of elevated triglycerides, hypertension, diabetes, and low HDL-C were 2.1 (95% confidence interval [95% CI] 1.9–2.3), 2.2 (95% CI 2.1–2.4), 2.3 (95% CI 2.0–2.7), and 2.2 (95% CI 2.0–2.4), respectively. Adjusted odds ratios of developing one and all four new risk factors were 1.9 (95% CI 1.8–2.1) and 7.9 (95% CI 5.9–10.5), respectively.ConclusionObese patients are approximately twice as likely to develop cardiometabolic risk factors compared with those having normal weight over 5 or more years.     

Mortality and Morbidity among Farmers,Nonfarming Rural Men,and Urban Referents: A Prospective Population-Based Study

Abstract

A cohort of 1,220 farmers, 1,130 nonfarming rural men, and 1,087 urban referents from Sweden were monitored for 12 years. Farmers had lower mortality than urban referents for all causes of death (hazard ratio [HR] = 0.51; 95% confidence interval [CI], 0.37–0.71), cancer (HR = 0.44; 95% CI, 0.24–0.78) and cardiovascular diseases (HR = 0.60; 95% CI, 0.36–0.99). Nonfarming rural men had lower mortality than urban referents for all causes of deaths (HR = 0.81; 95% CI, 0.70–0.94). Farmers and nonfarming rural men had significantly lower morbidity risks of cancer and of psychiatric disorders than urban referents. Farmers had significantly lower risk of endocrine disorders, cardiovascular disorders, and respiratory disorders. In general, morbidity was lower among nonfarming rural men compared with urban referents and was even lower among farmers. Urban referents had, however, significantly less musculoskeletal disorder morbidity. An urban–rural factor and a farming occupational or lifestyle factor results in lower mortality and morbidity rates except concerning musculoskeletal disorders.