Inflammatory profile associated with insulin resistance in non-overweight versus overweight people living with HIV in Pune,Western India

BackgroundPeople living with HIV have greater diabetes (T2DM) than the general population despite lower prevalence of overweight/obesity. Both insulin resistance (IR), a T2DM precursor, and HIV are independently associated with chronic inflammation. Inflammation may be a pathophysiological link explaining IR in people living with HIV who are not overweight but is not well understood.AimsTo study the association between inflammation and IR in non-overweight and overweight people living with HIV.MethodsIn a cohort of adult people living with HIV with undetectable viral load in Pune, India, we measured fasting insulin, glucose, and 9 inflammatory markers. IR was defined as HOMA-IR ≥2, and non-overweight as BMI ≤23 kg/m². We used modified Poisson regression to evaluate the association between inflammatory markers and IR in overweight and non-overweight.ResultsOf 288 participants, 66% (n = 189) were non-overweight. Among non-overweight, prevalence of IR was 34% (n = 65). Each doubling of MCP-1 and leptin was associated with IR on univariate analysis (prevalence ratio (PR) 1.29, 95%CI 1.07–1.53, p < 0.01; PR 1.13 95%CI 1.01–1.26, p = 0.03). Leptin remained associated with IR after adjustment for age, MCP-1, gender, cholesterol, and waist circumference (adjusted PR 1.20 95%CI 1.06–1.36, p < 0.01). Among overweight, prevalence of IR was 69% and no markers were associated with IR.ConclusionsOne in 3 non-overweight people living with HIV in India with controlled viremia have IR. Leptin was associated with IR among non-overweight people living with HIV and may provide insight into the pathophysiology of metabolic disease in this population.     

Occupational Risk Factors for COPD Phenotypes in the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study

Introduction: The contribution of occupational exposure to the risk of chronic obstructive pulmonary disease COPD in population-based studies is of interest. We compared the performance of self-reported exposure to a newly developed JEM in exposure-response evaluation. Methods: We used cross-sectional data from Multi-Ethnic Study of Atherosclerosis (MESA), a population-based sample of 45–84 year olds free of clinical cardiovascular disease at baseline. MESA ascertained the most recent job and employment, and the MESA Lung Study measured spirometry, and occupational exposures for 3686 participants. Associations between health outcomes (spirometry defined airflow limitation and Medical Research Council-defined chronic bronchitis) and occupational exposure [self-reported occupational exposure to vapor-gas, dust, or fumes (VGDF), severity of exposure, and a job-exposure matrix (JEM)-derived score] were evaluated using logistic regression models adjusted for non-occupational risk factors. Results: The prevalence of airflow limitation was associated with self-reported exposure to vapor-gas (OR 2.6, 95%CI 1.1–2.3), severity of VGDF exposure (P-trend < 0.01), and JEM dust exposure (OR 2.4, 95%CI 1.1–5.0), and with organic dust exposure in females; these associations were generally of greater magnitude among never smokers. The prevalence of chronic bronchitis and wheeze was associated with exposure to VGDF. The association between airflow limitation and the combined effect of smoking and VGDF exposure showed an increasing trend. Self-reported vapor-gas, dust, fumes, years and severity of exposure were associated with increased prevalence of chronic bronchitis and wheeze (P < 0.001). Conclusions: Airflow limitation was associated with self-reported VGDF exposure, its severity, and JEM-ascertained dust exposure in smokers and never-smokers in this multiethnic study.     

Prevalence and determinants of Helicobacter pylori sero-positivity in the Australian adult community

Background and Aim: To estimate the sero‐prevalence of Helicobacter Pylori infection in the Australian adult population and identify determinants. Methods: We analyzed serum samples and questionnaire data from 1355 community controls who participated in a nationwide case‐control study of esophageal cancer in Australia between 2002 and 2005. We estimated the prevalence ratio and 95% confidence interval using log binomial regression models. Results: The age and sex standardized sero‐prevalence of H. pylori was 15.5%. The prevalence of infection varied significantly with age, ranging from 5% (< 40 years) to 32% (≥ 70 years). H. pylori infection was significantly higher among those born overseas (prevalence ratio [PR] 1.63; 95% confidence interval [CI] 1.34–1.98) compared with those born in Australia or New Zealand. H. pylori sero‐prevalence was 23% higher among participants living in the lowest quartile of socio‐economic areas (PR 0.77; 95%CI 0.59–0.99 for Q4 compared with Q1). H pylori serostatus was significantly inversely associated with university education (PR 0.56; 95%CI 0.38–0.83), frequent reflux symptoms (PR 0.62; 95%CI 0.42–0.91), use of proton pump inhibitor (PR 0.69; 95%CI 0.48–0.98) and use of medications for gut spasms (PR 0.48; 95%CI 0.25–0.93). H. pylori serostatus was not associated with body mass index, smoking, alcohol or physical activity. Conclusions: The prevalence of H. pylori infection in Australian adults is lower than other developed countries. H. pylori infection is most common among those living in the areas of socio‐economic disadvantage or who were born overseas.     

Prevalence of pulmonary embolism in patients with obstructive sleep apnea and chronic obstructive pulmonary disease: The overlap syndrome

ObjectiveGrowing evidence indicates that both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) may be closely associated with the prevalence of pulmonary embolism (PE). However, the relationship of overlap syndrome (OS) (coexistence of OSA and COPD) with PE is unclear. The purpose of this study was to investigate whether OS were associated with increased PE prevalence.MethodsWe performed a retrospective chart review of patients who underwent sleep study at Beijing An Zhen Hospital from 2011 to 2014. The association of OS with PE prevalence was estimated by using logistic regression models.ResultsIn contrast to control patients (neither OSA nor COPD), those subjects with OS had higher odds of PE (OR9.61; 95%CI 4.02–21.31, p < 0.001) with significance persisting after adjusting for covariates (OR 5.66; 95%CI 1.80–16.18, p = 0.004). Meanwhile, patients with OS compared with those with isolated OSA also had significantly higher odds of PE in univariate (OR 4.79; 95%CI 2.04–10.33, p = 0.0007) and adjusted models (OR 3.89; 95%CI 1.27–10.68, p = 0.019). In subgroup analysis, patients with OS had higher odds of PE than control group among male subjects (OR 8.12, 95%CI1.86–31.87, p = 0.007) and patients ≥ 58years (OR 5.50, 95%CI 1.51–18.14, p = 0.012) in multivariable models. Percentage of total sleep time with saturation lower than 90% (T90) ≥ 2.6% was significantly associated with prevalence of PE (OR 4.72, 95%CI1.34–19.83, p = 0.015) in subgroup of patients older than 58.ConclusionsOS is independently associated with PE prevalence. Longitudinal studies are needed to better understand the relationship with incident PE.     

Effect of Indoor Air Pollution from Biomass and Solid Fuel Combustion on Prevalence of Self-Reported Asthma among Adult Men and Women in India: Findings from a Nationwide Large-Scale Cross-Sectional Survey

Objectives. Increasing prevalence of asthma in developing countries has been a significant challenge for public health in recent decades. A number of studies have suggested that ambient air pollution can trigger asthma attacks. Biomass and solid fuels are a major source of indoor air pollution, but in developing countries the health effects of indoor air pollution are poorly understood. In this study we examined the effect of cooking smoke produced by biomass and solid fuel combustion on the reported prevalence of asthma among adult men and women in India. Methods. The analysis is based on 99,574 women and 56,742 men aged between 20 and 49 years included in India’s third National Family Health Survey conducted in 2005–2006. Effects of exposure to cooking smoke, determined by the type of fuel used for cooking such as biomass and solid fuels versus cleaner fuels, on the reported prevalence of asthma were estimated using multivariate logistic regression. Since the effects of cooking smoke are likely to be confounded with effects of tobacco smoking, age, and other such factors, the analysis was carried out after statistically controlling for such factors. Results. The results indicate that adult women living in households using biomass and solid fuels have a significantly higher risk of asthma than those living in households using cleaner fuels (OR: 1.26; 95%CI: 1.06–1.49; p = .010), even after controlling for the effects of a number of potentially confounding factors. Interestingly, this effect was not found among men (OR: 0.98; 95%CI: 0.77–1.24; p = .846). However, tobacco smoking was associated with higher asthma prevalence among both women (OR: 1.72; 95%CI: 1.34–2.21; p < .0001) and men (OR: 1.35; 95%CI: 1.49–2.25; p < .0001). Combined effects of biomass and solid fuel use and tobacco smoke on the risk of asthma were greater and more significant in women (OR: 2.16; 95%CI: 1.58–2.94; p < .0001) than they were in men (OR: 1.34; 95%CI: 1.04–1.72; p = .024). Conclusions. The findings have important program and policy implications for countries such as India, where large proportions of the population still rely on polluting biomass fuels for cooking and heating. Decreasing household biomass and solid fuel use and increasing use of improved stove technology may decrease the health effects of indoor air pollution. More epidemiological research with better measures of smoke exposure and clinical measures of asthma is needed to validate the findings.     

Childhood Asthma Prevalence in Northern Puerto Rico,the Rio Grande,and Loíza Experience

Objective. Childhood asthma is highly prevalent in some areas of Puerto Rico. The objective of this study was to estimate the prevalence of asthma in two municipalities of Northern Puerto Rico. Methods. Children 6 to 7 and 13 to 14 years of age participated in the school-based cross-sectional study. Results. A total of 1,467 elementary school students and 1,334 junior-high school students were included in the survey. A high prevalence of asthma was observed; 46% in elementary schools and 24% in junior-high schools. In elementary schools, family history of asthma (FHA) was associated with ever wheezed (PR = 2.00, 95%CI 1.59, 2.52), wheeze during last year (PR = 2.02, 95%CI 1.54, 2.62), and asthma (PR = 2.33, 95%CI 1.86, 2.92). For junior-high schools FHA was associated with ever wheezed (PR = 2.01, 95%CI 1.56, 2.57), wheeze during previous year (PR = 2.00, 95%CI 1.47, 2.73), and asthma (PR = 2.72, 95%CI 2.06, 3.60). Conclusions. This study showed a high prevalence of asthma and related symptoms in Northern Puerto Rico. FHA was strongly associated with asthma and its symptoms. Further research is recommended to look at genetics, sensitivity levels, indoor and outdoor pollution, and gene-environment interactions.     

Prevalence and characteristics of apparent treatment-resistant hypertension in older people in China: a cross-sectional study

ABSTRACT

The prevalence and associated risk factors of apparent treatment-resistant hypertension (aTRH) in older people in China is unknown. The aim of this study is to investigate the prevalence of aTRH in older people and describe the characteristics of older patients with aTRH. Using two-stage random clustering sampling, 3774 patients with hypertension aged ≥60–75 years were recruited between July 2012 and December 2015. The patients were divided into two groups: aTRH and non-aTRH groups according to their blood pressure (BP) levels, and whether or not they reached goal BP value. A multivariable logistical model was used to evaluate the risk factors of aTRH. The rate of antihypertensive treatment was 75.1%, BP control rate was 40.7%, and the prevalence of aTRH was 5.97% (169) according to the cross-sectional data among all the patients. The prevalence of aTRH patients taking 4 different classes of antihypertensive drugs or more was found to be 3.29% (93) in this study. Compared with non-aTRH patients, those with aTRH had a worse cardiovascular risk profile, including obesity (29.61% vs 20.53%, P = 0.005), hyperlipidemia (54.44% vs 46.66%, P = 0.050), type 2 diabetes mellitus (2-DM) (34.31% vs 25.64%, P = 0.013), and stroke (26.03% vs 19.26%, P = 0.032). After multivariable adjustment, logistic regression analyses showed that the risk factors of aTRH were male sex (OR 1.638; 95%CI 1.196–2.245, P = 0.002) and 2-DM (OR 1. 371; 95%CI 0.995–1.888, P = 0.049). Regular physical exercise (OR 0.696; 95%CI 0.505–0.960, P = 0.049) was a protective factor of aTRH. The prevalence of aTRH was 5.97% in older people in this cross-sectional study in China.     

High triglycerides to HDL-cholesterol ratio is associated with insulin resistance in normal-weight healthy adults

AimTo evaluate the association between high triglyceride/HDL-cholesterol (TG/HDL-C) ratio and insulin resistance (IR) or hyperinsulinemia after oral glucose tolerance test (OGTT) in normal-weight healthy adults.MethodsWe carried out an analytical cross-sectional study in euthyroid non-diabetic adults, who attended the outpatient service of a private clinic in Lima-Peru from 2012 to 2016. Participants were divided in two groups according to the presence or absence of high TG/HDL-C ratio, IR or hyperinsulinemia after OGTT. TG/HDL-C ratio values ≥ 3 were considered as high. IR was defined as a Homeostasis Model Assessment (HOMA-IR) value ≥ 2.28 and hyperinsulinemia after OGTT as a serum insulin value ≥ 80μU/mL after 120 min of 75-g glucose intake. We elaborated crude and adjusted Poisson generalized linear models to evaluate the association between high TG/HDL-C ratio and IR or hyperinsulinemia after OGTT and reported the prevalence ratio (PR) with their respective 95% confidence intervals (95%CI).ResultsWe analyzed the data of 118 individuals. Prevalence of high TG/HDL-C ratio was 17.8% (n = 21) while the prevalence of IR and hyperinsulinemia after OGTT was 24.6% (n = 29) and 17.0% (n = 20), respectively. TG/HDL-C-ratio values were positively correlated with HOMA-IR (r = 0.498; p < 0.01) and serum insulin after OGTT (r = 0.326; p < 0.001). In the adjusted model, high TG/HDL-C ratio was associated with both IR (aPR = 3.16; 95%CI: 1.80–5.77) and hyperinsulinemia after OGTT (aPR = 2.36; 95%CI: 1.20–4.63).ConclusionsHigh TG/HDL-C ratio was associated with both IR markers used in our study, appearing to be a clinically useful tool to assess IR in euthyroid normal-weight adults without type 2 diabetes mellitus.     

Factors associated with poor balance ability in older adults of nine high-altitude communities

IntroductionPoor balance ability in older adults result in multiple complications. Poor balance ability has not been studied among older adults living at high altitudes. In this study, we analysed factors associated with poor balance ability by using the Functional Reach (FR) among older adults living in nine high-altitude communities.Material and methodsAnalytical cross-sectional study, carried out in inhabitants aged 60 or over from nine high-altitude Andean communities of Peru during 2013–2016. FR was divided according to the cut-off point of 8 inches (20.32 cm) and two groups were generated: poor balance ability (FR less or equal than 20.32 cm) and good balance ability (greater than 20.32 cm). Additionally, we collected socio-demographic, medical, functional and cognitive assessment information. Poisson regression models were constructed to identify factors associated with poor balance ability. Prevalence ratio (PR) with 95% confidence intervals (95CI%) are presented.ResultsA total of 365 older adults were studied. The average age was 73.0 ± 6.9 years (range: 60–91 years), and 180 (49.3%) participants had poor balance ability. In the adjusted Poisson regression analysis, the factors associated with poor balance ability were: alcohol consumption (PR = 1.35; 95%CI: 1.05–1.73), exhaustion (PR = 2.22; 95%CI: 1.49–3.31), gait speed (PR = 0.67; 95%CI: 0.50–0.90), having had at least one fall in the last year (PR = 2.03; 95%CI: 1.19–3.46), having at least one comorbidity (PR = 1.60; 95%CI: 1.10–2.35) and having two or more comorbidities (PR = 1.61; 95%CI: 1.07–2.42) compared to none.ConclusionsApproximately a half of the older adults from these high-altitude communities had poor balance ability. Interventions need to be designed to target these balance issues and prevent adverse events from concurring to these individuals.     

Pregnant women with heart disease: Placental characteristics and their association with fetal adverse events

Background: Pregnant women with heart disease (HD) have higher rates of adverse fetal outcomes. We describe placental pathologic characteristics and their association with fetal events. Methods: In pregnant women, known HD were categorized into: (1) cardiomyopathy (CM) or (2) other HD (congenital, coronary, arrhythmia, or valvular). Outcomes were maternal major adverse cardiac events (MACE), fetal adverse clinical events (FACE), a composite of infant death, prematurity, underweight status, intracranial hemorrhage, and respiratory distress. Only pathologically reported placental analyses were included. Results: We studied 86 pregnancies in women with CM and HD, with pathologic analyses on 35 CM and 52 HD placentas. CM placentas, compared with those with HD, were more likely to have ischemic changes (65.7% vs. 37%, p 0.008), demonstrate immaturity (62.90% vs. 10%, p < 0.001), and have a lower weight (p < 0.001), despite similar gestational age. CM was independently associated with increased risk for MACE (OR 7.38, 95%CI 2.20–24.76). Ischemic placental changes were associated with increased odds of FACE (OR 24.78, 95%CI 2.37–259.03). Conclusions: Women with CM were more likely to have ischemic placentas, with lower placental and fetal weights, and evidence of immaturity compared with those with other forms of HD, and an increased odds of MACE.     

Elevated chronic bronchitis diagnosis risk among women in a local emergency department patient population associated with the 2012 heatwave and drought in Douglas county,NE USA

BackgroundConcerns about global climate change force local public health agencies to assess potential local disease risk.ObjectiveDetermine if risk of an emergency department chronic bronchitis diagnosis in Douglas County, NE, was higher during the 2012 heatwave compared to the same calendar period in 2011.MethodsRetrospective, observational, case-control design selecting subjects from 2011 and 2012 emergency department (ED) admissions. Risk was estimated by conditional logistic regression.ResultsThe odds of an ED chronic bronchitis diagnosis among females was 3.77 (95% CI =1.37-10.21) times higher during the 2012 risk period compared to females admitted to the ED during the 2011 risk period. Chronic bronchitis ED diagnosis odds were 1.05 (95%CI=1.04 – 1.06) times higher for each year of age. ED, gender, and race modified the risk (i.e., effect). The overall chronic bronchitis ED risk estimate was 1.61 (95%CI=0.81 – 3.21) times higher during the 2012 risk period compared to the 2011 risk period. The mean ambient absolute humidity upon admission was 11.44 gr/m³ (95%CI; 10.40 – 12.47) among chronic bronchitis cases and 12.67 gr/m³ (95%CI; 12.63 – 12.71) among controls.ConclusionThe odds of ED chronic bronchitis diagnosis was higher among female subjects admitted during the 2012 risk period compared to females admitted during the 2011 risk period.  Age also increased chronic bronchitis ED diagnosis risk among 2012 risk period admissions compared to 2011 risk period admissions.     

Comparison of frailty associated factors between older adult patients with rheumatoid arthritis and community dwellers

PurposeTo determine whether frailty associated factors differ between community dwellers and older adult patients with rheumatoid arthritis (RA).MethodsWe used the cross-sectional data for patients with RA from the RA epidemiological quality-of-life study (n = 210, mean age 71.8 ± 3.7 years) and community dwellers from the Japan Gerontological Evaluation Study (n = 53,255, mean age 71.7 ± 4.0 years). Frailty status was assessed using the Kihon Checklist (KCL), and the primary outcome was frailty (KCL score ≥8 points). Information on predictor variables, including age, sex, marital status, educational level, body mass index (BMI), drinking and smoking status and social participation were obtained from a standardized questionnaire. We employed Poisson regression to calculate the prevalence ratio (PR) of frailty according to its predictors.ResultsWe found frailty in 37.6% of the patients with RA and 15.7% of the community dwellers. In the multivariate models, BMI and social participation were independently associated with frailty in patients with RA (BMI <18.5: PR, 1.62; 95% confidence interval [CI] 1.09–2.41. BMI ≥25.0: PR, 1.81; 95% CI 1.20–2.71. Active social participation: PR, 0.61; 95% CI 0.42–0.87) and community dwellers (BMI <18.5: PR, 1.77; 95% CI 1.67–1.88. BMI ≥25.0: PR, 1.27; 95% CI 1.22–1.33. Active social participation: PR, 0.46; 95% CI 0.44–0.48). All other predictors were significantly associated with frailty in the community dwellers.ConclusionMaintaining appropriate body weight and participating in social activities are important for preventing frailty in patients with RA as well as community dwellers.     

Association between waist circumference and waist-to-height ratio with insulin resistance biomarkers in normal-weight adults working in a private educational institution

AimTo assess the association between elevated waist circumference (WC) and high waist-to-height ratio (WHtR) with insulin resistance biomarkers.MethodsWe conducted an analytical cross-sectional study in normal-weight adults. Participants were divided in two groups according to WC or WHtR levels. We considered values of WC ≥ 90 in male participants and WC ≥ 80 in adult women as elevated, and values of WHtR≥0.50 as high, for both genders. Our outcomes were high triglycerides to HDL-cholesterol (TG/HDL-C) ratio and elevated triglycerides and glucose index (TGI). We considered values of TG/HDL-C ratio ≥ 3 as high and TGI values ≥ 8.37 as elevated. We elaborated crude and adjusted Poisson generalized linear models to evaluate the proposed associations and explored the gender interaction using stratified models. We reported the prevalence ratio (PR) with their respective 95% confidence intervals (95%CI).ResultsWe analyzed 355 participants. The prevalence of elevated WC and high WHtR was 17.2% (n = 61) and 33.2% (n = 118), respectively, while the prevalence of high TG/HDL-C ratio and elevated TGI was 24.8% (n = 88) and 12.7% (n = 45), respectively. In the adjusted regression model, elevated WC was associated with high TG/HDL-C ratio only in female participants (aPR = 3.61; 95%CI: 1.59–8.20). Similarly, high WHtR was associated with high TG/HDL-C ratio in women (aPR = 2.54; 95%CI:1.08–5.97). We found an association with statistically marginal significance between elevated WC and elevated TGI in women (aPR = 1.54; 95%CI: 0.95–2.50); as well as for the association between high WHtR and elevated TGI in male participants (aPR = 1.87; 95%CI: 1.00–3.50).ConclusionElevated WC and high WHtR were associated with a high TG/HDL-C ratio in women. It is necessary to perform prospective follow-up studies in the Peruvian population in order to corroborate our results.     

Gout Is Associated With Worse Post-PCI Long-Term Outcomes

BackgroundGout is a common chronic inflammatory disease with increasing prevalence over the last decades. However, there is limited evidence on outcomes of PCI in patients with gout.MethodsA Retrospective cohort study of all adult patients who underwent PCI in a large [1000 bed] tertiary care center from January 2002 to August 2020. Patients were stratified according to a diagnosis of gout. The primary outcome was defined as the first event of all-cause mortality or major CV event that included acute coronary syndrome -(ACS) or congestive heart failure -(CHF) related admission. To examine the association between gout and outcome, a multi-variable cox proportional hazard model was used.ResultsOut of 12,951 who patients underwent PCI during the study period, 344 (2.7%) had a diagnosis of gout. The study median follow-up time was 105 months. Patients with gout had significantly higher crude rates of clinical events (73.8% vs. 59.5%, p < 0.001). Gout was associated with increased risk for ACS and HF-admissions [HR 1.24 95%CI (1.07–1.43), p = 0.04; HR 1.99, 95%CI (1.57–2.54) p < 0.001, respectively], as well as for any clinical event (HR 1.2 95%CI (1.04–1.38), P = 0.01).ConclusionGout is associated with increased post-PCI cardiovascular risk. Therefore, patients with gout should be considered as a higher risk cohort.     

Impact of aging on immature platelet count and its relationship with coronary artery disease

Abstract

Despite the fact that elderly patients represent a prevalent and challenging population in the current practice, few data exist on the impact of platelet parameters on cardiovascular risk in these patients. Therefore, the aim of the present study was to evaluate the impact of age on the immature platelet count (IPC) and their relationship with CAD. We included a total of 2236 consecutive patients undergoing coronary angiography in a single center. Elderly patients (age ≥ 75 years) were 756 (33.7%). IPC was measured at admission. Elderly patients were more often females (p < .001), with lower BMI and prevalence of smokers (p < .001), and a more complex cardiovascular risk profile and coronary disease (p = .02). Platelet count decreased with aging (p = .05), whereas no difference in the mean IPC was found between patients < or ≥75 years. In fact, advanced age did not emerge as an independent predictor of IPC above III tertile (≥8.6*10^6/ml), (adjusted OR[95%CI] = 0.97[0.78–1.21], p = .79). When considering elderly patients according to tertiles values of IPC (<5.1,5.1–8.59; ≥8.6*10^6/ml), we found no impact of IPC on the prevalence of CAD (81.1% vs 84.5% vs 81.5%, p = .92; adjusted OR[95%CI] = 1.08[0.67–1.72], p = .75) and its extent (37.7% vs 34.5% vs 40.2%, p = .57; adjusted OR[95%CI] = 1.22[0.85–1.73], p = .28). However, we observed a higher rate of calcified and type C lesions in elderly patients with higher IPC (p = .03 and p < .001, respectively). Therefore, advanced age is not associated with higher immature platelet count and the prevalence and severity of CAD. Moreover, IPC does not contribute to explain the higher prevalence and extent of coronary artery disease observed in elderly patients.     

Handgrip strength,chronic physical conditions and physical multimorbidity in middle-aged and older adults in six low- and middle income countries

PurposeHandgrip strength provides a clinically validated marker of overall health and mortality risk. There are however, no multi-national population-based studies investigating the associations between handgrip strength, chronic physical conditions, and physical multimorbidity (i.e., ≥2 chronic conditions). We aimed to assess these associations among community-dwelling middle-aged and older adults using nationally representative data from six in low- and middle-income countries (LMICs).MethodsCross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. Eleven chronic physical conditions (angina, arthritis, asthma, chronic back pain, chronic lung disease, diabetes, edentulism, hearing problems, hypertension, stroke, visual impairment) were assessed. Weak handgrip strength was defined as <30 kg for men and <20 kg for women. Multivariable logistic regression analysis was conducted.ResultsThe final sample included 34,129 individuals (62.4 ± 16.0 years; 52.1% female). After adjustment for potential confounders, when compared to those with no chronic physical conditions, having 1, 2, 3, and ≥4 physical chronic conditions was associated with 1.22 (95%CI = 1.08–1.37), 1.29 (95%CI = 1.11–1.50), 1.41 (95%CI = 1.18–1.68), and 1.78 (95%CI = 1.46–2.18) times higher odds for weak handgrip strength. Similar associations were observed in the analyses stratified by age and sex. There was a moderate level of between-country heterogeneity in the association between weak handgrip strength and physical multimorbidity (Higgin's I² = 67.8%) with the pooled estimate being 1.26 (95%CI = 1.06–1.50).ConclusionWeaker handgrip strength is associated with a range of chronic physical conditions and multimorbidity. Future research should seek to establish the predictive value of this inexpensive measure for clinical use.     

Baseline and incident hypochloremia in chronic heart failure outpatients: Clinical correlates and prognostic role

BackgroundElectrolyte serum disorders are associated with poor outcome in chronic heart failure. The aim of this study sought to identify the main driver of incident hypochloremia in chronic HF (CHF) outpatients and to determine the prognostic value of baseline and incident hypochloremia.MethodsConsecutive CHF outpatients were enrolled and clinical, laboratoristic and echocardiographic evaluations were performed at baseline and repeated yearly in a subgroup of patients. Baseline and incident hypochloremia were evaluated. During an up to 5-year follow-up, all-cause mortality was the primary end-point for outcome.ResultsAmong 506 patients enrolled, 120 patients died during follow-up. At baseline, hypochloremia was present in 10% of patients and it was associated with mortality at univariate (HR: 3.25; 95%CI: 2.04–5.18; p<0.001) and at multivariate analysis (HR 2.14; 95%CI: 1.23–3.63; p: 0.005) after correction for well-established CHF prognostic markers. Among patients with repeated evaluations and without baseline hypochloremia, in 13% of these, incident hypochloremia occurred during follow-up and furosemide equivalent daily dose was its first determinant (HR for 1 mg/die: 1.008; 95%CI: 1.004–1.013; p<0.001) at forward stepwise logistic regression analysis. Finally, incident hypochloremia was associated with mortality at univariate (HR: 4.69; 95%CI: 2.69–8.19; p<0.001) as well as at multivariate analysis (HR: 2.97; 95%CI: 1.48–5.94; p: 0.002).ConclusionsIn CHF outpatients baseline and incident hypochloremia are independently associated with all-cause mortality, thus highlighting the prognostic role of serum chloride levels which are generally unconsidered. Future studies should evaluate if the strict monitoring and correction of hypochloremia could exert a beneficial effect on prognosis.     

Comorbidities,repeated hospitalizations,and age ≥ 80 years as indicators of anemia development in the older population

Anemia represents a common condition among the elderly; however, its prevalence and causes are not well known. This retrospective analysis was performed on 981 patients aged ≥?60 in Poland over 2013–2014. The prevalence of anemia was 17.2% and increased with age. The predominant causes of anemia were the following: anemia of chronic disease (33.1%), unexplained anemia (28.4%), deficiency anemia (22.5%, including iron deficiency 13%), and chemo-/radiotherapy-induced anemia (8.9%). In the multivariate logistic regression model, factors increasing the risk of anemia were the following: age?≥?80 years (OR 2.29; 95%CI 1.19–4.42; P?=?0.013), the number of comorbidities (two diseases OR 2.85; 95%CI 1.12–7.30; P?=?0.029, three diseases OR 6.28; 95%CI 2.22–17.76; P?=?0.001, four diseases OR 4.64; 95%CI 1.27–17.01; P?=?0.021), and hospitalizations (OR 1.34; 95%CI 1.13–1.58; P?=?0.001). After a 2-year follow-up, the cumulative survival among patients without anemia in relation to the group with anemia was 90.76 vs. 78.08% (P?<?0.001). In the multivariate model, anemia (HR 3.33, 95%CI 1.43–7.74, P?=?0.005), heart failure (HR 2.94, 95%CI 1.33–6.50, P?=?0.008), and cancer (HR 3.31, 95%CI 1.47–7.49, P?<?0.004) were all significantly correlated with mortality. In patients ≥?60 years, the incidence of anemia increases with age, number of comorbidities, and frequency of hospitalizations and has an adverse impact on survival.     

Job strain,bullying and violence at work and asthma in Peruvian cleaners—a cross-sectional analysis

Objectives: An increased asthma prevalence was found in cleaners. Many of them work in precarious employment conditions, potentially leading to stress, a known risk factor for asthma. We aimed to analyze whether asthma in cleaners might partly be explained by psychosocial working conditions. Methods: The study population of this cross-sectional study included 199 cleaners employed at regional public health services in Puno Province (Peru). They were compared to 79 unexposed workers from Lima, Peru (response 83%). Both groups answered the short version of the European Working Condition Survey and a modified version of the European Community Respiratory Health screening questionnaire. After multiple imputation, the association between psychosocial working conditions and asthma (wheeze without cold or use of asthma medication) was assessed. Results: The 12-months prevalence of asthma was 22% among cleaners versus 5% among unexposed workers (p_Chi² = .001). Cleaners were more likely than unexposed workers to work with temporary or sub-contracts, have a high employment insecurity, high strain working conditions and low social support (all p_Chi² < .05). Twenty-six percent vs. 10% reported a high bullying score; 39% vs. 8% had experienced violence at work (both p_Chi² < .001). High bullying score (adjusted Odds Ratio 5.6; 95% Confidence Interval 1.5–21.4) and violence (2.4; 1.1–5.4) were the main predictors of asthma. Taking these factors into account, being a cleaner was not statistically significantly associated with the outcome (3.5; 0.9–13.8). Conclusions: Poor psychosocial working conditions of cleaners may partly explain the high prevalence of asthma. The underlying mechanism might be a stress-induced inflammatory immune response.