Is diabetes‐specific health literacy associated with diabetes‐related outcomes in older adults?

Background: The present study examined the association between a measure of diabetes‐specific health literacy and three different Type 2 diabetes outcome indicators in a national sample of older adults. Methods: Data were taken from the Health and Retirement Study (HRS) 2003 Diabetes module and the HRS 2002 core wave. Analysis was performed on data from 1318 respondents aged 42–96 years [mean (±SD) 67.96 ± 8.65 years] who submitted responses on all relevant independent variable measures along with an HbA1c test kit. The index of diabetes‐specific health literacy was constructed from responses to 10 diabetes self‐care regimen items (α = 0.927). Results: Using a multivariate regression strategy to analyze weighted data, the diabetes‐specific health literacy index was significantly and positively associated with self‐graded assessment of diabetes self‐care (R² = 0.231). However, diabetes‐specific health literacy was not independently associated with the HbA1c level or the average number of days five recommended self‐management behaviors were practiced each week. Conclusions: No previous single study has focused on the relationship between diabetes‐specific health literacy and multiple diabetes‐related outcomes. The direct association of diabetes‐specific health literacy with patients’ assessment of their self‐care practice acumen is useful information for the design of effective patient intervention and/or communication strategies. Health literacy is a broad, multidimensional construct that bridges basic literacy skills and various health and illness contexts. Because it is so important to adults engaged in the self‐management of chronic illness, indicators of disease‐specific knowledge and/or understanding should be included in efforts to measure health literacy.     

The association between drinking motives and alcohol‐related consequences – room for biases and measurement issues?

Aims To investigate whether the predominant finding of generalized positive associations between self‐rated motives for drinking alcohol and negative consequences of drinking alcohol are influenced by (i) using raw scores of motives that may weight inter‐individual response behaviours too strongly, and (ii) predictor‐criterion contamination by using consequence items where respondents attribute alcohol use as the cause. Design Cross‐sectional study within the European School Survey Project on Alcohol and other Drugs (ESPAD). Setting School classes. Participants Students, aged 13–16 (n = 5633). Measurements Raw, rank and mean‐variance standardized scores of the Drinking Motives Questionnaire—Revised (DMQ‐R); four consequences: serious problems with friends, sexual intercourse regretted the next day, physical fights and troubles with the police, each itemized with attribution (‘because of your alcohol use’) and without. Findings As found previously in the literature, raw scores for all drinking motives had positive associations with negative consequences of drinking, while transformed (rank or Z) scores showed a more specific pattern: external reinforcing motives (social, conformity) had negative and internal reinforcing motives (enhancement, coping) had non‐significant or positive associations with negative consequences. Attributed consequences showed stronger associations with motives than non‐attributed ones. Conclusion Standard scoring of the Drinking Motives Questionnaire (Revised) fails to capture motives in a way that permits specific associations with different negative consequences to be identified, whereas use of rank or Z‐scores does permit this. Use of attributed consequences overestimates the association with drinking motives.     

Is portal hypertension associated with protein‐losing enteropathy?

BACKGROUND AND AIM: Hypoalbuminemia in patients with decompensated cirrhosis has traditionally been assumed to be a result of to impaired liver synthesis; however, protein-losing enteropathy (PLE) may also contribute. The aim of this study was to assess whether hypoalbuminemic cirrhotic patients with portal hypertension had evidence of PLE. METHODS: Sixteen patients with alcoholic cirrhosis, hypoalbuminemia and portal hypertension underwent whole gut lavage with polyethylene glycol solution. The effluent obtained was analyzed for albumin, immunoglobulin (Ig)G and alpha1-antitrypsin (alpha1-AT). Serum C-reactive protein (CRP) was also measured to assess the systemic inflammatory response. RESULTS: Twelve of the 16 enrolled patients had a persistently low albumin concentration at the time of lavage. Only one patient (who was subsequently found to have celiac disease) had elevated concentrations of lavage albumin, alpha1-AT and IgG levels. There was a significant correlation between lavage albumin and alpha1-AT (r = 0.671, P = 0.024), and between lavage albumin and IgG (r = 0.614, P = 0.045). There was no correlation between serum albumin and lavage proteins. Six patients had elevated serum CRP levels, but serum albumin or lavage protein concentrations did not correlate with serum CRP. CONCLUSION: There is no evidence of a significant PLE in patients with alcoholic cirrhosis, hypoalbuminemia and portal hypertension.     

Is COPD associated with increased mortality and morbidity in hospitalized pneumonia? A systematic review and meta‐analysis

This review aimed to investigate whether chronic obstructive pulmonary disease (COPD) is associated with increased mortality and morbidity in patients hospitalized with community‐acquired pneumonia (CAP). EMBASE, PubMed and Web of Science were searched for cohort studies and case–control studies investigating the impact of COPD on CAP. The primary outcome was all‐cause mortality, and secondary outcomes included length of hospital stay, intensive care unit (ICU) admission and need for mechanical ventilation. Methodological quality was assessed using the Newcastle–Ottawa Scale. The Mantel–Haenszel method and inverse variance method were used to calculate pooled relative risks (RRs) and mean differences (MD), respectively. Eleven studies (nine cohort studies and two case–control studies), involving 257 958 patients, were included. The overall methodological quality was high. COPD was not associated with increased mortality in hospitalized CAP patients (RR, 1.20; 95% confidence interval (CI): 0.92–1.56; P = 0.19; I² = 55%) in cohort studies, and was associated with reduced mortality in case–control studies (RR, 0.82; 95% CI: 0.74–0.90; P < 0.0001; I² = 80%). COPD was not associated with longer hospital stay (MD, 0.11; 95% CI: ?0.42 to 0.64; P = 0.68; I² = 21%), more frequent ICU admission (RR, 0.97; 95% CI: 0.70–1.35; P = 0.87; I² = 65%), and more need for mechanical ventilation (RR 0.91, 95% CI: 0.71–1.16; P = 0.44; I² = 4%).The current available evidence indicates that COPD may not be associated with increased mortality and morbidity in patients hospitalized with CAP. This conclusion should be re‐evaluated by prospective population‐based cohort studies.     

Is transient elastography valuable for high‐risk esophageal varices prediction in patients with hepatitis‐B‐related cirrhosis?

Background and Aim: The aim of this study was to evaluate the clinical value of transient elastography (TE) for high‐risk esophageal varices (HREV) prediction in hepatitis‐B‐related cirrhosis patients. Methods: A total of 238 patients with hepatitis B cirrhosis were prospectively enrolled. All patients had undergone TE and upper gastrointestinal endoscopy. Diagnostic value was assessed by the area under ROC curve (AUROC), predictive value and likelihood ratio. Results: The size of esophageal varices correlated with liver stiffness with Kendall's tau_b 0.236 overall and 0.425 in patients with ALT ≥ 5 × upper limit of normal (ULN). The AUROC of TE predicting HREV was 0.73 (95% confidence interval 0.66–0.80) overall and 0.92 (0.82–1.01) for patients with ALT ≥ 5 × ULN. In patients with ALT ≥ 5 × ULN, cut‐off 36.1 kPa predicted HREV with a 100% negative predictive value (NPV), an indefinite negative likelihood ratio (NLR), a 72.7% positive predictive value (PPV) and a positive likelihood ratio (PLR) of 9.3. The AUROC of HREV‐predicting model, constructed by ultrasonography and TE (USLS), was 0.84 (0.77–0.90) in the training set and 0.85 (0.76–0.94) in the validating set. Cut‐off 3.30 excluded HREV with NPV 0.946 and NLR 0.10, and cut‐off 5.98 determined HREV with PPV 0.870 and PLR 10.24. Using USLS, nearly 50% of patients could avoid endoscopic screening. The model's predictive values were maintained at similar accuracy in the validation set. Differences of AUROC in USLS, liver stiffness/spleen diameter to platelet ratio score and ultrasonic score were not significant. Conclusions: TE may predict HREV in patients with ALT ≥ 5 × ULN. Overall, the clinical values of TE and USLS for HREV prediction should be evaluated by further studies.     

Are long working hours associated with weight‐related outcomes? A meta‐analysis of observational studies

The relationship between long working hours and body weight outcomes remains inconclusive; thus, we conducted a meta‐analysis to assess the effect of long working hours on weight‐related outcomes. PubMed and Embase databases were searched from their inception to June 2019. A random‐effects model was used to assess the pooled odds ratio (OR) and corresponding confidence interval (CI). Subgroup analyses and sensitivity analyses were conducted to explore sources of heterogeneity. Publication bias was evaluated by the Begg's and Egger's tests. A total of 29 articles involving 374 863 participants were included. The pooled OR of long working hours on weight‐related outcomes was 1.13 (95% CI, 1.07‐1.19). In subgroup analysis stratified by definition of outcomes, the pooled ORs of long working hours on “weight gain/BMI increase,” “BMI ≥ 25 kg/m²,” and “BMI ≥ 30 kg/m²” were 1.19 (95% CI, 1.02‐1.40), 1.07 (95% CI, 1.00‐1.14), and 1.23 (95% CI, 1.09‐1.39), respectively. We found evidence of publication bias, but correction for this bias using the trim‐and‐fill method did not alter the combined OR substantially. There was evidence to suggest that long working hours are associated with adverse weight‐related outcomes. Preventative interventions such as improved flexibility and healthy working schedules should be established for employees.