Sociodemographic,clinical, and psychological factors associated with attrition in a prospective study of cardiovascular prevention: the Heart Strategies Concentrating on Risk Evaluation study

PurposeTo identify factors associated with attrition in a longitudinal study of cardiovascular prevention.MethodsDemographic, clinical, and psychosocial variables potentially associated with attrition were investigated in 1841 subjects enrolled in the southwestern Pennsylvania Heart Strategies Concentrating on Risk Evaluation study. Attrition was defined as study withdrawal, loss to follow-up, or missing 50% or more of study visits.ResultsOver 4 years of follow-up, 291 subjects (15.8%) met criteria for attrition. In multivariable regression models, factors that were independently associated with attrition were black race (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.55–3.16; P < .001), younger age (OR per 5-year increment, 0.88; 95% CI, 0.79–0.99; P < .05), male gender (OR, 1.79; 95% CI, 1.27–2.54; P < .05), no health insurance (OR, 2.04; 95% CI, 1.20–3.47; P < .05), obesity (OR, 1.80; 95% CI, 1.07–3.02; P < .05), CES-D depression score 16 or higher (OR, 2.02; 95% CI, 1.29–3.19; P < .05), and higher ongoing life events questionnaire score (OR, 1.09; 95% CI, 1.04–1.13; P < .001). Having a spouse/partner participating in the study was associated with lower odds of attrition (OR, 0.60; 95% CI, 0.37–0.97; P < .05). A synergistic interaction was identified between black race and depression.ConclusionsAttrition over 4 years was influenced by sociodemographic, clinical, and psychological factors that can be readily identified at study entry. Recruitment and retention strategies targeting these factors may improve participant follow-up in longitudinal cardiovascular prevention studies.     

Birth weight predicts the risk of gestational diabetes mellitus and pregravid obesity

ObjectivesIt has been suggested that birth weight may determine metabolic abnormalities later in life. The aim of the current study was to assess the association between birth weight and future risk of gestational diabetes mellitus (GDM) and pregravid obesity in a homogenous sample of Caucasian Polish women.MethodsIn this retrospective study, we collected the medical reports of 787 women with GDM and 801 healthy pregnant women. We analyzed the following data: birth weight, age, pregravid weight, prior GDM, prior macrosomia, parity, and family history of diabetes.ResultsBirth weight was inversely associated with the risk of GDM; for each decrease in birth weight of 500 g, the risk increased by 11% (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.02–1.21). Birth weight was a strong predictor of GDM independent of other risk factors (OR, 1.19; 95% CI, 1.09–1.31), and it was positively correlated with pregravid weight (R = 0.21; P < 0.00001). An increase in birth weight of 500 g substantially increased the risk of overweight and obesity (OR, 1.17; 95% CI, 1.01–1.34 and OR, 1.35; 95% CI 1.11–1.64, respectively). Each of the traditional risk factors for GDM were also strong predictors of pregravid obesity: age (P < 0.0001), prior GDM (P < 0.01), prior macrosomia (P < 0.0001), multiparity (P < 0.0001), and maternal (but not paternal) history of diabetes (P < 0.0001).ConclusionsAmong Caucasian Polish women, the risk of GDM is associated with low birth weight, and pregravid obesity is associated with high birth weight. Traditional risk factors for GDM, including maternal (but not paternal) history of diabetes, are also risk factors for pregravid obesity.     

Differences between Hispanic and non-Hispanic white women with breast cancer for clinical characteristics and their correlates

PurposeBody size and ethnicity may influence breast cancer tumor characteristics at diagnosis. We compared Hispanic and non-Hispanic white (NHW) cases for stage of disease, estrogen receptor (ER) status, tumor size, and lymph node status, and the associations of these with body size in the 4-Corners Breast Cancer Study.MethodsOne thousand five hundred twenty-seven NHW and 798 Hispanic primary incident breast cancer cases diagnosed between October 1999 and May 2004 were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multiple logistic regression.ResultsHispanic women were more likely to have larger (>1 cm) ER? tumors and more than four positive lymph nodes (P < .003). Lymph node status was not associated with body size. However, among NHW women, obesity (body mass index >30) and increased waist circumference (>38.5 inches) were significantly positively associated with ER? tumor status (OR, 1.87; 95% CI, 1.24–2.81 and OR, 2.59; 95% CI, 1.58–4.22, respectively). In contrast, among Hispanic women, obesity and waist circumference had inverse associations with ER? tumor status (OR, 0.49; 95% CI, 0.29–0.84 and OR, 0.56; 95% CI, 0.30–1.05, respectively).ConclusionsHispanic ethnicity may modify the association of body size and composition with ER? breast cancer. This finding could have relevance to clinical treatment and prognosis.     

Body mass index and risk of head and neck cancer by race: the Carolina Head and Neck Cancer Epidemiology Study

PurposeMost studies, primarily conducted in populations of European ancestry, reported increased risk of head and neck cancer (HNC) associated with leanness (body mass index [BMI] <18.5 kg/m²) and decreased for overweight or obesity (25.0 to <30.0 and >30 kg/m², respectively), compared with normal weight (18.5 to <25.0 kg/m²).MethodsThe Carolina Head and Neck Cancer Epidemiology Study is a population-based, racially diverse case-control study of 1289 incident HNC cases (330 African Americans) and 1361 controls (261 African Americans). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for associations between BMI 1 year prediagnosis and HNC risk stratified by race and adjusted for age, sex, smoking, alcohol, and education.ResultsMultiplicative interaction between BMI and race was evident (P_int = .00007). Compared with normal weight, ORs for leanness were increased for African Americans (OR, 3.91; 95% CI, 0.72–21.17) and whites (OR, 1.48; 95% CI, 0.60–3.65). For overweight and obesity, ORs were decreased in African Americans (OR, 0.51; 95% CI, 0.32–0.83 and OR, 0.47; 95% CI, 0.28–0.79, respectively) but in not whites. The increased risk associated with leanness was greater for smokers than nonsmokers (P_int = .02).ConclusionsThese data, which require replication, suggest that leanness is associated with increased HNC risk among African Americans to a greater extent than whites and overweight and obesity is associated with decreased HNC risk only among African Americans.     

Impact of Comorbidities on Hospital-Acquired Infections in a Geriatric Rehabilitation Unit: Prospective Study of 252 Patients

ObjectivesHospital-acquired infections (HAIs) remain a major source of morbidity and mortality in long-term care units, despite advances in antimicrobial therapy and preventive measures. Our aim was to investigate risk factors for HAIs, especially in the elderly, and to describe the relationship between comorbidities (number, severity, and specific diseases) and HAIs using a comprehensive inventory of comorbidities.DesignProspective cohort studySettingGeriatric rehabilitation unit in a university hospital in the Paris metropolitan area.ParticipantsParticipants were 252 consecutive patients aged 75 years or older (mean age, 85 ± 6.2 years) and admitted between 2006 and 2008.MeasurementsSurveillance of HAI was conducted. A complete inventory of comorbidities was done using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Potential risk factors were evaluated in 2 risk models, one with HAI acquisition, CIRS-G, activities of daily living score less than 10, and at least 1 invasive procedure (yes/no) and the other with HAI acquisition and specific invasive procedures and diseases.ResultsOf the 252 patients, 97 experienced HAIs, for an incidence of 5.6 infections per 1000 bed-days. The most common HAI sites were the respiratory tract (48%; 65/136) and urinary tract (37%; 51/136). The CIRS-G global score and comorbidity index were higher in patients with than without HAIs. Among HAI categories, respiratory and urogenital diseases were more prevalent in the group with HAIs. In the model combining CIRS-G, activities of daily living score less than 10, and at least 1 invasive procedure, independent risk factors for HAI were CIRS-G index (odds ratio [OR], 1.55; 95% confidence interval [95% CI], 1.13–2.11; P = .005) and invasive procedures (OR, 5.18; 95% CI, 2.77–9.71; P < .001). In the model including specific procedures and diseases, independent risk factors for HAI were intravenous catheter (OR, 7.39; 95% CI, 2.94–18.56; P < .001), urinary catheter (OR, 3.33; 95% CI, 1.40–7.88; P = .006), gastrointestinal endoscopy (OR, 3.69; 95% CI, 1.12–12.16; P = .03), pressure sores (OR, 2.52; 95% CI, 1.04–6.10; P = .03), and swallowing impairment (OR, 3.37; 95% CI, 1.16–9.74; P = .02).ConclusionsThis study identified several important risk factors for HAIs. There is a need for HAI prevention via the implementation of infection-control programs, including surveillance, in rehabilitation units.     

Physical Activity and Health Service Utilization Among Older People

BackgroundRising health care use among older people presents a challenge to medical care. Physical activity (PA) is beneficial; however, it is unknown if initiating PA among the very old reduces health service use. We examined the effects of changing PA levels on emergency room (ER) visits and hospitalization at ages 78 and 85.MethodsA representative sample (born 1920–1921) from the Jerusalem Longitudinal Cohort Study (1990–2010) were assessed at ages 78 and 85 for self-reported PA; ER visits and hospitalization; and social, functional, and medical domains.ResultsWe examined 896 and 1173 subjects at ages 78 and 85, respectively. ER usage at ages 78 and 85 respectively was lower among active subjects (15.8% vs 37.4%, P < .0001; 30.6% vs 50.8%, P < .0001), as was hospitalization (10.5% vs 16.7%, P < .05; 22.1% vs 37.8%, P < .0001). We adjusted for gender, education, loneliness, functional dependence, cognitive impairment, depression, diabetes, heart disease, hypertension, neoplasm, renal disease, self-rated health, body mass index, and smoking. PA at age 78 was associated with a reduced likelihood of ER visits (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.27–0.89), but not hospitalization (OR 1.14, 95% CI 0.54–2.42); at age 85 with a reduced likelihood for ER visits (OR 0.72, 95% CI 0.52–0.99) and hospitalization (OR 0.68, 95% CI 0.48–0.98). Compared with subjects consistently active at ages 78 and 85, initiating PA between ages 78 and 85 resulted in similar lower likelihood of ER visits (OR 0.6, 95% CI 0.23–1.56) and hospitalization (OR 1.20, 95% CI 0.48–3.02); stopping PA and never being active between 78 and 85 were respectively associated with increased ER visits (OR 1.72, 95% CI 1.02–2.88; OR 2.18, 95% CI 1.04–4.57) and hospitalization (OR 1.85, 95% CI 1.06–3.23; OR 2.01, 95% CI 0.92–4.4).ConclusionsAmong the oldest old, not only continuing but also becoming physically active is associated with reduced health service use. Initiating PA among the very old should be encouraged.     

Predictors of Mortality,Rehospitalization for Syncope,and Cardiac Syncope in 352 Consecutive Elderly Patients With Syncope

ObjectivesTo investigate the etiologies of syncope and predictors of all-cause mortality, rehospitalization, and cardiac syncope in consecutive elderly patients presenting with syncope to our emergency department.ParticipantsParticipants were 352 consecutive patients aged 65 years or older with syncope admitted to hospital from the emergency department.DesignObservational retrospective study.MeasurementsReview of medical records for history, physical examination, medications, and tests to determine causes of syncope. Cox stepwise logistic regression analysis was performed to identify significant independent prognostic factors for rehospitalization with syncope, all-cause mortality, and cardiac syncope.ResultsOf 352 patients, mean age 78 years, the etiology of syncope was diagnosed in 243 patients (69%). Vasovagal syncope was diagnosed in 12%, volume depletion in 14%, orthostatic hypotension in 5%, cardiac syncope in 29%, carotid sinus hypersensitivity in 2%, and drug overdose/others in 7% of patients. During a mean follow-up of 24 months, 10 patients (3%) were readmitted to the hospital for syncope and 39 (11%) died. Stepwise logistic regression analysis identified history of congestive heart failure (OR 5.18; 95% CI 1.23–21.84, P = .0257) and acute coronary syndrome (OR 5.95; 95% CI 1.11–31.79, P = .037) as independent risk factors for rehospitalization. Significant independent prognostic factors for mortality were diabetes mellitus (OR 2.08; 95% CI 1.09–3.99, P = .0263), history of smoking (OR 2.23; 95% CI 1.10–4.49, P = .0255), and use of statins (OR 0.37; 95% CI 0.19–0.72, P = .0036). Independent risk factors for predicting a cardiac cause of syncope were an abnormal electrocardiogram (OR 2.58; 95% CI 1.46–4.57, P = .0012) and reduced ejection fraction (OR 2.92; 95% CI 1.70–5.02, P < .001). The San Francisco Syncope Rule and Osservatorio Epidemiologico sulla Sincope nel Lazio scores did not predict mortality or rehospitalization in our study population.ConclusionsSignificant independent risk factors for rehospitalization for syncope were congestive heart failure and acute coronary syndrome. Significant independent risk factors for mortality were diabetes mellitus, history of smoking, and use of statins (inverse association).     

Factors Associated With Remaining in a Skilled Nursing Facility for Over 90 Days from Admission: Residents' Participation in Therapy and Desire to Return to the Community

BackgroundTo identify the factors associated with stay in a skilled nursing facility (SNF) among new enrollees who did not fully participate in therapy sessions.MethodsData (n = 36,133) were obtained from the Minimum Data Set version 2.0 in the state of Michigan in 2009. Study participants were new SNF enrollees (n = 699) who did not fully participate in therapy sessions despite their desire to return to the community. Multivariate logistic regressions were performed to identify factors contributing to remaining in a nursing home for 91 days or longer.ResultsNew SNF enrollees were more likely to remain in nursing home when they were depressed (odds ratio [OR] = 1.41; 95% confidence interval [CI], 1.09–2.08; P = .01), experiencing delirium (OR = 3.20; 95% CI, 1.48–5.92; P < .001), were not in pain (OR = 0.83; 95% CI, 0.60–0.95; P = .03), or in less complex care (OR = 0.57; 95% CI, 0.44–0.81; P < .01).ConclusionsA higher number of new SNF enrollees than previously reported were likely to stay in nursing homes (28.0%). Depression and delirium were associated with stay in an SNF, while pain and higher complexity of care were associated with returning to the community.     

Cognitive Impairment Predicts Sarcopenia 9 Years Later among Older Adults

ObjectiveTo assess the longitudinal association between cognitive impairment and sarcopenia in a sample of Brazilian community-dwelling older adults.DesignNine-year observational prospective study.Setting and ParticipantsA total of 521 community-dwelling older adults from 2 Brazilian sites of the Frailty in Brazilian Older Adults (FIBRA in Portuguese) study.MethodsSarcopenia was defined as low hand-grip strength and low muscle mass. Cognitive impairment was determined at baseline using the Mini-Mental State Examination, with education-adjusted cutoff scores. The logistic regression model was used to assess the association between cognitive impairment and incident sarcopenia after adjusting for gender, age, education, morbidities, physical activity, and body mass index. Inverse probability weighting was applied to correct for sample loss at follow-up.ResultsThe mean age of the study population was 72.7 (±5.6) years, and 365 were women (70.1%). Being 80 years and older [odds ratio (OR), 4.62; 95% CI, 1.38–15.48; P = .013], being under- and overweight (OR, 0.29; 95% CI, 0.11–0.76; P = .012, and OR, 5.12; 95% CI, 2.18–12.01; P < .001, respectively) and having cognitive impairment (OR, 2.44; 95% CI, 1.18–5.04; P = .016) at baseline predicted sarcopenia after 9 years.Conclusion and ImplicationsCognitive impairment may predict sarcopenia in Brazilian older adults. More studies are necessary to identify the main mechanisms shared by sarcopenia and cognitive decline, which could support the development of prevention interventions.     

Demographic,Clinical, and Counseling Factors Associated with the Selection of Pregnancy Termination Method in the Second Trimester for Fetal and Pregnancy Anomalies

ObjectiveDespite women's preference for induction of labor (IOL) or dilation and evacuation (D&E) for pregnancy termination in the setting of second trimester fetal or pregnancy abnormality, many women are not given a choice between delivery methods. We investigated patient and clinical related factors associated with selecting IOL or D&E.MethodsThis retrospective cohort experienced pregnancy termination at 17–24 weeks of gestation for fetal anomaly, intrauterine fetal demise, or premature previable rupture. We compared the demographic, reproductive, social, and clinical experience variables between women who select IOL and D&E, adjusting for confounders through logistic regression.ResultsOne hundred eleven women (21.6%) selected IOL and 403 (78.4%) selected D&E. Greater proportions of women of color (p < .01), lower education (p < .01), lower employment (p < .01), and lower status jobs (p < .01) selected IOL. Women selected D&E more often for chromosomal anomaly (p < .01). In adjusted analyses, women with intrauterine fetal demise (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.8–34.7), premature previable rupture (OR, 110; 95% CI, 23.0–526.8), prior substance use disorder (OR, 35.5; 95% CI–2.7, 473.7), or counseling from obstetrics (OR, 3.3; 95% CI–1.3, 8.4), pediatrics (OR, 3.3; 95% CI–1.3, 8.6), or social services (OR, 12.6; 95% CI, 4.2–37.3) had higher odds of selecting IOL.ConclusionsPatient characteristics, medical factors, and type of counseling are associated with the selection between D&E and IOL for anomalous pregnancies. Institutional, regional, and state policies should permit women both delivery methods to preserve autonomous decision-making at the time of pregnancy termination.     

Association between junk food consumption and mental health in a national sample of Iranian children and adolescents: The CASPIAN-IV study

ObjectivesThe consumption of high energy and low nutritional content foods, which are known as junk foods, has increased. The aim of this study was to evaluate the association between junk food intake and mental health in a national sample of Iranian children and adolescents.MethodData were obtained from a surveillance system entitled CASPIAN-IV (Childhood and Adolescence Surveillance and Prevention of Adult Non communicable Disease) study of school students, ages 6 to 18 y in Iran. The students and their parents completed two sets of reliable questionnaires obtained from Global School Health Survey translated to Persian. The student questionnaire comprised several questions such as psychiatric distress (worry, depression, confusion, insomnia, anxiety, aggression, and worthless) and violent behaviors (physical fighting, being a victim, and bullying). The junk foods consisted of sweets, sweetened beverages, fast foods, and salty snacks.ResultsIn the sample of 13 486 children and adolescents, the frequency of junk food consumption was significantly associated with psychiatric distress (P < 0.001). There was a significant association between violent behaviors and intake of junk foods (P < 0.001) except for sweets, whereas the association between sweetened beverages consumption and being a victim was not significant (P > 0.05). Additionally, the results of logistic regression showed that daily consumption of sweetened beverages and snacks significantly increased the odds of self-reported psychiatric distress. Also, daily consumption of salty snacks was significantly associated with violent behavior, including physical fighting (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.21–1.60), being a victim (OR, 1.19; 95% CI, 1.04–1.37), and bullying (OR, 1.55; 95% CI, 1.32–1.82).ConclusionJunk food consumption may increase the risk for psychiatric distress and violent behaviors in children and adolescents. Improvement of eating habits toward healthier diets may be an effective approach for improving mental health.     

Egg and Dietary Cholesterol Consumption and the Prevalence of Metabolic Syndrome: Findings from a Population-Based Nationwide Cohort

BackgroundAlthough the Chinese Dietary Guidelines (2016) removed restrictions on dietary cholesterol intake, evidence of egg and dietary cholesterol intake and cardiometabolic diseases is inconsistent. Associations between egg and cholesterol consumption and metabolic syndrome (MetS) in non-Western populations are still poorly documented.ObjectiveOur aim was to assess egg and dietary cholesterol intake in relation to the prevalence of MetS among participants in a Chinese nationwide study.DesignThis cross-sectional study used data from the China Health and Nutrition Survey (1991-2009).Participants/settingThe sample consisted of 8,241 healthy Chinese adults (20 years and older).Main outcome measuresMetS cases were defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria.Statistical analysisCumulative means of egg and cholesterol consumption were calculated in accordance with 3 consecutive 24-hour dietary recalls in each examination cycle. Logistic regression models were conducted to assess the associations with prevalent MetS.ResultsOverall, 2,580 (31.3%) participants were identified as MetS cases in 2009. After multivariate adjustment, total egg consumption (>1 egg/d) was associated with 20% higher odds of MetS (odds ratio [OR] 1.20, 95% CI 1.06 to 1.37; P trend = .001) compared with consumption of ≤1/2 egg/d. Examining cooking methods, a positive association was observed between fried egg consumption and MetS odds (OR comparing the highest category [>1/2 egg/d] with the lowest category [≤1/7 egg/d] 1.22, 95% CI 1.08 to 1.39; P trend = .001), and nonfried egg intake was not associated with MetS odds (P trend = .08). Total dietary intake and egg-sourced cholesterol intake were both positively correlated with MetS odds (OR 1.31, 95% CI 1.12 to 1.53; P trend = .005) comparing the highest consumption (>371 mg · 2,000 kcal^–1 · d^–1) with the lowest consumption (≤132 mg · 2,000 kcal^–1 · d^–1) for total dietary cholesterol (OR 1.36; 95% CI 1.17 to 1.58; P trend < .001) and comparing the highest consumption (>232 mg · 2,000 kcal^–1 · d^–1) with the lowest consumption (≤46 mg · 2,000 kcal^–1 · d^–1) for egg-sourced cholesterol; similar associations were not observed for non–egg-sourced cholesterol consumption (P trend = .83). Substituting eggs and fried eggs for other protein sources, including low-fat and whole-fat dairy products; nuts and legumes; total red meat; processed meat; poultry meat; or seafood, was still associated with higher odds of MetS.ConclusionsConsumption of >1 egg/d and >1/2 fried egg/d was associated with a higher prevalence of MetS than consumption of ≤1/2 egg/d and ≤1/7 fried egg/d. Future longitudinal cohort studies and randomized controlled trials are needed to further investigate the relationship between egg consumption and MetS and explore possible mechanisms of action.     

Relationship Between Nutritional Status and Insomnia Severity in Older Adults

ObjectivesBoth insomnia and malnutrition are quite common and can cause similar negative consequences, such as falls, depression, and cognitive impairment in older adults, but there is no study investigating the relationship between the 2. The aims were to investigate relationships between insomnia/insomnia severity and Mini Nutritional Assessment (MNA) score and serum nutrient levels.Setting and participantsAged 65 years or older, 575 outpatients were included.MethodsMNA scores >23.5, 17-23.5, and <17 were categorized as normal nutritional status, malnutrition risk, and malnutrition, respectively. Serum vitamin B₁₂, vitamin D, and folate deficiencies were also evaluated. Insomnia Severity Index (ISI) with scores of 8 and higher indicated insomnia, which was further stratified as mild (8-14), moderate (15-21), or severe (22-28).ResultsThe mean age was 73.1 ± 7.7 years, with 73.2% being female. The prevalence of patients with no insomnia, mild insomnia, moderate insomnia, and severe insomnia were 34.4%, 20.9%, 30.1%, and 14.6%, respectively. After adjusting for gender, education, number of drugs, Charlson Comorbidity Index, presence of depression, and Mini-Mental State Examination scores, patients with insomnia had lower MNA scores than those without insomnia (OR = 0.84, 95% CI: 0.7-0.9, P < .001). There were significant relationships between moderate/severe insomnia and the presence of malnutrition and risk of malnutrition (OR = 1.6, 95% CI: 1.0-2.5, P = .046; OR = 1.6, 95% CI: 1.0-2.7, P = .042) and MNA scores (OR = 0.83, 95% CI: 0.7-0.9, P < .001)/OR = 0.82, 95% CI: 0.7-0.9, P < .001). There was no significant difference between insomnia severity status and serum vitamin D, vitamin B₁₂, folate levels, or classification of these nutrients (P > .05).Conclusions/ImplicationsThere is a close relationship between MNA scores and insomnia or insomnia severity in older adults. Therefore, when evaluating an older patient with insomnia, malnutrition should be evaluated, or insomnia should also be questioned in an older patient with malnutrition. Thus, more effective management of the 2 can be possible.     

The STRONGkids nutritional screening tool in hospitalized children: A validation study

ObjectiveThe STRONG_kids is a nutritional screening tool for hospitalized children, which was found to predict a negative weight for height (WFH) standard deviation score (SDS) and a prolonged hospital length of stay (LOS) in a Dutch population of hospitalized children. This study aimed to test the ease of use and reproducibility of the STRONG_kids, and to confirm its concurrent and prospective validity in a Belgian population of hospitalized children.MethodsReproducibility was tested in a cohort of 29 hospitalized children in a tertiary center and validity was tested in 368 children (105 hospitalized in a tertiary and 263 in three secondary hospitals) ages between 0.08 and 16.95 y (median 2.2 y).ResultsSubstantial intrarater (κ = 0.66) and interrater (κ = 0.61) reliabilities were found between observations. STRONG_kids scores correlated negatively with WFH SDS of the patients (ρ = –0.23; P < 0.01; odds ratio [OR], 2.47; 95% confidence interval [CI], 1.11–5.49; P < 0.05). It had a sensitivity and negative predictive value (NPV) of respectively 71.9% and 94.8% to identify acutely undernourished children. STRONG_kids did not correlate with weight loss during hospitalization, but correlated with LOS (ρ = 0.25; OR 1.96; 95% CI, 1.25–3.07; both P < 0.01) and the set-up of a nutritional intervention during hospitalization (OR, 18.93; 95% CI, 4.48–80.00; P < 0.01). The sensitivity and NPV to predict a LOS ≥ 4 d were respectively 62.6% and 72%, and respectively 94.6% and 98.9% to predict a nutritional intervention.ConclusionsSTRONG_kids is an easy-to-use screening tool. Children classified as “low risk” have a 5% probability of being acutely malnourished, with only a 1% probability of a nutritional intervention during hospitalization.     

Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study

ObjectiveSensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium.DesignCross-sectional study nested in the 2017 “Delirium Day” project.Setting and ParticipantsPatients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy.MethodsDelirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters).ResultsA total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2–2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1–1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6–1.2, P = .36; OR 1.1; CI 0.8–1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6–1.2, P = .27; OR 1.1, CI 0.8–1.4, P = .63).Conclusions and implicationsOur findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.     

Alcohol Consumption and Risk of Incident Frailty: The English Longitudinal Study of Aging

BackgroundAlcohol consumption is a common modifiable lifestyle factor. Alcohol may be a risk factor for frailty, however, there is limited evidence in the literature.ObjectiveThe objectives of this study were to examine the association of alcohol consumption with the risk of incident frailty.MethodsThis is a prospective panel study of 2544 community-dwelling people aged 60 years and older in England. Frailty status defined by frailty phenotype criteria was measured at baseline and 4 years later. Participants free of frailty at baseline were divided into 5 groups based on quantity of self-reported alcohol consumption per week with cut-points at 0, 7, 14, and 21 UK units per week. Adjusted odds ratios (OR) were calculated for incident frailty according to the alcohol consumption using logistic regression models.ResultsCompared with the low consumption group (>0 and ≤7 units per week), incident frailty risk over 4 years was significantly higher among nondrinkers [OR 1.71, 95% confidence interval (CI) 1.12‒2.60, P value = .01], after controlling for sociodemographic confounders. In a supplementary analysis this became nonsignificant after further adjustment for baseline health status. Heavy drinkers (>21 units per week) had a significantly lower incident frailty risk (unadjusted OR 0.45, 95% CI 0.27‒0.75, P < .01), which became nonsignificant on adjustment for sociodemographic factors (OR 0.64, 95% CI 0.37‒1.13, P = .12).Conclusions/ImplicationsWe found that nondrinkers were more likely than those with low alcohol consumption to develop frailty, but this appeared to be explained by poorer baseline health status. No evidence was found for an association between high levels of alcohol consumption and becoming frail. Future studies with information on life-course history of alcohol use, especially for those classified as nondrinkers in old age, are warranted.     

Impact of prior bariatric surgery on risk and severity of COVID-19 infection: A meta-analysis of observational studies

BackgroundThe association of prior bariatric surgery (BS) with infection rate and prognosis of coronavirus disease 2019 (COVID-19) remains unclear. We conducted a meta-analysis of observational studies to address this issue.MethodsWe searched databases including MEDLINE, Embase, and CENTRAL from inception to May, 2022. The primary outcome was risk of mortality, while secondary outcomes included risk of hospital/intensive care unit (ICU) admission, mechanical ventilation, acute kidney injury (AKI), and infection rate.ResultsEleven studies involving 151,475 patients were analyzed. Meta-analysis showed lower risks of mortality [odd ratio (OR)= 0.42, 95% CI: 0.27–0.65, p < 0.001, I² = 67%; nine studies; 151,113 patients, certainty of evidence (COE):moderate], hospital admission (OR=0.56, 95% CI: 0.36–0.85, p = 0.007, I² =74.6%; seven studies; 17,810 patients; COE:low), ICU admission (OR=0.5, 95% CI: 0.37–0.67, p < 0.001, I² =0%; six studies; 17,496 patients, COE:moderate), mechanical ventilation (OR=0.52, 95% CI: 0.37–0.72, p < 0.001, I² =57.1%; seven studies; 137,992 patients, COE:moderate) in patients with prior BS (BS group) than those with obesity without surgical treatment (non-BS group). There was no difference in risk of AKI (OR=0.74, 95% CI: 0.41–1.32, p = 0.304, I² =83.6%; four studies; 129,562 patients, COE: very low) and infection rate (OR=1.05, 95% CI: 0.89–1.22, p = 0.572, I² =0%; four studies; 12,633 patients, COE:low) between the two groups. Subgroup analysis from matched cohort studies demonstrated associations of prior BS with lower risks of mortality, ICU admission, mechanical ventilation, and AKI.ConclusionOur results showed a correlation between prior BS and less severe COVID-19, which warrants further investigations to verify.     

Association of IPS1 polymorphisms with peginterferon efficacy in chronic hepatitis B with HBeAg-positive in the Chinese population

AimsTo investigate whether IPS1 polymorphisms affect peginterferon alpha (PEG-IFN) efficacy in chronic hepatitis B (CHB) patients using a tag- single nucleotide polymorphism (SNP) approach.MethodsA total of 212 hepatitis B e antigen (HBeAg)-positive patients treated with a 48 weeks of PEG-IFN monotherapy were enrolled initially and 127 patients were followed for 48 weeks posttreatment. Genotype analysis was performed for 10 tag-SNPs in IPS1.ResultsThe end of virological response (EVR) rate was 45.8% (97/212) and the sustained virological response (SVR) rate was 45.7% (58/127). Meanwhile, 35.4% (75/212) achieved HBeAg seroconversion at the end of treatment. In a multivariate analysis, the rs2464 CC genotype was independently associated with EVR (OR 2.21, 95% CI 1.23–3.98, P = 0.008) and SVR (OR 2.34, 95% CI 1.05–5.20, P = 0.037) after adjustment for sex, age, HBV genotype, baseline levels of HBV DNA and ALT. Meanwhile, rs2464 CC genotype were also independently associated with decline of HBsAg levels below 1500 IU/mL at 12 weeks of treatment (OR 2.52, 95% CI 1.01–6.29, P = 0.047). Furthermore, three SNPs were found to be independently associated with HBeAg seroconversion at the end of treatment. (1) The rs2326369 CC genotype was independently associated with no HBeAg seroconversion (OR 0.52, 95% CI 0.29–0.95, P = 0.034); (2) The rs6515831 TT genotype was independently associated with HBeAg seroconversion (OR 2.11, 95% CI 1.14–3.90, P = 0.017); (3) The rs2464 CC genotype was independently associated with HBeAg seroconversion (OR 2.36, 95% CI 1.26–4.42, P = 0.007).ConclusionsPolymorphisms in IPS1 are independently associated with treatment response to PEG-IFN among Chinese HBeAg-positive CHB patients.     

Discharge Destinations of Delirious Patients: Findings From a Prospective Cohort Study of 27,026 Patients From a Large Health Care System

ObjectivesDelirium is known to contribute to increased rates of institutionalization and mortality. The full extent of adverse outcomes, however, remains understudied. We aimed to systematically assess the discharge destinations and mortality risk in delirious patients in a large sample across all hospital services.DesignPragmatic prospective cohort study of consecutive admissions to a large health care system.Setting and ParticipantsA total of 27,026 consecutive adults (>18 years old) with length of stay of at least 24 hours in a tertiary care center from January 1 to December 31, 2014.MethodsPresence of delirium determined by routine delirium screening. Clinical characteristics, discharge destination, and mortality were collected. Calculation of odds ratios (ORs) with logistic regression with adjustment for age, sex, and Charlson comorbidity index (CCI).ResultsDelirium was detected in 19.7% of patients (5313 of 27,026), median age of delirious patients was 56 years (25–75 interquartile range = 37–70). The electronic health record (DSM-5-based) delirium algorithm correctly identified 93.3% of delirium diagnoses made by consultation-liaison psychiatrists. Across services, the odds of delirious patients returning home was significantly reduced [OR 0.12; confidence interval (CI) 0.10–0.13; P < .001]. Rather, these patients were transferred to acute rehabilitation (OR 4.15; CI 3.78–4.55; P < .001) or nursing homes (OR 4.12; CI 3.45–4.93; P < .001). Delirious patients had a significantly increased adjusted mortality risk (OR 30.0; CI 23.2–39.4; P < .001).Conclusions and ImplicationsThis study advances our understanding of the discharge destination across all services in adults admitted to a large hospital system. Delirium was associated with reduced odds of returning home, increased odds of discharge to a setting of higher dependency, and excess mortality independent of comorbidity, age, and sex. These findings emphasize the potentially devastating outcomes associated with delirium and highlight the need for timely diagnosis and hospital-wide management.     

Trends in Antipsychotic and Mood Stabilizer Prescribing in Long-Term Care in the U.S.: 2011–2014

ObjectiveThe Centers for Medicare and Medicaid Services’ National Partnership to Improve Dementia Care in Nursing Homes focuses on but is not limited to long-term care (LTC) residents with dementia; the potential impact on residents with other diagnoses is unclear. We sought to determine whether resident subpopulations experienced changes in antipsychotic and mood stabilizer prescribing.DesignRepeated cross-sectional analysis of a 20% Medicare sample, 2011–2014.Setting and ParticipantFee-for-service Medicare beneficiaries with Part D coverage in LTC (n = 562,485) and a secondary analysis limited to persons with depression or bipolar disorder (n = 139,071).MethodsMain outcome was quarterly predicted probability of treatment with an antipsychotic or mood stabilizer.ResultsFrom 2011 to 2014, the adjusted predicted probability (APP) of antipsychotic treatment fell from 0.120 [95% confidence interval (CI) 0.119–0.121] to 0.100 (95% CI 0.099–0.101; P < .001). Use decreased for all age, sex, and racial/ethnic groups; the decline was larger for persons with dementia (P < .001). The APP of mood stabilizer use grew from 0.140 (95% CI 0.139–0.141) to 0.185 (95% CI 0.184–0.186), growth slightly larger among persons without dementia (P < .001). Among persons with depression or bipolar disorder, the APP of antipsychotic treatment increased from 0.081 (95% CI 0.079–0.082) to 0.087 (95% CI 0.085–0.088; P < .001); APP of mood stabilizer treatment grew more, from 0.193 (95% CI 0.190–0.196) to 0.251 (0.248–0.253; P < .001). Quetiapine was the most commonly prescribed antipsychotic. The most widely prescribed mood stabilizer was gabapentin, prescribed to 70.5% of those who received a mood stabilizer by the end of 2014.Conclusions and ImplicationsThe likelihood of antipsychotic and mood stabilizer treatment did not decline for residents with depression or bipolar disorder, for whom such prescribing may be appropriate but who were not excluded from the Partnership's antipsychotic quality measure. Growth in mood stabilizer use was widespread, and largely driven by growth in gabapentin prescribing.