Incidence of coronary heart disease in two generations of men exposed to different levels of risk factors

Within an epidemiological study on coronary heart disease (CHD) (alive) two samples of middle aged men living in two rural areas of Northern and Central Italy, two subgroups of individuals aged 51-59 (alive), free from CHD (alive) belonging to different generations have been identified. Group A (n = 593) was followed-up from 1960 to 1970 and group B (n = 553) from 1970 to 1980. Entry mean levels of some classical risk factors were higher in group B than in group A (serum cholesterol by 19 mg/dl; diastolic blood pressure by 2.9 mmHg; body mass index by 0.9 units), whereas physical activity at work was lower by 0.2 units of a score. The 10 year incidence of hard-criteria CHD events has been higher though not significantly so in group B by 19%, suggesting a connection with the different levels of risk factors, mainly serum cholesterol.     

Haematological cancers and the risk of severe COVID-19: Exploration and critical evaluation of the evidence to date

From the outset of the COVID-19 pandemic, patients and healthcare professionals have been concerned that a history of haematological malignancy will lead to an increased risk of severe COVID-19. This led to the UK government advising patients with blood cancers to shield, massive re-organisation of NHS haematology and cancer services, and changes in treatment plans for thousands of patients. Given the unknown effects that relaxation of social-distancing measures will have on the infection rate, we review the evidence to date to see whether a history of haematological malignancy is associated with increased risk of COVID-19. Multivariable analysis of large population studies, taking other known risk factors into account, do indicate that patients with haematological malignancy, especially those diagnosed recently, are at increased risk of death from COVID-19 compared to the general population. The evidence that this risk is higher than for those with solid malignancies is conflicting. There is suggestive evidence from smaller cohort studies that those with myeloid malignancy may be at increased risk within the blood cancer population, but this needs to be confirmed on larger studies. Ongoing large collaborative efforts are required to gain further evidence regarding specific risk factors for severe complications of COVID-19.     

National Patterns of Risk-Standardized Mortality and Readmission After Hospitalization for Acute Myocardial Infarction,Heart Failure,and Pneumonia: Update on Publicly Reported Outcomes Measures Based on the 2013 Release

BACKGROUND

The Centers for Medicare & Medicaid Services publicly reports risk-standardized mortality rates (RSMRs) within 30-days of admission and, in 2013, risk-standardized unplanned readmission rates (RSRRs) within 30-days of discharge for patients hospitalized with acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Current publicly reported data do not focus on variation in national results or annual changes.

OBJECTIVE

Describe U.S. hospital performance on AMI, HF, and pneumonia mortality and updated readmission measures to provide perspective on national performance variation.

DESIGN

To identify recent changes and variation in national hospital-level mortality and readmission for AMI, HF, and pneumonia, we performed cross-sectional panel analyses of national hospital performance on publicly reported measures.

PARTICIPANTS

Fee-for-service Medicare and Veterans Health Administration beneficiaries, 65 years or older, hospitalized with principal discharge diagnoses of AMI, HF, or pneumonia between July 2009 and June 2012. RSMRs/RSRRs were calculated using hierarchical logistic models risk-adjusted for age, sex, comorbidities, and patients’ clustering among hospitals.

Results

Median (range) RSMRs for AMI, HF, and pneumonia were 15.1% (9.4–21.0%), 11.3% (6.4–17.9%), and 11.4% (6.5–24.5%), respectively. Median (range) RSRRs for AMI, HF, and pneumonia were 18.2% (14.4–24.3%), 22.9% (17.1–30.7%), and 17.5% (13.6–24.0%), respectively. Median RSMRs declined for AMI (15.5% in 2009–2010, 15.4% in 2010–2011, 14.7% in 2011–2012) and remained similar for HF (11.5% in 2009–2010, 11.9% in 2010–2011, 11.7% in 2011–2012) and pneumonia (11.8% in 2009–2010, 11.9% in 2010–2011, 11.6% in 2011–2012). Median hospital-level RSRRs declined: AMI (18.5% in 2009–2010, 18.5% in 2010–2011, 17.7% in 2011–2012), HF (23.3% in 2009–2010, 23.1% in 2010–2011, 22.5% in 2011–2012), and pneumonia (17.7% in 2009–2010, 17.6% in 2010–2011, 17.3% in 2011–2012).

Conclusions

We report the first national unplanned readmission results demonstrating declining rates for all three conditions between 2009–2012. Simultaneously, AMI mortality continued to decline, pneumonia mortality was stable, and HF mortality experienced a small increase.     

Rosmarinus plants: Key farm concepts towards food applications

Rosmarinus species are aromatic plants that mainly grow in the Mediterranean region. They are widely used in folk medicine, food, and flavor industries and represent a valuable source of biologically active compounds (e.g., terpenoids, flavonoids, and phenolic acids). The extraction of rosemary essential oil is being done using three main methods: carbon dioxide supercritical extraction, steam distillation, and hydrodistillation. Furthermore, interesting antioxidant, antibacterial, antifungal, antileishmanial, anthelmintic, anticancer, anti‐inflammatory, antidepressant, and antiamnesic effects have also been broadly recognized for rosemary plant extracts. Thus the present review summarized data on economically important Rosmarinus officinalis species, including isolation, extraction techniques, chemical composition, pharmaceutical, and food applications.     

Sexuality Among Middle-Aged and Older Adults With Diagnosed and Undiagnosed Diabetes: A national, population-based study

OBJECTIVE

To describe sexual activity, behavior, and problems among middle-age and older adults by diabetes status.

RESEARCH DESIGN AND METHODS

This was a substudy of 1,993 community-residing adults, aged 57–85 years, from a cross-sectional, nationally representative sample (N = 3,005). In-home interviews, observed medications, and A1C were used to stratify by diagnosed diabetes, undiagnosed diabetes, or no diabetes. Logistic regression was used to model associations between diabetes conditions and sexual characteristics, separately by gender.

RESULTS

The survey response rate was 75.5%. More than 60% of partnered individuals with diagnosed diabetes were sexually active. Women with diagnosed diabetes were less likely than men with diagnosed diabetes (adjusted odds ratio 0.28 [95% CI 0.16–0.49]) and other women (0.63 [0.45–0.87]) to be sexually active. Partnered sexual behaviors did not differ by gender or diabetes status. The prevalence of orgasm problems was similarly elevated among men with diagnosed and undiagnosed diabetes compared with that for other men, but erectile difficulties were elevated only among men with diagnosed diabetes (2.51 [1.53 to 4.14]). Women with undiagnosed diabetes were less likely to have discussed sex with a physician (11%) than women with diagnosed diabetes (19%) and men with undiagnosed (28%) or diagnosed (47%) diabetes.

CONCLUSIONS

Many middle-age and older adults with diabetes are sexually active and engage in sexual behaviors similarly to individuals without diabetes. Women with diabetes were more likely than men to cease all sexual activity. Older women with diabetes are as likely to have sexual problems but are significantly less likely than men to discuss them.Advances in treatment for diabetes have prolonged and improved quality of life for many of the ∼12 million affected individuals aged ≥60 years in the U.S. Clinical guidelines for diabetes care include assessment and treatment of erectile problems in men (1). Sexual problems may be a warning sign of diabetes or a consequence that can lead to depression, lack of adherence to treatment, and strained intimate relationships. In contrast, older women''s sexual issues have been largely overlooked in screening for and treating diabetes (1,2). Failure to recognize and address sexual issues among middle-aged and older adults with diabetes may impair quality of life and adaptation to the disease.Some adults with diabetes maintain sexual relationships throughout their lives (3). Prior studies have focused on the pathophysiological effects of diabetes on male sexual function, primarily erection and sexual desire. The effects of diabetes on women''s sexual functioning are poorly understood and probably multifactorial (2). Sexual problems in adults with diabetes have been associated with age, disease duration, and comorbidity (1). The effects of chronic hyperglycemia, degree of diabetes control, or use of glucose-lowering drugs are less clear (4), in part because individuals with undiagnosed or preclinical diabetes are typically aggregated with control subjects in other studies (1). Psychosocial correlates of sexual problems in individuals with diagnosed diabetes have been found in younger adults. Studies including older adults find associations with depression (1), vulnerability, lifestyle restrictions due to disease management (5), and marital conflict (6).Prior data on sexuality in individuals with diabetes were derived primarily from studies that are small, have not included very old individuals or aggregated individuals ≥65 years, lacked a comparison group, and relied on convenience or other nongeneralizable samples (1,2). Comprehensive, population-based data are needed to further physicians'' understanding of the sexual norms and problems of older adults with diagnosed and undiagnosed diabetes. Virtually nothing is known about sexual function among individuals with undiagnosed diabetes; this information could be relevant for diagnosis, motivation to engage in treatment, and prevention of sexual and nonsexual diabetes-related complications. The National Social Life, Health and Aging Project (NSHAP) provides disease-specific data on the sexual activity, behaviors, and problems of middle-aged and older adults affected by diabetes.