ResearchPad - 1692 https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Association between chronic kidney disease and incident diagnosis of dementia in England: a cohort study in Clinical Practice Research Datalink]]> https://www.researchpad.co/article/elastic_article_12555 To investigate the association between chronic kidney disease (CKD) and dementia diagnosis in a real-world primary care setting in England.DesignMatched cohort study.SettingsEnglish primary care in the Clinical Practice Research Datalink.ParticipantsPeople aged ≥18 years with predialysis CKD (stages 3–5, defined as two measurements of estimated glomerular filtration rate <60 mL/min/1.73 m2 for 3 months) from 2004 to 2014, and people without known CKD who were matched on age, sex, general practice and calendar time in a 1:1 ratio.Primary and secondary outcome measuresFirst-ever diagnosis of dementia recorded by GPs. We also examined all-cause death as a secondary outcome to discuss potential competing risk of mortality in the association between CKD and dementia diagnosis.ResultsIn a matched cohort of 242 349 pairs with and without CKD (mean age 75.4±9.7 years, 39.3% male), the crude incidence rate of dementia diagnosis was 11.4/1000 and 9.4/1000 person-years, respectively. There was an association between CKD status and incident dementia diagnosis in the first 6 months of the follow-up (adjusted rate ratio (aRR) 1.58, 95% CI 1.44 to 1.74), which attenuated after 6 months (aRR 1.12, 95% CI 1.08 to 1.16). Among patients with CKD, there was no evidence of association between CKD stage and incident dementia diagnosis; compared with stage 3a, aRR (95% CI) was 1.04 (0.91 to 1.18) for stage 3b and 0.94 (0.74 to 1.20) for stages 4 or 5 in the first 6 months, and 0.97 (0.92 to 1.01) and 0.89 (0.80 to 0.98) thereafter. We found a strong association between worsening CKD stage and all-cause mortality.ConclusionWe identified a co-occurrence of detection of CKD and dementia in real-world clinical practice and a strong competing risk of mortality in the association between CKD stage and dementia, while a weak association between CKD status and dementia was suggested in the long term. ]]> <![CDATA[Behavioural and pharmaceutical interventions for the prevention of skin cancers in solid organ transplant recipients: a systematic review of randomised controlled trials]]> https://www.researchpad.co/article/elastic_article_12550 Solid organ transplant recipients are at increased risk of skin cancer, affecting more than 50% of recipients. We aimed to determine the effectiveness of interventions for behavioural change for sun protection or skin cancer prevention in solid organ transplant recipients.DesignSystematic review.Data sourcesWe searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL from inception to November 2019.Eligibility criteriaWe included randomised controlled trials that evaluated the effect of behavioural or pharmaceutical interventions on behavioural change or skin cancer prevention in solid organ transplant recipients.Data extraction and synthesisRisks of bias and evidence certainty were assessed using Cochrane and the Grading of Recommendations Assessment Development and Evaluation framework.ResultsTwenty trials (n=2295 participants) were included. It is uncertain whether behavioural interventions improve sun protection behaviour (n=3, n=414, standardised mean difference (SMD) 0.89, 95% CI −0.84 to 2.62, I2=98%) and knowledge (n=4, n=489, SMD 0.50, 95% CI 0.12 to 0.87, I2= 76%) as the quality of evidence is very low. We are uncertain of the effects of mammalian target of rapamaycin inhibitors on the incidence of non-melanocytic skin cancer (n=5, n=1080, relative risk 0.46, 95% CI 0.28 to 0.75, I2 =72%) as the quality of evidence is very low.ConclusionsBehavioural and pharmaceutical preventive interventions may improve sun protective behaviour and knowledge, and reduce the incidence of non-melanocytic skin cancer, but the overall quality of the evidence is very low and insufficient to guide decision-making and clinical practice.PROSPERO registration numberCRD42017063962. ]]> <![CDATA[Association between obesity-related anthropometric indices and multimorbidity among older adults in Shandong, China: a cross-sectional study]]> https://www.researchpad.co/article/elastic_article_12547 Whether the association between obesity-related anthropometric indices and multimorbidity differs by age among Chinese older adults (aged 65+) is unclear. We aimed to investigate the association between body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with multimorbidity among the young-old (aged 65–79) and old-old (aged 80+) adults.DesignCross-sectional population-based study.SettingShandong province on the eastern coast of China.Participants5493 subjects aged 65 years or above.MeasurementsDetails on sociodemographics, lifestyle characteristics and chronic conditions were collected using a structured questionnaire. The respondents were assessed with anthropometric measurements including height, weight, WC, hip circumference.ResultsThe overall prevalence of multimorbidity in older adults (aged 65+) was 35.2%. The BMI-obesity, WC-obesity and WHR-obesity rates were 7.4%, 57.5% and 80.4%, respectively. In the young-old adults (aged 65–79), the likelihood of multimorbidity was more than two times higher among the BMI-obese than the BMI-normal population (OR 2.08, 95% CI 1.66 to 2.60). Similar but less strong associations were found for the WC-obese and WHR-obese young-old population (OR 1.60, 95% CI 1.42 to 1.81; OR 1.31, 95% CI 1.10 to 1.56, respectively). For the old-old group (aged 80+), the BMI-obese, WC-obese and WHR-obese had a higher likelihood of having multimorbidity compared with the normal weight category (OR 2.10, 95% CI 0.96 to 4.57; OR 1.75, 95% CI 1.21 to 2.54; OR 2.15, 95% CI 1.18 to 3.93, respectively).ConclusionBMI-obesity, WC-obesity and WHR-obesity were associated with a greater risk of multimorbidity, and the associations were different between the young-old and the old-old adults. These age differences need to be considered in assessing healthy body weight in old age. These findings may be vital for public health surveillance, prevention and management strategies for multimorbidity in older adults. ]]> <![CDATA[International Mind, Activities and Urban Places (iMAP) study: methods of a cohort study on environmental and lifestyle influences on brain and cognitive health]]> https://www.researchpad.co/article/elastic_article_9119 Numerous studies have found associations between characteristics of urban environments and risk factors for dementia and cognitive decline, such as physical inactivity and obesity. However, the contribution of urban environments to brain and cognitive health has been seldom examined directly. This cohort study investigates the extent to which and how a wide range of characteristics of urban environments influence brain and cognitive health via lifestyle behaviours in mid-aged and older adults in three cities across three continents.Methods and analysisParticipants aged 50–79 years and living in preselected areas stratified by walkability, air pollution and socioeconomic status are being recruited in Melbourne (Australia), Barcelona (Spain) and Hong Kong (China) (n=1800 total; 600 per site). Two assessments taken 24 months apart will capture changes in brain and cognitive health. Cognitive function is gauged with a battery of eight standardised tests. Brain health is assessed using MRI scans in a subset of participants. Information on participants’ visited locations is collected via an interactive web-based mapping application and smartphone geolocation data. Environmental characteristics of visited locations, including the built and natural environments and their by-products (e.g., air pollution), are assessed using geographical information systems, online environmental audits and self-reports. Data on travel and lifestyle behaviours (e.g., physical and social activities) and participants’ characteristics (e.g., sociodemographics) are collected using objective and/or self-report measures.Ethics and disseminationThe study has been approved by the Human Research Ethics Committee of the Australian Catholic University, the Institutional Review Board of the University of Hong Kong and the Parc de Salut Mar Clinical Research Ethics Committee of the Government of Catalonia. Results will be communicated through standard scientific channels. Methods will be made freely available via a study-dedicated website.Trial registration numberACTRN12619000817145. ]]> <![CDATA[Using Baidu search index to monitor and predict newly diagnosed cases of HIV/AIDS, syphilis and gonorrhea in China: estimates from a vector autoregressive (VAR) model]]> https://www.researchpad.co/article/elastic_article_9106 Internet search engine data have been widely used to monitor and predict infectious diseases. Existing studies have found correlations between search data and HIV/AIDS epidemics. We aimed to extend the literature through exploring the feasibility of using search data to monitor and predict the number of newly diagnosed cases of HIV/AIDS, syphilis and gonorrhoea in China.MethodsThis paper used vector autoregressive model to combine the number of newly diagnosed cases with Baidu search index to predict monthly newly diagnosed cases of HIV/AIDS, syphilis and gonorrhoea in China. The procedures included: (1) keywords selection and filtering; (2) construction of composite search index; (3) modelling with training data from January 2011 to October 2016 and calculating the prediction performance with validation data from November 2016 to October 2017.ResultsThe analysis showed that there was a close correlation between the monthly number of newly diagnosed cases and the composite search index (the Spearman’s rank correlation coefficients were 0.777 for HIV/AIDS, 0.590 for syphilis and 0.633 for gonorrhoea, p<0.05 for all). The R2 were all more than 85% and the mean absolute percentage errors were less than 11%, showing the good fitting effect and prediction performance of vector autoregressive model in this field.ConclusionsOur study indicated the potential feasibility of using Baidu search data to monitor and predict the number of newly diagnosed cases of HIV/AIDS, syphilis and gonorrhoea in China. ]]> <![CDATA[Ecological study of the association between mental illness with human development, income inequalities and unemployment across OECD countries]]> https://www.researchpad.co/article/Ne3bbef0f-bdb0-4145-a851-0b17e0a7f821 Recent studies have demonstrated worsened mental health in relatively highly developed countries impacted by social inequalities and unemployment. Here, we investigate (1) whether mental health issues are differently or similarly affected by these social factors and (2) whether their effects on mental health are related or unrelated to each other.SettingAnalysis at the country level among Organization for Economic Cooperation and Development (OECD) countries (n=36). Data on social indicators were collected from OECD and the United Nations Development Programme databases. Data on the prevalence of mental issues were obtained from the Institute for Health Metrics and Evaluation’s Global Burden of Disease study 2017.ParticipantsNo involvement of participants.Primary and secondary outcome measuresUsing linear regression models, we investigated the relative contribution played by human development (as measured by the Human Development Index (HDI)), social inequalities (Gini index) and unemployment (unemployment rate) on the prevalence of 10 mental health issues. We then measured the relationship between the socioeconomic factors’ effects on mental issues using 2×2 Pearson’s correlation test and principal component analysis.ResultsFirst, the overall effect of each socioeconomic factor on a combination of mental health disorders was large (r range: 0.51 to 0.76; p<0.002). However, the influence of social factors on mental health was relative to each mental issue (r range: −0.34 to 0.74). Second, the socioeconomic factors’ effects on mental health showed strong interdependence (rHDI-Gini=0.93, rHDI-unemploy=0.81, runemploy-Gini=0.84; p<0.001. Principal component analysis demonstrated that the first principal component of the three variables (rHDI, rGini, runemploy) explained 91.5% of the variance.ConclusionThese results implore a reanalysis of the socioeconomic determinants of mental health where (1) the heterogeneity of mental health issues would be taken into account and (2) each socioeconomic indicator’s effect would be analysed and interpreted in conjunction with the others. ]]> <![CDATA[Trends in attention-deficit and hyperactivity disorder (ADHD) medications among children and young adults in Ireland: a repeated cross-sectional study from 2005 to 2015]]> https://www.researchpad.co/article/N5170fb60-44be-4de4-9979-951c59b18352 This study examined the prescribing patterns of attention-deficit hyperactivity disorder (ADHD) medications in Ireland between 2005 and 2015 in children, adolescents and young adults, and concomitant use of psychotropic medication.DesignRepeated cross-sectional study.SettingCommunity setting using pharmacy claims data in Ireland.ParticipantsChildren and young adults aged 0–24 years.Primary and secondary outcomesAuthorised medications used to treat ADHD during the study period, methylphenidate, dexamfetamine, lisdexamfetamine dimesylate and atomoxetine were extracted from a national pharmacy claims database. Dispensing of concomitant psychotropic medications including antipsychotics, anxiolytics, hypnotics/sedatives and antidepressants were examined.ResultsThe number on any ADHD medication ranged from 1913 in 2005 to 4853 in 2015, and the prevalence rate per 1000 eligible population aged <25 years increased significantly over time from 5.61 (95% CI 5.36 to 5.86) in 2005 to 8.36 (95% CI 8.13 to 8.60) in 2015 (p<0.0001). Negative binomial regression showed significant changes over time for ADHD prescribing (p<0.001), with significantly higher rates across the different age groups. The rates overall were three to five times higher in males. There was a significant increase in the percentage on concomitant antidepressants from 2% in 2005 to 6% in 2015 (p<0.001).ConclusionsThere were significantly higher rates of ADHD prescribing in children/adolescents and a significant increase in the coprescribing of antidepressants. The reasons for the increase are unclear but may reflect increasing awareness and diagnosis of the condition. ]]> <![CDATA[Prevalence and determinants of anaemia in children aged <b>6–59</b> months in Africa: a protocol for systematic review and meta-analysis]]> https://www.researchpad.co/article/Nd04d4751-39ea-45d8-b91d-b735e9e4b4fa Anaemia, especially in children aged <5 years, is a global health problem disproportionately affecting populations in low-income and middle-income countries. It is associated with high disability and death rates and has a negative effect on development. This study seeks to evaluate the prevalence and determinants of anaemia in children aged 6–59 months residing in Africa.Methods and analysisThis protocol was prepared using the 2015 Preferred Reporting Items for Systematic Reviews and Meta-analyses for Protocols guidelines. Relevant citations will be identified by searching EMBASE, Web of Science, PubMed, Global Medicus Index and African Journals Online from inception to 30 September 2019 with no language restrictions. Two authors will independently screen and select eligible studies for the review. Random-effect meta-analytic methods will be used to pool study-specific estimates and heterogeneity will be assessed and quantified using the χ2 test on Cochrane’s Q and I2 statistics, respectively. Publication bias will be evaluated using funnel plots and Egger’s test. Subgroup analysis and multiple meta-regression using backward elimination will be performed to investigate sources of substantial heterogeneity.Ethics and disseminationNo ethical approval is required for this study as it is based on already published data. The findings of the review will be published in a peer-reviewed journal and presented at conferences. ]]> <![CDATA[Definitions of blinding in randomised controlled trials of interventions published in high-impact anaesthesiology journals: a methodological study and survey of authors]]> https://www.researchpad.co/article/N585a62e0-4875-4be8-8309-b400c911a7ec To analyse the completeness of reporting of blinding in randomised controlled trials (RCTs) of interventions in anaesthesiology, the actual blinding status of various persons associated with an RCT and trial authors’ interpretation of blinding terminology related to RCTs.MethodsThis was a methodological study and a cross-sectional survey. We analysed reporting related to blinding in published RCTs of interventions published in seven highly cited anaesthesiology journals from 2014 to 2016 and registered protocols in ClinicalTrials.gov. We surveyed corresponding authors of included RCTs about their definitions of blinding. The primary outcome was the number of RCTs that explicitly described who was blinded in a trial. Secondary outcomes were definitions of blinding terminology in the trials; trial authors’ interpretation of blinding terminology; discrepancies in the blinding description within registered protocols and between registered protocols and publications.ResultsOut of 622 analysed RCTs, 38% were not explicitly described as either open label or blinded studies and 10% did not report any information about blinding or lack of blinding. Only one manuscript fully reported the status of blinding for various individuals that may be involved with a trial. The most common descriptor was that a trial was double-blind. We found discrepant information regarding blinding in the majority of registered protocols. Even when there were no discrepancies in the registration, we found discrepancies in the reporting of blinding between the majority of registered protocols and published manuscripts. The survey of authors (40 responses from 231 eligible authors; 17% response rate) of analysed RCTs showed that they differed in how they defined different levels of blinding in trials.ConclusionsReporting of the blinding status of key individuals involved in analysed anaesthesiology RCTs was insufficient. For reporting guidelines, peer reviewers and editors should insist on clear information on who was blinded in a trial instead of using the term ‘double-blind’ for different blinding practices. ]]> <![CDATA[The association between dementia severity and hospitalisation profile in a newly assessed clinical cohort: the South London and Maudsley case register]]> https://www.researchpad.co/article/N64a1e7c9-2c62-4811-8cf0-517ae1c17521 To evaluate the risk and common causes of hospitalisation in patients with newly diagnosed dementia and variation by severity of cognitive impairment.SettingWe used data from a large London mental healthcare case register linked to a national hospitalisation database.ParticipantsIndividuals aged ≥65 years with newly diagnosed dementia with recorded cognitive function and the catchment population within the same geography.Outcome measuresWe evaluated the risk and duration of hospitalisation in the year following a dementia diagnosis. In addition we identified the most common causes of hospitalisation and calculated age-standardised and gender-standardised admission ratios by dementia severity (mild/moderate/severe) relative to the catchment population.ResultsOf the 5218 patients with dementia, 2596 (49.8%) were hospitalised in the year following diagnosis. The proportion of individuals with mild, moderate and severe dementia who had a hospital admission was 47.9%, 50.8% and 51.7%, respectively (p= 0.097). Duration of hospital stay increased with dementia severity (median 2 days in mild to 4 days in severe dementia, p 0.0001). After excluding readmissions for the same cause, the most common primary hospitalisation discharge diagnoses among patients with dementia were urinary system disorders, pneumonia and fracture of femur, accounting for 15%, 10% and 6% of admissions, respectively. Overall, patients with dementia were hospitalised 30% more than the catchment population, and this trend was observed for most of the discharge diagnoses evaluated. Standardised admission ratios for urinary and respiratory disorders were higher in those with more severe dementia at diagnosis.ConclusionsIndividuals with a dementia diagnosis were more likely to be hospitalised than individuals in the catchment population. The length of hospital stay increased with dementia severity. Most of the common causes of hospitalisation were more common than expected relative to the catchment population, but standardised admission ratios only varied by dementia stage for certain groups of conditions. ]]> <![CDATA[Validation of an algorithm to evaluate the appropriateness of outpatient antibiotic prescribing using big data of Chinese diagnosis text]]> https://www.researchpad.co/article/N9f8fa2ca-f7c1-4ab3-bfac-12fcdcd3d29a

Objective

We aimed to evaluate the validity of an algorithm to classify diagnoses according to the appropriateness of outpatient antibiotic use in the context of Chinese free text.

Setting and participants

A random sample of 10 000 outpatient visits was selected between January and April 2018 from a national database for monitoring rational use of drugs, which included data from 194 secondary and tertiary hospitals in China.

Research design

Diagnoses for outpatient visits were classified as tier 1 if associated with at least one condition that ‘always’ justified antibiotic use; as tier 2 if associated with at least one condition that only ‘sometimes’ justified antibiotic use but no conditions that ‘always’ justified antibiotic use; or as tier 3 if associated with only conditions that never justified antibiotic use, using a tier-fashion method and regular expression (RE)-based algorithm.

Measures

Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the classification algorithm, using classification made by chart review as the standard reference, were calculated.

Results

The sensitivities of the algorithm for classifying tier 1, tier 2 and tier 3 diagnoses were 98.2% (95% CI 96.4% to 99.3%), 98.4% (95% CI 97.6% to 99.1%) and 100.0% (95% CI 100.0% to 100.0%), respectively. The specificities were 100.0% (95% CI 100.0% to 100.0%), 100.0% (95% CI 99.9% to 100.0%) and 98.6% (95% CI 97.9% to 99.1%), respectively. The PPVs for classifying tier 1, tier 2 and tier 3 diagnoses were 100.0% (95% CI 99.1% to 100.0%), 99.7% (95% CI 99.2% to 99.9%) and 99.7% (95% CI 99.6% to 99.8%), respectively. The NPVs were 99.9% (95% CI 99.8% to 100.0%), 99.8% (95% CI 99.7% to 99.9%) and 100.0% (95% CI 99.8% to 100.0%), respectively.

Conclusions

The RE-based classification algorithm in the context of Chinese free text had sufficiently high validity for further evaluating the appropriateness of outpatient antibiotic prescribing.

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<![CDATA[Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV): design and methods for a randomised controlled trial]]> https://www.researchpad.co/article/Nf91cde8b-8c5b-429d-b1b5-d359427ffc00

Introduction

Gay, bisexual and other men who have sex with men (gbMSM) have an increased risk of human papillomavirus (HPV) infection and HPV-associated diseases, such as anal cancer and anogenital warts. A carrageenan-based lubricant could prevent HPV infection, thereby reducing the disease burden in this population. This paper describes the protocol for the Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV) study, an ongoing randomised controlled trial (RCT), evaluating efficacy of a carrageenan-based personal lubricant in reducing type-specific anal HPV incidence and prevalence among sexually active gbMSM, efficacy by HIV status, safety and tolerability of the gel and participant adherence to the intervention.

Methods and analysis

The study is a double-blinded, placebo-controlled RCT. Volunteer gbMSM 18 years and older are randomly assigned 1:1 to receive the treatment (a self-applied anal microbicide gel with carrageenan) or placebo (a self-applied placebo gel). At each visit, computerised questionnaires are used to collect data on sociodemographic and clinical variables, lifestyle, sexual behaviour and the gels’ safety and tolerability. At baseline and each follow-up visit (months 1, 2, 3, 6, 9 and 12), nurses collect anal specimens tested for 36 HPV types (linear array assay). HIV status is determined at baseline and 12 months. The primary outcome is incidence of type-specific anal HPV infection(s) undetected at baseline. Secondary outcomes are prevalence of type-specific anal HPV infection, safety, tolerability and adherence. We aim to recruit 380 participants to attain the study’s objectives. Data will be analysed using intention-to-treat and per-protocol approaches with subgroup analyses by HIV status.

Ethics and dissemination

Ethics approval was obtained by the Research Ethics Boards of McGill University, the McGill University Health Centre, Concordia University and Centre Hospitalier de l’Université de Montréal. Trial results will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number

NCT02354144.

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<![CDATA[Prevalence of and factors associated with violations of a campus smoke-free policy: a cross-sectional survey of undergraduate students on a university campus in the USA]]> https://www.researchpad.co/article/Nd674f5dc-9058-4e95-84b7-48f7b6257851

Objective

The aim of this study is to estimate the prevalence of smoking behaviour on campus and to identify the key factors that influence adherence to a campus smoke-free policy.

Design & participants

This study employed a cross-sectional, self-administered survey of undergraduate students at the University of Mississippi. A random sample of all available undergraduate classes was recruited for data collection. Students were provided a survey that included questions on demographics, alcohol use, smoking status, policy awareness, policy attitudes, smoking attitudes, policy support, barriers to policy success and policy violations.

Results

The prevalence of past 30-day smoking was 23%. More than 63% of current smokers report ever smoking on campus, but less than 10% ever received a warning or a ticket for their violation. Nearly all respondents (92.5%) reported witnessing someone smoking on campus, and 22% reported witnessing someone receiving a ticket. Barriers to policy success include lack of reminders about the policy, lack of support from students and University administrators, and insufficient fines. Smoking behaviour (OR: 7.96; 95% CI: 5.13 to 12.36), beliefs about policy adherence (OR: 0.52; 95% CI: 0.40 to 0.69), support for the policy (OR: 0.71; 95% CI: 0.55 to 0.91) and attitudes against smoking behaviour (OR: 0.35; 95% CI: 0.25 to 0.49) were all significantly associated with self-reported policy violations.

Conclusions

This study found that violations of the campus smoke-free policy were fairly frequent and the policy has been largely ineffective, indicating a need for other interventions. Approaches to improve adherence to the policy should address barriers such as reminders about the policy, better policy enforcement and support from the administration.

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<![CDATA[Changes to cardiovascular risk factors over 7 years: a prospective cohort study of in situ urbanised residents in the Chaoyang District of Beijing]]> https://www.researchpad.co/article/N14dc4df0-590c-4e30-a6a4-e2b65d0580b5

Objectives

To examine changes in cardiovascular risk factors of in situ urbanised residents between 2010 and 2017.

Design

Population-based cohort study.

Setting

The Chaoyang District of Beijing, China.

Participants

A total of 942 in situ urbanised rural residents aged 35–64 who participated in the cardiovascular disease (CVD) risk factors study in China between 2010 and 2017.

Main outcome measures

Lifestyles (smoking, drinking and effective exercise) and medical history (diabetes, hypertension, dyslipidaemia, overweight and obesity) were self-reported. New cases of diabetes, hypertension, dyslipidaemia, overweight and obesity were confirmed by physical examination or blood biochemical tests. Multiple linear regression and log-binomial models analyses adjusted for sociodemographic confounders were conducted to evaluate any changes of clinical indexes and to estimate prevalence rate ratios (PRRs), respectively.

Results

During the study period of 2010–2017, diastolic blood pressure elevated by 3.55 mm Hg, central blood pressure increased by 4.39 mm Hg, total cholesterol decreased by 0.29 mmol/L and hypertension increased significantly (PRR=1.25, p<0.05) after adjusting for demographic, lifestyle and family history factors. Effective exercise rate (PRR=1.57), prevalence of diabetes (PRR=1.36) and dyslipidaemia (PRR=1.19) all increased from 2010 to 2017. However, these changes were not significant after adjusting for confounders (p>0.05). Prevalence of smoking, drinking, hypertension, overweight and obesity was significantly higher in males than females in both 2010 and 2017. In 2017, the 10-year risk of atherosclerotic CVD increased in 29.8% of participants and decreased in 6.1% of individuals.

Conclusions

CVD risk factors augmented remarkably for in situ urbanised rural residents aged 35–64 in the Chaoyang District of Beijing, especially those indicators related to blood pressure. Awareness of the direction and magnitude of these risk factor changes may be beneficial in informing targeted strategies for preventing CVDs of in situ urbanised populations.

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<![CDATA[Length of stay in long-term care facilities: a comparison of residents in six European countries. Results of the PACE cross-sectional study]]> https://www.researchpad.co/article/N624504e2-7fea-48a1-8025-10503d83a753

Objectives

This paper aims to investigate resident, facility and country characteristics associated with length of stay in long-term care facilities (LTCFs) across six European countries.

Setting

Data from a cross-sectional study of deceased residents, conducted in LTCFs in Belgium, England, Finland, Italy, the Netherlands and Poland.

Participants

All residents aged 65 years and older at admission who died in a 3-month period residing in a proportional random sample of LTCFs were included.

Primary and secondary outcome measures

The primary outcome was length of stay in days, calculated from date of admission and date of death. Resident, facility and country characteristics were included in a proportional hazards model.

Results

The proportion of deaths within 1 year of admission was 42% (range 32%–63%). Older age at admission (HR 1.04, 95% CI 1.03 to 1.06), being married/in a civil partnership at time of death (HR 1.47, 95% CI 1.13 to 1.89), having cancer at time of death (HR 1.60, 95% CI 1.22 to 2.10) and admission from a hospital (HR 1.84, 95% CI 1.43 to 2.37) or another LTCF (HR 1.81, 95% CI 1.37 to 2.40) were associated with shorter lengths of stay across all countries. Being female (HR 0.72, 95% CI 0.57 to 0.90) was associated with longer lengths of stay.

Conclusions

Length of stay varied significantly between countries. Factors prior to LTCF admission, in particular the availability of resources that allow an older adult to remain living in the community, appear to influence length of stay. Further research is needed to explore the availability of long-term care in the community prior to admission and its influence on the trajectories of LTCF residents in Europe.

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<![CDATA[Circulating liver enzymes and risks of chronic diseases and mortality in the prospective EPIC-Heidelberg case-cohort study]]> https://www.researchpad.co/article/Nb00af7b8-aff4-495e-a336-a5c7ee460ce4

Objectives

Elevated liver enzyme concentrations in blood are indicative of liver diseases and may provide an early signal for being at risk for other chronic diseases. Our study aimed to assess the relationships of alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), aspartate transaminase (AST) and the De Ritis ratio (AST/ALT) with incidence and mortality of cardiovascular diseases (CVD) and the four most common cancers, that is, breast, prostate, colorectal and lung.

Setting, participants and outcome measures

We analysed a case-cohort sample of the prospective European Prospective Investigation into Cancer and Nutrition-Heidelberg cohort, including cancer (n=1632), cancer mortality (n=761), CVD (n=1070), CVD mortality (n=381) and a random subcohort (n=2739) with an average follow-up duration of 15.6 years. Concentrations of liver enzymes were measured in prediagnostic blood samples and Prentice-weighted Cox regression models were used to estimate HRs with 95% CIs.

Results

High ALP levels were associated with increased risk for lung cancer and all-cause mortality (highest vs lowest quartile, multivariable adjusted HR=2.39 (95% CI 1.30 to 4.39), HR=1.31 (95% CI 1.02 to 1.67)), high AST levels with all-cause mortality (HR=1.45 (95% CI 1.15 to 1.82)), and a high De Ritis ratio with prostate cancer risk, all-cause and cancer mortality (HR=1.61 (95% CI 1.10 to 2.36), HR=1.60 (95% CI 1.25 to 2.04), HR=1.67 (95% CI 1.26 to 2.23)). Using cut-points for liver enzyme levels above normal, we observed positive associations for all-cause mortality with ALP, GGT and AST, and assigning a combined risk score resulted in positive associations with all-cause and cause-specific mortality.

Conclusions

Measurements of serum liver enzymes, as routinely performed in health check-ups, may support the identification of individuals at increased risk for all-cause mortality. Further prospective studies are needed to verify our first results on individual cancers and on a combined risk score.

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<![CDATA[Duration of sick leave after active surveillance, surgery or radiotherapy for localised prostate cancer: a nationwide cohort study]]> https://www.researchpad.co/article/N16c3da9e-ae05-430c-af2c-2e2f639f624d

Objectives

To compare the loss of working time due to sick leave by treatment strategy for localised prostate cancer.

Design

Nationwide cohort study.

Setting

Sweden.

Participants

A total of 15 902 working-aged men with localised low or intermediate-risk prostate cancer diagnosed during 2007–2016 from the Prostate Cancer Data Base Sweden, together with 63 464 prostate cancer-free men. Men were followed until 2016.

Primary and secondary outcome measures

Using multistate Markov models, we calculated the proportion of men on work, sick leave, disability pension and death, together with the amount of time spent in each state. All-cause and cause-specific estimates were calculated.

Results

During the first 5 years after diagnosis, men with active surveillance as their primary treatment strategy spent a mean of 17 days (95% CI 15 to 19) on prostate cancer-specific sick leave, as compared with 46 days (95% CI 44 to 48) after radical prostatectomy and 44 days (95% CI 38 to 50) after radiotherapy. The pattern was similar after adjustment for cancer and sociodemographic characteristics. There were no differences between the treatment strategies in terms of days spent on sick leave due to depression, anxiety or stress. Five years after diagnosis, over 90% of men in all treatment strategies were free from sick leave, disability pension receipt and death from any cause.

Conclusions

Men on active surveillance experienced less impact on working life compared with men who received radical prostatectomy or radiotherapy. From a long-term perspective, there were no major differences between treatment strategies. Our findings can inform men diagnosed with localised prostate cancer on how different treatment strategies may affect their working lives.

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<![CDATA[Vitamin D status in an Australian patient population: a large retrospective case series focusing on factors associated with variations in serum 25(OH)D]]> https://www.researchpad.co/article/N78a37400-c7e4-40a9-8190-92318c83957a

Objectives

To investigate whether sex, age, medical specialty and seasonal variations in serum concentration of 25-hydroxy vitamin D (25(OH)D) are evident among an Australian patient population.

Design

Retrospective study analysing the results of serum 25(OH)D lab tests and vitamin D supplementation from Royal Melbourne Hospital (RMH) between 2014 and 2017.

Setting

Tertiary healthcare centre in Victoria, Australia.

Participants

30 023 patients (inpatient and outpatient) who had their serum 25(OH)D levels measured at RMH between 2014 and 2017.

Main outcome measures

Serum 25(OH)D levels stratified according to patients’ sex, age and medical specialty admitted to, as well as the season and year (2014 to 2017) 25(OH)D level was measured.

Results

Mean serum 25(OH)D level of study population was 69.9 nmol/L (95% CI 69.5 to 70.2). Only 40.2% patients in this cohort were sufficient in vitamin D (>75 nmol/L). On average, 25(OH)D levels in male patients were 6.1 units (95% CI 5.4 to 6.9) lower than in females. Linear regression analysis found that 25(OH)D levels increased by 0.16 unit (95% CI 0.14 to 0.18) for every year increase in age. One-way analysis of variance showed patients from neurology had the highest average 25(OH)D level, 76.8 nmol/L (95% CI 74.2 to 79.3) compared with other medical specialties. Mean 25(OH)D level during winter, 64.9 nmol/L (95% CI 64.2 to 65.6) was significantly lower compared with other seasons despite supplementation. Average 25(OH)D level measured in 2014, 71.5 nmol/L (95 CI% 70.8 to 72.2) was significantly higher than levels measured in 2016–2017.

Conclusions

There is a sex, age, medical specialty, seasonal and yearly variation in vitamin D status in an Australian patient population. The association between low vitamin D status and winter despite supplementation suggests other interventions are required to boost serum 25(OH)D levels.

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<![CDATA[Obesity prevalence in Brazilian firefighters and the association of central obesity with personal, occupational and cardiovascular risk factors: a cross-sectional study]]> https://www.researchpad.co/article/Nc44753f3-93f8-4f1c-99df-8bd8f7785980

Objectives

This study aimed to investigate the obesity prevalence in a population of Brazilian firefighters and the association of central obesity (CO) with sociodemographic, occupational, life habits, fitness and health status variables.

Design

Cross-sectional study.

Settings

The data were collected during annual health inspections of firefighters from the Military Fire Service of the State of Espírito Santo, a state in Southeast Brazil.

Participants

The study encompassed 1018 active military firefighters. After exclusion criteria, 892 male firefighters were analysed.

Primary and secondary outcome measures

The collected data included: sociodemographic, occupational, lifestyle, fitness and health status variables. The associations between these factors and CO were calculated by adjusted OR through a hierarchical logistic regression model.

Results

Obesity estimation by body mass index indicated that 48.65% of the firefighters were overweight and 10.99% were obese. Concerning the body fat percentage, 26.23% of the participants were considered obese, while 18.61% of the firefighters were considered centrally obese or at risk using the waist circumference measure. After adjusted OR analysis, CO was more likely associated with the age range of 50 to 59 years old (OR 2.93; 95% CI 1.05 to 8.14), low self-reported physical activity (OR 1.95; 95% CI 1.14 to 3.34), low cardiorespiratory fitness (OR 5.15; 95% CI 3.22 to 8.23), hyperglycaemia (OR 1.70; 95% CI 1.07 to 2.72) and hypertriglyceridaemia fasting status (OR 3.12; 95% CI 1.75 to 5.55).

Conclusions

Our study identified an overall high prevalence of overweight and obese individuals in the examined firefighter population. Age and cardiovascular risk factors were directly associated with CO among the firefighters. Cardiovascular risk factors should be routinely inspected within the Brazilian firefighters’ corporations in order to improve the health condition and wellness of these workers. These endeavours will improve the performance of the services provided to the population.

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<![CDATA[Disability discrimination and well-being in the United Kingdom: a prospective cohort study]]> https://www.researchpad.co/article/N71d02a35-db5a-4127-b89f-80ab212ed60a

Objectives

Disability discrimination is linked with poorer well-being cross-sectionally. The aim of this study was to explore prospective associations between disability discrimination and well-being.

Design

Prospective cohort study.

Setting

The United Kingdom Household Longitudinal Study.

Participants

Data were from 871 individuals with a self-reported physical, cognitive or sensory disability.

Primary outcome measures

Depression was assessed in 2009/10. Psychological distress, mental functioning, life satisfaction and self-rated health were assessed in 2009/10 and 2013/14.

Results

Data were analysed using linear and logistic regression with adjustment for age, sex, household income, education, ethnicity and impairment category. Perceived disability discrimination was reported by 117 (13.4%) participants. Cross-sectionally, discrimination was associated with depression (OR=5.40, 95% CI 3.25 to 8.97) fair/poor self-rated health (OR=2.05; 95% CI 1.19 to 3.51), greater psychological distress (B=3.28, 95% CI 2.41 to 4.14), poorer mental functioning (B=−7.35; 95% CI −9.70 to −5.02) and life satisfaction (B=−1.27, 95% CI −1.66 to −0.87). Prospectively, discrimination was associated with increased psychological distress (B=2.88, 95% CI 1.39 to 4.36) and poorer mental functioning (B=−5.12; 95% CI −8.91 to −1.34), adjusting for baseline scores.

Conclusions

Perceived disability-related discrimination is linked with poorer well-being. These findings underscore the need for interventions to combat disability discrimination.

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