Ambulatory Adult Population Research Articles

Three-dimensional optical body shape and features improve prediction of metabolic disease risk in a diverse sample of adults.

This study examined whether body shape and composition obtained by three-dimensional optical (3DO) scanning improved the prediction of metabolic syndrome (MetS) prevalence compared with BMI and demographics. A diverse ambulatory adult population underwent whole-body 3DO scanning, blood tests, manual anthropometrics, and blood pressure assessment in the Shape Up! Adults study. MetS prevalence was evaluated based on 2005 National Cholesterol Education Program criteria, and prediction of MetS involved logistic regression to assess (1) BMI, (2) demographics-adjusted BMI, (3) 85 3DO anthropometry and body composition measures, and (4) BMI + 3DO + demographics models. Receiver operating characteristic area under the curve (AUC) values were generated for each predictive model. A total of 501 participants (280 female) were recruited, with 87 meeting the criteria for MetS. Compared with the BMI model (AUC=0.819), inclusion of age, sex, and race increased the AUC to 0.861, and inclusion of 3DO measures further increased the AUC to 0.917. The overall integrated discrimination improvement between the 3DO + demographics and the BMI model was 0.290 (p < 0.0001) with a net reclassification improvement of 0.214 (p < 0.0001). Body shape measures from an accessible 3DO scan, adjusted for demographics, predicted MetS better than demographics and/or BMI alone. Risk classification in this population increased by 29% when using 3DO scanning.

Demographic, behavioral, dietary, and clinical predictors of high-sensitivity C-reactive protein: The National Health and Nutrition Examination Surveys (NHANES)

Abstract Funding Acknowledgements Type of funding sources: None. Introduction High-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, is associated with atherosclerosis, and recent studies indicate that therapies targeting inflammation are associated with reductions in cardiovascular (CV) risk. However, factors predictive of elevated hs-CRP in the general population have not been elucidated. Purpose To determine independent predictors of hs-CRP levels in an ambulatory adult population in the US. Methods This study included 5412 adults from the NHANES 2015-2016 cohort and 5856 adults from the NHANES 2017-2018 cohort. The sample was scientifically selected to ensure representativeness of the larger US population. Multivariable logistic regression analysis was used to identify independent predictors of elevated hs-CRP (≥3 mg/L) utilizing the NHANES 2015-2016 cycle (derivation set). The model was verified utilizing the independent NHANES 2017-2018 cycle (validation set). Candidate variables comprised demographic, behavioral, and clinical factors, including standard CV risk factors. Models based on diet and nutrition were developed separately on a subsample of subjects who answered dietary questions. Model discrimination was assessed using area under the receiver-operator characteristic curve (c-statistic). Results Significant independent predictors of high hs-CRP included: increased age (OR 1.09; 95% CI 1.03-1.14 per decade; P=0.024), increased BMI (OR 1.12; 95% CI 1.10-1.14; P&amp;lt;0.001), elevated white blood cell count (OR 1.21; 95% CI 1.15-1.28 per 1000 white blood cells/uL; P=0.002), Black vs White race (OR 1.31; 95% CI 1.10-1.56; P=0.037), female sex (OR 1.57; 95% CI 1.36-1.80; P=0.003), and self-reported poor vs excellent health (OR 1.73; 95% CI 1.04-2.22; P=0.012). The model had excellent discrimination with a c-statistic of 0.77 in the 2015-2016 derivation cycle and 0.76 in the 2017-2018 validation cycle. None of the standard CV risk factors contributed to the model. The only significant nutritional predictor of lower hs-CRP was fiber intake (OR 0.99; 95% CI 0.98-0.99; P=0.035) and the only significant dietary predictor was fruit intake (OR 0.67; 95% CI 0.4-0.934; P=0.045). The dietary and nutrition models had poor discrimination with c-statistics of 0.60 in the 2015-2016 cohort and 0.61 in the 2017-2018 cohort for both models. In a sensitivity analysis, adding dietary factors to the main model did not improve discrimination. Conclusion Older age, female sex, Black race, increased BMI, higher white blood cell count, and self-reported poor health were independent predictors of elevated hs-CRP levels. Higher fruit and fiber consumption were associated with lower hs-CRP levels in univariate but not multivariable models. Additional studies are needed to determine if behavioral modifications (weight loss, increased fiber and fruit intake) can lower hs-CRP and whether this translates to reduced risk for cardiovascular disease.

Care Right Where You Are: Treating in Place to Avoid an Emergency Department Visit or Hospitalization

Care Right Where You Are: Treating in Place to Avoid an Emergency Department Visit or Hospitalization

Asymptomatic Shedding of Respiratory Virus among an Ambulatory Population across Seasons.

Most observation of human respiratory virus carriage is derived from medical surveillance; however, the infections documented by this surveillance represent only a symptomatic fraction of the total infected population. As the role of asymptomatic infection in respiratory virus transmission is still largely unknown and rates of asymptomatic shedding are not well constrained, it is important to obtain more-precise estimates through alternative sampling methods. We actively recruited participants from among visitors to a New York City tourist attraction. Nasopharyngeal swabs, demographics, and survey information on symptoms, medical history, and recent travel were obtained from 2,685 adults over two seasonal arms. We used multiplex PCR to test swab specimens for a selection of common respiratory viruses. A total of 6.2% of samples (168 individuals) tested positive for at least one virus, with 5.6% testing positive in the summer arm and 7.0% testing positive in the winter arm. Of these, 85 (50.6%) were positive for human rhinovirus (HRV), 65 (38.7%) for coronavirus (CoV), and 18 (10.2%) for other viruses (including adenovirus, human metapneumovirus, influenza virus, and parainfluenza virus). Depending on the definition of symptomatic infection, 65% to 97% of infections were classified as asymptomatic. The best-fit model for prediction of positivity across all viruses included a symptom severity score, Hispanic ethnicity data, and age category, though there were slight differences across the seasonal arms. Though having symptoms is predictive of virus positivity, there are high levels of asymptomatic respiratory virus shedding among the members of an ambulatory population in New York City.IMPORTANCE Respiratory viruses are common in human populations, causing significant levels of morbidity. Understanding the distribution of these viruses is critical for designing control methods. However, most data available are from medical records and thus predominantly represent symptomatic infections. Estimates for asymptomatic prevalence are sparse and span a broad range. In this study, we aimed to measure more precisely the proportion of infections that are asymptomatic in a general, ambulatory adult population. We recruited participants from a New York City tourist attraction and administered nasal swabs, testing them for adenovirus, coronavirus, human metapneumovirus, rhinovirus, influenza virus, respiratory syncytial virus, and parainfluenza virus. At recruitment, participants completed surveys on demographics and symptomology. Analysis of these data indicated that over 6% of participants tested positive for shedding of respiratory virus. While participants who tested positive were more likely to report symptoms than those who did not, over half of participants who tested positive were asymptomatic.

Frailty, Health-Related Quality of Life, Cognition, Depression, Vitamin D and Health-Care Utilization in an Ambulatory Adult Population With Type 1 or Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Cross-Sectional Analysis.

Frailty can cause increased vulnerability to adverse health outcomes, such as falls, fractures, depression and reduced health-related quality of life (HRQoL). This cross-sectional study compared the differences in body composition, HRQoL, mental health and cognitive and vitamin D (vitD) status with health-care utilization by frail and nonfrail adults with diabetes mellitus (type 1 and type 2) and with chronic kidney disease (stages 1 through 5). We studied adults with type 1 and type 2 diabetes and chronic kidney disease stages 1 through 5 who were participating in a longitudinal follow-up study (41 to 83 years of age; n=41). Body composition (dual-energy x-ray absorptiometry); vitD status (serum 25[OH]D3); frailty (Edmonton Frail Scale); depression (Major Depression Inventory); HRQoL (Short Form Health Survey-36); and cognitive status (Mini Mental State exam) were measured using validated tools. Participants who were on dialysis and had body weights >136 kg, and coinciding comorbidities known to influence vitD metabolism were excluded. Frailty occurred in 17% of participants (n=7). Frail participants had lower lean body mass, lower HRQoL scores (individual and composite scores), more depression (p=<0.05) and higher numbers of health visits (total, inpatient and emergency) compared with nonfrail participants (p<0.05). No differences in health-care visit types or vitD status were noted between frail and nonfrail participants (p>0.05). Frailty in an ambulatory population of adults with chronic kidney disease and diabetes is associated with low lean body mass, low HRQoL, greater depression and higher numbers of health-care visits.

Asymptomatic Summertime Shedding of Respiratory Viruses.

To determine rates of both symptomatic and asymptomatic infection among ambulatory adults, we collected nasopharyngeal swab specimens, demographic characteristics, and survey information from 1477 adult visitors to a New York City tourist attraction during April-July 2016. Multiplex polymerase chain reaction analysis was used to identify specimens positive for common respiratory viruses. A total of 7.2% of samples tested positive for respiratory viruses; among positive samples, 71.0% contained rhinovirus, and 21.5% contained coronavirus. Influenza virus, respiratory syncytial virus, and parainfluenza virus were also detected. Depending on symptomatologic definition, 57.7%-93.3% of positive samples were asymptomatic. These findings indicate that significant levels of asymptomatic respiratory viral shedding exist during summer among the ambulatory adult population.

Influenza Vaccination: A Cross-Sectional Survey of Knowledge, Attitude and Practices among the Lebanese Adult Population.

Background: Influenza is a common preventable infectious disease associated with high mortality and morbidity. Vaccination is the most cost-effective measure to prevent influenza, yet the vaccine uptake is known to be low. No previous studies have assessed the rate of seasonal influenza vaccination use among the Lebanese population, nor examined the knowledge and attitudes towards the influenza vaccine. Methods: A cross-sectional survey was performed in 30 pharmacies randomly selected across Lebanon. A 19-item questionnaire was used to record influenza vaccination status, knowledge and attitudes towards the influenza vaccine among the Lebanese general population. Results: The survey response rate was 93%. Among the 640 study participants, the overall 2014-2015 seasonal influenza vaccination rate was 27.6%. The majority of participants (72.4%) reported irregular uptake of the vaccine. Results of the multivariate analysis revealed that elderly people (OR = 2.25, CI = 1.08–4.71), with higher education (OR = 1.42, CI = 1.09–1.84), higher physical activity (OR significantly higher than 1 for all categories), and chronic respiratory disease (OR = 3.24, CI = 1.58–6.62) were more regularly vaccinated, while those who visit the doctor “only when needed” (OR = 0.55, CI = 0.34–0.88) and those who consume more than seven drinks/week (OR = 0.24, CI = 0.09–0.65) were less regularly vaccinated. When introducing knowledge and attitude variables to the model, “thinking that the vaccine was not needed” was the only correlate that demonstrated a significant inverse association with regular influenza vaccination (OR = 0.15; p = 0.017). Conclusions: Suboptimal vaccination rates exist among the Lebanese ambulatory adult population. Clear misinformation on the importance of regular influenza immunization is also highlighted. This evidence underscores a compelling need to raise public awareness regarding the efficacy of the influenza vaccine.

Characterization of diabetes risk factors in patients prescribed chronic statin therapy.

Determine the incidence of major diabetes risk factors over time in patients prescribed chronic statin therapy. Retrospective observational chart review of adult patients without diabetes in primary care who initiated statin therapy between 2005 and 2010. Presence of diabetes risk factors were determined 1 year prior to statin initiation and continued up to a maximum of 7 years. Diabetes risk factors included impaired fasting glucose, body mass index (BMI) ≥30 kg/m(2), hemoglobin A1c >6% and metabolic syndrome. Descriptive statistics were used to describe the incidence of diabetes risk factors over time. A total of 98 patients met study criteria; mean age was 57 ± 13 years, 43% were men and 71% self-identified as Caucasian/white. Mean baseline values were A1c of 5.97%, fasting glucose of 104 mg/dl and BMI of 28 kg/m(2). There were zero diabetes risk factors over time in 54% ± 7% of patients. The incidence over time of 1 risk factor was 25 ± 9%, 2 risk factors was 17 ± 5% and 3 risk factors was 3 ± 2%. A total of 12 patients were diagnosed with type 2 diabetes during the course of the study period. The incidence of diabetes risk factors did not change over time in an ambulatory adult population prescribed chronic statin therapy. Larger population studies assessing the incidence of and change in diabetes risk factors in patients on chronic statin therapy may help assess the association between statin therapy and presence of such risk factors.

A cloud medication safety support system using QR code and Web services for elderly outpatients

Drug is an important part of disease treatment, but medication errors happen frequently and have significant clinical and financial consequences. The prevalence of prescription medication use among the ambulatory adult population increases with advancing age. Because of the global aging society, outpatients need to improve medication safety more than inpatients. The elderly with multiple chronic conditions face the complex task of medication management. To reduce the medication errors for the elder outpatients with chronic diseases, a cloud medication safety supporting system is designed, demonstrated and evaluated. The proposed system is composed of a three-tier architecture: the front-end tier, the mobile tier and the cloud tier. The mobile tier will host the personalized medication safety supporting application on Android platforms that provides some primary functions including reminders for medication, assistance with pill-dispensing, recording of medications, position of medications and notices of forgotten medications for elderly outpatients. Finally, the hybrid technology acceptance model is employed to understand the intention and satisfaction level of the potential users to use this mobile medication safety support application system. The result of the system acceptance testing indicates that this developed system, implementing patient-centered services, is highly accepted by the elderly. This proposed M-health system could assist elderly outpatients' homecare in preventing medication errors and improving their medication safety.

Incremental direct medical expenditures associated with anxiety disorders for the U.S. adult population: Evidence from the Medical Expenditure Panel Survey

Data from the 2009 and 2010 Medical Expenditure Panel Survey (MEPS) were used to estimate the annual incremental healthcare expenditures associated with anxiety disorders, for the ambulatory adult population of the U.S. Individuals 18 years and older, who reported a diagnosis of, or had a medical event associated with anxiety disorder(s), were classified as anxiety population. Multivariate regression analyses, using generalized linear models, were conducted to calculate incremental costs associated with anxiety disorders. 8.74% of adult respondents reported being diagnosed with anxiety disorder(s). The annual overall healthcare expenditure associated with anxiety disorders was estimated at $1657.52 per person (SE: $238.83; p<0.001). Inpatient visits, prescription medications, and office-based visits together accounted for almost 93% of the overall cost. Given the prevalence of self-reported anxiety disorders in MEPS, their total direct medical expenditure is estimated at approximately $33.71 billion in 2013 US dollars, meaning this category of mental illnesses absorbs a significant portion of the U.S. healthcare resources.

Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey.

Data on the range of prescription and over-the-counter drug use in the United States are not available. To provide recent population-based information on use of all medications, including prescription and over-the-counter drugs, vitamins and minerals, and herbal preparations/natural supplements in the United States. Ongoing telephone survey of a random sample of the noninstitutionalized US population in the 48 continental states and the District of Columbia; data analyzed here were collected from February 1998 through December 1999. Use of medications, by type, during the preceding week, compared by demographic characteristics. Among 2590 participants aged at least 18 years, 81% used at least 1 medication in the preceding week; 50% took at least 1 prescription drug; and 7% took 5 or more. The highest overall prevalence of medication use was among women aged at least 65 years, of whom 12% took at least 10 medications and 23% took at least 5 prescription drugs. Herbals/supplements were taken by 14% of the population. Among prescription drug users, 16% also took an herbal/supplement; the rate of concurrent use was highest for fluoxetine users, at 22%. Reasons for drug use varied widely, with hypertension and headache mentioned most often (9% for each). Vitamins/minerals were frequently used for nonspecific reasons such as "health" (35%); herbals/supplements were also most commonly used for "health" (16%). In any given week, most US adults take at least 1 medication, and many take multiple agents. The substantial overlap between use of prescription medications and herbals/supplements raises concern about unintended interactions. Documentation of usage patterns can provide a basis for improving the safety of medication use.