Common Chronic Medical Conditions Research Articles

Social Media in the Management of Obesity and Diabetes: An Underutilised Population Educational Tool.

Obesity and diabetes are two of the most common chronic medical conditions encountered, putting an ever-increasing strain on healthcare systems worldwide. Social media meanwhile has taken the world by storm over the last 2 decades, providing a way to distribute information instantly and on a vast scale at the click of a button. The use of social media to aid in the management of obesity and diabetes though is an underutilised tool, with the potential to help in educating and supporting these patients in numerous ways both now and in the future, on a grand scale. The caveat to this, however, is the negative side of social media, which can include the spread of disinformation and bullying. In this commentary, we discuss the methodology and wide scale of positive and negative effects of social media across the management of obesity and diabetes, as well as the possible methods we can use this to our advantage in the medical profession to help our patients going forward.

Medication Adherence among Primary Care Patients with Common Mental Disorders and Chronic Medical Conditions in Rural India.

Only a few studies have explored the relationship between psychosocial factors and medication adherence in Indian patients with noncommunicable diseases (NCDs). We aimed to examine the association of psychosocial variables with medication adherence in people with NCDs and comorbid common mental disorders (CMDs) from primary care in rural southern India. We performed a secondary analysis using baseline data from a randomized controlled trial in 49 primary care health centers in rural southern India (HOPE study). Participants were adults (≥30 years) with NCDs that included hypertension, diabetes, and/or ischemic heart disease, and comorbid depression or anxiety disorders. Medication adherence was assessed by asking participants if they had missed any prescribed NCD medication in the past month. Data were collected between May 2015 and November 2018. The association between psychosocial and demographic variables and medication nonadherence were assessed via logistic regression analyses. Of the 2486 participants enrolled, almost one-fifth (18.06%) reported missing medication. Male sex (OR = 1.74, 95% CI 1.37-2.22) and higher internalized mental illness stigma (OR = 1.46, 95% CI 1.07-2.00) were associated with higher odds of missing medication. Older age (OR = 0.40, 95% CI 0.26-0.60, for participants aged 64-75 years vs 30-44 years), reporting more social support (OR = 0.65, 95% CI 0.49-0.86), and higher satisfaction with health (OR = 0.74, 95% CI 0.61-0.89) were associated with lower odds of missing medication. Greater internalized mental illness stigma and less social support are significantly associated with lower rates of medication adherence in patients with NCDs and comorbid CMDs in rural India.

1035-P: Area Deprivation Index and Rates of Specialty Care in Monogenic Diabetes Registry Participants

While diabetes is one of the most common chronic medical conditions, monogenic forms of diabetes represent a rare subtype, and face barriers to timely diagnosis similar to other rare diseases (RD), which are exacerbated by low health literacy (HL) and health care access barriers. The Monogenic Diabetes Registry (MDR) follows more than 1,200 participants with molecular diagnoses of monogenic diabetes who can offer insight into diagnostic barriers and facilitators. Aim: To assess area deprivation index (ADI- a measure of neighborhood disadvantage in the US) as a proxy of HL and health care provider type (specialist versus generalist) as a proxy of health care access in a subset of MDR participants with maturity-onset diabetes of the young (MODY). Methods: Cross-sectional analysis of REDCap data for 79 participants. ADI was constructed for each participant and descriptive statistics were analyzed with RStudio. Kruskal-Wallis was used for comparisons. Results: The median ADI of MDR participants was 26 (less than expected value of 50; p<0.001). Only 20% were from neighborhoods with >50th %ile deprivation. Sixty-two percent were under specialty care for diabetes. The median ADI for those under specialist care was lower than for those under generalist care (23 versus 36), but did not reach statistical significance. There was no difference in median ADI between participants receiving clinical versus research genetic testing or between those referred by providers versus self-referral. Discussion: ADI inversely correlates with HL and SES. MDR participants had ADI percentiles below the national median and a majority were under the care of diabetes specialists compared to ~15% of the general US population living with diabetes. These findings suggest inequity in who finds and enrolls in the Registry, and mimics the broader RD literature. Efforts are needed to better reach populations disproportionately affected by health disparities to ensure equity in monogenic diabetes diagnosis and management. Disclosure R.G.Son: None. R.N.Naylor: None. S.Uiversity of chicago monogenic diabetes registry : n/a. Funding National Institutes of Health (R01DK104942, P30DK020595, K23DK114564, UL1TR000430)

(497) Is Drug Development for Female Sexual Dysfunction Dead?

Abstract Introduction Various agents have been tested to treat female sexual dysfunction (FSD), particularly Hypoactive Sexual Desire Disorder and Female Sexual Arousal Disorder, but only two, flibanserin and bremelanotide, have met any regulatory standards (US only), and none is popular with patients or prescribers. Several more agents, e.g., sildenafil, testosterone, alprostadil, buspirone, bupropion and trazodone, have shown early promise but have not been developed further. Objective Evaluate whether drug development for FSD at a standstill and identify related factors. Methods Selective literature review using the largest, most high-quality surveys available on factors relating to the proportion of women likely to be treated for FSD and of the factors relating to convenience of the posology and the safety of agents for FSD. Results Surveys show that about 40% of women have sexual dysfunction, but lack of related distress and complicating factors decrease the proportion of women likely to be treated medically for primary FSD to about 0.1%. Such complicating factors include antidepressant use and chronic medical illness that prevent diagnosing primary FSD, lack of awareness, and prescriber reluctance. The posology of the available agents and their side effects may limit benefits and thus acceptance, also. Fear of regulatory rejection amid shifting standards for evaluation of efficacy and diagnostic criteria is an intangible but likely factor stalling drug development for FSD, too. Conclusions Major investment in developing medications for FSD may well have ended. The proportion of women with primary (stand-alone) FSD likely to be treated medically is limited to no more than 0.1% of the population because of low awareness of the diagnosis, lack of willingness to be treated, and lack of prescriber knowledge and willingness to diagnose and prescribe. Benign medications for primary FSD are not available with sufficiently robust efficacy and convenience to break down the barriers of patient and practitioner reluctance toward medical treatment. The lack of marketing success with current agents and the fear of surmounting regulatory hurdles probably have had additional chilling influences on drug development in this field. Developing agents for secondary FSD (FSD comorbid with common chronic medical conditions), e.g., HSDD and/or FSAD in women with the genitourinary syndrome of menopause, diabetes, cancer, depression, and antidepressant users, could help far more women, perhaps 10% of the female population. However, such patients should be expected to be more difficult to treat, might well require multimodal approaches using the biopsychosocial model of FSD. A combination of medication with targeted psychotherapy, couples’ therapy, and/or a mindfulness-based intervention might be necessary. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: S1 Biopharma, Sprout Pharma, Gedeon Richter.

Asthma Symptom Action Plan (ASAP): Assessing the Need for, Creating and Implementing a Standardized Form for San Diego County Schools

Asthma is one of the most common chronic medical conditions affecting school-aged children. One in two children report school absences due to asthma per year. SAMPRO (School-based Asthma, Allergy & Anaphylaxis Management Program) endorses standardized asthma action plans (AAP) in schools.

Annals for Educators - July 2022

Annals for Educators - July 2022

The association of diabetes mellitus and acute myocardial infarction in the development of atrial fibrillation

Diabetes mellitus is one of the most common chronic medical conditions and is an independent risk factor for both: acute myocardial infarction and the development of atrial fibrillation. Both, diabetes mellitus and acute myocardial infarction promote the development of a proinflammatory status and oxidative stress in the atrial tissue, these being a substrate of the development of atrial fibrosis, and consequently of atrial fibrillation.

Meeting the Primary Care Needs of Autistic Individuals.

In 1996, the Institute of Medicine adopted the following definition of primary care: the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.1 On the basis of our previous work in the Health Care Transitions Research Network, we know that young autistic adults and their families struggle to find adult primary care providers who understand their needs.2,3 The overall goals of health and health care are to increase lifespan and maximize quality of life. Primary care for autistic adults needs to improve for them to attain these goals.Autistic adults have a significantly higher prevalence of common chronic medical conditions, including dyslipidemia, hypertension, diabetes, obesity, and thyroid disease.4 However, despite an increased need for health services in this population, autistic individuals are faced with health care barriers from childhood to adulthood, which limit their access to high-quality primary and preventive care* services throughout the life course.Both autistic children and older youth have higher levels of health service use, including a higher percent of pediatrician visits, specialty care services, and inpatient hospitalizations, compared to non-autistic individuals. Interestingly, despite this increased contact with the health care system, autistic children are less likely to have received important preventive health services including immunizations for influenza and other vaccinations.5 In addition to receiving fewer vaccines in childhood, autistic individuals continue to face barriers in access to care as adults. Autistic adults report significantly higher odds of unmet health care needs related to physical health and mental health, compared to non-autistic adults.6 Furthermore, although autistic adults are as likely as non-autistic adults to have a primary care provider, they are less likely to have received a tetanus vaccine, and, if female, less likely to have received cervical cancer screening in the past 3 years. Beyond vaccination and cervical cancer screening, little is known about the use and access of autistic individuals to other routine guideline-driven preventive services such as colon cancer and breast cancer screening.The deficit in primary and preventive care services faced by autistic individuals, as well as the increased prevalence of various chronic medical conditions is related to a combination of both provider discomfort with treating autistic individuals as well as autism-specific barriers such as communication deficits, which pose a challenge for delivery of care through conventional models of medical practice. In a study on the patient experience, autistic patients experienced heightened anxiety when communicating with the physician, during the physical exam, and while in the waiting room. These difficulties could be alleviated by preplanning individualized accommodations to overcome environmental and process barriers such as rooming the patient immediately and not performing vital signs at the time of intake.7 Such interventions may help improve clinic visits as well as the patient-doctor interaction.Further interventions are needed to bridge the existing gaps in primary and preventive care and to address the increased prevalence of chronic health conditions in autistic individuals. Future directions should include research on differences in access to routine guideline-driven preventive health services such as colon and breast cancer screening, as well as further evaluation of the origin of the disparities in access to care faced by autistic individuals. Care for autistic individuals should incorporate guideline-driven practices provided to the general population in addition to personalized accommodations to improve delivery of care.

Influenza Antiviral Therapy and Length of Hospitalization

Source: Campbell AP, Tokars JI, Reynolds S, et al. Influenza antiviral treatment and length of stay. Pediatrics. 2021;148(4):e2021050417; doi:10.1542/peds.2021-050417Investigators from multiple institutions conducted a retrospective study to assess the effect of treatment with neuraminidase inhibitors (NAIs) on length of hospital stay (LOS) in children with influenza. Study data were abstracted from the Influenza Hospitalization Surveillance Network (FluServ-NET), a population-based surveillance network with data from 10 counties in different states and 5 entire states. Information on patients in the surveillance system, including demographics, patient characteristics, treatment with NAIs, symptom onset, and details on hospitalization were collected. Study participants were children <18 years old with laboratory-identified influenza who were divided into 2 cohorts for analysis. Cohort 1 included children with ≥1 medical condition and not admitted or transferred to an ICU who were hospitalized during the 2012–2013 influenza season. Cohort 2 were children with or without an underlying medical condition who were admitted to an ICU during 3 consecutive influenza seasons (2010–2011, 2011–2012, and 2012–2013). Exclusion criteria included missing information on receipt of NAIs, LOS <1 day, and symptom onset on or after ≥3 days prior to admission. Receipt of NAIs was classified as never, ≤2 days after onset of symptoms (early), or ≥3 days after symptoms (late). The primary study outcome was LOS, and the association of treatment with NAIs on LOS was evaluated using Cox regression after controlling for confounders.During the 2012–2013 influenza season, data on 1,924 children hospitalized with influenza were collected in FluServ-NET; 1,039 (54%) had ≥1 underlying medical condition. After applying exclusions, cohort 1 consisted of 309 children, of whom 199 (64.4%) received early NAI ≤2 days after treatment, 37 (12.0%) were treated ≥3 days after symptom onset, and 73 (23.6%) had no treatment with NAIs. After controlling for confounders, a shorter LOS was statistically associated with early NAI treatment (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.05, 1.80), but not late treatment (HR, 1.02; 95% CI, 0.67, 1.54). There were 299 children admitted to an ICU, included in cohort 2 analyses, with a median LOS of 5 days. NAIs were started ≤2 days after symptom onset in 168 (56%), ≥3 days after onset of symptoms in 45 (15%), and never in 86 (29%). In this cohort, early NAI treatment also was associated with shorter LOS (HR, 1.46; 95% CI, 1.11, 1.92), and late NAI treatment was not (HR, 1.20; 95% CI, 0.85, 1.69).The authors conclude that early treatment with NAIs in children with influenza was associated with shorter hospitalizations.Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Treatment with NAIs has been shown to reduce hospitalization among high-risk adults and children with influenza.1 NAIs also have been shown to reduce mortality among hospitalized adults when given ≤2 days after symptom onset but have not been associated with a reduction in mortality among children <16 years.2 Because of these studies and others, treatment with NAIs has been recommended for patients of all ages with influenza since 2009.3 However, since most studies of NAIs were performed on outpatients and adults, the experience among hospitalized children is limited.4 The current investigators close that gap.The investigators employed a large data set, controlled for confounding variables, and were careful to reject participants for whom NAI use was not known. Further, they studied children who would benefit the most from NAIs: those with ≥1 chronic illness and those admitted to the ICU. The most common chronic medical conditions included chronic lung and cardiac diseases such as asthma, neurologic diseases, prematurity, immunocompromise, and chronic metabolic or blood disorders. Interestingly, 48% of the chronic illness cohort and 37% of the ICU cohort were vaccinated for influenza. Vaccination status was not associated with LOS.The results of the current study affirm the Centers for Disease Control and Prevention (CDC) position to start early empiric treatment with NAIs on all patients suspected of influenza.3 Interestingly, the CDC also recommends NAIs in all hospitalized patients with influenza regardless of time of onset due to potential reduction in viral shedding and LOS.5Among children with influenza admitted to the ICU or with ≥1 chronic conditions, treatment with NAIs within ≤2 days of symptom onset is associated with a shorter LOS compared to those treated ≥3 days after symptom onset or not at all. (See AAP Grand Rounds. 2021;46[4]:39).6

Influenza viruses and SARS-CoV-2 in adult: 'Similarities and differences'.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causing a global pandemic starting from December 2019, showed a course that resulted in serious mortality in the world. In order to understand SARSCoV-2 better, here we aimed to compare the similar and different characteristics of Influenza viruses occurring in the same season with SARS-CoV-2. A total of 144 patients (31 patients with COVID-19, 62 patients with H1N1 influenza, and 51 patients with influenza B) were included in the study. Demographic findings, chronic diseases, laboratory values, chest x-ray, and chest CT findings of the patients were evaluated retrospectively. Median age of the COVID-19 patients and rate of male patients were higher than other patient groups (55 years; p< 0.001) (61% male; p< 0.001). The most common chronic medical conditions were hypertension and diabetes. Platelet numbers and alanine aminotransferase values were significantly higher in COVID-19 patients. Radiologically, bilateral (74.2%) and nonspecific distribution (58.1%), ground-glass opacities with consolidation (51.6%), patchy image (25.8%), ground-glass opacities with interstitial changes (22.6%) and halo sign (22.6%) were quite evident than other groups in COVID-19 patients (p< 0.05). We suggest that due to the higher PLT values observed in COVID-19 patients, initiation of anticoagulant therapy should be considered in the early stage and routine follow-up with d-dimer and fibrinogen should be applied for suspected patients. Moreover, attention should be paid in terms of possible liver toxicity of the drugs to be used in treatment due the higher ALT values observed in COVID-19 patients. Since we did not detect SARS-CoV-2 and influenza viruses concurrently in the same patient, it may be helpful to focus on only one virus in a patient with symptoms, and radiographic differences can be used to differentiate COVID-19 from influenza.

Annals for Educators - December 2021.

Annals for Educators - December 2021.

593 Odds of Receiving Sleep Diagnoses in Common Pediatric Chronic Medical Conditions

Abstract Introduction Sleep disorders (SD) are under-diagnosed in the general pediatric population. Children with chronic medical conditions (CMC) tend to have a higher prevalence rate of SD; however, the studies about the rates of diagnosis of SD are limited. We examined the odds of receiving SD diagnoses in children with various CMC and hypothesized that if this likelihood is established, screening tools can be developed to increase the rates of diagnoses and improve clinical outcomes. Methods Chi-square test and regression analysis were used to test the association between SD and CMC based on ICD-9 and -10 diagnosis codes retrieved from the Medicaid claims submitted for children (0 to 18 years) enrolled in the Centers for Medicare and Medicaid Services-funded Coordinated Health Care for Complex Kids (CHECK) project, at an urban, public tertiary care hospital. Children without a CMC were excluded. Results Among 16,609 children with CMC (mean [SD] age of 9.1 [5.3] years; 56.4% male; 77% with multiple CMC), 14.1% received a diagnosis of SD. Compared to the cohort without a particular CMC, children with attention deficit hyperactivity disorder (ADHD), obesity, developmental disorder, or asthma had following odds of receiving sleep diagnosis respectively (odds ratio (OR) [Confidence Interval]): insomnia (6.9 [5–9.5]; 2.4 [1.7–3.2]; 1.6 [1.2–2.3]; 0.7 [0.5–1]), circadian rhythm disorders (6.1[2.7–13.7]; 2.8 [1.3–2.6]; 3.0 [1.4–6.4]; 0.5* [0.2–1.1]), hypersomnia (2.9 [1.0–8.6]; 7.8 [3–20.2], 0.9* [0.3–2.6], 0.8* [0.3–2.2]), and sleep-related movement disorder (1.9* [0.9–4.3]; 4.4 [2.5–7.8]; 2.2 [1.2–3.9]; 0.6*[0.3–1.1]). (*=p value &amp;lt;0.05). Conclusion Odds of receiving sleep diagnoses vary across CMC. Among others, strong associations between obesity-hypersomnia and ADHD-insomnia were noted. This information may help clinicians implement appropriate screening interventions to improve early SD detection and management. Further studies to examine these associations are necessary. Support (if any):

Impact of self-monitoring of salt intake by salt meter in hypertensive patients: a randomised controlled trial (SMAL-SALT)

Abstract Background Hypertension is one of the most common chronic medical conditions. The concerned sequelae are the cardiovascular complications. In Thailand, the incidence of hypertension is increasing each year. Many clinical studies found that salt intake over the reference level (&amp;gt;5 g/day) would result in elevated blood pressure (BP) and morbidity. Dietary salt reduction campaigns were unsuccessful, in part, due to time limitation in the clinic, lacking of awareness, and the higher threshold to detect salt taste in chronic high salt ingestion. Salt meter is a device used to detect sodium content in daily food. It will facilitate monitoring and control of salt intake. This study aimed to compare the efficacy of salt meter plus dietary education compared with education alone in terms of salt intake reduction, blood pressure, salt taste sensitivity, and vascular consequence. Method A randomized-controlled trial was conducted in hypertensive patients whose BP was uncontrolled (SBP ≥140 mmHg or DBP ≥90 mmHg) despite therapy or antihypertensive-naïve. Patients were randomized to receive salt meter to use in conjunction with dietary education (group A) or receive education only (group B), and were followed up for 8 weeks. Dietary education was provided by certified dietician without awareness of patients' allocation. The primary endpoint was change in 24-hour urinary sodium excretion. Changes in BP, salt taste sensitivity threshold, cardio-ankle vascular index (CAVI), as well as motivation to maintain low salt diet were also analyzed. Results A total of 100 patients were enrolled, with 90 patients who met the eligible criteria and had completed to follow-up, 45 in group A and 45 in group B. Mean age was 62.9 years and 53% were females. 11.1% were treatment-naïve, and median number of antihypertensive agents was 2. Mean baseline 24-hour urine sodium was 151.6 mmol/24h and mean baseline SBP and DBP were 152.8 and 83.4 mmHg, respectively. Baseline characteristics including age, sex, number of drugs, BP, body weight, 24-hour urine sodium, creatinine, salt sensitivity, and CAVI were similar between two groups. At 8 weeks, mean decrease in 24-hour urine sodium were 29.1 mmol/24h and −0.9 mmol/24h in group A and group B, respectively (p=0.017). Mean decrease in BP (group A vs group B) were SBP, 14.3 vs 8.4 mmHg (p=0.043), and DBP 5.7 vs 1.8 mmHg (p=0.021). The salt sensitivity was improved in both groups, more in group A (detection threshold decrement = 1.547 in group A and 0.265 in group B). There was no different between change in CAVI. All patients have more motivation to maintain low salt diet after finish the study. No adverse event was observed throughout the study. Conclusions Salt meter in conjunction with dietary education, for self-monitoring of salt intake is superior to education alone in hypertensive patients, and provided better blood pressure control. Salt meter should be considered in patients with uncontrolled hypertension. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Faculty of Medicine, Ramathibodi Hospital of Mahidol University

The aging veteran population: Promoting awareness to influence best practices

The older adult population is the most rapidly growing population in the United States. It is projected that by 2035, the population of adults older than 65 years is expected to be greater than the population of children. The projected number of Veterans age 60 and older is about 11 million. Along with common age-related complex and high-risk chronic medical conditions, care of older adult Veteran requires a holistic approach that focuses on the culture, and subcultures, and unique health care needs resultant of military service. Veterans’ health care is often multifocal and complex, requiring an integrated, collaborative, and comprehensive model of care that better facilitates meeting health goals to the degree most realistic and attainable for each older adult Veteran. This highlights the need to promote awareness and provide educational opportunities for engaging in best practices that meet the unique needs of the aging Veteran population.

SARS-CoV-2 (COVID 19) Infection in Hypertensive Patients and in Patients With Cardiac Disease.

COVID 19, caused by the SARS-CoV-2 virus, a newly discovered coronavirus, has caused the global pandemic of early 2020. The first case was described in December 2019 in Wuhan, China, and by March 2020, most countries around the world have put in place some of the strictest restrictions seen in decades in order to slow down the spread of the disease. Patients with pre-existing hypertension and cardiovascular comorbidities were reported to be at an increased risk of serious infections caused by SARS-CoV-2. Considering that those are among the most common chronic medical conditions in the Western world, the potential impact of it is huge. The proposed mechanism behind those associations is the expression of angiotensin converting enzyme II (ACE II) in those patients. Furthermore, the association between ACE inhibitors/AR blockers, which are among the most frequently prescribed medications, and serious cases of COVID 19 has been studied with the same mechanism in mind. The reports on the association between hypertension and COVID 19 morbidity and mortality are less clear, and the International Society of Hypertension even claims that there is none. The reports on the association between heart failure or coronary disease and COVID 19 are more uniform, and all seem to point to a greater risk from serious infections faced by patients with those comorbidities. A significant effort will need to be invested by the scientific community into finding strategies for protecting those patients from contracting the virus in the first place and then, once infected, into developing management plans aimed at preserving cardiac function as much as possible.

Multidimensional Approach to Frailty among Rural Older People: Applying the Tilburg Frailty Indicator

Introduction: Frailty is a common geriatric syndrome. Studies of frailty and old age have been able to help reduce its underlying causes and complication. Understanding the frailty and its associated factors in developing countries such as Iran, can help gather information on conditions of the elderly and better plan for this age population. Therefore, the present study was implemented to investigate the prevalence and determinants of frailty in the rural elderly population of Shabestar, East Azarbayjan, Iran.&#x0D; Methods: This cross-sectional study was conducted among 565 rural older people in Shabestar, Iran during 2018-2019. The data collection tool was the Tilburg Frailty Indicator. The participants were selected by using stratified and simple random approach. Descriptive statistics, t-test, one-way ANOVA and logistic regression were used to perform data analysis.&#x0D; Results: Of the participants, 46.7% were detected as being frail. The associations between the prevalence of frailty and sociodemographic characteristics such as age, gender, marital status, types of lifestyle, educational level, and income status were statistically significant (p &lt; 0.05). Regression analysis showed that age (β = -0.84, p &lt; 0.05), the number of medications used (β = -2.72, p &lt; 0.001), hypertension (β = -0.633, p &lt; 0.006), diabetes (β = -535, p &lt; 0.045) and the history of fall during the last year (β = -4.21, p &lt; 0.001) were the most important predictors of frailty among non-institutionalized rural older people.&#x0D; Conclusion: The study confirms the importance of common chronic medical conditions and sociodemographic characteristics in the development of frailty syndrome among older adults. The descriptive nature of the study implies observational trials to clarify more deeply relationship between frailty and the determinants found.

Effectiveness of Romiplostim for Treatment of Adults with Newly Diagnosed or Persistent Primary Immune Thrombocytopenia in US Clinical Practice

Introduction: Immune thrombocytopenia (ITP) is an autoimmune disorder that is characterized by low platelet count, and that often requires rescue therapy (e.g., corticosteroids, intravenous immunoglobulin [IVIG]) and can lead to serious bleeding-related episodes (BREs). Based on the International Working Group (IWG), ITP is classified into three groups by duration of disease: newly diagnosed (0 to &lt;3 months), persistent (≥3 to ≤12 months), and chronic (&gt;12 months); patients in the newly diagnosed or persistent phase are considered to have early ITP. Romiplostim, an injectable thrombopoietin receptor agonist, has demonstrated efficacy in clinical trials of adults with chronic ITP. Evidence of drug efficacy from clinical trials of adults with chronic ITP may not, however, be reflective of drug effectiveness among adults with early ITP in clinical practice. The objective of this study was to evaluate the effectiveness of romiplostim for the treatment of adults with early ITP in real-world settings. Methods: A retrospective pre-post cohort design and data from a large healthcare claims repository (2009-2017) were employed. The study population comprised patients aged ≥18 years who initiated romiplostim and, during the 1-year period prior to therapy initiation ("pre-period"), had their first diagnosis of ITP and evidence of a BRE. Patients were excluded from the study population if they were not continuously enrolled during the 1-year pre-period and 1-year period following therapy initiation ("post-period") or if, during the pre-period, they had evidence of conditions (e.g., viral hepatitis B, hepatitis C, HIV, lupus, pancytopenia, cancer) that may lead to secondary thrombocytopenia. Study outcomes included BREs, use of rescue medication (oral/IV corticosteroids, IVIG, anti-RhD immunoglobulin [anti-D], platelet transfusions), splenectomy, and thrombocytopenia-related hospitalizations, and were compared between the 1-year maximum pre-period (depending on timing of initial ITP evidence relative to initiation of romiplostim) and the 1-year post-period using the McNemar test and paired-samples t-test. Results: The study population included 145 adults with early ITP who initiated romiplostim and had a history of BREs; mean age was 54 years, 54% were female, and 57% were in the newly diagnosed phase at the time of therapy initiation (duration from first ITP evidence to initiation of romiplostim: mean = 166 days, range = 4 - 365 days). Common acute and chronic medical conditions among patients in the study population included cardiovascular disease (24%), diabetes (21%), anemia (30%), and osteoarthritis (11%). From the variable pre-period to the 1-year post-period, incidence of BREs requiring a healthcare encounter decreased by 59% (p&lt;0.001) and use of rescue therapy decreased by 22% (p&lt;0.001) on an overall basis, ranging from 11% (p=0.052) for IV glucocorticosteroids to 100% (p&lt;0.001) for anti-D (Table). Thrombocytopenia-related hospitalizations decreased by 63% (p&lt;0.001); splenectomy increased from 9% to 13% (p&lt;0.001). Conclusions: In this real-world evaluation of adults with early ITP and a bleeding history who initiated romiplostim in US clinical practice, marked decreases were observed in the incidence of BREs, use of rescue therapy, and thrombocytopenia-related hospitalizations following initiation of romiplostim. Disclosures Hatfield: Amgen Inc.: Employment, Equity Ownership. Shah:Amgen Inc.: Employment, Equity Ownership. Lawrence:Amgen Inc.: Employment, Equity Ownership. Hanau:Amgen Inc.: Research Funding. Lonshteyn:Amgen Inc.: Research Funding. Weycker:Amgen Inc.: Research Funding.

Oxidative Toxicity in Diabetes Mellitus: The Role of Nanoparticles and Future Therapeutic Strategies

Diabetes mellitus is one of the most common chronic medical conditions in the world. Increasing evidence suggests that chronic hyperglycemia can cause excessive production of free radicals, particularly reactive oxygen species (ROS). Free radicals play important roles in tissue damage in diabetes. The relationship between exposure to nanoparticles (NPs) and diabetes has been reported in many previous studies. Evaluation of the potential benefits and toxic effects of NPs on diabetic disorders is of importance. This review highlights studies on the relationship between NPs and oxidative stress (OS) as well as the possible mechanisms in diabetic animal models and humans.

Meta-inflammaging at the crossroad of geroscience.

Geroscience posits that selected fundamental biological processes are the foundation of age‐related chronic diseases and are responsible for the decline in physical and mental function in old age. Late‐life chronic low‐grade inflammation (“inflammaging”) and altered signal transduction pathways in metabolism have been identified as two of the key themes in the aging process. Age‐related changes in the immune and metabolic responses are also recognized as playing a critical pathogenic role in most common chronic medical conditions that plague the elderly. Emerging investigations emphasize the interconnectedness of the immune and metabolic responses in aging, an area of gerontological research that can be termed “meta‐inflammaging.”

Increased risk of incident chronic medical conditions in infertile women: analysis of US claims data

The risk of common chronic medical conditions among infertile women is not known. The objective of the study was to study the association between female infertility and the risk of incident chronic disease. This was a retrospective cohort analysis using the Optum deidentified Clinformatics Datamart from 2003 through 2016. A total of 64,345 infertile women were identified by infertility diagnosis, testing, or treatment and compared with 3,128,345 noninfertile patients seeking routine gynecologic care. Women with a prior diagnosis of the relevant chronic disease or cancer or with either diagnosis within 6 months of the index event were excluded. The main outcome was a diagnosis of incident chronic disease as identified by International Classification of Diseases, ninth revision/International Classification of Diseases, 10th revision codes. Results were adjusted for age, index year, nulliparity, race, smoking, obesity, number of visits per year, and highest level of education. Infertile patients were more likely to develop diabetes (adjusted hazard risk, 1.44, confidence interval, 1.38-1.49), renal disease (adjusted hazard risk, 1.22, confidence interval, 1.12-1.32), liver disease (adjusted hazard risk, 1.25, confidence interval, 1.20-1.30), cerebrovascular disease (adjusted hazard risk, 1.26, confidence interval, 1.15-1.38), ischemic heart disease (adjusted hazard risk, 1.16, confidence interval, 1.09-1.24), other heart disease (adjusted hazard risk, 1.16, confidence interval, 1.12-1.20), and drug abuse (adjusted hazard risk, 1.24, confidence interval, 1.15-1.33) compared with noninfertile patients. Infertile patients were significantly less likely to develop alcohol abuse (adjusted hazard risk, 0.86, confidence interval, 0.79-0.95) compared with noninfertile patients. Risk associations were similar after excluding women with polycystic ovarian syndrome and premature ovarian insufficiency. In subgroup analyses of women who underwent pregnancy and childbirth during enrollment, several previously noted risk associations were attenuated compared with the overall cohort. While the absolute risk of chronic disease is low, infertility is associated with an increased risk of incident chronic disease compared with a group of noninfertile women.