Community-based Retrospective Cohort Study Research Articles

Protecting effects of smoking against COVID-19: a community-based retrospective cohort study in middle- and older-aged adults.

On December 7, 2022, China switched from dynamic zeroing strategy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to reopening. A nationwide SARS-CoV-2 epidemic emerged rapidly. The effect of smoking on SARS-CoV-2 infection remains unclear. We aimed to retrospectively investigate the relationship between smoking and coronavirus disease 2019 (COVID-19) using a community-based cohort of smokers and non-smokers. We included participants from a pre-pandemic cohort with a prolonged follow-up period. Data on smoking status, body mass index, and history of other diseases were collected from health examination and consultation clinic records. Cox regression analysis was used to identify the relationship between groups and SARS-CoV-2 infection over time. We analysed 218 male patients with varied smoking statuses (46.3% current or ex-smokers; average age 68.63 ± 9.81years). Two peaks in the epidemic were observed following the December 2022 outbreak. At the end of the second peak, non-smokers, current smokers, and ex-smokers had primary infection rates increase to 88.0%, 65.1%, and 81.0%, respectively, with a significant difference between the groups. Current smoking significantly protected against SARS-CoV-2 infection (HR 0.625, 95% CI 0.402-0.970, p = 0.036). Further analyses showed that the prevalence of pneumonia in the unvaccinated, older, diabetic, and non-smoking groups was significantly higher than that in the other groups (p < 0.05). Our study suggests a potential association between smoking and a reduced risk of SARS-CoV-2 infection and pneumonia. This indicates that nicotine and ACE2 play important roles in preventing COVID-19 and its progression. We suggest smokers use nicotine replacement therapy during hospitalization for COVID-19.

Triglyceride-glucose index predicts all-cause mortality, but not cardiovascular mortality, in rural Northeast Chinese patients with metabolic syndrome: a community-based retrospective cohort study

BackgroundMetabolic syndrome (MetS) includes a group of metabolic irregularities, including insulin resistance (IR), atherogenic dyslipidemia, central obesity, and hypertension. Consistent evidence supports IR and ongoing low-grade inflammation as the main contributors to MetS pathogenesis. However, the association between the triglyceride-glucose (TyG) index and mortality in people with MetS remains uncertain. The objective of this study was to examine the correlation between the baseline TyG index and all-cause and cardiovascular (CV) mortality in rural Northeast Chinese individuals with MetS.MethodsFor the Northeast China Rural Cardiovascular Health Study, 3918 participants (mean age, 55 ± 10; 62.4% women) with MetS at baseline were enrolled in 2012–2013 and followed up from 2015 to 2017. The TyG index was calculated using the equation TyG index = ln [fasting TG (mg/dL) × fasting glucose (mg/dL)/2] and subdivided into tertiles [Q1(< 8.92); Q2 (8.92–9.36); Q3 (≥ 9.36)]. Multivariate Cox proportional hazards models were developed to examine the correlations between mortality and the baseline TyG index.ResultsDuring a median of 4.66 years of follow-up, 196 (5.0%) all-cause deaths and 108 (2.8%) CV disease-related deaths occurred. The incidence of all-cause mortality was significantly different among TyG index tertiles of the overall population (P = 0.045). Kaplan–Meier analysis demonstrated a significantly increased risk of all-cause mortality in rural Chinese patients with a higher TyG index (log-rank P < 0.05). After adjusting for possible confounders, Cox proportional hazard analysis revealed that the TyG index could effectively predict all-cause mortality (HR for the third vs. first tertile of TyG was 1.441 [95% confidence interval, 1.009–2.059]), but not CV mortality, in rural Chinese patients with MetS.ConclusionsThe TyG index is an effective predictor of all-cause mortality in rural Chinese patients with MetS. This indicates that the TyG index may be useful for identifying rural Chinese individuals with MetS at a high risk of death.

Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation.

To assess clinicians' prescribing practices for anticoagulation in older adults with atrial fibrillation or atrial flutter (AF/F) and determine factors common among those without anticoagulation. We performed a community-based retrospective cohort study of adults aged 65 years and older with a history of nonvalvular AF/F to determine the rate of oral anticoagulation utilization. We also assessed for associations between anticoagulation use and comorbid conditions and common geriatric syndromes. A total of 3832 patients with a diagnosis of nonvalvular AF/F were included (mean [SD] age, 79.9 [8.4] years), 2693 (70.3%) of whom were receiving anticoagulation (51.7%, a vitamin K antagonist; 48.1%, a direct-acting oral anticoagulant). Patients with higher Elderly Risk Assessment index (ERA) scores, a surrogate for health vulnerability, received anticoagulation less often than patients with lower scores. The percentage of patients with a history of falling was higher among those who did not receive anticoagulation than among those who did (44.4% vs 32.8%; P < .001). Similarly, a diagnosis of dementia was more common in the no-anticoagulation group than the anticoagulation group (18.5% vs 12.7%; P < .001). A substantial proportion of older adults with AF/F do not receive anticoagulation. Those without anticoagulation had higher risk of health deterioration based on higher ERA scores and had a higher incidence of dementia and fall history. This suggests that the presence of geriatric syndromes may influence the decision to withhold anticoagulation.

S281 Chronic Diarrhea Compared to Chronic Constipation Results in More Colonic Diverticular Disease and GI Visits: A Community-Based Retrospective Cohort Study With &gt;10-Year Follow-Up

S281 Chronic Diarrhea Compared to Chronic Constipation Results in More Colonic Diverticular Disease and GI Visits: A Community-Based Retrospective Cohort Study With &gt;10-Year Follow-Up

Neonatal mortality and its predictors among neonates in Jabitehnan district, Northwest Ethiopia: A single-arm retrospective cohort study.

Neonatal period is the most vulnerable time in which children face the greatest risk of death. Worldwide, each year, millions of newborns died in the first month of life. Sub-Saharan Africa, Ethiopia, in particular, is largely affected. However, there is a dearth of information regarding the survival status of neonates and determinants of their mortality in the study area. Therefore, this study was aimed at investigating neonatal mortality and its predictors in Jabitehnan district, Northwest Ethiopia. A single-arm community-based retrospective cohort study was conducted in March 2021 among 952 neonates born between August 2020 and February 2021. Data were collected by a semi-structured questionnaire, and a multistage stratified sampling technique was employed to select one urban and 10 rural kebeles from the district. Then, the total sample size was proportionally allocated to these selected kebeles. Neonatal death was ascertained by community diagnosis. Kaplan-Meier curve was used to estimate survival time. Cox regression was used to identify factors, the hazard ratio was estimated, and a p-value < 0.05 was considered statistically significant. The neonatal mortality rate was 44 (95% confidence interval [CI]: 33-60) per 1000 live births; and the incidence rate was 1.64 (95% CI: 1.21-2.23) per 1000 neonate days. Three-quarters of deaths occurred in the first week of life. Medium household wealth index (adjusted hazard ratio [AHR] = 3.54; 95 CI: 1.21-10.35), increased number of pregnancies (AHR = 1.22; 95%CI: 1.01-1.47), being male (AHR = 2.45, 95% CI: 1.12-5.35) and not starting breastfeeding in the first hour of life (AHR = 4.00; 95% CI: 1.52-11.10) were found to be predictors of neonatal mortality. Neonatal mortality was high compared to the national target. Wealth, number of pregnancies, sex of the neonate, and breastfeeding initiation were factors associated with neonatal death. Hence, strengthening interventions such as providing sexual education in the population, considering households with a medium wealth index in the exemption service, and counseling mothers about early breastfeeding initiation would improve neonatal survival.

Effects of Severe Acute Respiratory Syndrome Coronavirus Vaccination on Reinfection: A Community-Based Retrospective Cohort Study.

Coronavirus disease 2019 (COVID-19) is a disease that is characterized by frequent reinfection. However, the factors influencing reinfection remain poorly elucidated, particularly regarding the effect of COVID-19 vaccination on preventing reinfection and its effects on symptomatology and the interval until reinfection. This retrospective cohort study examined patients with severe acute respiratory syndrome coronavirus reinfection between January 2020 and February 2022. This study included patients aged >17 years who were reinfected at least 90 days between two infections with severe acute respiratory syndrome coronavirus. The main outcome measure was a reduction in symptoms during reinfection, and reinfection interval. Overall, 712 patients (average age: 40.52 ± 16.41 years; 312 males) were included. The reduction rate of symptoms at reinfection than that at first infection was significantly higher in the vaccinated group than in the unvaccinated group (p < 0.001). The average reinfection interval was 265.81 days. The interval between the first and second infection was 63.47 days longer in the vaccinated group than in the unvaccinated group. The interval was also 57.23 days, significantly longer in the asymptomatic group than in the symptomatic group (p < 0.001). Besides its role in preventing severe acute respiratory syndrome coronavirus infection, vaccination reduces the rate of symptomatic reinfection and increases the reinfection interval; thus, it is necessary to be vaccinated even after a previous infection. The findings may inform the decision to avail COVID-19 vaccination.

Vitamin D Insufficiency is Associated with Higher Incidence of Dementia, a Large Community-Based Retrospective Cohort Study.

Active metabolite of vitamin D has neuro-immunomodulatory and neuroprotective properties. However, there is still a debate about the potential association between low serum levels of hydroxy-vitamin D and increased risk for dementia. To determine an association between hypovitaminosis D and dementia for different 25-hydroxyvitamin-D (25(OH)D) serum level cutoffs. Patients were identified utilizing the database of Clalit Health Services (CHS), the largest healthcare provider in Israel. For each subject, all available values of 25(OH)D during the study period, which lasted from 2002 to 2019, were obtained. Rates of dementia were compared across different cutoffs of 25(OH)D levels. Cohort included 4278 patients, of whom 2454 (57%) were women. The mean age at the beginning of follow-up was 53 (±17). During the 17-year study period, a total of 133 patients (3%) were diagnosed with dementia. In a fully adjusted multivariate analysis, the risk for dementia was almost 2-fold higher in patients with an average of vitamin D insufficiency (<75nmol/l) measurements (OR = 1.8, 95% C.I. = 1.0-3.2) compared to reference values (≥75nmol/l). Patients with vitamin D deficiency (<50nmol/l) demonstrated higher rates of dementia (OR = 2.6, 95% C.I. = 1.4-4.8). In our cohort, patients were diagnosed with dementia at a younger age in the deficiency (77 vs. 81 P-value = 0.05) and the insufficiency groups (77 vs. 81 P-value = 0.05) compared to the reference values (≥75nmol/l). Insufficient levels of vitamin D are associated with dementia. Dementia is diagnosed at a younger age in patients with insufficient and deficient vitamin D levels.

Time to complementary feeding initiation and its predictors among children aged 9-23 months in Meket District, Northeast Ethiopia: a Cox Weibull regression.

.Globally and nationally, only 64⋅5 and 49⋅2 % of infants received solid or semi-solid foods, respectively. The available evidence indicates that the time to initiate complementary feeding practices is still poor and varies by region. The aim of the present study was to assess the time to initiation of complementary feeding and its predictors among children aged 9-23 months in Meket District, Amhara Region, Ethiopia. A community-based retrospective cohort study was conducted from June to July 2022 among 459 systematically selected mothers/caregivers with their children from 9 to 23 months of age. The result of descriptive statistics was reported by table, frequency, Kaplan-Meier curve and percent. The proportional hazard model assumption was checked, and a Weibull regression model was used to see the predictors of timely initiation of complementary feeding. An adjusted hazard ratio with a 95 % confidence interval and a P-value of 0⋅05 were used to declare the significant predictors. The median time of complementary feeding initiation was 6 months. Attending primary education (adjusted hazard ration (AHR) 1⋅8; 95 % CI 1⋅16, 2⋅78), occupation of the mother (AHR 1⋅43; 95 % CI 1⋅04, 1⋅95), home delivery (AHR 1⋅61; 95 % CI 1⋅09, 2⋅37) and birth preparedness (AHR 1⋅37; 95 % CI 1⋅03, 1⋅81) were the predictors of time to complementary feeding initiation. The median time to complementary feeding initiation was consistent with the WHO recommendation. Maternal education, maternal employment, place of delivery and birth preparedness were the predictors of time to initiation of complementary feeding. Therefore, working with the education sector, increasing the delivery rate in health facilities, strengthening counselling on birth preparation, increasing maternity leave until 6 months of age and initiating corner feeding should be part of the complementary feeding practices promotion agenda.

Risk Factors Predictive of Cardiac Toxicities from Ibrutinib: A Community-Based Retrospective Cohort Study of Patients with NHL in Northern California

Background: Ibrutinib is a tyrosine kinase inhibitor (TKI) known to be effective in treating multiple hematologic malignancies. Although generally well tolerated, significant cardiac toxicities including atrial fibrillation, sudden cardiac death, and hypertension may occur shortly after starting therapy with ibrutinib. We aimed to identify predictors of ibrutinib cardiotoxicity in our cohort of patients with non-Hodgkin's lymphoma (NHL) in Northern California. Methods: We identified 550 adults with NHL who had been newly prescribed ibrutinib between January 2015 through June 2021 and were >60 years at time of first prescription within the Kaiser Permanente Northern California network. Patients with abnormal baseline measures were identified by abnormal echocardiogram (TTE), electrocardiogram (EKG), or blood pressure in the year prior to first ibrutinib prescription. New adverse clinical outcomes, including atrial fibrillation and cardiac and major bleeding events, were identified through diagnosis codes following first ibrutinib prescription. Bivariate comparisons were calculated using Chi-square tests for categorical variables, Student's T-tests for normally distributed continuous variables, and Wilcoxon-Mann-Whitney non-parametric tests for non-normally distributed continuous variables. Kaplan-Meier curves were created for significant clinical outcomes. Analyses were performed on the full NHL cohort and a sub cohort of chronic lymphocytic leukemia (CLL) patients. Results: Of the 550 patients on ibrutinib, 73.6% carried a diagnosis of CLL, 40% were female, 71.6% were over 70 years of age, and 76.4% identified as White. With respect to comorbid disease, 58.3% were either overweight or obese, 24.9% had diabetes, 48.5% had hypertension, 48.7% had dyslipidemia, 15.3% had liver disease, 31.3% had renal disease, 47% were smokers and 74% reported alcohol use. Within the entire cohort, abnormal baseline was associated with higher BMI and hypertension. Patients with abnormal baseline were more likely to have myocardial infarction (MI, p=0.0016) and stroke (p=0.0372). Within the CLL cohort, patients with abnormal baseline were more likely to have MI (p=0.0005) and stroke (p=0.0421). Abnormal baseline was significantly associated with faster time to stroke in the CLL cohort (p=0.0215), but not the full cohort. Interestingly, abnormal baseline was not predictive of atrial fibrillation or major bleeding events and was not associated with patient characteristics such as age, sex, ethnicity, cancer stage, diabetes, liver disease, or kidney disease. Conclusions: In this cohort, abnormal baseline TTE, EKG and blood pressure measures in patients were associated with MI and stroke, but these factors were not associated with an increase in atrial fibrillation or major bleeding events. The time to stroke was also found to be significantly shorter in CLL patients when compared to the full cohort. Based on these findings, we would recommend cardiac studies prior to initiation of ibrutinib to help define patients at higher risk of adverse cardiovascular events and faster time to stroke. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Benzodiazepine and Z-Drug Use and the Risk of Developing Dementia.

BackgroundBenzodiazepines (BZDs) and Z-drugs (BZDRs) are among the most prescribed medications for anxiety and insomnia, especially among older adults. Our objective was to investigate the association between the use of BZDRs and the risk of dementia.MethodsA community-based retrospective cohort study was conducted based on the data available from 2002 to 2015 in Catalan Health Service. This cohort included all BZDR users (N = 83 138) and nonusers (N = 84 652) older than 45 years. A minimum 5-year lag window and an adjustment for psychiatric problems were applied for the data analysis.ResultsThe hazard ratio (HR) for the risk of incident dementia among BZDR users was 1.22 (95% CI = 1.15 to 1.31). This risk was not significant after adjusting the data confounding factors (HR = 1.01; 95% CI = 0.94 to 1.08). We observed a higher risk with short-to-intermediate half-life BZDs (HR = 1.11; 95% CI = 1.04 to 1.20) and Z-drugs (HR = 1.20; 95% CI = 1.07 to 1.33) than for intermediate-to-long half-life BZDs (HR = 1.01; 95% CI = 0.94 to 1.08). We demonstrated a higher risk of incident dementia (HR = 1.23; 95% CI = 1.07 to 1.41 and odds ratio = 1.38; 95% CI = 1.27 to 1.50, respectively) in patients who received 91 to 180 defined daily doses (DDDs) and >180 DDDs compared with patients who received <90 DDD. Regarding patient sex, the risk of dementia was higher in women than in men.ConclusionWe found that the incidence of dementia was not higher among all BZDR users. Short half-life BZDs and Z-drugs increased the risk of dementia at the highest doses, especially in female patients, showing a dose-response relationship.

Reproductive Characteristics and Pregnancy Outcomes in Hidden Celiac Disease Autoimmunity.

Untreated symptomatic celiac disease (CD) adversely affects female reproduction; however, the effect of hidden CD autoimmunity is uncertain. We identified women who were not previously diagnosed with CD and tested positive for tissue transglutaminase and endomysial antibodies between 2006 and 2011 in a community-based retrospective cohort study. We evaluated (i) the rate of adverse pregnancy outcomes and medical complications of pregnancy in successful singleton deliveries and (ii) reproductive characteristics in seropositive women without a clinical diagnosis of CD and age-matched seronegative women. Among 17,888 women whose serum samples were tested for CD autoimmunity, 215 seropositive and 415 seronegative women were included. We reviewed 231 and 509 live singleton deliveries of 117 seropositive and 250 seronegative mothers, respectively. Menarche and menopausal age, gravidity, parity, and age at first child were similar in seropositive and seronegative women. CD seropositivity was not associated with an increased risk of maternal pregnancy complications. Maternal seropositivity was associated with small for gestational age in boys (OR 3.77, 95% CI: 1.47-9.71; P = 0.006), but not in girls (OR 0.57, 95% CI: 0.15-2.17; P = 0.41). CD serum positivity was not associated with prematurity, small for gestational age (birth weight <10th percentile), or 5-minute Apgar score of less than 7. Although underpowered, the present study did not show any difference in reproductive characteristics or rates of adverse pregnancy outcomes in women with and without CD autoimmunity, except for birth weight in male offspring. Larger studies are needed to determine the effects of CD autoimmunity on female reproduction.

Malaria and intestinal parasite co-infection and its association with anaemia among people living with HIV in Buea, Southwest Cameroon: A community-based retrospective cohort study

Both malaria and intestinal parasites are endemic in Cameroon, and their co-infection can be of great impact on anaemia among people living with HIV (PLWH). This community-based retrospective cohort study determined the prevalence and association of infections with anaemia in PLWH and HIV-negative individuals in Buea, Cameroon from March to August 2019. The study population comprised of 190 PLWH and 216 consenting HIV-negative individuals from the Buea community. Participants were examined clinically, the collected blood sample was used for malaria parasite (MP) detection, HIV diagnosis and haemoglobin (Hb) measurement while stool samples were examined for the detection of intestinal parasites (IPs). Proportions were compared using Pearson's Chi-square test and association of anaemia with independent variables was evaluated using logistic regression analysis. Out of the 406 participants, MP, IPs and MP/IP co-infection prevalences were 15.5%, 13.0% and 3.0% respectively. PLWH had a higher prevalence of MP (16.3%, P = 0.17), IPs (23.7%, P ˂ 0.001) and MP/IPs co-infection (3.7%, P = 0.04) when compared with HIV-negative participants. Similarly, PLWH had significantly lower mean haemoglobin value (11.10 ± 1.54 g/dL) than their HIV-negative counterparts (12.45 ± 2.06 g/dL). Also, PLWH co-infected with MP and IPs were observed to have a significantly lower mean haemoglobin value (10.6 ± 1.21 g/dL). PLWH had a significantly (P ˂ 0.001) higher prevalence of mild (56.8%), moderate (18.4%) and severe (1.6%) anaemia when compared with HIV-negative counterparts. The significant risk factors associated with anaemia included being febrile (P = 0.03), MP-infected only (P = 0.001), HIV-infected only (P < 0.001), having dual (P < 0.001) or triple-infections (P = 0.03). Malaria and intestinal parasites remain public health concerns among PLWH and anaemia as a serious haematological abnormality gets exacerbated even with the viral load suppression. Hence, routine medical check-ups among PLWH are recommended.

Sinopharm's BBIBP-CorV Vaccine Effectiveness on Preventing Hospital Admission and Deaths: Results From a Retrospective Study in the Emirate of Abu Dhabi, United Arab Emirates (UAE)

Background: This is a community-based retrospective cohort study conducted to determine effectiveness of the BBIBP-CorV inactivated vaccine in the real-world setting against hospital admissions and death.Methods: Study participants were chosen from 214,940 PCR-positive cases of COVID-19 reported to the Department of Health, Abu Dhabi Emirate, United Arab Emirates (UAE) between September 01, 2020 and May 1, 2021. Of these, 176,640 individuals were included in the study who were aged ≥15 years with confirmed COVID-19 positive status who had records linked to their vaccination status. Those with incomplete or missing records were excluded (n = 38,300). Study participants were divided into three groups depending upon their vaccination status: fully vaccinated (two doses), partially vaccinated (single dose), and non-vaccinated. Study outcomes included COVID-19-related admissions to hospital general and critical care wards and death. Vaccine effectiveness for each outcome was based on the incidence density per 1000 person-years.Findings: The fully-, partially- and non-vaccinated group included 62,931, 21,768 and 91,941 individuals, respectively. Based on the incidence rate ratios, the vaccine effectiveness in fully vaccinated individuals was 80%, 92%, and 97% in preventing COVID-19-related hospital admissions, critical care admissions, and death, respectively, when compared to the non-vaccinated group. No protection was observed for any of these outcomes for the partially vaccinated group.Interpretation: In a COVID-19 pandemic, use of the Sinopharm BBIBP-CorV inactivated vaccine is effective in preventing severe disease and death in a two-dose regimen. Lack of protection with the single dose may be explained by behavioral and biological factors.Funding Information: This study was not funded.Declaration of Interests: No conflict of interest.Ethics Approval Statement: This study was approved by the Abu Dhabi Health Research and Technology Ethics Committee (approval numbers DOH/CVDC/2021/994 and DOH/CVDC/2021/994) of the UAE Ministry of Health and Prevention.

Proton pump inhibitors and the risk of Alzheimer\u2019s disease and non-Alzheimer\u2019s dementias

Proton pump inhibitors (PPIs) are among the most prescribed medications. Previous epidemiological studies have presented contradictory results about PPIs and the risk of dementia. Our objective was to investigate the association between the use of PPIs and an increasing risk of incident AD or non-AD dementias. A community-based retrospective cohort study was conducted based on the data available from 1st January 2002 to 31st December 2015 in the Catalan health service (CatSalut) system. This cohort included all PPI users (N = 36,360) and non-users (N = 99,362). A lag window of 5 years was considered between the beginning of the PPI treatment and the diagnosis of dementia. PPI use was not associated with the risk of AD (adjusted odds ratio (OR) 1.06) (95% CI 0.93–1.21; p = 0.408). A weakly but significantly increased risk of non-AD dementias was observed among PPI users (adjusted OR 1.20, 95% CI 1.05–1.37; p = 0.007). A higher dose of PPIs was not associated with an increased risk of either AD or non-AD dementias (OR 1.20; 95% CI 0.91–1.61 and OR 0.95; 95% CI 0.74–1.22, respectively). Regarding the number of PPIs used, we observed an increased risk of AD (OR 1.47; 95% CI 1.18–1.83) and non-AD dementias (OR 1.38; 95% CI 1.12–1.70) in users of two types of PPIs compared with those who used only one type. We did not find a higher incidence of AD among PPI users, but a weak increase in the risk of non-AD dementias among PPI users was observed.

Age differences in the relationships between risk factors and loss of kidney function: a general population cohort study

BackgroundAnnual decline in kidney function is a widely applied surrogate outcome of renal failure. It is important to understand the relationships between known risk factors and the annual decline in estimated glomerular filtration rate (eGFR) according to baseline age; however, these remain unclear.MethodsA community-based retrospective cohort study of adults who underwent annual medical examinations between 1999 and 2013 was conducted. The participants were stratified into different age groups (40–49, 50–59, 60–69, 70–79, and ≥ 80 years) to assess the risk for loss of kidney function. A mixed-effects model was used to estimate the association between risk factors and annual changes in eGFR.ResultsIn total, 51,938 participants were included in the analysis. The age group of ≥80 years included 8127 individuals. The mean annual change in eGFR was − 0.39 (95% confidence interval: − 0.41 to − 0.37) mL/min/1.73 m2 per year. Older age was related to faster loss of kidney function. In the older age group, higher systolic blood pressure, proteinuria, and current smoking were related to faster loss of kidney function (p trend < 0.01, 0.03, and < 0.01, respectively). Conversely, each age group showed similar annual loss of kidney function related to lower hemoglobin levels and diabetes mellitus (p trend 0.47 and 0.17, respectively).ConclusionsHigher systolic blood pressure, proteinuria, and smoking were related to faster loss of kidney function, and a greater effect size was observed in the older participants. More risk assessments for older people are required for personalized care.

Hyperglycaemia in Pregnancy and Anthropometric Parameters in the Offspring at 10 Years: A Community-Based Retrospective Cohort Study in Sri Lanka.

Background Studies of developmental origins of health and disease have highlighted the possible role of intrauterine hyperglycaemia, increasing the future risk of obesity, diabetes, and cardiovascular diseases in the offspring. There is limited evidence from South Asian populations for risk estimates for childhood obesity that are attributable to maternal diabetes in utero. Objective The aim of this study was to determine the association between hyperglycaemia in pregnancy (HIP) and anthropometric parameters in the offspring at 10-11 years of age. Methods A community-based retrospective cohort study was conducted in Colombo district, Sri Lanka. In the first stage, children born in 2005 were identified, and the availability of antenatal records was assessed. In the second stage, the exposure status of participants was ascertained based on antenatal records and predefined criteria. In the third stage, height, weight, waist circumference, and triceps skinfold thickness (TSFT) of eligible participants were measured to ascertain the outcome status. Background characteristics were collected by interviewing mothers. A 24-hour dietary recall and a 3-day diet diary were recorded. Results 159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (nonexposed) participated. Mean ages (SD) of exposed and unexposed groups were 10.9 (0.3) and 10.8 (0.3) years, respectively. The median BMI (17.6 vs 16.1, p < 0.001), waist circumference (63 cm vs 59.3 cm, p < 0.001), and triceps skinfold thickness (13.7 mm vs 11.2 mm, p < 0.001) were significantly higher in the exposed group. Offspring of women with HIP were more likely to be overweight (aOR = 2.6, 95% CI 1.4–4.9) and have abdominal obesity (aOR = 2.7, 95% CI 1.1–6.5) and high TSFT (aOR = 2.2, 95% CI 1.06–4.7) at 10-11 years than children who were not exposed after adjusting for maternal BMI, maternal age at delivery, and birth order. Conclusions Intrauterine exposure to HIP is a significant determinant of overweight, high TSFT, and abdominal obesity in the offspring.

Predictors of long-term retention on opioid agonist treatment with buprenorphine: a 6-year, community-based retrospective cohort study in India

ABSTRACT Introduction: Most studies on opioid agonist treatment (OAT) from South Asia have assessed retention over short term. The aim of this study was to assess retention rates on buprenorphine-based OAT in a community clinic at 6 years, and to assess factors associated with long-term retention. Methods: Retrospective cohort study. Consecutive case records of patients with opioid dependence syndrome (as per International Classification of Diseases, Version 10) started on buprenorphine from 2005 to 2007 were reviewed for 6 years after an individual’s initiation on buprenorphine. Multi-variate logistic regression and odd’s ratio was used to assess variables that could predict retention to buprenorphine. Results: The OAT retention rate of 150 participants by the sixth year was 36%. Mean dose of buprenorphine was 6.4 milligram per day (SD: 2.3). Opioid withdrawals (OR: 0.05, 95% CI: 0.01–0.52), concomitant opioid use (OR: 0.02, 95% CI: 0–0.14), and visits to counselor (OR: 0.1, 95%CI: 0.01–0.87) predicted poor retention to buprenorphine maintenance. Improved occupational functioning (OR: 14.08, 95%CI: 4.62–42.93) significantly predicted OAT retention. Adjusting for other variables, illicit opioid use (OR: 0.04, 95%CI: 0–0.37) negatively predicted, while improved occupational functioning (OR: 12.96, 95%CI: 3.43–48.91) positively predicted retention. Conclusion: Patients have fairly good long-term retention rates on OAT with buprenorphine in community-based setting. Maintaining abstinence and improved occupational functioning improve buprenorphine retention.

Sofosbuvir based regimens in the treatment of chronic hepatitis C genotype 1 infection in African-American patients: a community-based retrospective cohort study.

BackgroundDirect-acting antiviral (DAA) drugs have been highly effective in the treatment of chronic hepatitis C (HCV) infection. Limited data exist comparing the safety, tolerability, and efficacy of DAAs in African–American (AA) patients with chronic hepatitis C genotype 1 (HCV GT-1) in the community practice setting. We aim to evaluate treatment response of DAAs in these patients.Patients and methodsAll the HCV GT-1 patients treated with DAAs between January 2014 and January 2018 in a community clinic setting were retrospectively analyzed. Pretreatment baseline patient characteristics, treatment efficacy with a sustained virologic response at 12 weeks post-treatment (SVR12), and adverse reactions were assessed.ResultsTwo-hundred seventy-eight patients of AA descent were included in the study. One-hundred sixty-two patients were treated with ledipasvir/sofosbuvir (SOF)±ribavirin, 38 were treated with simeprevir/SOF±ribavirin, and 38 patients were treated with SOF/velpatasvir. Overall, SVR at 12 weeks was achieved in 94.6% in patients who received one of the three DAA regimens (93.8% in ledipasvir/SOF group, 92.1% in simeprevir/SOF group, and 97.4% in SOF/velpatasvir group). Previous treatment experience, HCV RNA levels and HIV status had no statistical significance on overall SVR achievement (P=0.905, 0.680, and 0.425, respectively). Compensated cirrhosis in each of the treatment groups did not influence overall SVR of 12. The most common adverse effect was fatigue (27%). None of the patients discontinued the treatment because of adverse events.ConclusionIn the real-world setting, DAAs are safe, effective, and well tolerated in African–American patients with chronic HCV GT-1 infection with a high overall SVR rate of 94.6%. Treatment rates did not differ on the basis of previous treatment and compensated cirrhosis status.

Time spent being malnourished during the first five years of life! An unseen aspect of child malnutrition.

The burden of malnutrition is often estimated in terms of 'prevalence' without considering two important contributing factors: incidence and duration. To illustrate this, we conducted a community-based retrospective cohort study involving 24,278 children enrolled in an integrated child development scheme in India. Anthropometric data of study participants from birth to five years of age were collected from the growth charts maintained by Anganwadi workers. Of all the growth charts reviewed, 1460 (6.0%) children died before their fifth birthday and 4013 (16.5%) were excluded after initial screening because either the growth chart was incomplete (4.8%) or had missing entries (11.7%). Of the remaining 20,265 children included in the study, in the first five years of their life, 35.6% suffered from exclusive moderate malnourishment and 9.4% from severe malnourishment. The most common age groups for the onset of moderate and severe malnutrition were 9-11 months and 12-15 months, respectively. The mode, median and mean duration of time spent by children being severely underweight was 3, 7 and 8.4 months respectively, and being moderately underweight was 8, 11 and 15.1 months, respectively. Thus, a comprehensive strategy for preventing the onset of malnutrition (both moderate and severe) among children is urgently needed.

Health related quality of life of preterm born children at three years in a sub urban district in Sri Lanka: a retrospective cohort study

BackgroundPreterm birth leads to multiple morbidities affecting the health of a child. Lack of information on the health impact of prematurity hinders the possibility of any effective public health interventions in this regard. Our aim was to determine the association between preterm birth and Health-Related Quality of Life (HRQOL) among 3 years old children in the Gampaha district, Sri Lanka.MethodsA community-based retrospective cohort study was conducted among 790 preterm and term born children who were 03 years old. Multi-stage cluster sampling technique was used to identify children. The exposure status, a preterm birth, was established using the maternal pregnancy records. Outcome status was measured using a validated health related quality of life questionnaire (prepared in Sinhala) for preschool-aged children. Mothers of the children responded to an interviewer-administered questionnaire which had variables on the exposure status, outcome and additional variables such as child development status and birth related information. Quality of life was measured in twelve different domains of health (subscales). The impact was analyzed using the multiple linear regression.ResultsResponse rate was 95.5% (n = 379) for preterm group and 95.2% (n = 378) for term-born group. Health-Related Quality of Life scores obtained by preterm children were lower than the term born children in eight subscales. Preterm birth showed statistically significant association with subscales on sleep wellbeing, general wellbeing and abdominal symptoms in the adjusted analysis (p < 0.05). Among preterm children prolonged illness, delayed development status, socio economic status and maternal perception on the health status of the child were common predictors of quality of life.ConclusionPreterm birth affected health related quality of life of preschool aged children.