Median Regression Analyses Research Articles

Causal Relationships Between 4 Exposure Factors and Rotator Cuff Syndrome Using Mendelian Randomization Analysis.

Although previous studies have investigated the risk factors for rotator cuff syndrome (RCS), there remains controversy due to uncontrolled and uncertain confounding factors in their analyses. To perform Mendelian randomization (MR) analysis using single-nucleotide polymorphisms to investigate the causal relationship between RCS and 4 risk factors: type 2 diabetes mellitus (T2DM), high blood pressure (HBP), body mass index (BMI), and low high-density lipoprotein cholesterol (HDL-C). Descriptive epidemiology study. Genome-wide association study (GWAS) data for T2DM (ebi-a-GCST006867), BMI (ieu-b-40), HBP (finn-b-I9_HYPTENS), HDL-C (ieu-b-109), and RCS (ukb-b-50) were obtained from the IEU Open GWAS Project. The dataset of each risk factor was combined with the dataset of RCS, generating 4 datasets. Potential confounders and single-nucleotide polymorphisms related to RCS were excluded from these datasets. The causal relationships between the exposure factors and RCS were analyzed using 5 regression models: MR-Egger, weighted median estimate (WME), inverse-variance weighting (IVW), simple mode, and weighted mode. Heterogeneity in the causal effects was assessed using MR-Egger regression and IVW analyses. Sensitivity analyses were performed to determine the stability of the results. The MR-Egger regression intercepts for T2DM, BMI, HBP, and HDL-C showed no horizontal pleiotropic effects. The results of the Cochran Q test showed P values of .075 and .080 for BMI in the MR-Egger regression and IVW models, respectively, indicating the absence of heterogeneity between BMI and RCS. The results of the weighted median estimate and IVW regression analyses showed a significant causal association between BMI and RCS, with odds ratios of 1.002 (95% CI, 1-1.004; P = .038) and 1.003 (95% CI, 1.001-1.005; P = .0003), respectively. No significant associations were found for T2DM, HDL-C, or HBP. In the present study, BMI was positively associated with the risk of developing RCS, while T2DM, HBP, and low HDL-C were not associated with RCS development.

Accelerated aging and altered subclinical response to ozone exposure in young, healthy adults.

Ozone exposure induces a myriad of adverse cardiopulmonary outcomes in humans. Although advanced age and chronic disease are factors that may exacerbate a person's negative response to ozone exposure, there are no molecular biomarkers of susceptibility. Here, we examine whether epigenetic age acceleration (EAA) is associated with responsiveness to short-term ozone exposure. Using data from a crossover-controlled exposure study (n = 17), we examined whether EAA, as measured in lung epithelial cells collected 24 h after clean air exposure, modifies the observed effect of ozone on autonomic function, cardiac electrophysiology, hemostasis, pulmonary function, and inflammation. EAA was assessed in lung epithelial cells extracted from bronchoalveolar lavage fluids, using the pan-tissue aging clock. We used two analytic approaches: (i) median regression to estimate the association between EAA and the estimated risk difference for subclinical responses to ozone and (ii) a block randomization approach to estimate EAA's effect modification of subclinical responses. For both approaches, we calculated Fisher-exact P-values, allowing us to bypass large sample size assumptions. In median regression analyses, accelerated epigenetic age modified associations between ozone and heart rate-corrected QT interval (QTc) ([Formula: see text]= 0.12, P-value = 0.007) and between ozone and C-reactive protein ([Formula: see text] = -0.18, P = 0.069). During block randomization, the directions of association remained consistent for QTc and C-reactive protein; however, the P-values weakened. Block randomization also revealed that responsiveness of plasminogen activator inhibitor-1 (PAI-1) to ozone exposure was modified by accelerated epigenetic aging (PAI-1 difference between accelerated aging-defined block groups = -0.54, P-value = 0.039). In conclusion, EAA is a potential biomarker for individuals with increased susceptibility to ozone exposure even among young, healthy adults.

Association between inflammatory bowel disease and frailty: a two-sample Mendelian randomization study

BackgroundAn association has been identified between inflammatory bowel disease (IBD) and frailty; however, the causal nature of this connection remains uncertain. We consequently conducted a two-sample Mendelian randomization (MR) analysis to explore this particular association.MethodsWe acquired distinct datasets for inflammatory bowel disease (IBD), Crohn's disease (CD), ulcerative colitis (UC), and frailty from the published genome-wide association studies (GWAS) database, meticulously selecting instrumental variables (IVs). Subsequently, we employed a bidirection MR to examine the causal relationship between IBD (including CD and UC) and frailty. We utilized statistical methods, with a primary emphasis on inverse-variance weighted (IVW), accompanied by a series of sensitivity analyses to confirm heterogeneity and pleiotropy influenced the outcomes of the MR.ResultsWe found positive causal effects of genetically increased frailty risk on IBD (OR: 1.015, 95% CI 1.005–1.025, P = 0.004). Furthermore, when scrutinizing specific IBD subtypes, both Crohn's disease (CD) and ulcerative colitis (UC) demonstrated an increased predisposition to frailty (OR: 1.018, 95% CI 1.01–1.027, P < 0.05) and (OR = 1.016, 95% CI 1.005–1.027, P < 0.05). Nevertheless, despite the consistent trends observed in the weighted median and MR-Egger regression analyses for both conditions, statistical significance remained elusive. Notably, the results of the inverse MR analysis did not establish an association between frailty and an elevated risk of IBD development.ConclusionsOur research indicates that IBD, encompassing both CD and UC, may augment the propensity for frailty. Clinical practitioners must prioritize early frailty assessment in individuals afflicted with inflammatory bowel disease, inclusive of Crohn's disease and ulcerative colitis, facilitating proactive measures and timely interventions. However, our findings do not provide evidence supporting a causal effect of frailty on IBD (including CD and UC). Consequently, further studies are essential to explore the intricate mechanisms that clarify the effect of frailty on IBD.

Linking phenotype with obstructive sleep apnoea severity: A cross-sectional cephalometric and polysomnographic study of obstructive sleep apnoea patients

Background Cephalometric features have been identified as phenotypic traits of individuals with obstructive sleep apnoea (OSA). However, few studies have investigated how cephalometric parameters varied with OSA severity, especially in the Asian population. Objectives The aim of this study was to investigate the relationship between cephalometric parameters and severity of OSA in the Southeast Asian Chinese population. A novel cephalometric measurement, length of soft palate below the functional occlusal plane, was also studied. Methods In this retrospective cross-sectional study of 113 Southeast Asian Chinese patients with OSA diagnosed by overnight polysomnography, the association of cephalometric parameters with the apnoea-hypopnoea index (AHI) was evaluated, controlling for age, gender and body mass index (BMI). STROBE guidelines were used in this study. Results Positive association was found between age and AHI (Median Regression Coefficient = 0.26; 95% CI 0.07 to 0.44; p = 0.006). The distance of hyoid bone to mandibular plane was positively associated with AHI (Median Regression Coefficient = 0.58; 95% CI 0.05 to 1.11; p = 0.032), but the correlation did not reach statistical significance after Bonferroni correction ( p = 0.64) or adjustment for age, gender and BMI ( p = 0.106). Median regression analyses revealed a statistically significant negative correlation between facial axis angle and AHI (Median Regression Coefficient = −0.53; 95% CI - 1.04 to −0.01; p = 0.046), after adjusting for age, gender and BMI. Conclusion This study indicated that AHI was positively associated with age and negatively associated with facial axis angle.

Genetically predicted plasma levels of amino acids and metabolic dysfunction-associated fatty liver disease risk: a Mendelian randomization study

BackgroundEmerging metabolomics-based studies suggested links between amino acid metabolism and metabolic dysfunction-associated fatty liver disease (MAFLD) risk; however, whether there exists an aetiological role of amino acid metabolism in MAFLD development remains unknown. The aim of the present study was to assess the causal relationship between circulating levels of amino acids and MAFLD risk.MethodsWe conducted a two-sample Mendelian randomization (MR) analysis using summary-level data from genome-wide association studies (GWAS) to evaluate the causal relationship between genetically predicted circulating levels of amino acids and the risk of MAFLD. In the discovery MR analysis, we used data from the largest MAFLD GWAS (8434 cases and 770,180 controls), while in the replication MR analysis, we used data from a GWAS on MAFLD (1483 cases and 17,781 controls) where MAFLD cases were diagnosed using liver biopsy. We used Wald ratios or inverse variance-weighted (IVW) methods in the MR main analysis and weighted median and MR-Egger regression analyses in sensitivity analyses. Furthermore, we performed a conservative MR analysis by restricting genetic instruments to those directly involved in amino acid metabolism pathways.ResultsWe found that genetically predicted higher alanine (OR = 1.43, 95% CI 1.13–1.81) and lower glutamine (OR = 0.83, 95% CI 0.73–0.96) levels were associated with a higher risk of developing MAFLD based on the results from the MR main and conservative analysis. The results from MR sensitivity analyses and complementary analysis using liver proton density fat fraction as a continuous outcome proxying for MAFLD supported the main findings.ConclusionsNovel causal metabolites related to MAFLD development were uncovered through MR analysis, suggesting future potential for evaluating these metabolites as targets for MAFLD prevention or treatment.

Response time of high impact factor medical journals versus an expert-curated, online oncology platform before and during the COVID-19 pandemic.

465 Background: The objective of this study was to characterize the publication speed of high impact factor medical journals (HIFMJ) compared with the dissemination speed of a private, expert-curated, online platform (ECOP) designed for oncologists. We also aimed to describe determinants of response speed to questions on this platform. Methods: We selected 100 HIFMJ and calculated their reported peer review time (Submission to Acceptance [STA]). The platform database was queried between the dates 2017 and 2022 with information collected about day of query, response time (RespT), and poster gender, region, and medical school graduation year. This data was analyzed utilizing univariable median regression analyses and two t-tests as appropriate. Results: Of the 26 available medical journal response times, the average STA was 57.36 days (range: 2.6 - 204 days). Of the 4,346 online platform questions and answers (Q+A), the mean RespT was noted to be significantly lower at 2.63 days (CI, 2.19 - 3.07 days). With the ECOP, the mean RespT for male posters (mean: 2.58 days; CI, 2.08 - 3.08) and female posters (mean: 2.72 days, CI, 1.89 - 3.56) was not significantly different (p=0.61). RespT from 2017 to 2019 increased slightly (p&lt;0.001) before trending down during the COVID pandemic (p&lt;0.02). Mean RespT before the Covid pandemic in the United States, March 15, 2020 (2.68 days, CI, 2.11 - 3.25), was non-significantly reduced as compared with questions after March 15, 2020 (2.17 days, CI, 1.88 - 2.46, p=0.13). Conclusions: Traditional peer review proves a lengthy process in contrast to real-time, Q+A-based oncology platforms. An ECOP allows physicians the ability to provide their expertise regarding rare, nuanced patient cases in order to better ensure all patients receive the highest level of clinical care. During the onset of the COVID-19 pandemic, the ability to share medically curated information to ensure safe and effective oncologic care in a timely manner proved imperative, as information regarding the virus was evolving rapidly. During this unprecedented time, this platform provided oncologists with a novel way to quickly vet case reports and disseminate scientific information. This, in turn, translated into cancer care “best practices” during a rapidly evolving crisis.

Do patients experience decisional regret after sacral neuromodulation for refractory overactive bladder?

Success following urological procedures is traditionally defined through objective endpoints. This approach may not capture the impact on patient satisfaction. There is a paucity of literature evaluating patient-centered metrics such as satisfaction and decisional regret in the field of urology. This study investigates long-term satisfaction and decisional regret amongst patients who underwent sacral neuromodulation (SNM) for the treatment of refractory overactive bladder (OAB). This study retrospectively reviewed patients who underwent SNM for refractory OAB from 2015 to 2022 at a single institution serving an ethnically diverse and underrepresented community. Demographic data were collected through chart review and surveys conducted via telephone calls. Patient satisfaction and decisional regret was measured with the validated modified SDS-DRS scale (satisfaction with decision scale-decision regret scale). Descriptive statistics, Wilcoxan rank sum, and median regression analyses were performed using STATA 15.0 with p < 0.05 as significant. Out of 191 patients who underwent SNM, 63 were unreachable (wrong number in chart, number not in service, patient did not answer, deceased). Eighty-nine out of 128 patients reached agreed to participate (70% response rate). The mean time since surgery was 37.3 ±25.2 months. The median satisfaction with decision score was 4.0 (IQR: 3.7-4.7) with a score of 1 correlating with low satisfaction and a score of 5 correlating with high satisfaction. The median decisional regret score was 2.0 (IQR: 1.2-2.9)with a score of 1 correlating with low decisional regret and a score of 5 correlating with strong decisional regret. Ten patients reported complications after surgery, which was significantly associated with lower SDS and higher DRS scores (p < 0.01), and persisted after adjusting for age, body mass index, sex, and comorbidities (SDS β coef: -0.84, 95% CI: -1.5 to0.15,p = 0.02;DRS β coef: 1.48, 95% CI:0.55-2.41,p < 0.01). Patients who underwent SNMfor refractory OAB overall had low regret and high satisfaction with their decision at an average 3 years of follow-up. As expected, those who developed postoperativecomplications had worse scores. The inclusion of patient-centric outcomes is imperative when determining the success of a surgical procedure and is useful for shared decision-making when advancing to third-line therapy for OAB. Longer-term follow-up is necessary to assess durability of high satisfaction and low regret over time.

Cost-of-illness and associated factors among persons with type 2 diabetes: Findings from a tertiary care center in South India

ObjectiveOur aim was to estimate the cost of illness (COI) from the patient's perspective among individuals with type 2 diabetes (PWDs) attending a public tertiary care center in southern India. MethodsThis cross-sectional analytical study included PWDs on treatment for at least one year. Interviews captured direct medical costs (hospitalization, tests, medications), direct non-medical costs (meals, travel), and indirect costs (wage loss). Median regression analyses examined factors associated with total COI. ResultsOf total 1002 PWDs included, the mean (SD) age was 56 (12) years. Majority were males and from rural areas. One-third had diabetes for more than ten years, half were on insulin therapy, and more than half had comorbidities. Median (IQR) reported household income was US$637 (US$318–US$1115)/year. The Median (IQR) annual COI was US$39 (US$20-US$67), of which 73% was direct costs with a median of US$28. Majority of the participants (n=818, 81.6%) spent on laboratory investigations as direct medical costs and travel (n=1000, 99.8%) as direct non-medical costs. Travel costs represented the largest share of total COI (41%), followed by wage loss. Median annual COI was higher for males, salaried PWDs, and PWDs on insulin. ConclusionsOur findings highlight that PWDs attending a public tertiary care center bear significant out-of-pocket expenses for diabetes care, primarily due to direct costs. Particularly, travel costs were identified as the most substantial component of the total COI.

Causal analysis between gastro-oesophageal reflux disease and obstructive sleep apnoea.

Based on evidence from existing observational research, clarifying the causal relationship between gastro-oesophageal reflux disease (GORD) and obstructive sleep apnoea (OSA) is challenging. Here, Mendelian randomisation, a method based on genetics, was used to provide new evidence for causality. Summary statistics from two publicly available genome-wide association studies were used to evaluate the causal relationship between GORD and OSA (the GORD database was used as an exposure variable and the OSA database as an outcome). Inverse variance weighting was used as the main analytical tool in Mendelian randomisation to estimate causal effects. The robustness of the results was evaluated by sensitivity analysis. Possible mediators were evaluated using multivariate Mendelian randomisation. A statistically significant causal relationship was observed between GORD and OSA (OR 1.597, 95% CI 1.401-1.821, p<0.001), and similar results were observed in weighted median and Mendelian randomisation-Egger regression analyses. No bias was found in the sensitivity analysis of Mendelian randomisation estimation. Multivariate Mendelian randomisation showed that GORD significantly increased the risk of developing OSA, even when the possible mediator was excluded (OR 1.107, 95% CI 1.101-1.212, p<0.001). Our study confirmed a causal relationship between GORD and OSA and suggests that intervention measures should be taken for patients with GORD to prevent the occurrence of OSA.

Association between neighborhood food environments and bariatric surgery outcomes.

Individual characteristics associated with weight loss after bariatric surgery are well established, but the neighborhood characteristics that influence outcomes are unknown. The objective of this study was to determine if neighborhood characteristics, including social determinants and lifestyle characteristics, were associated with weight loss after bariatric surgery. Single university healthcare system, United States. In this retrospective cohort study, all patients who underwent primary bariatric surgery from 2008 to 2017 and had at least 1 year of follow-up data were included. Patient-level demographics and neighborhood-level social determinants (area deprivation index, urbanicity, and walkability) and lifestyle factors (organic food use, fresh fruit/vegetable consumption, diet to maintain weight, soda consumption, and exercise) were analyzed. Median regression with percent total body weight (%TBW) loss as the outcome was applied to examine factors associated with weight loss after surgery. Of the 647 patients who met inclusion criteria, the average follow-up period was 3.1 years, and the mean %TBW loss at the follow-up was 22%. In adjusted median regression analyses, Roux-en-Y gastric bypass was associated with greater %TBW loss (11.22%, 95% confidence interval [8.96, 13.48]) compared to sleeve, while longer follow-up time (-2.42% TBW loss per year, 95% confidence interval [-4.63, -0.20]) and a preoperative diagnosis of diabetes (-1.00% TBW loss, 95% confidence interval [-1.55, -0.44]) were associated with less. None of the 8 neighborhood level characteristics was associated with weight loss. Patient characteristics rather than neighborhood-level social determinants and lifestyle factors were associated with weight loss after bariatric surgery in our cohort of bariatric surgery patients. Patients from socioeconomically deprived neighborhoods can achieve excellent weight loss after bariatric surgery.

Symptom Burden Is Lower in Asian and Pacific Islander and Black Men Admitted to Home-Based Palliative Care in an Integrated Health Care System.

Background: Little is known about racial/ethnic differences in symptom severity among patients receiving home-based palliative care (HomePal). Objectives: To determine whether symptom severity differs between White patients and patients of color receiving HomePal and whether gender moderates the difference. Design: This is a cross-sectional exploratory study. Setting/Subjects: Baseline data were from 2090 patients receiving HomePal in Kaiser Permanente Southern California. Measurements: Multivariable median regression analyses were carried out across race/ethnicity groups and stratified by gender to assess differences in Edmonton Symptom Assessment System (ESAS) scores at HomePal admission. Results: Asian/Pacific Islander men and Black men had lower ESAS scores compared than White men (-5 [-7.8, -2.2], p = 0.0005 and -5.4 [-8.7, -2.1], p = 0.001, respectively); there were marginal ESAS differences across race/ethnic groups for women. Conclusion: Patients of color reported lower symptom severity than White patients. More research is needed to understand how the intersection of culture and gender affects symptom experience and reporting in patients living with serious illness. Trial Registration: ClinicalTrials.gov: NCT#03694431.

Assessment of multiple mycotoxin exposure and its association with food consumption: a human biomonitoring study in a pregnant cohort in rural Bangladesh

Aflatoxins (AFs), ochratoxin A (OTA), citrinin (CIT), fumonisin B1 (FB1), zearalenone (ZEN), and deoxynivalenol (DON) are mycotoxins that may contaminate diets, especially in low-income settings, with potentially severe health consequences. This study investigates the exposure of 439 pregnant women in rural Bangladesh to 35 mycotoxins and their corresponding health risks and links their exposure to certain foods and local stimulants. Overall, 447 first-morning urine samples were collected from pregnant women between July 2018 and November 2019. Mycotoxin biomarkers were quantified by DaS-HPLC–MS/MS. Urinary concentration of frequently occurring mycotoxins was used to estimate dietary mycotoxin exposure. Median regression analyses were performed to investigate the association between the consumption of certain foods and local stimulants, and urinary concentration of frequently occurring mycotoxins. Only in 17 of 447 urine samples (4%) were none of the investigated mycotoxins detected. Biomarkers for six major mycotoxins (AFs, CIT, DON, FB1, OTA, and ZEN) were detected in the urine samples. OTA (95%), CIT (61%), and DON (6%) were most frequently detected, with multiple mycotoxins co-occurring in 281/447 (63%) of urine samples. Under the lowest exposure scenario, dietary exposure to OTA, CIT, and DON was of public health concern in 95%, 16%, and 1% of the pregnant women, respectively. Consumption of specific foods and local stimulants—betel nut, betel leaf, and chewing tobacco—were associated with OTA, CIT, and DON urine levels. In conclusion, exposure to multiple mycotoxins during early pregnancy is widespread in this rural community and represents a potential health risk for mothers and their offspring.

C-Reactive Protein to Albumin Ratio as Prognostic Marker in Locally Advanced Non-Small Cell Lung Cancer Treated with Chemoradiotherapy.

Despite the implementation of consolidative immune checkpoint inhibition after definitive chemoradiotherapy (CRT), the prognosis for locally advanced non-small-cell lung cancer (NSCLC) remains poor. We assessed the impact of the C-reactive protein (CRP) to albumin ratio (CAR) as an inflammation-based prognostic score in patients with locally advanced NSCLC treated with CRT. We retrospectively identified and analyzed 52 patients with primary unresectable NSCLC (UICC Stage III) treated with definitive/neoadjuvant CRT between 2014 and 2019. CAR was calculated by dividing baseline CRP by baseline albumin levels and correlated with clinicopathologic parameters to evaluate prognostic impact. After dichotomizing patients by the median, univariate and multivariate Cox regression analyses were performed. An increased CAR was associated with advanced T-stage (p = 0.018) and poor performance status (p = 0.004). Patients with pre-therapeutic elevated CAR had significantly lower hemoglobin and higher leukocyte levels (hemoglobin p = 0.001, leukocytes p = 0.018). High baseline CAR was shown to be associated with worse local control (LPFS, p = 0.006), shorter progression-free survival (PFS, p = 0.038) and overall survival (OS, p = 0.022), but not distant metastasis-free survival (DMFS). Multivariate analysis confirmed an impaired outcome in patients with high CAR (LPFS: HR 3.562, 95% CI 1.294–9.802, p = 0.011). CAR is an easily available and independent prognostic marker after CRT in locally advanced NSCLC. CAR may be a useful biomarker for patient stratification to individualize treatment concepts.

Post-operative outcomes of inflammatory thoracic aortitis: a study of 41 patients from a cohort of 1119 surgical cases.

Aortitis is found in 2-12% of thoracic aortic aneurysm repair/replacement surgeries. Yet little is known about such patients' post-operative outcomes or the role of post-operative corticosteroids. The study was undertaken across three tertiary referral hospitals in Sydney, Australia. Prospectively collected data for all thoracic aortic repair/replacement patients between 2004 and 2018 was accessed from a national surgical registry and analysed. Histopathology records identified cases of inflammatory aortitis which were subclassified as clinically isolated aortitis (CIA), giant cell arteritis (GCA), Takayasu (TAK) or other aortitis. Between-group outcomes were compared utilising logistic and median regression analyses. Between 2004 and 2018, a total of 1119 thoracic aortic surgeries were performed of which 41 (3.7%) were inflammatory aortitis cases (66% CIA, 27% GCA, 5% TAK, 2% other). Eight out of 41 (20%) aortitis patients received post-operative corticosteroids. Compared to non-aortitis patients, the aortitis group was predominantly female (53.7% vs. 28.1%, p < 0.01), was older (mean 70 vs. 62years, p < 0.01) and had higher prevalence of hypertension (82.9% vs. 67.1%, p = 0.03) and pre-operative immunosuppression (9.8% vs. 1.4%, p < 0.01). There was no difference (p > 0.05) between aortitis and non-aortitis groups for 30-day mortality (7.3% vs 6.5%), significant morbidity (14.6% vs. 22.4%), or infection (9.8% vs. 6.4%). Outcomes were similar for the non-corticosteroid-treated aortitis subgroup. Histologic evidence of inflammatory thoracic aortitis following surgery did not affect post-operative mortality or morbidity. Withholding corticosteroids did not adversely affect patient outcomes. These findings will assist rheumatologists and surgeons in the post-operative management of aortitis.

Valuing health states of people with type2 diabetes: Analyses of the nationwide representative linked databases.

Aims/IntroductionTo estimate preference‐based measures of health‐related quality of life associated with sociodemographic and clinical characteristics in type 2 diabetes patients.Materials and MethodsIndividuals with EuroQol‐5 dimensions‐3 levels data were identified from Taiwan’s National Health Interview Survey in 2009 and 2013. Status of diabetes, comorbidities, complications and treatments were ascertained through data linkage to Taiwan’s National Health Insurance Research Database. Multivariable ordinary least squares, Tobit and median regression analyses were used to estimate the coefficients that represented independent impacts of patients’ characteristics on health‐related quality of life.ResultsThe mean health utility score for 2,104 participants was 0.838. Being female, aging, divorced/widowed, never worked or underweight, or having a lower monthly household income, injectable glucose‐lowering therapy, comorbid connective tissue disease or depression were associated with lower health utilities. Having an amputation led to the largest reduction by 0.288 in health utilities, followed by debilitating stroke (0.266), heart failure (0.237), other coronary heart disease (0.185), kidney dialysis/transplant (0.148), coronary revascularizations (0.093), transient ischemic attack/stroke (0.078), diabetic neuropathy (0.062), polyneuropathy (0.055) and other neuropathy (0.043).ConclusionsMajor vascular complications, connective tissue disease and depression are associated with considerably worse health‐related quality of life. These health utility estimates can facilitate health economic evaluations to determine cost‐effective strategies for diabetes management.

Underweight and obesity are strong predictors of clinical outcomes in patients with ankylosing spondylitis: data from the Smart-phone SpondyloArthritis Management System.

Background:The aim of this study was to examine the impact of underweight, overweight and obesity on clinical outcomes and treatment responses to biologics in Chinese patients with ankylosing spondylitis (AS).Methods:Body mass index (BMI) was available in 1074 patients from the Smart-phone SpondyloArthritis Management System. Patients were categorized into four groups based on BMI: underweight, normal weight, overweight and obesity. Multivariable median regression analyses examined the effect of underweight and obesity on clinical outcomes and treatment response to biologics.Results:Among 1074 patients with AS, normal weight accounted for 49.1%, while underweight, overweight, and obesity for 8.1%, 30.1%, and 12.0%, respectively. Compared to patients with normal weight, patients with underweight, overweight and obesity had an increased disease activity, while patients with underweight and obesity had a significantly poor Bath Ankylosing Spondylitis Functional Index and Assessment of Spondyloarthritis International Society Health Index scores. For tumor necrosis factor (TNF)-α inhibitor users, BMI was found to be negatively correlated with changes in disease activity in the multivariate regression model (all p < 0.05). Besides, the patients using TNF-α inhibitor in the overweight or obesity categories were much less likely to achieve a significant reduction on disease activity during follow-up period in the multivariate regression model (all p < 0.05), taking these with normal-weight patients as a reference.Conclusions:Both underweight and obesity except for overweight were associated independently with worse disease activity, physical function and health status. Overweight and obesity might impact on treatment responses to biologics in patients with AS. This argues that weight management, to maintain it at a normal level, should be one of the disease management strategies in patients with AS.

Association Of Household Food Security And Physical Activity Among Youth And Young Adults With Diabetes

Physical activity (PA) is so essential in diabetes management that it is usually prescribed as a lifestyle change in addition to medications. Food insecurity may cause youth and young adults (YYAs) with diabetes to be more fatigued, thereby negatively impacting their PA. PURPOSE: The purpose of this study is to examine the association between household food security and PA in YYAs with diabetes. METHODS: Data from 2,195 YYAs with diabetes (1,855 type 1, 340 type 2, mean age: 21.4 years) were analyzed from the SEARCH for Diabetes in Youth Study. Household food security status was measured with the 18-item U.S. Household Food Security Survey Module by adult participants or parents of minors. Households that affirmed ≥3 food insecure conditions or behaviors were considered food insecure. PA was measured with the International Physical Activity Questionnaire Short Form. Walking, moderate (excluding walking) intensity physical activity (MPA), and vigorous intensity physical activity (VPA) minutes/week were multiplied by 3.3, 4.0, and 8.0, respectively, to obtain metabolic equivalent minutes (MET min/wk), and summed to calculate total PA MET min/wk. We conducted median regression analyses, adjusting for socioeconomic, demographic and clinical covariates, for both the full sample and by diabetes type. RESULTS: 20% of the sample (15% type 1, 5% type 2) was food insecure. The median amount of walking, MPA, VPA, and total PA were 991, 481, 955, and 2,967 MET min/wk, respectively. In the unadjusted analysis, food insecurity was significantly associated with less VPA (β: -480; p=0.0067) and more walking (β: 399; p-value=0.0006) MET min/wk. The effect for walking persisted after covariate adjustment (β: 242; p=0.0238). There was no significant difference observed by diabetes type. CONCLUSION: Household food security was not associated with MPA, VPA, or total PA MET min/wk in adjusted analyses. Food insecurity was associated with more walking MET min/wk. Future research should consider walking for travel vs. walking for leisure among food insecure YYAs with diabetes. Future research should also consider use of an objective measure of PA in contrast to the present study which relied on subjective recall. Supported by NIH Grant R01DK117461.

Causal association between periodontitis and risk of rheumatoid arthritis and systemic lupus erythematosus: a Mendelian randomization

To investigate whether periodontitis is causally associated with risk of rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). We performed two-sample Mendelian randomization (MR) analysis using the inverse variance-weighted (IVW), weighted median, and MR-Egger regression methods on publicly available summary statistics datasets using aperiodontitis genome-wide association study (GWAS) as an exposure and RA and SLE GWASs on individuals of European descent as outcomes. We selected 7 or 20 single-nucleotide polymorphisms from aperiodontitis GWAS as instrumental variables for RA or SLE. The IVW method results support acausal association between periodontitis and RA (beta = 0.168, SE = 0.080, p = 0.035) and SLE (beta = 0.0001, SE = 0.0001, p = 0.046) risk; however, the weighted median approach did not indicate asignificant causal association. MR-Egger regression revealed that directional pleiotropy was unlikely to be biasing the RA (intercept = -0.115, p = 0.078) or SLE results (intercept = 4.68E-05, p = 0.394); no significant causal association was found between periodontitis and RA and SLE. The MR estimates from the IVW, weighted median, and MR-Egger regression analyses were not consistent. Only the results of MR analysis by the IVW method indicated that periodontitis is likely causally associated with an increased risk of RA and SLE incidence. Our MR showed weak causal association between periodontitis and RA or SLE. These findings may assist in elucidating the underlying mechanisms of the effects of periodontitis on RA and SLE incidence.

Why does child maltreatment occur? Caregiver perspectives and analyses of neighborhood structural factors across twenty years

Research on caregivers' views of factors that contribute to child maltreatment and analyses of neighborhood structural factors offer opportunities for enhancing prevention and intervention efforts. This study compared explanations of the factors that contribute to child maltreatment in a neighborhood-based sample of adult caregivers at two-time points: 1995–1996 and 2014–2015 along with analyses of neighborhood structural conditions during the same period. The study sample consisted of two cross-sectional subsamples: 400 adult caregivers in 20 census tracts in Cleveland, Ohio from a 1995–1996 study, and 400 adult caregivers of the same 20 census tracts surveyed in 2014–2015. At each time point, residents were asked to rate how much each of 13 factors contributes to child abuse and neglect. Median regression analyses adjusted for individual and neighborhood characteristics showed that “lack of religion” decreased somewhat in importance over time, while that of “single parents” increased slightly. Otherwise, there was substantial consistency in caregivers' perceptions of factors contributing to maltreatment over the two study points. In terms of overall ranking, at each time point the most important contributors to child maltreatment were “drugs,” “alcohol,” and “psychological or emotional problems,” while the least important were “divorce,” “single parents,” and “lack of religion.” Differences in ratings of contributing factors were associated with individual and neighborhood characteristics, most consistently by participant race and age and by neighborhood maltreatment investigation rate. Despite these differences, for any maltreatment prevention or intervention effort using or planning to use maltreatment etiology in some way in its activities, etiology seems to represent a fairly stable platform for programming.

Vitamin D level and risk of systemic lupus erythematosus and rheumatoid arthritis: a Mendelian randomization.

The aim of this study was to examine whether the vitamin D level is causally associated with risk of systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). We performed two-sample Mendelian randomization (MR) analyses using the inverse-variance weighted (IVW), weighted median, and MR-Egger regression methods on publicly available summary statistics datasets using two vitamin D level genome-wide association studies (GWASs) as exposure and SLE and RA GWASs on people of European descent as outcomes. We selected three independent single-nucleotide polymorphisms located at SSTR4 (rs2207173), GC (rs2282679), and NADSYN1 (3829251) with genome-wide significance from two GWASs on vitamin D levels as instrumental variables. The IVW, weighted median, and MR-Egger regression methods yielded no evidence of a causal association between vitamin D level and risk of SLE (beta = 0.032, SE = 0.119, p = 0.789; beta = 0.233, SE = 0.274, p = 0.552; beta = 0.054, SE = 0.125, p = 0.665; respectively) or RA (beta = 0.026, SE = 0.061, p = 0.664; beta = 0.025, SE = 0.065, p = 0.695; beta = 0.025, SE = 0.065, p = 0.695; respectively). In addition, MR-Egger regression revealed directional pleiotropy was unlikely to be biasing the result for SLE (intercept = - 0.058, p = 0.545) or RA (intercept = - 0.027, p = 0.558). The MR estimates from IVW, weighted median, and MR-Egger regression analyses were consistent. MR analysis did not support a causal association between the vitamin D level and SLE or RA.