Reduction In Odds Research Articles

Homogeneity in the association of body mass index with type 2 diabetes across the UK Biobank: A Mendelian randomization study.

Lifestyle interventions to reduce body mass index (BMI) are critical public health strategies for type 2 diabetes prevention. While weight loss interventions have shown demonstrable benefit for high-risk and prediabetic individuals, we aimed to determine whether the same benefits apply to those at lower risk. We performed a multi-stratum Mendelian randomization study of the effect size of BMI on diabetes odds in 287,394 unrelated individuals of self-reported white British ancestry in the UK Biobank, who were recruited from across the United Kingdom from 2006 to 2010 when they were between the ages of 40 and 69 years. Individuals were stratified on the following diabetes risk factors: BMI, diabetes family history, and genome-wide diabetes polygenic risk score. The main outcome measure was the odds ratio of diabetes per 1-kg/m2 BMI reduction, in the full cohort and in each stratum. Diabetes prevalence increased sharply with BMI, family history of diabetes, and genetic risk. Conversely, predicted risk reduction from weight loss was strikingly similar across BMI and genetic risk categories. Weight loss was predicted to substantially reduce diabetes odds even among lower-risk individuals: for instance, a 1-kg/m2 BMI reduction was associated with a 1.37-fold reduction (95% CI 1.12-1.68) in diabetes odds among non-overweight individuals (BMI < 25 kg/m2) without a family history of diabetes, similar to that in obese individuals (BMI ≥ 30 kg/m2) with a family history (1.21-fold reduction, 95% CI 1.13-1.29). A key limitation of this analysis is that the BMI-altering DNA sequence polymorphisms it studies represent cumulative predisposition over an individual's entire lifetime, and may consequently incorrectly estimate the risk modification potential of weight loss interventions later in life. In a population-scale cohort, lower BMI was consistently associated with reduced diabetes risk across BMI, family history, and genetic risk categories, suggesting all individuals can substantially reduce their diabetes risk through weight loss. Our results support the broad deployment of weight loss interventions to individuals at all levels of diabetes risk.

Dog Ownership at Three Months of Age Is Associated With Protection Against Food Allergy

To investigate how environmental factors, specifically pet ownership, during infancy were associated with food allergy.The study consisted of 1303 3-month-old, healthy, exclusively breastfed infants from the general population of England and Wales. The study was done within the Inquiring About Tolerance study, an intervention study assessing the utility of early introduction of common allergens into diet, using the same group of infants.This prospective cohort study was planned as part of the Inquiring About Tolerance Study. Surveys were used at enrollment and monthly to determine environmental exposures in the study population. Family history of atopy, mode of childbirth, day care, antibiotic use, and pet ownership were included in the surveys. Specific immunoglobulin E assay and skin prick test (SPT) for cow’s milk, egg white, cod, peanut, sesame, and wheat were performed at the 3-, 12-, and 36-month visits to evaluate food sensitization in a double-blind placebo-controlled setting. Similarly, SPTs for house dust mites, cat, dog, grass, and tree pollen were performed at 12 and 36 months to evaluate aeroallergen sensitization. Infants were also assessed for atopic dermatitis and skin barrier function. Logistic regression analyses were then applied to assess the exposure variables in a dose-dependent manner (number of pets, access of pets of living spaces).Sixty-eight infants (6.1%, 68 out of 1124) were diagnosed with food allergy during the course of the study. Of those diagnosed, there was an increased association with atopy at the beginning of the study (crude odds ratio [cOR]: 5.74, P < .001), impaired skin barrier (cOR: 5.62, P < .001), and family history of allergy. Cohabitation with dogs was a protective factor against developing food allergy, as evident by a 90% odds reduction (adjusted odds ratio [aOR]: 0.10, P = .02). In fact, a dose-dependent response was seen in which more dogs and more access to living areas was associated with more protection (aOR: 0.11, P = .03). In those living with 2 dogs, there were no study participants who developed allergy. Dog ownership was also associated with decreased food SPT sensitization at 12 months (aOR: 0.17, P < .01) and 36 months (aOR: 0.35, P = .05), decreased aeroallergen sensitization at 36 months (aOR: 0.51, P = .05), and reduction in house dust mite sensitization (aOR: 0.34, P = .02).In the results of the study, it is suggested that cohabitation with dogs may prevent the development of food allergy in infants. The number of dogs present and their degree of access to the home were associated with a dose-dependent response. Additionally, dogs were found to be associated with decreased aeroallergen and house dust mite sensitization.The authors suggest that owning dogs and allowing dogs more access in the household protects against food and environmental allergies. Although efforts were made to adjust for confounding factors, it is difficult to adjust for all possible confounding environmental factors that may be impacting food allergy and atopy development. For example, could dog ownership be associated with increased time outdoors, allowing more sunlight exposure (vitamin D)? Greater understanding of the impacts of modifiable risk factors on allergy will allow improved counseling to families asking questions about whether lifestyle modifications can be beneficial.

Metformin Is Associated With Reduced Odds for Colorectal Cancer Among Persons With Diabetes.

INTRODUCTION:Metformin may be associated with reduced colorectal cancer (CRC) risk, but findings from previous studies have been inconsistent and had insufficient sample sizes to examine whether the association differs by anatomic site. This study examined whether metformin was associated with reduced CRC risk, both overall and stratified by anatomic site, in a large sample of persons with diabetes who underwent colonoscopy.METHODS:We performed a case-control study of US Veterans with prevalent diabetes who underwent colonoscopy between 1999 and 2014 using Department of Veterans Affairs electronic health record data. Cases were defined by presence of CRC at colonoscopy, while controls had normal colonoscopy. The primary exposure was metformin use at time of colonoscopy (yes/no). Association of metformin exposure with CRC (further stratified by proximal, distal, or rectal subsite) was examined using multivariable and multinomial logistic regression and summarized by odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS:We included 6,650 CRC patients and 454,507 normal colonoscopy patients. CRC cases were older and had lower metformin exposure. Metformin was associated with 8% relative reduction in CRC odds (OR: 0.92, 95% CI: 0.87–0.96). By subsite, metformin was associated with a 14% statistically significant reduced rectal cancer odds (OR: 0.86, 95% CI: 0.78–0.94) but no reduced distal or proximal cancer odds.DISCUSSION:Metformin was associated with reduced CRC odds—particularly rectal cancer—in a large sample of persons with diabetes undergoing colonoscopy.

2246. Improved Outcomes for Cancer Patients Treated With Ceftazidime–Avibactam vs. Polymyxin-Containing Regimens for Carbapenem-Resistant Enterobacteriaceae Bacteremia

BackgroundOutcomes are improved with ceftazidime–avibactam (CZA) compared with polymyxin-based regimens (PBR) for carbapenemase-producing carbapenem-resistant Enterobacteriaceae. It is unclear whether this finding is true in non-carbapenemase (non-CP) producing CRE. The purpose of this study was to compare the efficacy and safety of CZA-based and PBR for CRE bacteremia in cancer patients with a high prevalence of non-CP CRE.MethodsAdult cancer patients with first occurrence of CRE (i.e., meropenem non-susceptible) bacteremia treated with either CZA or PBR as directed therapy were included. Day 14 integrated benefit-risk outcomes based on desirability of outcome ranking (DOOR; (1) cured and discharged home, (2) cured and hospitalized, (3) cured and hospitalized with renal failure, (4) not cured, (5) dead) were used. DOOR is a recently developed statistical approach designed to unify important patient and clinician outcomes. Inverse probability of treatment weighted (IPTW) ordered logistic regression was used to model the odds of moving down ranked DOOR categories (i.e., having a worse outcome). The probability of a patient treated with CZA or a PBR having a worse DOOR category was also calculated. IPTW logistic regression was used to model the odds of 14-day mortality.Results43 patients (CZA, n = 24; PBR, n = 19) with similar demographics and relative illness were included. Klebsiella pneumoniae (n = 21) and Escherichia coli (n = 16) were most common. 16/43 (37%) were CP CRE, 19/43 (44%) were non-CP CRE, and the remainder were unknown. The probability of a better DOOR for patients treated with CZA was 58% (95% CI 53% - 62%). Patients treated with CZA had an 81% reduction in IPTW-adjusted odds of a worse DOOR (OR 0.19, 95% CI 0.05 – 0.76; P = 0.02). 14-day mortality was 2/24 (8%) for patients receiving CZA vs. 5/19 (26%) for patients treated with PBR (IPTW-adjusted OR 0.12, 95% CI 0.02 – 0.82, P = 0.03).ConclusionThese data suggest that CZA-based treatment, compared with PBR, has a superior integrated benefit-risk profile for the treatment of CRE bacteremia in cancer patients with a high burden of non-CP CRE. These findings build upon available data and suggest that CZA is preferred to PBR for CRE with heterogenous resistance mechanisms.DisclosuresSamuel L. Aitken, PharmD, Melinta Therapeutoics: Grant/Research Support, Research Grant; Merck, Sharpe, and Dohme: Advisory Board; Shionogi: Advisory Board.

Characteristics of Adenocarcinoma of the Gallbladder Following Cholecystectomies in the Hispanic Population

Abstract Introduction Gallbladder adenocarcinoma (GBC) is a rare malignancy. Frequency of incidental adenocarcinoma of the gallbladder in the literature is approximately 0.2% to 3%. Typically, GBC is the most common type and is discovered late, not until significant symptoms develop. Common symptoms include right upper quadrant pain, nausea, anorexia, and jaundice. A number of risk factors in the literature are noted for GBC. These risk factors are also more prevalent in Hispanic populations. This study sought to compare patients with incidental gallbladder adenocarcinomas (IGBC) to those with high preoperative suspicion for GBC. Predictor variables included age, sex, ethnicity, radiologic wall thickening, gross pathology characteristics (wall thickness, stone size, stone number, and tumor size), histologic grade, and staging. Methods Cases of GBC were retrospectively analyzed from 2009 through 2017, yielding 21 cases. Data were collected via Cerner EMR of predictor variables noted above. Statistical analysis utilized conditional logistic regression analysis. Results The majority of patients were female (n = 20) and Hispanic (n = 19). There were 14 IGBCs and 7 nonincidental GBCs. In contrast with previous research, exact conditional logistic regression analysis revealed no statistically significant findings. For every one-unit increase in AJCC TNM staging, there was a nonsignificant 73% reduction in odds (OR = 0.27) of an incidental finding of gallbladder carcinoma. Conclusion This study is important in that it attempts to expand existing literature regarding a rare type of cancer in a unique population, one particularly affected by gallbladder disease. Further studies are needed to increase predictive knowledge of this cancer. Longer studies are needed to examine how predictive power affects patient outcomes. This study reinforces the need for routine pathologic examination of cholecystectomy specimens for cholelithiasis.

Does prior antithrombotic therapy influence recurrence and bleeding risk in stroke patients with atrial fibrillation or atrial flutter?

Whilst antithrombotic therapy is recommended in people with atrial fibrillation, little is known about the survival benefits of antithrombotic treatment in those with both high ischaemic and bleeding risk scores. We aim to describe the distribution of these risk scores in those with a prior diagnosis of atrial fibrillation who have suffered stroke and to determine the net clinical benefit of antithrombotic treatment. We used regional stroke register data in the UK. Patients with a prior diagnosis of atrial fibrillation and ischaemic or haemorrhagic stroke patients were selected and their ischaemic stroke risk score (CHA2DS2-VASc) and bleeding risk score (HEMORR2HAGES) scores retrospectively calculated. Logistic regression and Cox proportional hazards models were constructed to determine the association between antithrombotic therapy prior to stroke and in-hospital and long-term mortality. A total of 1928 stroke patients (mean age 81.3 years (standard deviation 8.5), 56.8% women) with prior atrial fibrillation were included. Of these, 1761 (91.3%) suffered ischaemic stroke. The most common phenotype (64%) was of those with both high CHA2DS2-VASc (≥2) and high HEMORR2HAGES score (≥4). In our fully adjusted model, patients on antithrombotic treatment with both high ischaemic and bleeding risk had a significant reduction in odds of 31% for in-hospital mortality (odds ratio 0.69 (95% confidence interval 0.48-1.00: p = 0.049)) and 17% relative risk reduction for long-term mortality (hazard ratio 0.83 (95% confidence interval 0.71-0.97: p = 0.02)). Our study suggests that antithrombotic treatment has a prognostic benefit following incident stroke in those with both high ischaemic risk and high bleeding risk. This should be considered when choosing treatment options in this group of patients.

Impact of Hospitalist Comanagement on Outcomes in the Vascular Surgery Inpatient Population

Surgical comanagement with hospital medicine reduces mortality, increases patient satisfaction, and saves cost. Physicians can focus on their area of expertise, improving physician engagement. Comanagement is more prevalent in surgical specialties treating medically complex patients. The impact of comanagement has not been investigated thoroughly in vascular surgery. We sought to evaluate the impact of a strategic plan for comanagement of vascular surgery inpatients. The database at an academic medical center was queried for all admissions to vascular surgery between January 1, 2007 and December 31, 2017. In 2014, a hospitalist comanagement agreement was established to reduce surgical trainee workload, to improve outcomes, and to reduce cost. We collected data on demographics, comorbidities, length of stay, 30-day mortality, readmission, myocardial infarction (MI), and infection. Data were assessed to gauge impact on outcomes. There were 1438 admissions that met criteria for inclusion. Prevalence of comorbidities was 18.2% diabetes, 63.8% hypertension, 28.0% chronic kidney disease, and 46.7% coronary artery disease; mean age was 66.1 years, and 57.2% were male (similar in both groups). Mean length of stay was 8.2 days overall and 8.6 days before and 7.6 days after comanagement agreement (P = .0022), although logistic regression analysis revealed no significant difference. The 30-day mortality was 2.5%, similar in both groups. MI prevalence was 4.7%, significantly reduced with comanagement (2.6% vs 6.0%; P = .0028). Logistic regression modeling controlling for diabetes, hypertension, hyperlipidemia, coronary artery disease, chronic kidney disease, and peripheral artery disease demonstrated a 56% reduction in odds of MI in patients who were comanaged (P = .008). Given the health care industry's focus on quality of care, surgical outcomes, cost containment, and physician engagement, surgical comanagement paradigms should be considered a strategy to accomplish these goals. Comanagement has resulted here in a significant reduction in adverse cardiac events. The population of vascular surgery patients, with its advanced age and often multiple comorbidities, is well suited to benefit from a collaborative working relationship between vascular surgeons and their hospital medicine colleagues. Further assessment of benefits of comanagement is warranted.

Inherited alterations of TGF beta signaling components in Appalachian cervical cancers.

This study examined targeted genomic variants of transforming growth factor beta (TGFB) signaling in Appalachian women. Appalachian women with cervical cancer were compared to healthy Appalachian counterparts to determine whether these polymorphic alleles were over-represented within this high-risk cancer population, and whether lifestyle or environmental factors modified the aggregate genetic risk in these Appalachian women. Appalachian women's survey data and blood samples from the Community Awareness, Resources, and Education (CARE) CAREI and CAREII studies (n = 163 invasive cervical cancer cases, 842 controls) were used to assess gene-environment interactions and cancer risk. Polymorphic allele frequencies and socio-behavioral demographic measurements were compared using t tests and χ2 tests. Multivariable logistic regression was used to evaluate interaction effects between genomic variance and demographic, behavioral, and environmental characteristics. Several alleles demonstrated significant interaction with smoking (TP53 rs1042522, TGFB1 rs1800469), alcohol consumption (NQO1 rs1800566), and sexual intercourse before the age of 18 (TGFBR1 rs11466445, TGFBR1 rs7034462, TGFBR1 rs11568785). Interestingly, we noted a significant interaction between "Appalachian self-identity" variables and NQO1 rs1800566. Multivariable logistic regression of cancer status in an over-dominant TGFB1 rs1800469/TGFBR1 rs11568785 model demonstrated a 3.03-fold reduction in cervical cancer odds. Similar decreased odds (2.78-fold) were observed in an over-dominant TGFB1 rs1800469/TGFBR1 rs7034462 model in subjects who had no sexual intercourse before age 18. This study reports novel associations between common low-penetrance alleles in the TGFB signaling cascade and modified risk of cervical cancer in Appalachian women. Furthermore, our unexpected findings associating Appalachian identity and NQO1 rs1800566 suggests that the complex environmental exposures that contribute to Appalachian self-identity in Appalachian cervical cancer patients represent an emerging avenue of scientific exploration.

More- Versus Less-Intensive Lipid-Lowering Therapy.

It has not been yet adequately addressed whether the addition of the nonstatin LDL-C (low-density lipoprotein cholesterol)-lowering agents on top of statins has the same magnitude of risk reduction in the cardiovascular events as compared with more-intensive statin therapy. We performed a systematic review and meta-analysis of RCTs (randomized controlled trials) comparing more- versus less-intensive lipid-lowering therapy (LLT) on clinical outcomes in patients with atherosclerotic cardiovascular risk. We included 23 studies involving 133 037 patients (more-intensive LLT: 67 691 patients and less-intensive LLT: 65 346 patients). We evaluated 3 types of more- versus less-intensive LLT including more versus less statins (57 672 patients), combination therapy of ezetimibe versus statins alone (20 688 patients), or a PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitor with statins versus statins alone (54 677 patients). The odds for major adverse cardiovascular events (MACE; equivalent to the composite of coronary heart death, nonfatal myocardial infarction, stroke, or coronary revascularization) were significantly lower in the more-intensive LLT group compared with the less-intensive LLT group in the entire study population (odds ratio, 0.84; 95% CI, 0.79-0.88; P<0.001), and in all the 3 categories of more-intensive LLT strategies (more-intensive statin therapy: odds ratio, 0.83; 95% CI, 0.76-0.90; P<0.001, ezetimibe: odds ratio, 0.90; 95% CI, 0.85-0.96; P<0.001, and PCSK9 inhibitors: odds ratio, 0.81; 95% CI, 0.73-0.90; P<0.001) with numerically greater relative odds reduction by more-intensive statin therapy and PCSK9 inhibitors than by ezetimibe. Odds reduction for MACE per 20 mg/dL LDL-C reduction was also different across the 3 types of more-intensive LLT (more-intensive statin therapy: 17.4%, ezetimibe: 11.0%, and PCSK9 inhibitors: 6.6%). In this meta-analysis, more-intensive LLT as compared with less-intensive LLT was associated with significant odds reduction for MACE in the entire study population and in all the 3 categories of more-intensive LLT such as more-intensive statin therapy, ezetimibe, and PCSK9 inhibitors. However, overall odds reduction for MACE and odds reduction for MACE per 20 mg/dL LDL-C reduction were different across the 3 types of more-intensive LLT. Registration: URLs: https://www.crd.york.ac.uk/PROSPERO/ and http://www.umin.ac.jp/ctr. Unique identifiers: PROSPERO: CRD42018081196, and UMIN-CTR: R000036229.

Parasitic infections in Malaysian aborigines with pulmonary tuberculosis: a comparative cross-sectional study

The geographical distribution of tuberculosis (TB) overlaps with various parasitic infections. Uncovering the characteristics of coinfecting parasites that potentially affect the host susceptibility to TB is pertinent as it may provide input to current TB therapeutic and prophylactic measures. The present study was aimed at examining the types of parasitic infections in TB patients and healthy TB contacts (HC) in Orang Asli, Malaysian aborigines, who dwelled in the co-endemic areas. Stool and serum samples were collected from Orang Asli who fulfilled the selection criteria and provided written informed consents. Selected parasitic infections in the two study groups were determined by stool examination and commercial serum antibody immunoassays. The prevalence of parasitic infections in TB and HC participants were 100% (n = 82) and 94.6% (n = 55) respectively. The parasitic infections comprised toxocariasis, trichuriasis, amoebiasis, toxoplasmosis, hookworm infection, ascariasis, strongyloidiasis, and brugian filariasis, in decreasing order of prevalence. Overall, helminth or protozoa infection did not show any significant association with the study groups. However, when the species of the parasite was considered, individuals exposed to trichuriasis and toxoplasmosis showed significant odds reduction (odds ratio (OR) 0.338; 95% confidence interval (CI) 0.166, 0.688) and odds increment (OR 2.193; 95% CI 1.051, 4.576) to have active pulmonary TB, respectively. In conclusion, trichuriasis and toxoplasmosis may have distinct negative and positive associations respectively with the increase of host susceptibility to TB.

General and abdominal obesity is related to socioeconomic status and food choices: a cross-sectional study

PurposeThis paper aims to evaluate the prevalence of general obesity (GO) and abdominal obesity (AO) in the north-west of Iran and investigate the association with food choices and socioeconomic status (SES).Design/methodology/approachIn this cross-sectional study, 500 subjects aged ≥ 18 years were studied. Data on their basic characteristics, anthropometric measurements, dietary habits and physical activity were collected. The authors examined the association between GO and AO with SES and food choices using multiple logistic regression analysis.FindingsThe prevalence of GO and AO was 26.6 and 43.4%, respectively. A positive association was observed between age and GO (p for trend <0.001) and AO (p for trend 0.005) in both sexes. However, a negative correlation was detected between education and income with GO and AO (p for trend <0.001). Two or more servings of fruit consumption a day were associated with lower odds of obesity. It was observed that the odds of GO and AO decreased by three or more servings of daily fruit. The consumption of dairy products in two or more servings a day led to a reduction in odds of GO and AO. The consumption of five or more servings of legumes, beans and nuts a week was associated with lower odds of GO and AO.Originality/valueEducational attainment, greater income and a higher intake of some specific food groups were associated with lower odds of obesity in the area. More population-based investigations are required to develop effective preventive strategies to control the status of being overweight and obesity in different regions.

Assessing the effects of vegetable consumption on the psychological health of healthy adults: a systematic review of prospective research

To alleviate the immense health and economic burden of mental illness, modifiable targets to promote psychological health are required. Emerging evidence suggests that both fruit and vegetable (F&V) consumption may play an important role. However, the precise contribution of vegetable consumption, which may represent a more potent target than the consumption of fruit, has received little attention. This review aimed to synthesize and evaluate research investigating the effects of vegetable consumption on mental health and psychological well-being in nonclinical, healthy adult populations. We aimed to provide insight into the causal relation between vegetable consumption and these outcomes. Only studies with prospective or experimental data were included. The survey of the literature was last implemented on 1 February, 2019. Ten eligible studies were identified, with a total sample size of n=33,645, that measured vegetable intake separately from fruit, or combined this with fruit intake. Where studies explored the independent effects of fruit and vegetable consumption on psychological health (n=3), 2 reported a preferential effect of vegetables (compared with fruit) on psychological well-being, whereas 1 reported a superior effect of fruit intake on odds reduction of symptoms of depression. More broadly, there was evidence that consuming the recommended amount of F&V (and exceeding this) was associated with increased psychological well-being. However, the effects of F&V consumption on mental health symptoms were inconsistent. Increased F&V consumption has a positive effect on psychological well-being and there appears to be a preferential effect of vegetables (compared with fruit) from the limited data examined. The effect of F&V intake on mental health is less clear and, at present, there are no clear data to support a preferential effect of vegetable intake on mental health outcomes. Hence, additional research is warranted to investigate the influence of vegetables, compared with fruit, on psychological health in order to inform nutrition-based interventions. This review was registered at www.crd.york.ac.uk/prospero as CRD42017072880.

Impact of Mobile Crisis Services on Emergency Department Use Among Youths With Behavioral Health Service Needs.

Youths are using emergency departments (EDs) for behavioral health services in record numbers, even though EDs are suboptimal settings for service delivery. In this article, the authors evaluated a mobile crisis service intervention implemented in Connecticut with the aim of examining whether the intervention was associated with reduced behavioral health ED use among those in need of services. The authors examined two cohorts of youths: 2,532 youths who used mobile crisis services and a comparison sample of 3,961 youths who used behavioral health ED services (but not mobile crisis services) during the same fiscal year. Propensity scores were created to balance the two groups, and outcome analyses were used to examine subsequent ED use (any behavioral health ED admissions and number of behavioral health ED admissions) in an 18-month follow-up period. A pooled odds ratio of 0.75 (95% confidence interval [CI]=0.66-0.84) indicated that youths who received mobile crisis services had a significant reduction in odds of a subsequent behavioral health ED visit compared with youths in the comparison sample. The comparable result for the continuous outcome of number of behavioral health ED visits yielded an incidence risk ratio of 0.78 (95% CI=0.71-0.87). Using comparison groups, the authors provided evidence suggesting that community-based mobile crisis services, such as Mobile Crisis, reduce ED use among youths with behavioral health service needs. Replication in other years and locations is needed. Nevertheless, these results are quite promising in light of current trends in ED use.

Improving incidence trends of severe intraventricular haemorrhages in preterm infants

ObjectiveTo describe the trend and risk factors for severe intraventricular haemorrhage (IVH) among infants <32 weeks gestation.DesignPopulation-based cohort study.SettingAustralia and New Zealand.PatientsAll preterm infants <32 weeks gestation in the Australian...

Adherence to Self-monitoring of Dietary Intake During a Weight Loss Intervention: Does a Personalized Approach Maintain Adherence? (FS11-04-19)

ObjectivesWe compared self-monitoring adherence in participants randomized to two weight loss programs: a STANDARDIZED, one-size-fits-all, low-fat diet, or a diet PERSONALIZED to minimize the postprandial glycemic response. MethodsParticipants were adults with pre-diabetes or type 2 diabetes, and a BMI >27 k/m2. Both groups were instructed to restrict total calories, monitor dietary intake with the Personal Nutrition Program (PNP) smartphone app, and attend videoconference behavioral counseling sessions on the same intervention schedule. STANDARDIZED (n = 12) received app feedback about intake of total calories and dietary fat. PERSONALIZED (n = 20) received app feedback about intake of total calories plus a meal-specific predicted glycemic score. Total meal entries were measured at 1, 2 and 3 months. Self-monitoring adherence was defined as logging >50% of expected meals each month into the PNP app, assuming 3 meals/day. Session attendance was also measured. Repeated measures binomial logistic regression analysis was used to assess change in adherence due to treatment group, time (i.e., months), and the interaction between treatment and time, adjusting for age, gender and BMI. ResultsProportion adherent was 75.0%, 41.7% and 8.3% in the STANDARDIZED group and 85.0%, 80.0% and 75.0% in the PERSONALIZED group during months 1, 2 and 3, respectively. The repeated measures model demonstrated a significant effect of month (P < 0.001) and a treatment*month interaction (P = 0.011). After adjusting for covariates, these effects remained significant, showing a significant reduction in odds of adherence by month (OR [95%CI]: 0.13 [0.05, 0.37]; P < 0.001). Moreover, compared to the STANDARDIZED, PERSONALIZED participants had greater odds of adherence over time (OR [95%CI]: 5.12 [1.49, 17.6]; P = 0.009). Higher BMI was significantly associated with lower adherence (OR [95%CI]: 0.92 [0.87, 0.98]; P = 0.006). The proportion of attendance at videoconference sessions was similar between groups (STANDARDIZED: 77.1%; PERSONALIZED: 77.5%). ConclusionsTwo weight loss programs having similar calorie targets, behavioral approach, and contact schedule resulted in similar session attendance. However, adherence to self-monitoring was better when feedback was personalized. Funding SourcesAmerican Heart Association.

Nationwide improvement in outcomes of emergency admission for ulcerative colitis in England, 2005‐2013

SummaryBackgroundThe UK IBD Audit Programme reported improved inpatient care processes for ulcerative colitis (UC) between 2005 and 2013. There are no independent data describing national or institutional trends in patient outcomes over this period.AimTo assess the association between the outcome of emergency admission for UC and year of treatment.MethodsRetrospective analysis of hospital administrative data, focused on all emergency admissions to English public hospitals with a discharge diagnosis of UC. We extracted case mix factors (age, sex, co‐morbidity, emergency bed days in last year, deprivation status), outcomes of index admission (death and first surgery), 30‐day emergency readmissions (all‐cause, and selected causes) and outcome of readmission.ResultsThere were 765 deaths and 3837 unplanned first operations in 44 882 emergency admissions, with 5311 emergency readmissions (with a further 171 deaths and 517 first operations). Case mix adjusted odds of death for any given year were 9% lower (OR 0.91, 95% CI: 0.89‐0.94), and that for emergency surgery 3% lower (OR 0.97, 95% CI: 0.95‐0.98) than the preceding year. Results were robust to sensitivity analysis (admissions lasting ≥4 days). There was no reduction in odds for all‐cause readmission, but rates for venous thromboembolism declined significantly. Analysis of institutional‐level metrics across 136 providers showed a stepwise reduction in outliers for mortality and unplanned surgery.ConclusionsRisk of death and unplanned surgery for UC patients admitted as emergencies declined consistently, as did unexplained variation between hospitals. Risk of readmission was unchanged (over 1 in 10). Multiple factors are likely to explain these nationwide trends.

LACE+ Index as Predictor of 30-Day Readmission in Brain Tumor Population

The LACE+ index (Length of stay, Acuity of admission, Charlson Comorbidity Index score, and Emergency department [ED] visits in the past 6 months) is a tool used to predict 30-day readmissions. We sought to examine this predictive tool in patients undergoing brain tumor surgery. Admissions and readmissions for patients undergoing craniotomy for supratentorial neoplasm at a single multihospital academic medical center were analyzed. All brain tumor cases for which the patient was alive at 30 days after surgery were included (n= 352). Simple logistic regression analyses were used to assess the ability of the LACE+ index and subsequent single variables to accurately predict the outcome measures of 30-day readmission, reoperation, and ED visit. Analysis of the model's or variable's discrimination was determined by the receiver operating characteristic curve as represented by the C-statistic. The sample included admissions for craniotomy for supratentorial neoplasm (n= 352). Assessment of the LACE+ index demonstrates a 1.02× increased odds of 30-day readmission for every 1-unit increase in LACE+ score (P=0.031, CI= 1.00-1.03). Despite this, analysis of the receiver operating characteristic curve indicates that LACE+ index has poor specificity in predicting 30-day readmission (C-statistic= 0.58). A 1-unit increase in LACE+ score also predicts a 0.98× reduction in odds of home discharge (P < 0.001, CI= 0.97-0.99, C-statistic= 0.70). But LACE+ index does not predict 30-day reoperation (P= 0.945) or 30-day ED visits (P= 0.218). The results of this study demonstrate that the LACE+ index is not yet suitable as a prediction model for 30-day readmission in a brain tumor population.

Arterial stiffness is a predictor for acute kidney injury following coronary artery bypass graft surgery

BackgroundCardiac surgery-associated acute kidney injury (CSA-AKI) is a serious postoperative complication of cardiac surgery, an episode of which impacts on patient morbidity and mortality. Pulse wave velocity (PWV; a non-invasive measurement tool to assess arterial stiffness) has been shown to predict kidney disease progression, and cardiovascular and all-cause mortality in patients with chronic kidney disease. We hypothesised that PWV would also predict acute kidney injury in subjects who have undergone non-valve repair elective coronary artery bypass graft (CABG) surgery .MethodsThis was a prospective, observational, exploratory study. PWV was determined with a Vicorder device, together with standard clinical and biochemical parameters. AKI staging was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines.Results137 patients were included in the study. 85% were male, and mean age was 66.3 years (SD = 9.7 years). There were 40 episodes (29%) of CSA-AKI. Each 1 unit increase in PWV score was associated with a 1.5 fold greater odds of a CSA-AKI event (p = 0.006(odds ratio = 1.5; confidence interval:1.13–2.10). A 1 unit increase in estimated glomerular filtration rate resulted in an estimated 85% decrease in the odds of developing AKI, each year, men have an odds reduction of 15% of developing AKI compared with females and each 1 year increase in age lowered the odds of developing AKI by 87%.ConclusionsThis pilot exploratory study revealed that PWV, assessed prior to non-valve repair elective CABG surgery, independently predicts CSA-AKI events. PWV is a simple, non-invasive technique that could potentially be used to risk stratify for CSA- AKI following elective cardiac surgery.Trial registrationClinTrial.Gov NCT02364427. Registered 18 February 2015.

Association of free sugar intake with blood pressure and obesity measures in Australian adults.

This study examined the association of free sugar (FS) intake with obesity measures and blood pressure (BP) among a nationally representative sample of Australian adults. Data from adults (weighted n = 5136) who completed 2 × 24-h recalls and had complete data for BP, waist circumference (WC), waist-to-height ratio (WHtR), and body mass index (BMI) were analyzed. Associations between percentage energy of FS from all food sources (%EFStotal), beverages only (%EFSbeverages), and non-beverages sources only (%EFSnon-beverages) and obesity measures and BP were examined using linear and non-linear regressions. Logistic regression was used to calculate the odds ratios (OR) of being classified as overweight and/or obese, having increased cardiometabolic risks, and elevated BP per 5% point increase in %EFStotal, %EFSbeverages, and %EFSnon-beverages. All regression analyses were adjusted for known socio-economic and lifestyle confounders. %EFSbeverage was positively associated with BMI, WC, and WHtR (all p < 0.05), while %EFSnon-beverage was inversely associated with these outcomes. Increases in odds of having an undesirable WC/WHtR were found with increasing %EFSbeverages (OR per 5% point increase in %EFSbeverages: 1.19 for WC; 1.23 for WHtR, both p < 0.001). %EFStotal and %EFSnon-beverages were weakly and negatively associated with diastolic BP. A 5% point increase in %EFStotal and %EFSnon-beverage was associated with a 10-25% reduction in odds of having elevated BP. Our results suggested that only a higher FS intake from beverages may be associated with obesity, and higher FS intake was associated with reduced odds of having elevated BP.

Abstract P4-10-06: Factors impacting the accuracy of self-reported breast procedures among women with and without breast cancer

Abstract Background: Clinical/epidemiologic observational studies frequently rely on participants' recall for information about breast procedures. However, there is limited data on the accuracy of self-reported breast procedures. To address this knowledge gap and inform future study design and collection and interpretation of similar data, we investigated the impact of type, diagnosis, age, time, and other patient characteristics on the accuracy of self-report in a prospective cohort. Methods: All benign breast biopsies, lumpectomies, and mastectomies for breast cancer treatment among women enrolled in the BOSS Cohort, a prospective study of women and men with a familial risk of breast/ovarian cancer, were identified. Study staff obtained pathology reports for 93% of women from self-reported breast procedure locations. For this analysis, we focused on 577 women who had at least one ascertained pathology report, and who self-reported at least one breast procedure at baseline. We estimated the percentage of self-reports (95% confidence interval (CI)) with matching pathology report within 6 months (+/- 6 months), and agreement between self-reported procedures and pathology-confirmed diagnoses (normal/benign vs. atypical hyperplasia vs. LCIS, and DCIS vs. invasive cancer) with the Kappa statistic. We also examined predictors of an accurate biopsy self-report, including age at baseline, personal and family history of breast cancer, educational attainment, and time between biopsy and baseline, using logistic regression models. Results: At baseline, 158 women reported having at least one benign biopsy, 193 women reported having a lumpectomy for cancer treatment, and 174 women reported having a mastectomy for cancer treatment. The median time between biopsy, lumpectomy, mastectomy, and baseline was 9 years, 2 years, and 2 years, respectively. Fifty-seven percent (95% CI: 49-64.5%) of benign biopsy self-reports, 90.7% (95% CI: 85.6-94.1%) of lumpectomy self-reports, and 85.1% (95% CI: 78.9-89.7%) of mastectomy self-reports had a matching pathology report within 6 months. Further diagnostic agreement was moderate for biopsies, lumpectomies, and mastectomies with Kappa statistics of 0.65, 0.66, 0.65, respectively. Age at baseline (p-interaction =0.01) and time (p-interaction = 0.03) were independent and joint predictors of accurate biopsy self-reports. Women less than 49 years old had the largest reduction in odds of having an accurate self-report (26%) for every additional year between biopsy and baseline [adjusted odds ratio = 0.74 (95% CI: 0.63-0.88)]. Similarly, women with a biopsy within 4 years prior to baseline had a 10% reduction in the odds of having an accurate self-report with increasing age [adjusted odds ratio = 0.9 (95% CI: 0.84-0.97)]. Conclusions: In this highly-educated cohort, the overall accuracy of self-report of benign biopsies was only modest, and the accuracy of self-report of lumpectomies and mastectomies was lower than expected. This study suggests that age at baseline and time between procedure and baseline are important predictors of accuracy of self-report and should be considered when utilizing self-reported information. Furthermore, where possible, prospective collection of breast procedure data should be prioritized. Citation Format: Schaeffer ML, May B, Cimino-Mathews A, Orellana M, McCullough M, Hogan B, Armstrong D, Visvanathan K. Factors impacting the accuracy of self-reported breast procedures among women with and without breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-06.