Chronic Disease Status Research Articles

Effects of BMI and grip strength on older adults' falls—A longitudinal study based on CHARLS

BackgroundBody Mass Index (BMI) and grip strength are potentially important risk factors for falls among the older adults. Currently, there is no consensus on the combined effects of grip strength and BMI on falls in the older adults, particularly among the Chinese older adults.ObjectiveTo investigate the incidence of falls among older adults in China and explore the association between BMI and grip strength and the risk of falls in older adults.MethodsData of participants over 60 in China Health and Retirement Longitudinal Study in 2011 and 2013 were collected. Sociodemographic variables, lifestyle, chronic disease status, history of falls and depression and cognitive status were obtained through the 2011 baseline questionnaire. Height, weight and grip strength were collected from a unified physical examination in 2011. Falls during the follow-up period were obtained through the follow-up questionnaire in 2013. Logistic regression was used to explore the association between BMI and grip strength and the risk of falls.ResultsThree thousand six hundred and eighty-five participants over 60 (67.14 ± 6.08) were included, with a fall incidence rate of 17.37%. The fall incidence rate in females (21.15%) was higher than that in male (13.46%). After adjusting covariates, high grip strength was associated with lower falls risks in general population (OR = 0.76; 95 CI: 0.630–0.923) and males (OR = 0.68; 95 CI: 0.503–0.919). Underweight was associated with lower falls risks in general population (OR = 0.77; 95 CI: 0.595–0.981) and females (OR = 0.69; 95 CI: 0.486–0.962) compared to the normal BMI group. Compared with the low grip strength group, females with high grip strength (OR = 0.54; 95 CI: 0.29–0.98) had a lower risk of falls in the underweight BMI group and males with high grip strength (OR = 0.63; 95 CI: 0.43–0.92) had lower risk of falls in the normal BMI group.ConclusionsHigh grip strength and underweight BMI are independently correlated with a lower fall risk, which varies between males and females.

Predicting postoperative pulmonary infection risk in patients with diabetes using machine learning

BackgroundPatients with diabetes face an increased risk of postoperative pulmonary infection (PPI). However, precise predictive models specific to this patient group are lacking.ObjectiveTo develop and validate a machine learning model for predicting PPI risk in patients with diabetes.MethodsThis retrospective study enrolled 1,269 patients with diabetes who underwent elective non-cardiac, non-neurological surgeries at our institution from January 2020 to December 2023. Predictive models were constructed using nine different machine learning algorithms. Feature selection was conducted using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression. Model performance was assessed via the Area Under the Curve (AUC), precision, accuracy, specificity and F1-score.ResultsThe Ada Boost classifier (ADA) model exhibited the best performance with an AUC of 0.901, Accuracy of 0.91, Precision of 0.82, specificity of 0.98, PPV of 0.82, and NPV of 0.82. LASSO feature selection identified six optimal predictive factors: postoperative transfer to the ICU, Age, American Society of Anesthesiologists (ASA) physical status score, chronic obstructive pulmonary disease (COPD) status, surgical department, and duration of surgery.ConclusionOur study developed a robust predictive model using six clinical features, offering a valuable tool for clinical decision-making and personalized prevention strategies for PPI in patients with diabetes.

Sarcopenia Seems to Be Common in Older Patients With Restless Legs Syndrome.

Restless legs syndrome (RLS) is a disorder characterized by nocturnally exacerbating pain that leads to significant sleep disturbances. The hormonal and metabolic changes caused by sleep disruption may increase the incidence of muscle-related diseases like sarcopenia in older adults, which is defined by a progressive loss of muscle strength and mass. This study aimed to investigate the relationship between RLS and sarcopenia, which may affect each other through common pathophysiological pathways in older adults. This was a cross-sectional study including 109 patients with RLS and 220 without RLS who applied to the geriatric clinic. RLS was assessed using the Turkish version of the International Restless Legs Syndrome Study Group (IRLSSG). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People-2 criteria. All the demographics, comorbid conditions, medications and findings of comprehensive geriatric assessments were recorded. The association between RLS and sarcopenia was examined by logistic regression. The mean age was 75 ± 7.4 and 73.8 ± 7 years for the RLS and the control groups, respectively (p > 0.05) and the ratio of females was higher in the RLS group (69.7% vs. 57.9%) (p = 0.035). The frequencies of coronary artery disease (CAD), hypertension (HT) and peripheral artery disease (PAD) were significantly higher in RLS patients (p = 0.020, p = 0.047, p = 0.010, respectively), while the prevalence of anaemia was 41% and 25-OH Vitamin D levels (25[OH]D) were higher than in the control group (p < 0.001). The frequency of probable sarcopenia and sarcopenia was higher in patients with RLS than in controls (20% vs. 11%, p = 0.037 and 8% vs. 2.3%, p = 0.047, respectively). A significant association between RLS and an increased likelihood of probable sarcopenia, sarcopenia and slow gait speed (odds ratio [OR]: 2.621, 95% confidence interval [CI] [1.265, 5.431]; OR: 4.542, 95% CI [1.284, 16.071]; OR: 2.663, 95% CI [1.432, 4.951], respectively) was found after adjusting for factors such as gender, HT, CAD, PAD, serum 25(OH)D levels, anaemia, chronic kidney disease (CKD) and nutritional status. However, the significance of low muscle mass disappeared (p > 0.05). This study demonstrated that sarcopenia is prevalent among older patients with RLS, which seems to be associated with low muscle strength and slow gait speed. Given the negative health outcomes related to sarcopenia, interventions aimed at preventing its development could be significantly beneficial for patients with RLS in older adults as well.

Gabapentinoids and Risk of Hip Fracture

The increased use of gabapentinoids has been most pronounced in older people who are also susceptible to hip fractures. To investigate the overall association between gabapentinoids and the risk of hip fractures and the stratified association across age groups, frailty status, and history of chronic kidney disease. This was a case-case-time-control study in patients hospitalized for hip fracture in Victoria, Australia, between March 1, 2013, and June 30, 2018, with at least 1 prescription for a gabapentinoid before fracture. Conditional logistic regression was used to estimate the odds ratio (OR) and 95% CI for gabapentinoid dispensing in the index (1-60 days prefracture) compared with the reference (121-180 days prefracture) period. To adjust for the underlying time trend in gabapentinoid use, each index case was matched with up to 5 controls, selected from future cases of the same age and sex. Subgroup analyses were conducted in subgroups with or without chronic kidney disease (CKD), frailty scores less than 5, and frailty scores 5 and above. Frailty was computed using the Hospital Frailty Risk Score (HFRS). Data were analyzed from November 2023 to April 2024. Gabapentinoids (pregabalin or gabapentin). Hip fracture. Of 28 293 patients hospitalized for hip fractures, 2946 (1752 [59.5%] aged ≥80 years; 2099 [71.2%] female) were dispensed a gabapentinoid before hip fracture. Gabapentinoid dispensing was associated with increased odds of hip fractures (OR, 1.96; 95% CI, 1.66-2.32). After adjusting for the exposure-time trend and concomitant use of other central nervous system medications, the odds of hip fractures remained elevated (OR, 1.30; 95% CI, 1.07-1.57). The association between gabapentinoid dispensing and hip fracture was higher in patients with HFRS 5 and above (OR, 1.75; 95% CI, 1.31-2.33) and CKD (OR, 2.41; 95% CI, 1.65-3.52). In this case-case-time-control study of Australian residents hospitalized for hip fracture, gabapentinoid use was associated with an increased risk of hip fractures, especially in patients who were frail or had chronic kidney disease. In addition to the known risk associated with kidney impairment, frailty status may be an important risk factor when considering use of gabapentinoids.

Abstract 4135985: Association of Plasma Cystatin-C with Cancer Risk in Individuals with and without Cardiovascular and Chronic Kidney Disease: An Atherosclerosis Risk in Communities (ARIC) Study

Background: While previous studies suggested a relationship between circulating Cystatin-C (Cys-C), a cysteine protease inhibitor involved in regulating tissue inflammation and a renal filtration marker, and both cancer and CVD, they often lacked long-term follow-up or did not account for the impact of CVD on the relationship between Cys-C and cancer. Methods: We included participants from the Atherosclerosis Risk in Communities (ARIC) study followed from visit 2 (1990-1992) through 2015. Plasma Cys-C level was measured by SomaScan. Other renal filtration markers beta-2 microglobulin (B2M) and beta-trace protein (BTP) were used to compare their cancer association with Cys-C. Incident cancer was ascertained by state cancer registry linkage supplemented with medical records. After adjusting for age, sex, race, and study center, adjusted hazard ratios (aHR) of total and site-specific cancers were estimated using Cox proportional hazards regression stratified by baseline chronic kidney disease (CKD) and CVD status. Results: Among 10,869 individuals (median age of 56.9 years, 55% female, 25% Black, 74% White), 3352 incident cancers were ascertained over a median follow-up of 22.9 years. Among 9585 individuals with no history of CKD or CVD, higher Cys-C was significantly associated with a higher risk of total (aHR 1.22, 95%CI 1.02-1.46), bladder, lung, colorectal, and hematologic malignancies. Among 1,050 individuals with CVD, but not CKD, Cys-C level was not associated with total cancer (aHR 1.22, 95%CI 0.74-2.01), but was significantly inversely associated with colorectal (aHR 0.19, 95%CI 0.05-0.76) and positively associated with post-menopausal breast (aHR 4.52, 95%CI 1.05-19.40) cancer risk. In individuals with CKD but not CVD, Cys-C was negatively associated with bladder (HR 0.08, 95%CI 0.0-0.77) and lung (0.23, 95%CI 0.06-0.82) cancers. Lastly, those with both CKD and CVD showed higher hematopoietic and lymphatic cancer with higher Cys-C (HR 4.68, 95%CI 1.32-16.60). Similar patterns were observed for B2M and BTP proteins. Conclusions: Our study highlights the intricate relationship between various renal filtration markers and cancer risk. It suggests that they may play a significant role in cancer development among the general population and CVD patients but not CKD patients. Further research should explore the biological mechanism underlying these associations with even more CKD cases to refine risk estimates. Funding: NHLBI, NCI, NPCR

Association between frailty status and risk of chronic lung disease: an analysis based on two national prospective cohorts

BackgroundThe association between the frailty index (FI) and the risk of chronic lung diseases (CLDs) remains unexplored, warranting further research.Methods and materialsThis study investigated the relationship between FI and CLD risk using data from the China Health and Retirement Longitudinal Study (CHARLS) and English Longitudinal Study of Ageing (ELSA), comprising a combined sample of 9642 individuals. Propensity score weighting was used to ensure similar distribution of covariates across FI groups. The Wilcoxon rank-sum test was used to analyze differences in FI scores between groups with and without CLD. Kaplan–Meier curves and Cox regression analysis were employed to explore the association between frailty status and CLD incidence, with sensitivity analyses conducted for validation.ResultsHigher FI scores were significantly associated with increased CLD risk in both cohorts (p < .05). Kaplan–Meier survival and Cox regression analyses indicated that frail individuals have a significantly elevated risk of CLD compared to robust individuals, particularly in certain subgroups (e.g., female) within the CHARLS cohort (p < .05). The ELSA cohort yielded similar results (p < .05), affirming FI as a strong predictor of CLD. Additional risk factors identified included age, smoking, and unmarried status (p < .05). Frail individuals consistently exhibited the highest risk in both cohorts (CHARLS HR = 1.54, p = .003; ELSA HR = 6.64, p < .001). The sensitivity analysis did not substantially alter the significant associations.ConclusionThese findings emphasize the critical role of frailty in the development of CLD, suggesting that targeted interventions could reduce CLD risk.

The impact of internet medical service on rural gender inequality in health opportunity: a cross-sectional study

BackgroundThe increasing popularity of Internet medical service may have alleviated the gender inequality in health opportunity faced by rural women. However, research to ascertain the association between Internet medical service and gender inequality in health opportunity is scarce. This study explored the impact of Internet medical service on gender inequality in health opportunity among rural women and the underlying mechanisms involved.MethodsA multistage stratified cross-sectional survey was conducted across six counties in three provinces in China, yielding 3,108 responses for a 97.13% response rate. The questionnaire was used to collect information on Internet healthcare use, health status, health behaviors, social activities and personal exercise, chronic disease status, and demographic and socio-economic characteristics of the participants. Based on Roemer's theory of equality of opportunity (EOP), we established a decomposition strategy for the fairness gap between genders, which we used for the measurement of the gender inequality in health opportunity Fixed effects models, propensity score matching (PSM), and least absolute shrinkage and selection operator (LASSO) regression were utilized to explore the impact of Internet medical service on rural gender inequality in health opportunity.ResultsOn average, rural women experienced a gender health fairness gap of 1.63. Internet medical service significantly mitigated this inequality (β = -0.0602, P = 0.0002), and this finding remained significant across propensity score matching (PSM) and LASSO regression analyses. Mechanistic analysis revealed that human capital positively moderates this effect (β = -0.0510, P < 0.01), while income (β = 0.0370, P < 0.001) and marital status (β = 0.2039, P < 0.001) have negative moderating effects.ConclusionsBy focusing on gender inequality in the digital era, this study highlights the mitigating role of Internet medical service on gender inequality in health opportunity in rural areas. This study proposes and validates the mechanisms through which Internet medical service alleviates gender inequality in health opportunity, suggesting that human capital amplifies this effect, while high personal income and marital status attenuate this effect. These findings contribute to understanding how the digital age can narrow gender health opportunity equality, providing support for future interventions aimed at promoting health equity and gender equality.

FUNCTIONAL HEALTH STATUS EVALUATION IN PATIENTS APPLYING TO FAMILY MEDICINE

AimOur study was conducted to determine whether the functional health status of patients treated at the Family Medicine Outpatient Clinic at Van Yüzüncü Yıl University Dursun Odabaş Medical Center differed significantly according to chronic disease status and sociodemographic characteristics.Materials and methodsIn this cross-sectional study, 303 volunteer patients were evaluated. A seven-question sociodemographic information form and an 8-question COOP WONCA scale were used. The SPSS (ver: 13) package was used for the statistical calculations.ResultsWhile 53.5% (n = 162) of the participants had chronic diseases, 46.5% (n = 141) did not have chronic diseases. Higher mean COOP-WONCA scores indicate worse functional health status. The functional health status decreased as the age of the patients increased (p < 0.01). Among the sociodemographic characteristics, gender had an effect on functional health status, and women had greater mean COOP-related WONCA scores than men did for the mood, social activity and daily activity subheadings (p < 0.05). Individuals who were married or single had better functional health status than those whose spouse was deceased or divorced (p < 0.01). The mean COOP WONCA scores and mean scores for all questions were greater for people with chronic diseases than for healthy individuals (p < 0.01).ConclusionOur study revealed the importance of age, sex, marital status, education level and chronic diseases on functional health status and quality of life. Determining the functional health status of patients applying to family medicine with appropriate scales and taking necessary recommendations and measures will reduce mortality and morbidity.

The Impact of Adhering to a Mediterranean Diet on the Severity of Overuse Tendinopathy Symptoms

Aim: The Mediterranean diet’s high carbohydrate content and antioxidant and anti-inflammatory properties make it appealing to athletes. Tendinopathy etiology is influenced by nutrition. Athletes with high adherence to the Mediterranean diet may have a lower severity of tendinopathy. This study aimed to investigate the effect of adherence to the Mediterranean diet on tendinopathy severity. Material and Methods: Exercise habits, physical activity level, body region, stage of the injury, age, body mass index, gender, smoking status, and presence of chronic diseases of individuals older than 18 years of age and who were diagnosed with tendinopathy in the sports medicine clinic were recorded in this cross-sectional study. The Revised Oslo Sports Trauma Research Centre Overuse Injury and Health Problems Questionnaires and the Mediterranean diet adherence screener were applied to participants. Results: A total of 152 participants, 52% (n=79) of whom were female, with lateral epicondylopathy (n=71), Achilles tendinopathy (n=25), plantar fasciitis (n=23), patellar tendinopathy (n=13), and other tendinopathies were included in the study. Upon examination of the relationship between the level of adherence to the Mediterranean diet and the severity of complaints due to overuse, no significant differences were found between groups (p=0.935, and p=0.927, respectively). A weak negative correlation was found between weekly exercise duration and adherence to the Mediterranean diet (rs=-0.237; p=0.016). Conclusion: No evidence was found that adherence to the Mediterranean diet was associated with differences in the severity of tendinopathy complaints. Athletes with high weekly exercise durations do not adopt the Mediterranean diet as an optimal dietary approach.

Epidemiology of stroke in France

Background: It has been nearly 10 years since the first national stroke plan in France.Aims: To examine the epidemiology of strokes, how they are managed and patient outcomes.Methods: Adults hospitalized for stroke in 2022 were identified in the national database. Stroke prevalence at 1 January 2023 was defined as the number of people alive at that date with a history of hospitalization for stroke or a chronic long-term disease status due to stroke (2012–2022). Patients were monitored up for up to 1 year after hospitalization for a stroke.Results: In 2022, 122,422 adults were hospitalized due to stroke, and there were an estimated 1,086,795 cases. Important geographical and socioeconomic disparities were observed. Admission to a stroke intensive care unit was found in 46.8% of patients, with significant variations by department of residence, age and gender. Only 7.2% of ischaemic strokes resulted in mechanical thrombectomy. Among survivors at 6 months, admission to a rehabilitation unit was found for 34.3% for patients with ischaemic strokes and 41.7% of those with haemorrhagic strokes, while 28.8% and 18.8%, respectively, had a consultation with a neurologist, and 19.5% and 10.9% were seen by a cardiologist within 6 months. Mortality rates after 1 year were 20.8% and 37.9% among patients hospitalized due to ischaemic and haemorrhagic strokes, respectively.Conclusion: The considerable numbers and rates of stroke – and disparities by age, sex and area – highlight the need for more effective stroke prevention, regular information campaigns on the symptoms of stroke and improved availability and accessibility of stroke units.

Impact of Chronic Kidney Disease and Gout on End-Stage Renal Disease in Type 2 Diabetes: Population-Based Cohort Study.

We examined the impact of gout on the end-stage renal disease (ESRD) risk in patients with type 2 diabetes mellitus (T2DM) and determined whether this association differs according to chronic kidney disease (CKD) status. Using the Korean National Health Insurance Service, this nationwide cohort study enrolled 847,884 patients with T2DM who underwent health checkups in 2009. Based on the presence of CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) and gout (two outpatient visits or one hospitalization within 5 years), patients were classified into four groups: CKD-Gout-, CKD- Gout+, CKD+Gout-, and CKD+Gout+. Patients with incident ESRD were followed up until December 2018. Among 847,884 patients, 11,825 (1.4%) experienced progression to ESRD. ESRD incidence increased in the following order: 0.77 per 1,000 person-years (PY) in the CKD-Gout- group, 1.34/1,000 PY in the CKD-Gout+ group, 8.20/1,000 PY in the CKD+Gout- group, and 23.06/1,000 PY in the CKD+Gout+ group. The presence of gout modified the ESRD risk in a status-dependent manner. Hazard ratios (HR) were 1.49 (95% confidence interval [CI], 1.32 to 1.69) and 2.24 (95% CI, 2.09 to 2.40) in patients without and with CKD, respectively, indicating a significant interaction (P<0.0001). The CKD+Gout+ group had a markedly higher risk of developing ESRD (HR, 18.9; 95% CI, 17.58 to 20.32) than the reference group (CKD-Gout-). Gout substantially enhances the risk of ESRD, even in the absence of CKD. Concurrent CKD and gout synergistically increase the risk of ESRD. Therefore, physicians should carefully screen for hyperuricemia to prevent progression to ESRD.

Analysis and Monitoring Application of Medical Data for Chronic Diseases in Elderly Living Alone Based on Wearable Medical Sensor Wristbands

This paper focuses on the analysis and monitoring application of medical data for chronic diseases in elderly individuals living alone using wearable medical sensor wristbands. It introduces the background, objectives, significance, content, and methods of the research. The development and application of wearable medical sensor wristbands and the status of chronic diseases in elderly living alone are discussed, highlighting existing research gaps. The section on the characteristics and needs analysis of chronic diseases in elderly living alone defines the term, analyzes common types and characteristics of chronic diseases, and examines the medical needs of such patients. The principles and technologies of wearable medical sensor wristbands are explained, covering working principles, common sensor technologies, and data collection and transmission technologies. The section on the collection and processing of medical data for chronic diseases in elderly living alone discusses data collection methods and steps, data processing and analysis methods, and data security and privacy protection. The design of a chronic disease medical monitoring system for elderly living alone based on wearable medical sensor wristbands is detailed, including system architecture and functional design, data visualization and report generation, and real-time monitoring and warning mechanisms. The experimental and results analysis section describes the experimental design and data collection methods, followed by an analysis and discussion of the results. In the summary and outlook section, the research work is summarized, existing problems and potential improvements are pointed out, and future developments are anticipated. This research provides new insights into the analysis and monitoring application of medical data for chronic diseases in elderly living alone using wearable medical sensor wristbands, offering a new approach to promoting health management and disease prevention for the elderly living alone.

Unveiling loneliness: health determinants of feeling alone in the older urban residents

Abstract In older people health condition contributes to the feeling of being alone (loneliness). We aimed to assess which chronic health conditions are the strongest determinants of loneliness in older urban residents. Participants of the Polish part of the HAPIEE Study (Health Alcohol and Psychosocial Factors in Eastern Europe) examined in 2019-20 were included to the analysis. Trained nurses interviewed respondents in their homes. Loneliness was assessed using 3-item UCLA scale (range: 3-9, cuf-off≥ 6 points). Socioeconomic data, self-rated health (SRH) and the history of 18 diseases diagnosed by the doctor was assessed using standardized questionnaire. Multivariable logistic regression was used; odds ratios and 95% confidence intervals are presented (OR (95%CI)). There were 461 participants (48% males) of mean age 72 years (SD = 6.3). In 34 participants (7%) UCLA score was 6 or more. The majority (63%) of respondents were married or cohabiting. Nearly 90% declared having children. After adjustment for marital status and having children, poor distance vision 3.84 (1.31-6.12), hearing problems 2.20 (1.07-4.53), acute back pain syndrome 2.21 (1.06-4.59) and cancer 2.36 (1.03-5.41) were determinants of loneliness. Further adjustment for age weakened the association with distance vision 2.74 (1.26-5.94) and waved the relationship with hearing problems 2.06 (0.99-4.29). The estimates for remaining health conditions remained almost unchanged. The strongest predictor of loneliness was SRH. After adjustment for age, marital status, having children and objective burden of chronic diseases, compared to good SRH, participants with moderate and poor SRH were more likely to report loneliness by over 3 and 6 times: 3.41 (1.29-9.05) and 6.60 (2.16-20.18), respectively. The perception of poor health and diagnosis of cancer strongly determined loneliness in older people, but other important predictors of loneliness were conditions that objectively hinder maintaining social contacts. Key messages • In older people health condition is related to the feeling of being alone, and the strongest objective health determinant of loneliness was diagnosis of cancer. • Independently of objective burden of chronic diseases, self-rated health was a significant predictor of loneliness in older urban residents.

A simplified bedside model for acute kidney injury prediction after percutaneous coronary intervention

Abstract Background Concern for acute kidney injury (AKI) after percutaneous coronary intervention (PCI) is a major determinant in the decision to pursue cardiac catheterization if otherwise indicated. A bedside AKI risk prediction model derived from the National Cardiovascular Data Registry (NCDR), most recently updated in 2023, employs relatively complex parameters for AKI prediction. Purpose To test the efficacy of a simplified pre-procedural 5-variable bedside score for post-PCI AKI prediction based on the NCDR model. Methods We analyzed our institution’s NCDR-reported catheterization laboratory registry between Q2 2022 and Q1 2023. Inclusion criteria, variable selection, and definitions were based on the NCDR model. A bedside prediction model was validated, including 5 pre-procedural variables: anemia (hemoglobin &amp;lt;10 mg/dl), history of heart failure, stage 4 or 5 chronic kidney disease (glomerular filtration rate &amp;lt;30 mg/dl), cardiac arrest, and shock status. Results We included 840 patients, of which 593 (70.6%) were men. Mean age was 69 (±12.5). Most procedures were performed on an urgent basis (444, 52.9%). AKI developed in 107 (12.7%) patients. Compared to the non-AKI group, patients who developed AKI were older (age 74±11.5 vs 68.3 ±12.5), and more frequently had anemia (23.6% vs 7.4%), diabetes (51.4% vs 35.2%), severe frailty (45.8% vs 23.7%), heart failure (62.6% vs 29.7%), cardiac arrest (13.1% vs 2.9%), CKD (30.8% vs 6%), shock (12.1% vs 1.5%), and mechanical circulatory support (7.5% vs 2.9%), p&amp;lt;0.001. Utilizing integer scores, the simplified bedside model employing 5 pre-procedural variables demonstrated discrimination similar to the bedside NCDR model, with a C-statistic of 0.77 (0.60-0.88) and excellent calibration (intercept of 0.31 and slope of 1.03) (Figure), indicating the robust performance of the model (compared to bedside NCDR model with a C-statistic 0.793, intercept of -0.197, and slope of 0.957). Conclusion A simplified NCDR-based bedside score using 5 pre-procedural variables is an effective tool for predicting AKI as a complication of PCI, with comparable performance to the 2023 updated bedside NCDR AKI risk model.

The relationship between health literacy and healthy lifestyle behaviors: A meta-analysis.

Health literacy and healthy lifestyle behaviors are both pivotal elements for public health improvement. This meta-analysis aims to scrutinize studies investigating the nexus between health literacy and healthy lifestyle behaviors and to examine the correlation between health literacy and such behaviors. Studies conducted from 2013 to 2023 exploring the association between health literacy and healthy lifestyle behaviors, as well as the impact of gender and chronic disease status on health literacy, were included. The selection criteria for the meta-analysis involved a literature search utilizing databases such as PubMed, Google Academic, Web of Science, and the National Thesis Center. The keywords "health literacy" and "healthy lifestyle behaviors" were employed, identifying 206 studies. Subsequently, 53 studies meeting predetermined criteria were deemed suitable for inclusion in the meta-analysis. The analysis of the relationship between health literacy and healthy lifestyle behaviors revealed no publication bias. Despite heterogeneity among the studies, the correlation effect size was determined to be 0.278 using the random effect model. In the meta-analysis examining the effect of gender on health literacy, no publication bias was detected. Since there was heterogeneity among the studies, the average effect size was calculated as 0.078 according to the random effect model. Regarding the meta-analysis on the effect of chronic disease status on health literacy, no publication bias was observed, and due to homogeneity between the studies, the average effect size was determined to be -0.098 using the fixed effect model. A positive yet weak relationship was identified between health literacy and healthy lifestyle behaviors. Notably, gender was a significant sociodemographic factor affecting health literacy, with higher levels observed in women. Moreover, individuals without chronic diseases exhibited higher mean health literacy scores than those with chronic diseases.

Relationship Between Serum Uromodulin as a Marker of Kidney Damage and Metabolic Status in Patients with Chronic Kidney Disease of Non-Diabetic Etiology.

Chronic kidney disease (CKD) is often associated with dyslipidemia, marked by lipid abnormalities that can worsen kidney function and increase cardiovascular risk. A promising biomarker for evaluating kidney function and metabolic status in chronic kidney disease (CKD) is serum uromodulin (sUmod). This study sought to further investigate the relationship between sUmod levels and metabolic status in non-diabetic CKD patients. A sensitive ELISA method was used to determine sUmod levels in 90 adults with obstructive nephropathy and 30 healthy controls. Kidney function was assessed using the measured glomerular filtration rate (mGFR) through renal clearance of 99mTc-diethylenetriamine penta-acetic acid, along with cystatin C levels. Additionally, glycemic and lipid statuses were evaluated. sUmod concentrations showed a significant association with High-density lipoprotein (HDL) levels. Furthermore, CKD patients with lower sUmod levels had significantly lower Apolipoprotein A-I (Apo A-I) values compared to the control group. Significant predictors of lower sUmod concentrations identified in this study were higher glycemia (B = -15.939; p = 0.003) and lower HDL cholesterol levels (B = 20.588; p = 0.019). We conclude that, in addition to being significantly reduced in CKD patients, sUmod is a potential predictor of metabolic syndrome (MS) in this population. Lower sUmod concentrations, independent of mGFR, predict lower HDL cholesterol levels and higher glycemia values.

Associations of mediterranean diet score and age-related macular degeneration in Korean elderly

BackgroundPrevious studies have reported associations between individual nutrients or specific foods and the risk of age-related macular degeneration (AMD). However, the relationship between overall dietary quality, specifically the alternative Mediterranean diet (aMED) score, and AMD remains unclear. Therefore, this study aimed to investigate the association between the aMED score, as an indicator of overall diet quality, and AMD in the Korean population.MethodsWe conducted a cross-sectional analysis using nationally representative samples of older adults aged ≥ 65 years (895 men and 1,191 women) from the Korea National Health and Nutrition Examination Survey (2017–2018). Food intake and the aMED score were estimated using 24-h recall. AMD was diagnosed by an ophthalmologist based on fundus photography. The associations of aMED score tertiles with AMD were determined using odds ratios (ORs) from multivariate logistic regressions.ResultsMultiple logistic regression analysis revealed a significantly negative association between the aMED score and AMD (adjusted ORs = 0.58; 95% confidence interval = 0.39–0.88; p-trend = 0.021) in older men after adjusting for confounding factors such as age, body mass index, family monthly income, current smoking, alcohol consumption, physical activity, chronic disease status, and energy intake. Notably, this association was exclusively observed in men, and no significant association was observed between the aMED score and AMD in women (adjusted OR = 0.88; 95% CI = 0.61–1.29; p-trend = 0.691).ConclusionsThis study’s findings suggest that a high aMED score may be associated with a reduced risk of AMD in older men. Future studies with larger sample sizes and a prospective or interventional design are required to enhance current understanding regarding the association between diet quality and AMD.

Self-efficacy as a Predictor of Self-Management Capacity in Cancer Patients

Background: Self-efficacy, a fundamental concept in psychology, reflects an individual’s confidence in their ability to accomplish specific tasks and achieve goals. It significantly influences cancer patients' coping mechanisms, treatment adherence, psychological distress management, and overall well-being. Specific Background: While existing literature highlights various aspects of self-efficacy among cancer patients, few studies comprehensively address the relationship between self-efficacy and socio-demographic variables. Knowledge Gap: There remains a paucity of research examining the interaction between self-efficacy and demographic characteristics such as age, gender, and educational attainment among cancer patients. Aims: This study aims to assess the level of self-efficacy in cancer patients and explore its correlation with socio-demographic characteristics. Results: A cross-sectional descriptive design was employed with a purposive sample of 107 cancer patients. The findings revealed that 83% of participants exhibited a high level of self-efficacy, while only 6.50% demonstrated low self-efficacy. A statistically significant association was identified between age and self-efficacy levels (P-value = 0.000). Novelty: This research is among the first to highlight the influence of age and chronic illness on self-efficacy in cancer patients while showing no significant relationships with gender, education, or social status. Implications: The study underscores the importance of promoting self-efficacy in cancer care, particularly through targeted interventions that consider age and chronic disease status. Enhancing self-efficacy can improve treatment adherence and psychological adjustment, thereby positively impacting the overall health outcomes of cancer patients. Highlights: 83% of cancer patients had high self-efficacy levels. Age significantly correlates with self-efficacy (P-value = 0.000). Self-efficacy unaffected by gender, education, or social status. Keywords: self-efficacy, cancer patients, socio-demographic characteristics, treatment adherence, psychological well-being

Improving Compliance With Valid Oxygen Prescriptions for Surgical Inpatients in a District General Hospital: A Single-Centre Quality Improvement Study.

Introduction Medical oxygen is a drug and, as such, must be correctly prescribed according to British Thoracic Society (BTS) guidelines. These guidelines state that a valid prescription must include a target oxygen saturation range, and that all inpatients should have a valid oxygen prescription. A 2008 BTS audit revealed only 32% of patients receiving oxygen had valid prescriptions, and a 2015 re-audit showed improvement to 57.5%, still below the national 95% target. Unregulated oxygen administration can lead to complications such as hypoxia, hyperoxia, and increased healthcare costs. Our quality improvement project (QIP) aimed to improve adherence to BTS guidelines on two general surgical wards at Royal Blackburn Teaching Hospital, aiming for complete adherence. Methods A quality improvement study was conducted using electronic patient records (EPRs). In the baseline audit, data was collected on patients over a one-week period. Thirty-three patients were included, with information on age, oxygen prescriptions, and Chronic Obstructive Pulmonary Disease (COPD) status recorded. Four interventions were then implemented: the addition of reminders to handover sheets, visual prompts around the ward, announcements during nursing huddles, and WhatsApp reminders to the ward doctors. A re-audit was conducted after the interventions, including 31 patients, and data was compared using the Chi-squared test. Results In the baseline audit, 18% of patients had oxygen prescribed. Following the interventions, this rose to 54.8% (χ²(1, N=64) = 9.3, p < 0.01), and as such, was statistically significant. Among patients requiring oxygen, compliance improved from 0% to 90.9%. Discussion The interventions significantly improved oxygen prescription compliance, demonstrating the effectiveness of simple, targeted measures. The inclusion of the multidisciplinary team (MDT) was crucial, as both nurses and doctors play essential roles in oxygen delivery. However, compliance remained below the BTS target of 100%. Limitations include not assessing the impact of individual interventions and analyzing only two points in time. Future audits should focus on targeting prescribers early in admissions and integrate electronic systems for automated prescription prompts. Spot audits could help ensure long-term success. Conclusion This QIP improved compliance with BTS oxygen prescribing guidelines at Royal Blackburn Teaching Hospital, from 18% to 54.8%. Engaging the MDT and using reminders increased compliance, but further efforts are needed to achieve the 100% target. Future interventions should focus on EPRintegration, ongoing education, and further audit cycles for sustained improvement.

Use of cholesterol-lowering medications in relation to risk of primary liver cancer in the Clinical Practice Research Datalink.

Although the relation between statin use and liver cancer risk has been extensively examined, few studies have examined other cholesterol-lowering medications in relation to liver cancer risk. The authors examined five classes of nonstatin medications and liver cancer risk. A nested case-control including 3719 cases and 14,876 matched controls was conducted within the Clinical Practice Research Datalink. Additional matches on type 2 diabetes and chronic liver disease were also implemented. The medications examined included cholesterol absorption inhibitors, bile acid sequestrants, fibrates, niacin, and omega-3 fatty acids. Conditional logistic regression estimated odds ratios and 95% confidence intervals. Cholesterol absorption inhibitor use was associated with reduced liver cancer risk in the overall analysis (odds ratio, 0.69; 95% confidence interval, 0.50-0.96) and in analyses based on type 2 diabetes and chronic liver disease status. Although bile acid sequestrant use was associated with increased liver cancer risk in the overall analysis (odds ratio, 5.31; 95% confidence interval, 3.53-7.97), the results of the analyses based on type 2 diabetes and chronic liver disease status were inconsistent. [Correction added on 19 August 2024, after first online publication: In the preceding sentence, the value '3.534' has been changed to '3.54'.]. No associations were observed for the other medications. Cholesterol absorption inhibitors may be associated with reduced liver cancer risk. Whether bile acid sequestrant use was associated with increased risk was only partially supported in the current study.