In more than 400 older patients with AML who could not receive myeloablative therapy, the incidence of composite complete remission was higher (66.4% vs. 28.3) and the median overall survival was ...longer (14.7 vs. 9.6 months) among patients who received azacitidine plus venetoclax (a B-cell lymphoma 2 antagonist) than among those who received azacitidine alone.
Background
In the USA, nearly 40% of adults ≥ 20 years have a body mass index (BMI) ≥ 30, and 11% of households are reported as food insecure. In adults, evidence shows women are more likely than men ...to be food insecure. Among adults with food insecurity, differences in BMI exist between men and women with women reporting higher BMI. Factors associated with this difference in BMI between genders are less understood.
Objective
The aim of this study was to assess gender differences in the relationship between food insecurity and BMI.
Design
Hierarchical models were analyzed using a general linear model by entering covariates sequentially in blocks (demographics, lifestyle behaviors, comorbidities, and dietary variables) and stratified by gender.
Participants
The sample included 25,567 adults in the USA from the National Health and Nutrition Examination Survey (NHANES), 2005–2014.
Main Measures
The dependent variable was BMI, and food insecurity was the primary predictor.
Key Results
Approximately 51% of the sample was women. Food insecure women were significantly more likely to have higher BMI compared to food secure women in the fully adjusted model after controlling for demographics (
β
= 1.79; 95% CI 1.17, 2.41); demographic and lifestyle factors (
β
= 1.79; 95% CI 1.19, 2.38); demographic, lifestyle, and comorbidities (
β
= 1.21; 95% CI 0.65, 1.77); and demographic, lifestyle, comorbidities, and dietary variables (
β
= 1.23; 95% CI 0.67, 1.79). There were no significant associations between food insecure and food secure men in the fully adjusted model variables (
β
= 0.36; 95% CI − 0.26, 0.98).
Conclusion
In this sample of adults, food insecurity was significantly associated with higher BMI among women after adjusting for demographics, lifestyle factors, comorbidities, and dietary variables. This difference was not observed among men. More research is necessary to understand this relationship among women.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We investigated interindividual differences in the rate of change of posterior vitreous detachment (PVD) stage and vitreomacular adhesion area (VMAA). Crosssectional studies demonstrated increasing ...PVD stage and decreasing VMAA with age, but population-level means may mask interindividual variation in the rate of change.
We retrospectively evaluated PVD stage and VMAA in asymptomatic eyes of subjects who underwent repeated optical coherence tomography screening for high-risk medication use or isolated retinal disease in the fellow eye. A Turnbull estimator modeled changes in the PVD stage, and linear mixed models evaluated VMAA change.
We evaluated 101 eyes of 101 subjects. Seventy-six eyes remained in the same stage. Twenty-three eyes progressed to a higher stage. Modeling of longitudinal data predicts that at age 30, time to convert to Stage 4 is 26 years; at age 40, it is 16 years; at age 50, it is 9 years; and at age 60, it is 8 years. In 37 eyes with Stage 1 partial PVD, VMAA decreased at a similar rate. The average population level decline in VMAA was 0.13 mm2/year.
Individuals vary in age at which they progress to complete PVD. In early partial PVD, VMAA decreases at a similar rate across individuals.
The Medicare-enrolled population is heterogeneous across race, ethnicity, age, dual eligibility, and a breadth of chronic health, mental and behavioral health, and disability-related conditions, ...which may be differentially impacted by the COVID-19 pandemic.
To quantify changes in all-cause mortality prior-to and in the first year of the COVID-19 pandemic across Medicare's different sociodemographic and health-condition subpopulations.
This observational, population-based study used stratified bivariate regression to investigate Medicare fee-for-service subpopulation differences in pre-pandemic (i.e., 2019 versus 2016) and pandemic-related (2020 versus 2019) changes in all-cause mortality.
All-cause mortality in the combined Medicare-Advantage (i.e., managed care) and fee-for-service beneficiary population improved by a relative 1% in the ten years that preceded the COVID-19 pandemic, but then escalated by a relative 15.9% in 2020, the pandemic's first year. However, a closer look at Medicare's fee-for-service subpopulations reveals critical differences. All-cause mortality had actually been worsening prior to the pandemic among most psychiatric and disability-related condition groups, all race and ethnicity groups except White Non-Hispanic, and Medicare-Medicaid dual-eligible (i.e., low-income) beneficiaries. Many of these groups then experienced all-cause mortality spikes in 2020 that were over twice that of the overall Medicare fee-for-service population. Of all 61 chronic health conditions studied, beneficiaries with schizophrenia were the most adversely affected, with all-cause mortality increasing 38.4% between 2019 and 2020.
This analysis reveals subpopulation differences in all-cause mortality trends, both prior to and in year-one of the COVID-19 pandemic, indicating that the events of 2020 exacerbated preexisting health-related inequities.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Study Objective. To explore the clinical characteristics of hyperglycemia in patients treated with olanzapine.
Design. Retrospective, epidemiologic survey of spontaneously reported adverse events ...related to olanzapine therapy.
Setting. Government‐affiliated drug evaluation center.
Patients. Two hundred thirty‐seven patients with olanzapine‐associated diabetes or hyperglycemia.
Intervention. One hundred ninety‐six cases from January 1994‐May 15, 2001, were identified with the United States Food and Drug Administration's MedWatch Drug Surveillance System, and 41 cases published through May 15, 2001, were identified with MEDLINE or through meeting s.
Measurements and Main Results. Of the 237 cases, 188 were new‐onset diabetes, 44 were exacerbations of preexistent disease, and 5 could not be classified. Mean patient age for newly diagnosed cases was 40.7 ± 12.9 years and male:female ratio was 1.8. Seventy‐three percent of all cases of hyperglycemia appeared within 6 months of start of olanzapine therapy. Eighty patients had metabolic acidosis or ketosis, 41 had glucose levels of 1000 mg/dl or greater, and 15 patients died. When olanzapine was discontinued or the dosage decreased, 78% of patients had improved glycemic control. Hyperglycemia recurred in 8 of 10 cases with rechallenge.
Conclusions. Number of reports, temporal relationship to start of olanzapine therapy, relatively young age, and improvement on drug withdrawal suggest that olanzapine may precipitate or unmask diabetes in susceptible patients.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Genotype-guided dosing of vitamin K antagonists Koller, Elizabeth A; Roche, Jeffrey C; Rollins, James A
The New England journal of medicine,
05/2014, Volume:
370, Issue:
18
Journal Article
Abstract Medicare is keenly aware of the secular changes in weight gain and of the nearly parallel increases in both the incidence and prevalence of type 2 diabetes throughout the U.S. population. ...The Medicare population, however, differs from the population at large because of its advanced age and frequency of comorbid conditions and/or disability. These factors affect life span as well as participation in and potential benefit from lifestyle modification and risk-factor reduction activities. Further, macrovascular disease is the greatest burden for older beneficiaries with diabetes, and its risks may antedate the appearance of hyperglycemia. Both diabetes prevention and treatment must be considered in this context. Medicare benefits focus on reduction of cardiovascular risk and mitigation of more temporally immediate complications of weight gain and glucose elevation. These preventive services and interventions are described.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Study Objective. To explore the clinical characteristics of hyperglycemia in patients treated with risperidone.
Design. Pharmacovigilance survey of spontaneously reported adverse events in ...risperidone‐treated patients, with reports of haloperidol‐associated hyperglycemia used as a control.
Setting. Government‐affiliated drug evaluation center.
Intervention. The Food and Drug Administration MedWatch surveillance program was queried (risperidone, 1993‐February 2002; haloperidol, late 1970s‐February 2002) and results pooled with published cases.
Measurements and Main Results. We identified 131 reports of risperidone‐associated hyperglycemia in addition to seven reports of patients with hyperglycemia who received combined risperidone‐haloperidol therapy and six reports of acidosis that occurred in the absence of hyperglycemia. We found 13 reports of haloperidol‐associated hyperglycemia and 11 reports of acidosis without hyperglycemia. Of the reports of risperidone‐associated hyperglycemia (monotherapy), 78 patients had newly diagnosed hyperglycemia, 46 had exacerbated preexisting diabetes, and 7 could not be classified. Mean ± SD age was 39.8 ± 17.4 years (range 8–96 yrs). Patients with new‐onset diabetes (mean ± SD age 34.8 ± 15.7 yrs) were younger than those with preexisting diabetes (mean ± SD age 48.8 ± 17.5 yrs). The overall male:female ratio was 1.5. In most patients, hyperglycemia appeared within 3 months of the start of risperidone therapy. Severity of disease ranged from mild glucose intolerance to diabetic ketoacidosis or hyperosmolar coma. Twenty‐six patients with acidosis or ketosis were reported. Four patients died.
Conclusion. Atypical antipsychotic treatment may unmask or precipitate hyperglycemia. Although such cases attributed to clozapine or olanzapine are more numerous than those associated with risperidone, the number for risperidone‐associated hyperglycemia is relatively higher than that observed with the conventional neuroleptic haloperidol.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
To explore the clinical characteristics of hyperglycemia in patients treated with quetiapine.
A pharmacovigilance survey of spontaneously reported adverse events in quetiapine-treated patients was ...conducted using reports from the U.S. Food and Drug Administration MedWatch program (January 1, 1997, through July 31, 2002) and published cases using the search terms hyperglycemia, diabetes, acidosis, ketosis, and ketoacidosis.
We identified 46 reports of quetiapine-associated hyperglycemia or diabetes and 9 additional reports of acidosis that occurred in the absence of hyperglycemia and were excluded from the immediate analyses. Of the reports of quetiapine-associated hyperglycemia, 34 patients had newly diagnosed hyperglycemia, 8 had exacerbation of preexisting diabetes mellitus, and 4 could not be classified. The mean +/- SD age was 35.3 +/- 16.2 years (range, 5-76 years). New-onset patients (aged 31.2 +/- 14.8 years) tended to be younger than those with preexisting diabetes (43.5 +/- 16.4 years, p = .08). The overall male:female ratio was 1.9. Most cases appeared within 6 months of quetiapine initiation. The severity of cases ranged from mild glucose intolerance to diabetic ketoacidosis or hyperosmolar coma. There were 21 cases of ketoacidosis or ketosis. There were 11 deaths.
Atypical antipsychotic use may unmask or precipitate hyperglycemia.
An additional 23 cases were identified since August 1, 2002, the end of the first survey, by extending the search through November 30, 2003, bringing the total to 69.
Genotype-Guided Dosing of Vitamin K Antagonists Koller, Elizabeth A; Roche, Jeffrey C; Rollins, James A ...
The New England journal of medicine,
05/2014, Volume:
370, Issue:
18
Journal Article
Peer reviewed
Open access
To the Editor:
Three articles in the December 12 issue
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3
address pharmacogenetics and dosing of coumarin anticoagulants. Because it is more usual for elderly patients to have an international ...normalized ratio (INR) outside the targeted therapeutic range and to have frank bleeding, it would be of clinical interest to know whether the authors stratified patients by age and whether coexisting conditions or the use of concomitant medications contributed to any effects related to age.
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In addition, because the frequency of polymorphisms varies according to ethnic background, it would be of clinical interest to know the differential effects of . . .
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