Background
Sleep duration has been implicated in the etiology of obesity but less is known about the association between sleep and other behavioral risk factors for cardiovascular disease.
Purpose
...The aim of this study was to examine the associations among sleep duration, chronotype, and physical activity, screen-based sedentary behavior, tobacco use, and dietary intake.
Methods
Regression models were used to examine sleep duration and chronotype as the predictors and cardiovascular risk factors as outcomes of interest in a cross-sectional sample of 439,933 adults enrolled in the UK Biobank project.
Results
Short sleepers were 45 % more likely to smoke tobacco than adequate sleepers (9.8 vs. 6.9 %, respectively). Late chronotypes were more than twice as likely to smoke tobacco than intermediate types (14.9 vs. 7.4 %, respectively). Long sleepers reported 0.61 more hours of television per day than adequate sleepers. Early chronotypes reported 0.20 fewer daily hours of computer use per day than intermediate chronotypes. Early chronotypes had 0.25 more servings of fruit and 0.13 more servings of vegetables per day than late chronotypes.
Conclusions
Short and long sleep duration and late chronotype are associated with greater likelihood of cardiovascular risk behaviors. Further work is needed to determine whether these findings are maintained in the context of objective sleep and circadian estimates, and in more diverse samples. The extent to which promoting adequate sleep duration and earlier sleep timing improves heart health should also be examined prospectively.
In this study, continuous positive airway pressure plus weight loss was no better than either one alone in reducing C-reactive protein levels in patients with obstructive sleep apnea, but ...improvements were seen in insulin resistance, triglyceride levels, and blood pressure.
Available clinical data derived largely from observational studies link obstructive sleep apnea
1
to proatherosclerotic risk factors, including insulin resistance,
2
dyslipidemia, hypertension,
3
and inflammation.
4
Obesity and obstructive sleep apnea are strongly associated.
5
–
8
Like obstructive sleep apnea, obesity is linked to insulin resistance,
6
dyslipidemia,
9
hypertension,
9
,
10
and inflammation.
10
However, the relative causal roles that obstructive sleep apnea and obesity play in these abnormalities is unclear.
6
,
11
,
12
The interrelationships between obesity and obstructive sleep apnea are complex and bidirectional, and they cannot be confidently discerned in observational studies. Randomized trials have shown the beneficial effects of weight loss on cardiovascular risk . . .
Background
To study national trends in the mastectomy rate for treatment of early stage breast cancer.
Methods
We analyzed data from the Surveillance, Epidemiology, and End Results database, ...including 256,081 women diagnosed with T1–2 N0–3 M0 breast cancer from 2000 to 2008. We evaluated therapeutic mastectomy rates by the year of diagnosis and performed a multivariable logistic regression analyses to determine predictors of mastectomy as the treatment choice.
Results
The proportion of women treated with mastectomy decreased from 40.1 to 35.6 % between 2000 and 2005. Subsequently, the mastectomy rate increased to 38.4 % in 2008 (
p
< 0.0001). Simple logistic regression models demonstrated that mastectomy rates between 2005 and 2008 were moderated by age (
p
< 0.0001), marital status (
p
= 0.0230), and geographic location (
p
< 0.0001). Multivariate logistic regression analysis found that age, race, marital status, geographic location, involvement of multiple regions of the breast, lobular histology, increasing T stage, lymph node positivity, increasing grade, and negative hormone receptor status were independent predictors of mastectomy. Additionally, multivariate analysis confirmed that women diagnosed in 2008 were more likely to undergo mastectomy than women diagnosed in 2005 (odds ratio 1.17, 95 % confidence interval 1.13 to 1.21,
p
< 0.0001).
Conclusions
There is evidence of a reversal in the previously declining national mastectomy rates, with the mastectomy rate reaching a nadir in 2005 and subsequently rising. Further follow-up to confirm this trend and investigation to determine the underlying cause of this trend and its effect on outcomes may be warranted.
Objective To assess the association between early anthropometric measurements, device-assisted feeding, and early neurodevelopment in infants with complex congenital heart diseases (CHDs). Study ...design Bayley Scales of Infant Development II were used to assess cognitive and motor skills in 72 infants with CHD at 6 and 12 months of age. Linear regression models were used to assess the association between mode of feeding and anthropometric measurements with neurodevelopment at 6 and 12 months of age. Results Of the 72 infants enrolled in the study, 34 (47%) had single-ventricle physiology. The mean Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) scores at 6 months of age were 92 ± 10 and 81 ± 14, respectively. At 12 months of age, the mean MDI and PDI scores were 94 ± 12 and 80 ± 16, respectively. Lower length-for-age z score ( P < .01) and head circumference-for-age z score ( P < .05) were independently associated with lower MDI at 6 months, and both increased hospital length of stay ( P < .01) and lower length-for-age z score ( P = .04) were associated independently with lower MDI at 12 months. Device-assisted feeding at 3 months ( P = .04) and lower length-for-age z score ( P < .05) were independently associated with lower PDI at 6 months. Both lower weight-for-age z score ( P = .04) and lower length-for-age z score ( P = .04) were associated independently with PDI at 12 months. Conclusion Neonates with complex CHD who required device-assisted feeding and those with lower weight and length and head circumference z scores at 3 months were at risk for neurodevelopmental delay at 6 and 12 months of age.
There has been a rapid shift in the modern food environment towards increased processing in foods consumed in the United States (US) and globally. The NOVA system (not an acronym) for classifying ...food on degree of processing currently has the most empirical support. Consumption of foods in the NOVA 4 category, ultra-processed foods (UPF), is a risk factor for a host of poor health outcomes including heart disease, stroke, and cancer. Despite these poor health outcomes, UPF make up 58% of calories consumed in the US. Methodologies for assessing the reinforcing and rewarding properties of these foods are necessary tools. The Becker-DeGroot-Marschak auction paradigm (BDM) is a well validated tool for measuring value and is amenable to neuromonitoring environments. To allow for the testing of hypotheses based on level of food processing, we present a picture set of 14 UPF and 14 minimally-processed foods (MPF) matched on visual properties, food characteristics (fat, carbohydrate, cost, etc.), and rated perceptual properties. Further, we report our scoring of these foods using the NOVA classification system and provide additional data from credentialed nutrition professionals and on inter-rater reliability using NOVA, a critique of the system. Finally, we provide all pictures, data, and code used to create this picture set as a tool for researchers.
Rural disparities in age-adjusted mortality are growing in the United States. While socioeconomic variables have been found to explain significant variation in life expectancy across US counties, ...previous research has not examined the role of socioeconomic variables in explaining rural mortality disparities. The purpose of this study was to quantify the rural mortality disparity after controlling for socioeconomic variables.
Recursive partitioning, or tree regression, was used to fit models predicting premature mortality across counties in the United States, adjusted for age, median income, and percent in poverty in 4 time periods (from 2004 to 2012) with and without inclusion of an urban-rural variable.
We found median income and percent in poverty explained about 50% of the variation in age-adjusted premature mortality rates across US counties in each of the four time periods. After controlling for these socioeconomic variables, rural mortality disparities largely disappeared, explaining less than 2% of the variance in premature mortality.
Addressing poverty and other socioeconomic issues should be a priority to improve health in rural communities. Interventions designed to target social determinants of health in rural areas are needed to address the growing rural mortality disparity that is largely explained by measures of poverty and income. Researchers examining rural health disparities should routinely include socioeconomic variables in their analyses.
Standard therapy for an enhancing renal mass is surgical. However, operative treatment may not be plausible in all clinical circumstances. Data on the natural history of untreated enhancing renal ...lesions is limited but could serve as a decision making resource for patients and physicians. We examined available data on the natural history of observed solid renal masses.
A Medline review of the literature was performed from 1966 to the present regarding untreated, observed, localized solid renal masses. To these data we added our institutional experience with a total of 61 lesions observed in 49 patients for a minimum of 1 year. Variables examined were initial lesion size at presentation, growth rate, duration of followup, pathological findings and progression to metastatic disease. Overall weighted mean estimates were calculated for lesion size at presentation, growth rate and followup based upon combining single institutional series with complete information.
We identified 10 reports from 9 single institutional series in the world literature regarding the natural history of untreated solid localized renal lesions. The series included 6 to 40 patients (mean 25) with a mean followup of 30 months (range 25 to 39). When combined with our institutional data, a total of 286 lesions were analyzed, of which 234 could be included in the meta-analysis. Mean lesion size at presentation was 2.60 cm (median 2.48, range 1.73 to 4.08). Meta-analysis revealed a mean growth rate of 0.28 cm yearly (median 0.28, range 0.09 to 0.86) at a mean followup of 34 months (median 32, range 26 to 39) in all series combined. Pathological confirmation was available in 46% of the cases (131 of 286) and it confirmed 92% (120 of 131) as RCC variants. Evaluable data in this subset of confirmed RCC demonstrated a mean growth rate of 0.40 cm yearly (median 0.35, range 0.42 to 1.6). Lesion size at presentation did not predict the overall growth rate (p = 0.46). Progression to metastatic disease was identified in only 1% of lesions (3 of 286) during followup.
The majority of small enhancing renal masses grow at a slow rate when observed. Although metastatic and cancer specific death are low, serial radiographic data alone are insufficient to predict the true natural history of these lesions. Therefore, physicians and patients assume a calculated risk when following these tumors. Basic biological data are needed to assess the natural history of untreated renal masses.
Objectives
To evaluate the association between a system of medication management services provided by specially trained hospital and community pharmacists (Pharm2Pharm) and rates and costs of ...medication‐related hospitalization in older adults.
Design
Quasi‐experimental interrupted time series design comparing intervention and nonintervention hospitals using a mixed‐effects analysis that modeled the intervention as a time‐dependent variable.
Setting
Sequential implementation of Pharm2Pharm at six general nonfederal acute care hospitals in Hawaii with more than 50 beds in 2013 and 2014. All five other such hospitals served as a contemporaneous comparison group.
Participants
Adult inpatients who met criteria for being at risk for medication problems (N = 2,083), 62% of whom were aged 65 or older.
Intervention
A state‐wide system of medication management services provided by specially trained hospital and community pharmacists serving high‐risk individuals from hospitalization through transition to home and for up to 1 year after discharge.
Measurements
Medication‐related hospitalization rate per 1,000 admissions of individuals aged 65 and older, adjusted for case mix; estimate of costs of hospitalizations and actual costs of pharmacist services.
Results
The predicted, case mix–adjusted medication‐related hospitalization rate of individuals aged 65 and older was 36.5% lower in the Pharm2Pharm hospitals after implementation than in the nonintervention hospitals (P = .01). The estimated annualized cost of avoided admissions was $6.6 million. The annual cost of the pharmacist services for all Pharm2Pharm participants was $1.8 million.
Conclusion
The Pharm2Pharm model was associated with an estimated 36% reduction in the medication‐related hospitalization rate for older adults and a 2.6:1 return on investment, highlighting the value of pharmacists as drug therapy experts in geriatric care.
Concerns have been raised about the potential for worse treatment outcomes because of dosimetric inaccuracies related to tumor motion and increased toxicity caused by the spread of low-dose radiation ...to normal tissues in patients with locally advanced non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy (IMRT). We therefore performed a population-based comparative effectiveness analysis of IMRT, conventional 3-dimensional conformal radiation therapy (3D-CRT), and 2-dimensional radiation therapy (2D-RT) in stage III NSCLC.
We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify a cohort of patients diagnosed with stage III NSCLC from 2002 to 2009 treated with IMRT, 3D-CRT, or 2D-RT. Using Cox regression and propensity score matching, we compared survival and toxicities of these treatments.
The proportion of patients treated with IMRT increased from 2% in 2002 to 25% in 2009, and the use of 2D-RT decreased from 32% to 3%. In univariate analysis, IMRT was associated with improved overall survival (OS) (hazard ratio HR 0.90, P=.02) and cancer-specific survival (CSS) (HR 0.89, P=.02). After controlling for confounders, IMRT was associated with similar OS (HR 0.94, P=.23) and CSS (HR 0.94, P=.28) compared with 3D-CRT. Both techniques had superior OS compared with 2D-RT. IMRT was associated with similar toxicity risks on multivariate analysis compared with 3D-CRT. Propensity score matched model results were similar to those from adjusted models.
In this population-based analysis, IMRT for stage III NSCLC was associated with similar OS and CSS and maintained similar toxicity risks compared with 3D-CRT.
Abstract
Background
Almost 60% of adults with amnestic mild cognitive impairment (aMCI) have obstructive sleep apnea (OSA). Treatment with continuous positive airway pressure (CPAP) may delay ...cognitive decline, but CPAP adherence is often suboptimal. In this study, we report predictors of CPAP adherence in older adults with aMCI who have increased odds of progressing to dementia, particularly due to Alzheimer’s disease.
Methods
The data are from Memories 2, “Changing the Trajectory of Mild Cognitive Impairment with CPAP Treatment of Obstructive Sleep Apnea.” Participants had moderate to severe OSA, were CPAP naïve, and received a telehealth CPAP adherence intervention. Linear and logistic regression models examined predictors.
Results
The 174 participants (mean age 67.08 years, 80 female, 38 Black persons) had a mean apnea–hypopnea index of 34.78, and 73.6% were adherent, defined as an average of ≥4 hours of CPAP use per night. Only 18 (47.4%) Black persons were CPAP adherent. In linear models, White race, moderate OSA, and participation in the tailored CPAP adherence intervention were significantly associated with higher CPAP use at 3 months. In logistic models, White persons had 9.94 times the odds of adhering to CPAP compared to Black persons. Age, sex, ethnicity, education, body mass index, nighttime sleep duration, daytime sleepiness, and cognitive status were not significant predictors.
Conclusions
Older patients with aMCI have high CPAP adherence, suggesting that age and cognitive impairment should not be a barrier to prescribing CPAP. Research is needed to improve adherence in Black patients, perhaps through culturally tailored interventions.
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