Background
The aim of this study is to compare metrics specific for stress‐induced hyperglycemia (SIH) with glucose for predicting ischemic stroke outcome.
Methods
This observational retrospective ...study (n = 300) included patients acutely hospitalized for ischemic stroke over a 3.8‐year period. We assessed the association between acute ischemic stroke outcome with the stress hyperglycemia ratio (SHR, relative increase in glycemia) and glycemic gap (GG, absolute increase in glycemia) using admission values and 5‐day maximum values, along with incidence of poor outcome above recognized clinical thresholds of glucose 10 mmol/L, SHR 1.14, and GG 2.5 mmol/L.
Results
At admission, only SHR was associated with outcome after adjustment for clinical covariates (odds ratio OR = 2.88; 95% CI: 1.05‐7.91; P = .041), while glucose or GG were not. Admission SHR ≥ 1.14 was also an indicator of poor outcome (39.1% vs 23.4%, P = .016), but not glucose ≥10 mmol/L or GG ≥ 2.5 mmol/L. All 5‐day maximum glucose metrics were associated with outcome, as was any SHR ≥ 1.14 (40.9% vs 20.1%, P < .001) or GG ≥ 2.5 mmol/L (42.9% vs 23.4%, P = .011), but not glucose ≥10 mmol/L. Increased comorbidity was strongly associated with worse outcome (P < .001) in all models.
Conclusions
SHR provided the best prognostic insight at admission to assess the relationship between SIH and ischemic stroke outcome. Absolute glucose levels failed to account for natural interpatient variation in background glycemia and provided little prognostic insight. To assess the impact of SIH, future interventional studies need to be designed using designated markers of SIH such as SHR in preference to absolute glucose.
摘要
背景
本研究的目的是比较应激性高血糖(SIH)特异性指标相对于葡萄糖来预测缺血性卒中结局的效果。
方法
这项观察回顾性研究(n=300)涵盖了在3.8年间因缺血性中风而急诊住院的患者。我们使用入院值和5天最大值评估急性缺血性卒中预后与应激性高血糖比率(SHR, 血糖相对升高)和血糖间隙(GG, 血糖绝对升高)之间的关系, 以及超过临床阈值葡萄糖10 mmol/L, SHR 1.14和GG 2.5 mmol/L的不良预后发生率。
结果
入院时, 经临床协变量校正后, 只有自发性高血压与预后相关(优势比OR=2.88, 95%CI:1.05~7.91, P=0.041), 而葡萄糖或GG不是。入院SHR≥1.14也是预后不良的指标(39.1%vs 23.4%, P=0.016), 葡萄糖≥10 mmol/L或GG≥2.5 mmol/L则不是。所有5天最高血糖以及SHR≥1.14(40.9%vs 20.1%, P<.001)或GG≥2.5 mmol/L(42.9%vs 23.4%, P=0.011)都与预后相关, 葡萄糖≥10 mmol/L则不是。在所有模型中, 合并症增加与较差的预后密切相关(P<0.001)。
结论
SHR在入院时提供了很好的预后判断来评估自发性高血压与缺血性卒中预后的关系。绝对血糖水平不能解释患者间背景血糖的自然变化, 也不能提供对预后的判断。为了评估自发性高血压的影响, 未来的干预性研究需要使用自发性高血压的特定标记物, 如SHR, 而不是绝对葡萄糖值。
Highlights
The impact of stress‐induced hyperglycemia on outcome is poorly reflected by absolute glucose levels.
The stress hyperglycemia ratio (SHR) biomarker discriminates between interpatient variation in normal premorbid background glycemia related to glycosylated hemoglobin and the acute relative increase in glucose related to physiological stress that truly represents stress‐induced hyperglycemia.
SHR at admission was superior to glucose in predicting ischemic stroke outcome.
There is a need for interventional studies based on SHR rather than glucose to best assess management of stress‐induced hyperglycemia.
Digital health stations offer an affordable and accessible platform for people to monitor their health; however, there is limited information regarding the demographic profile of users and the health ...benefits of this technology.
This study aimed to assess the demographic representativeness of health station users, identify the factors associated with repeat utilization of stations, and determine if the health status of repeat users changed between baseline and final health check.
Data from 180,442 health station users in Australia, including 8441 repeat users, were compared with 2014-2015 Australian National Health Survey (NHS) participants on key demographic and health characteristics. Binary logistic regression analyses were used to compare demographic and health characteristics of repeat and one-time users. Baseline and final health checks of repeat users were compared using McNemar tests and Wilcoxon signed rank tests. The relationship between the number of checks and final health scores was investigated using generalized linear models.
The demographic profile of SiSU health station users differs from that of the general population. A larger proportion of SiSU users were female (100,814/180,442, 55.87% vs 7807/15,393, 50.72%), younger (86,387/180,442, 47.88% vs 5309/15,393, 34.49% aged less than 35 years), and socioeconomically advantaged (64,388/180,442, 35.68% vs 3117/15,393, 20.25%). Compared with NHS participants, a smaller proportion of SiSU health station users were overweight or obese, were smokers, had high blood pressure (BP), or had diabetes. When data were weighted for demographic differences, only rates of high BP were found to be lower for SiSU users compared with the NHS participants (odds ratio OR 1.26; P<.001). Repeat users were more likely to be female (OR 1.37; P<.001), younger (OR 0.99; P<.001), and from high socioeconomic status areas-those residing in socioeconomic index for areas quintiles 4 and 5 were significantly more likely to be repeat users compared with those residing in quintile 1 (OR 1.243; P<.001 and OR 1.151; P<.001, respectively). Repeat users were more likely to have a higher BMI (OR 1.02; P<.001), high BP (OR 1.15; P<.001), and less likely to be smokers (OR 0.77; P<.001). Significant improvements in health status were observed for repeat users. Mean BMI decreased by 0.97 kg/m2 from baseline to final check (z=-14.24; P<.001), whereas the proportion of people with high BP decreased from 15.77% (1080/6848) to 12.90% (885/6860; χ
=38.2; P<.001). The proportion of smokers decreased from 11.91% (1005/8438) to 10.13% (853/8421; χ
=48.4; P<.001). Number of repeat health checks was significantly associated with smoking status (OR 0.96; P<.048) but not with higher BP (P=.14) or BMI (P=.23).
These findings provide valuable insight into the benefits of health stations for self-monitoring and partially support previous research regarding the effect of demographics and health status on self-management of health.
Vaccination is fast becoming a key intervention against the ongoing COVID-19 pandemic. We conducted cross-sectional online surveys to investigate COVID-19 vaccine acceptance across nine Low- and ...Middle-Income Countries (LMICs; N = 10,183), assuming vaccine effectiveness at 90% and 95%. The prevalence of vaccine acceptance increased from 76.4% (90% effectiveness) to 88.8% (95% effectiveness). Considering a 90% effective vaccine, Malaysia, Thailand, Bangladesh, and five African countries (Democratic Republic of Congo, Benin, Uganda, Malawi, and Mali) had lower acceptance odds compared to Brazil. Individuals who perceived taking the vaccine as important to protect themselves had the highest acceptance odds (aOR 2.49) at 95% effectiveness.Vaccine acceptance was also positively associated with COVID-19 knowledge, worry/fear regarding COVID-19, higher income, younger age, and testing negative for COVID-19. However, chronic disease and female gender reduced the odds for vaccine acceptance. The main reasons underpinning vaccine refusal were fear of side effects (41.2%) and lack of confidence in vaccine effectiveness (15.1%). Further research is needed to identify country-specific reasons for vaccine hesitancy in order to develop mitigation strategies that would ensure high and equitable vaccination coverage across LMICs.
Highlights • There is limited evidence on the best mortality predictor in older adults following RTA. • One in every 6 older adults involved in a RTA will die. • Pedestrians and very elderly adults ...(≥75 years) have higher mortality rates. • An urgent need for guidelines specific for older adults in LMIC.
(1) Background: Excess weight in the form of adiposity plays a key role in the pathogenesis of cardiometabolic diseases. Lifestyle modifications that incorporate continuous energy restriction (CER) ...are effective at inducing weight loss and reductions in adiposity; however, prescribing daily CER results in poor long-term adherence. Over the past decade, intermittent fasting (IF) has emerged as a promising alternative to CER that may promote increased compliance and/or improvements in cardiometabolic health parameters independent of weight loss. (2) Methods: This paper presents a secondary analysis of data from a 12-week intervention investigating the effects of a twice-weekly fast (5:2 IF; IFT group) and CER (CERT group) when combined with resistance exercise in 34 healthy participants (17 males and 17 females, mean BMI: 27.0 kg/m2, mean age: 23.9 years). Specifically, changes in cardiometabolic blood markers and ratings of hunger, mood, energy and compliance within and between groups were analysed. Dietary prescriptions were hypoenergetic and matched for energy and protein intake. (3) Results: Both dietary groups experienced reductions in total cholesterol (TC; mean reduction, 7.8%; p < 0.001), low-density lipoprotein cholesterol (LDL-C; mean reduction, 11.1%; p < 0.001) and high-density lipoprotein cholesterol (mean reduction 2.6%, p = 0.049) over the 12 weeks. Reductions in TC and LDL-C were greater in the IFT group after adjustment for baseline levels and change in weight. No significant changes in markers of glucose regulation were observed. Both groups maintained high levels of dietary compliance (~80%) and reported low levels of hunger over the course of the intervention period. (4) Conclusions: Secondary data analysis revealed that when combined with resistance training, both dietary patterns improved blood lipids, with greater reductions observed in the IFT group. High levels of compliance and low reported levels of hunger throughout the intervention period suggest both diets are well tolerated in the short-to-medium term.
This study examines the 20-year trend of suicide in 46 Muslim-majority countries throughout the world and compares their suicide rates and trends with the global average. Ecological-level ...associations between the proportion of the Muslim population, the age-standardized suicide rates, male-to-female suicide rate ratio, and the Human Development Index (HDI) in 2019 were examined.
Age-standardized suicide rates were extracted from the WHO Global Health Estimates database for the period between 2000 and 2019. The rates in each country were compared with the age-standardized global average during the past 20 years. The countries were further grouped according to their regions/sub-regions to calculate the regional and sub-regional weighted age-standardized suicide rates involving Muslim-majority countries. Correlation analyses were conducted between the proportion of Muslims, age-standardized suicide rate, male: female suicide rate ratio, and the HDI in all countries. Joinpoint regression was used to analyze the age-standardized suicide rates in 2000-2019.
The 46 countries retained for analysis included an estimated 1.39 billion Muslims from a total worldwide Muslim population of 1.57 billion. Of these countries, eleven (23.9%) had an age-standardized suicide rate above the global average in 2019. In terms of regional/sub-regional suicide rates, Muslim-majority countries in the Sub-Saharan region recorded the highest weighted average age-standardized suicide rate of 10.02/100,000 population, and Southeastern Asia recorded the lowest rate (2.58/100,000 population). There were significant correlations between the Muslim population proportion and male-to-female rate ratios (r=-0.324, p=0.028), HDI index and age-standardized suicide rates (r=-0.506, p<0.001), and HDI index and male-to-female rate ratios (r=0.503, p<0.001) in 2019. Joinpoint analysis revealed that seven Muslim-majority countries (15.2%) recorded an increase in the average annual percentage change regarding age-standardized suicide rates during 2000-2019.
Most Muslim-majority countries had lower age-standardized suicide rates than the global average, which might reflect religious belief and practice or due to Muslim laws in their judicial and social structure which may lead to underreporting. This finding needs further in-depth country and region-specific study with regard to its implication for public policy.
Polypharmacy, defined as the concurrent use of multiple medications, is a growing concern globally. This study aimed to identify the significant factors that predict the perceived burden of ...medication and health-related quality of life.
Adults, aged 18 years and above who have used at least two regular medicines, were invited to complete the study questionnaires between June and October 2019. Multiple linear regression analysis was conducted to identify significant predictors for perceived burden of medication and health-related quality of life.
A total of 119 participants completed this study. The average age of the participants was 63 years (SD±16 years). Factors significantly predicting perceived burden of medication were participants' current health condition (p = 0.001), overall burden of treatment (p<0.001) and being hypertensive (p = 0.037). Similarly, participants' current health condition (p<0.001) and overall burden of treatment (p = 0.086) were significant predictors for perceived health-related quality of life.
This study revealed that hypertensive participants in poor health tended to experience higher perceived burden of medication, which in turn was found to be correlated with lower perceived health-related quality of life.
What is already known about this topic:
Suicide is the leading cause of death among people aged 15-24 years in Australia.
International students are at high risk for developing suicide ideation ...because of their exposure to stressors connected to living abroad.
Stressful life events are associated with risk for suicidal ideation in Asian international students studying in universities in Australia. However, there is little empirical research that has explored moderators that may buffer against the adverse effects of such stressors in international students.
What this topic adds:
Compared to Asian international students who feel less socially connected, those who feel more socially connected feel less suicidal even when experiencing a high level of stressful life events.
Compared to Asian international students who use less problem focused coping skills, those who use more problem focused coping skills feel less suicidal even when experiencing a high level of stressful life events.
Social support, involvement in one's university campus, and problem focused coping skills act as a buffer against the effects of stressful life events on suicidal ideation in Asian international students.
Stressful life events have been identified as risk factors for suicidal ideation in students. However, little research has explored the extent to which such events constitute a risk for suicidal ideation in Asian international students living in Australia. Even fewer studies have explored variables that moderate the relationship between stressful life events and suicidal ideation in this cohort.
One hundred and thirty-eight such students were asked to complete a battery of online questionnaires measuring experiences of stressful life events, loneliness, campus connectedness, coping strategies and suicidal ideation.
Regression analyses indicated that the relationship between stress and suicidal ideation was moderated by lower levels of loneliness, higher levels of campus connectedness and problem-focused coping.
These findings emphasise factors to be addressed in suicide prevention for Asian international students studying in Australia.
Staff working in residential aged care facilities face unique challenges and stressors in their workplaces which increase their risk for occupational burnout. Burnout in this workforce results in low ...job satisfaction, increased levels of absenteeism and poor retention rates. Given Australia's ageing population and the demand for residential aged care staff, it is imperative to explore predictors of burnout in this cohort in order to help staff prevent and manage burnout.
This study examined the extent to which co-worker and supervisor support, self-confidence and adaptive coping skills predicted burnout among residential aged care staff, after controlling for staff demographics, organisational climate and work patterns. One hundred and thirty three residential aged care staff across Australia were surveyed using online questionnaires measuring levels of co-worker and supervisor support, self- confidence, adaptive coping skills and burnout.
Regression analyses indicated that, overall, co-worker and supervisor support, self-confidence, and adaptive coping predicted each dimension of burnout (emotional exhaustion, depersonalization and personal accomplishment). After controlling for covariates and other predictors: confidence significantly predicted all three dimensions; support significantly predicted emotional exhaustion and depersonalization, and adaptive coping significantly predicted emotional exhaustion.
These findings suggest that co-worker and supervisor support, self- confidence and adaptive coping skills need to be addressed to prevent and manage occupational burnout for residential aged care staff in Australia.
There is a need to understand the psychological characteristics of suicide attempters to prevent future suicide attempts. This study aims to examine potential differences between individuals who have ...attempted suicide and those who have not done so, on several risk and protective measures.
Participants were 11,806 undergraduate students from seven provinces in China, of which 237 reported a non-fatal suicide attempt. We used the random numbers generator function within the SPSS to randomly select a control subset of 1185 participants to be used as the comparison group based on a 1:5 case-control ratio. Scores on three commonly used risk measures (depression, hopelessness, and psychache) and three protective measures (social support, self-esteem, and purpose in life) for suicidality were adopted to compare the responses of the two groups.
Suicide attempters had indicated higher Median scores for all three risk factor measurements. Suicide attempters also reported significantly lower Median scores for all three protective factor measurements compared to non-suicide attempters. The results suggest that the suicide attempters' group had higher risks of suicidality compared to the non-attempter group.
Suicide attempters continued to report higher scores of risk factors and lower scores of protective factors, indicating that they may continue to be at a higher likelihood of a suicide attempt. Key protective factors should be identified for each individual in order to deliver appropriate clinical interventions to reduce their risk of reattempting.
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