Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors in improvement of fatty liver index in patients with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease: A retrospective nationwide claims database study in Japan.

AIM: To date, there are limited clinical studies and real-world evidence investigating whether sodium-glucose cotransporter-2 inhibitors (SGLT2i) are associated with improved hepatic steatosis. This study aimed to evaluate the effectiveness of SGLT2i compared with that of dipeptidyl peptidase-4 inhibitors (DPP4i) in improving the fatty liver index (FLI) in patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD). MATERIALS AND METHODS: This retrospective cohort study included new users of SGLT2i or DPP4i with T2DM and MASLD from a large claims database (JMDC Claims Database). The primary outcome was the incidence of improvement of the FLI. Cox proportional hazard models, weighted using propensity scores for predicting the initiation of treatment, were fitted to estimate hazard ratios with 95% confidence intervals (CIs). Time-course changes in the FLI values were also assessed. RESULTS: This study included 9127 SGLT2i and 12 286 DPP4i initiators. SGLT2i showed a higher incidence of improvement in the FLI (≥30%, ≥40% and ≥50% reduction from baseline FLI) compared with DPP4i, and the weighted hazard ratios were 1.27 (95% CI 1.18-1.38), 1.24 (95% CI 1.13-1.37) and 1.19 (95% CI 1.05-1.33), respectively. SGLT2i indicated a greater decreased in FLI values compared with DPP4i at up to 3 years of the follow-up period. CONCLUSION: SGLT2is use appeared to be associated with a greater improvement of the FLI than DPP4i use in patients with T2DM and MASLD. In the absence of direct head-to-head comparisons from clinical studies, our study, using real-world data, may support physicians' decision-making in clinical practice.

Impact of beta blockers on resting respiratory rate in older adults: A cross-sectional study.

[Purpose] Beta blockers, commonly prescribed for older adults, affect heart rates and blood pressure and may reduce respiratory rates, which are used to evaluate patient status and predict outcomes. However, limited clinical evidence is available on the impact of beta blockers on respiratory rates. This study aimed to investigate the impact of beta blockers on respiratory rates in older adults. [Methods] This cross-sectional study included patients aged ≥60 years who underwent an annual checkup. Patients were excluded if they had a diagnosis of severe heart failure, chronic obstructive pulmonary disease, interstitial pneumonitis, severe anemia, or neurodegenerative disease. Doubly robust estimation with inverse probability weighting was applied to estimate the mean differences between beta blocker users and non-users. The dose-response relationship between the administered beta blockers and respiratory rates was examined using multivariable regression models. [Results] Of 637 participants, 108 had received beta blockers regularly. The adjusted mean differences (95% confidence interval, CI) in respiratory rates, pulse rates, systolic blood pressure, and diastolic blood pressure between beta blocker users and non-users were 0.35 (-0.68 to 1.37), -3.56 (-6.34 to -0.78), -5.53 (-8.53 to -2.52), and -4.70 (-8.27 to -1.14), respectively. The adjusted mean differences (95% CI) in respiratory rates per 1 mg of a carvedilol equivalent dose in all beta blocker users, liposoluble beta blocker users, and carvedilol users were -0.10 (-0.18 to -0.02), -0.35 (-0.59 to -0.11), and -0.29 (-0.54 to -0.06), respectively. [Conclusions] Beta blockers may dose-dependently reduce the respiratory rates of older adults. However, in clinical settings, the impact of beta-blocker use or non-use on the respiratory rate may not occur at a clinically important level. Clinicians should note the potentially suppressive impact of beta blockers on respiratory rates according to the situation.

Resting respiration rate predicts all-cause mortality in older outpatients.

BACKGROUND: Although respiratory rate has been a sensitive predictor for prognosis in acute settings, resting respiratory rate (RRR) is undervalued in chronic care. The clinical significance of RRR among older people is not well documented. AIM: We investigated the association between RRR and all-cause mortality among older outpatients. METHODS: A retrospective cohort study exhaustively included patients who had undergone medical checkups in a facility between April 2017 and March 2018 and followed up for at least 2 years. We excluded patients who were less than 60 years of age or had not undergone regular outpatient appointments. Sex, age, smoking habits, history of hospitalization, polypharmacy, long-term care insurance certification status, Mazzaglia index, pulse rate, systolic blood pressure, and Charlson Comorbidity Index were measured at the baseline medical checkup. Survival was confirmed by chart review and by contacting physicians in charge. The risk ratios were estimated by converting the odds ratios derived from the multivariable logistic regression models. RESULTS: Of the 853 patients who underwent baseline checkups, 749 were enrolled in the analyses; death occurred in 53 patients (7.1%), with no loss to follow-up. The RRR was independently associated with all-cause mortality after adjusting for covariates [adjusted risk ratio of RRR per 1 bpm = 1.14, 95% confidence interval (CI): 1.06 - 1.22]. DISCUSSION: Given the independent association of RRR for existing predictors, this simple index seems worthy of consideration in further studies aimed at defining its predictive role in older people and in different settings. CONCLUSION: RRR was independently associated with all-cause mortality.

Factors associated with the frequency of respiratory rate measurement by hospital nurses: a multicentre cross-sectional study.

BACKGROUND: Although the respiratory rate (RR) is a sensitive predictor of patient deterioration, it is often neglected. Moreover, only a few studies have investigated the factors that cause health professionals to disregard RR. AIMS: This cross-sectional study aimed to elucidate the factors affecting the frequency of RR measurement by the nurses. METHODS: An original questionnaire, comprising 18 factors extracted from previous studies, was administered to nurses from nine hospitals. FINDINGS: Of the 644 eligible nurses, 592 (92%) completed the questionnaire. The adjusted odds ratios and 95% confidence intervals of the factors of importance, educational experiences, shortened-count method use, negative experiences, and inconvenience were 2.24 (1.13-4.45), 2.26 (1.20-4.26), 0.61 (0.42-0.91), 0.45 (0.29-0.70), and 0.41 (0.26-0.65), respectively. CONCLUSION: Education, feedback systems, and automation are the primary issues that need attention. Prioritising these factors could provide a practical guide for optimising the frequency of RR measurement.

Timing of Initiation of Xanthine Oxidase Inhibitors Based on Serum Uric Acid Level Does Not Predict Renoprognosis in Patients with Preserved Kidney Function.

Background: Despite recent evidence of remaining possibility that early initiation of xanthine oxidase inhibitors (XOIs) is beneficial in renoprognosis for patients with stage 2 or less chronic kidney disease (CKD), no evidence is available regarding the difference in renoprognosis based on serum uric acid (sUA) levels at the initiation of XOIs among patients with preserved kidney function. Methods: New XOI initiators were divided into quartiles based on baseline sUA. Primary outcome was the composite incidence of a significant estimated glomerular filtration rate (eGFR) decline (≥40% decline in eGFR from baseline or development of eGFR <30 mL/1.73 m2/min) or all-cause death within 5 years. Results: After excluding inapplicable patients, 1170 XOI initiators were analyzed (mean ± standard deviation age: 68 ± 14.3 years; sUA: 10.6 ± 1.15 mg/dL). On overall median [interquartile range (IQR)] follow-up of 824 (342, 1576) days, incidence rate of the primary outcome was 287 per 1000 person-years for 5 years. Although the nonadjusted model showed a dose-response association between baseline sUA level and the outcome, the adjusted model showed no significant association. Adjusted hazard ratios (95% confidence interval) of the second, third, and fourth quartiles of baseline sUA with the composite outcome within 5 years compared to the first quartile were 1.00 (0.78, 1.29), 1.00 (0.80, 1.30), and 1.02 (0.80, 1.32), respectively. Conclusions: Early initiation of XOIs did not predict a significant benefit on renoprognosis even among the population with preserved kidney function. The validity of initiating XOIs with the aim of improving renoprognosis based on sUA is questionable.

Longitudinal Association of Working From Home on Work Functioning Impairment in Desk Workers During COVID-19 Pandemic: A Nationwide Cohort Study.

OBJECTIVE: This study clarifies the longitudinal association between working from home and work functioning impairment among desk workers. METHODS: Nationwide surveys were conducted from 2020 to 2022, analyzing 3532 desk workers who never worked from home before the COVID-19 pandemic. RESULTS: The adjusted hazard ratio (95% confidence intervals) of working from home at least once a month or more with the composite result (incidence of work functioning or reduced work participation) was 1.22 (1.04-1.43). The cause-specific hazard ratios of work functioning impairment and reduced work participation were 1.30 (1.04-1.61) and 1.13 (0.86-1.47). CONCLUSIONS: Working from home could be longitudinally associated with work functioning impairment, especially for workers who are in higher positions. Workers and policy makers should be aware of the potential risk of working from home regarding presenteeism.

Strong chu-hai, a Japanese ready-to-drink high-alcohol-content beverage, and hazardous alcohol use: A nationwide cross-sectional study.

BACKGROUND: A new ready-to-drink premixed high-alcohol-content beverage, called strong chu-hai, was launched in Japan, and more recently, in Taiwan and Australia. We aimed to examine the popularity and association of strong chu-hai with individual alcohol use, both of which remained unclear. METHODS: We conducted a cross-sectional study using data from the Japan "Society and New Tobacco" Internet Survey conducted from February 1 to 28, 2022, in Japan. We enrolled 27,993 respondents (aged 15 to 81 years; male 48.5%), including 15,083 current alcohol users. Using inverse probability weighting of data from the 2016 Comprehensive Survey of Living Conditions on Health and Welfare, we estimated the weighted proportions of strong chu-hai users among all respondents and constructed multivariable logistic regression models to estimate the weighted odds ratios (OR) and 95% confidence intervals (CI) of strong chu-hai use for hazardous and harmful alcohol use, defined as a score ≥8 of the Alcohol Use Disorder Identification Test, among current alcohol users. RESULTS: Among all respondents, 56.2% (weighted proportions: past, 35.9%; and current, 20.3%) drank strong chu-hai. Among drinkers, both past and current strong chu-hai use, compared to never use, were associated with hazardous and harmful alcohol use (past, OR 1.73, 95% CI 1.42 to 2.12; current, OR 2.19, 95% CI 1.79 to 2.69). CONCLUSIONS: Our study found that more than half of the respondents experienced strong chu-hai consumption, suggesting that it is widely used in Japan. In addition, both past and current strong chu-hai use were associated with hazardous and harmful alcohol use among current alcohol users.

Association Between Paid Work and Health-Related Quality of Life Among Community-Dwelling Older Adults: The Sukagawa Study.

In this study, we aimed to determine whether paid work has an impact on health-related quality of life (HRQOL) among older adults. Over three years, we longitudinally collected data from 5,260 community-dwelling older adults aged 75 years or older from a city in Japan. We assessed HRQOL using the Short-Form-8. We estimated the mean difference between the physical component summary (PCS) and the mental component summary (MCS) scores, which were stratified based on gender using multivariate, generalized estimating equation models. We further conducted a subgroup analysis based on the participants' occupational backgrounds. Engagement in paid work was associated with increased MCS scores across both genders and with increased PCS scores among women. In the subgroup analysis, only women who had previously worked as managerial workers showed an inverse association with MCS scores. In this population, engagement in paid work may be a crucial factor associated with well-being.

Differences in attitude toward COVID-19 based on internet and social media usage among community-dwelling older adults during the first state of emergency.

AIM: In order to understand the digital divide among older adults during the coronavirus disease 2019 (COVID-19) pandemic, we investigated the association between internet use and compliance with COVID-19 preventive behaviors during the first state of emergency in Japan. METHODS: A total of 8952 community-dwelling citizens aged 75 years and above were asked about their preventive behaviors during the first state of emergency using a paper-based questionnaire. Among them, 51% responded and were divided into internet users and non-users. We used multivariable logistic regression models to estimate the adjusted odds ratios and 95% confidence intervals of internet use for compliance with preventive behaviors. RESULTS: Approximately 40% of the respondents used the internet, and 9.29% used social media to collect COVID-19-related information. Internet usage was independently associated with compliance with using hand sanitizers, avoiding going out, avoiding eating out, avoiding traveling, getting vaccinated, and getting tested for COVID-19; the adjusted odds ratios (95% confidence intervals) were 1.21 (1.05-1.38), 1.19 (1.04-1.37), 1.20 (1.05-1.38), 1.32 (1.15-1.52), 1.30 (1.11-1.53), and 1.23 (1.07-1.41), respectively. Exploratory subgroup analyses demonstrated that social media users might have shown early adaptation to newly recommended preventive behaviors during the first state of emergency. CONCLUSIONS: Results suggest that a digital divide exists, as evidenced by the varied compliance with preventive behaviors depending on internet use. Additionally, social media use may be associated with early adaptation to newly recommended preventive behaviors. Therefore, future studies regarding the digital divide among older adults should investigate differences depending on the types and content of internet resources. Geriatr Gerontol Int 2023; 23: 289-296.

Incorporating Medical Supply and Demand into the Index of Physician Maldistribution Improves the Sensitivity to Healthcare Outcomes.

BACKGROUND: Since the association between disparity in physician distribution and specific healthcare outcomes is poorly documented, we aimed to clarify the association between physician maldistribution and cerebrovascular disease (CeVD), a high-priority health outcome in Japan. METHODS: In this cross-sectional study, we conducted multivariable regression analysis with the Physician Uneven Distribution Index (PUDI), a recently developed and adopted policy index in Japan that uniquely incorporates the gap between medical supply and demand, as the independent variable and CeVD death rate as the dependent variable. Population density, mean annual income, and prevalence of hypertension were used as covariates. RESULTS: The coefficient of the PUDI for the CeVD death rate was -0.34 (95%CI: -0.49--0.19) before adjusting for covariates and was -0.19 (95%CI: -0.30--0.07) after adjusting. The adjusted R squared of the analysis for the PUDI was 0.71 in the final model. However, the same multivariable regression model showed that the number of physicians per 100,000 people (NPPP) was not associated with the CeVD death rates before or after adjusting for the covariates. CONCLUSION: Incorporating the gap between the medical supply and demand in physician maldistribution indices could improve the responsiveness of the index for assessing the disparity in healthcare outcomes.

Contrasting characters of quick methods to measure respiratory rate in a clinical setting.

INTRODUCTION: Many medical professionals unofficially use quick methods for saving time. However, the evidence of such assessments is limited. The main aim of this article is verifying the agreement of these methods. OBJECTIVES: Overall, 106 out-patients were simultaneously evaluated with respect to the respiratory time measurement (RTM; 60 divided by the single respiratory time), 15 seconds period quadruple respiratory rate (15secRR; 15 seconds respiratory rate multiplied by 4), and 1-min respiratory rate (1minRR; gold standard respiratory rate). METHOD: We assessed the correlation, Bland-Altman plot, kappa value, and normalized root mean square error of the quick methods for the respiratory rate, with 1minRR as the gold standard. RESULTS: The mean ± SD of 1minRR, RTM, and 15secRR are 20.4 ± 5.6, 19.1 ± 5.7, and 21.4 ± 6.5 breathes per minute, respectively. The correlation between RTM and 1minRR was 0.85 (95% confidence interval [95% CI]: 0.79-0.90), while that between 15secRR and 1minRR was 0.81 (95% CI: 0.74-0.87). The kappa coefficients between RTM and 1minRR, between 15secRR and 1minRR, and between RTM and 15secRR were 0.57 (95% CI: 0.41-0.72), 0.59 (95% CI: 0.43-0.74), and 0.37 (95% CI: 0.20-0.53), respectively. The normalized root mean square error between RTM and 1minRR was 16.9% and that between 15secRR and 1minRR was 15.0%. The Bland Altman plot demonstrated that RTM and 15secRR showed contrasting characteristics. CONCLUSION: Compared to the gold standard, RTM tends to underestimate, while 15secRR tends to overestimate the respiratory rate. Therefore, health care professionals should be aware of this methodological tendency to assess vital signs properly.

Aging is independently associated with an increasing normal respiratory rate among an older adult population in a clinical setting: A cross-sectional study.

AIM: Clinical prediction scores for older patients are inaccurate, partially because they do not account for the effects of aging on the respiratory rate. The principal aim of the present study was to assess the effects of aging on the normal respiratory rate in older patients in a clinical setting. METHODS: We recruited 634 participants aged >59 years to <100 years who presented to our hospital (Iwakuni Municipal Miwa Hospital, for regular appointments without any new symptoms. We assessed the relationship between age and respiratory rate using Pearson's correlation coefficient and the Jonckheere-Terpstra test. We carried out multiple linear regression analysis, with sex, age, blood pressure, heart rate and 14 comorbidities as dependent variables, and respiratory rate as the independent variable. RESULTS: The mean ± standard deviation respiratory rate for all for all participants was 16.1 ± 4.28. The mean ± standard deviation respiratory rates for individuals aged in their 60s, 70s, 80s and 90s were 14.8 ± 4.28, 15.5 ± 3.62, 16.37 ± 4.48 and 17.1 ± 4.45, respectively. Pearson's correlation coefficient between age and respiratory rate was 0.17 (95% confidence interval 0.10-0.25). The Jonckheere-Terpstra test and multiple linear regression analysis showed a significant positive trend between age group and respiratory rate (P < 0.001). CONCLUSIONS: Although the correlation coefficient between age and respiratory rate was low (R = 0.17), aging was a statistically significant factor in determining the normal respiratory rate in older patients. Furthermore, the respiratory rate increased with age. Geriatr Gerontol Int 2019; 19: 1179-1183.

Duloxetine and Angiotensin II Receptor Blocker Combination Potentially Induce Severe Hyponatremia in an Elderly Woman.

We encountered a case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) caused by duloxetine, serotonin and norepinephrine reuptake inhibitor (SNRI). A 74-year-old woman complaining of severe lethargy was transferred to our emergency department. Her serum sodium level was 109 mEq/L. Plasma hypo-osmolality with urine normo-osmolality was observed, indicating SIADH. Her essential hypertension had long been treated with telmisartan, and she had just started duloxetine 20 mg/day for chronic musculoskeletal pain 4 days prior to admission. On prescribing duloxetine in the primary care setting, clinicians should be aware of the possibility of duloxetine-induced hyponatremia, particularly in combination with telmisartan.

A Comparison of Methods to Count Breathing Frequency.

BACKGROUND: Counting breaths for a full minute for all patients to determine breathing frequency could result in excessive work load for many medical staff. The aim of this study was to verify the agreement of 2 quick screening methods with counting breaths for a full minute. METHODS: We conducted a cross-sectional study to compare the breathing frequency estimates from a 15-s period multiplied by 4 (15-s quadruple) and a value which is 60 divided by the time measured for a single breath (ie, breathing time measurement) against counting breaths for a full minute. Subjects of this study included 58 nurses; 1 nurse acted as the patient, and 57 nurses counted the patient's breathing frequency using each of the 3 methods. Each nurse examiner performed the breathing time measurement, the 15-s quadruple method, and the 1-min breath count, in that order. We performed correlation and Bland-Altman analyses between the 15-s quadruple and 1-min breath count methods, and between the breathing time measurement and 1-min breath count methods. Using paired t tests, we compared the absolute difference between the 15-s quadruple and the 1-min breath count methods to the absolute difference between the breathing time measurement and the 1-min breath count methods. RESULTS: The coefficient of correlation between the 15-s quadruple and 1-min breath count was 0.83, while the coefficient of correlation between the breathing time measurement and 1-min breath count methods was 0.90. Brand-Altman analysis indicated that the bias of 15-s quadruple method to the 1-min breath count method was -2.1 ± 2.9 SD, and the limit of agreement was ±5.6; the bias of the breathing time measurement method to the 1-min breath count method was 0.5 ± 2.6 SD, and the limit of agreement was ±5.0. There were statistically significant differences between the 15-s quadruple and 1-min breath count methods and between the breathing time measurement and 1-min breath count methods (P < .001). CONCLUSIONS: The breathing time measurement method had better agreement with the 1-min breath count method than did the 15-s quadruple method in this study setting.