The Association between Habitual Sleep Duration and Sleep Quality with Glycemic Traits: Assessment by Cross-Sectional and Mendelian Randomization Analyses.

Evidence on whether habitual sleep duration and sleep quality are associated with increased insulin resistance is inconsistent. Here, we investigated the associations between different measures of habitual sleep with glycemic traits through cross-sectional and Mendelian randomization (MR) analyses. We assessed the associations of sleep duration and sleep quality with glycemic traits using multivariable linear regression models adjusted for potential confounders in 4672 middle-aged (45-65 years; 48% men) nondiabetic participants of the Netherlands Epidemiology of Obesity (NEO) study. Genetic variants for total, short, and long sleep duration were used as instrumental variables in MR analyses using summary-level data of glycemic traits in nondiabetic individuals (MAGIC; n = 58,074). In cross-sectional analyses, shortest sleepers (median 5.0 h of sleep per night) had 14.5% (95% confidence interval (CI): 2.0; 28.6%) higher fasting insulin level and 16.3% (95% CI: 2.7; 31.7%) higher HOMA-ß. Bad sleep quality was associated with higher insulin resistance (e.g., 14.3% (95% CI: 4.7; 24.9%) higher HOMA-IR). All these associations disappeared after adjustment for BMI and the risk of sleep apnea. MR analyses did not indicate a causal association between total, short or long sleep duration and glycemic traits. Therefore, our used measures of habitual sleep duration and sleep quality are unlikely to directly associate with insulin resistance.

Assessment of maximal handgrip strength: how many attempts are needed?

BACKGROUND: Handgrip strength (HGS) is used to identify individuals with low muscle strength (dynapenia). The influence of the number of attempts on maximal HGS is not yet known and may differ depending on age and health status. This study aimed to assess how many attempts of HGS are required to obtain maximal HGS. METHODS: Three cohorts (939 individuals) differing in age and health status were included. HGS was assessed three times and explored as continuous and dichotomous variable. Paired t-test, intraclass correlation coefficients (ICC) and Bland-Altman analysis were used to test reproducibility of HGS. The number of individuals with misclassified dynapenia at attempts 1 and 2 with respect to attempt 3 were assessed. RESULTS: Results showed the same pattern in all three cohorts. Maximal HGS at attempts 1 and 2 was higher than at attempt 3 on population level (P < 0.001 for all three cohorts). ICC values between all attempts were above 0.8, indicating moderate to high reproducibility. Bland-Altman analysis showed that 41.0 to 58.9% of individuals had the highest HGS at attempt 2 and 12.4 to 37.2% at attempt 3. The percentage of individuals with a maximal HGS above the gender-specific cut-off value at attempt 3 compared with attempts 1 and 2 ranged from 0 to 50.0%, with a higher percentage of misclassification in middle-aged and older populations. CONCLUSIONS: Maximal HGS is dependent on the number of attempts, independent of age and health status. To assess maximal HGS, at least three attempts are needed if HGS is considered to be a continuous variable. If HGS is considered as a discrete variable to assess dynapenia, two attempts are sufficient to assess dynapenia in younger populations. Misclassification should be taken into account in middle-aged and older populations.

Prediction of 90-day mortality in older patients after discharge from an emergency department: a retrospective follow-up study.

BACKGROUND: Older people frequently attend the emergency department (ED) and have a high risk of poor outcome as compared to their younger counterparts. Our aim was to study routinely collected clinical parameters as predictors of 90-day mortality in older patients attending our ED. METHODS: We conducted a retrospective follow-up study at the Leiden University Medical Center (The Netherlands) among patients aged 70 years or older attending the ED in 2012. Predictors were age, gender, time and way of arrival, presenting complaint, consulting medical specialty, vital signs, pain score and laboratory testing. Cox regression analyses were performed to analyse the association between these predictors and 90-day mortality. RESULTS: Three thousand two hundred one unique patients were eligible for inclusion. Ninety-day mortality was 10.5 % for the total group. Independent predictors of mortality were age (hazard ratio [HR] 1.06, 95 % confidence interval [95 % CI] 1.04-1.08), referral from another hospital (HR 2.74, 95 % CI 1.22-6.11), allocation to a non-surgical specialty (HR: 1.55, 95 % CI 1.13-2.14), increased respiration rate (HR up to 2.21, 95 % CI 1.25-3.92), low oxygen saturation (HR up to 1.96, 95 % CI 1.19-3.23), hypothermia (HR 2.27, 95 % CI 1.28-4.01), fever (HR 0.43, 95 % CI 0.24-0.75), high pain score (HR 1.55, 95 % CI 1.03-2.32) and the indication to perform laboratory testing (HR 3.44, 95 % CI 2.13-5.56). CONCLUSIONS: Routinely collected parameters at the ED can predict 90-day mortality in older patients presenting to the ED. This study forms the first step towards creating a new and simple screening tool to predict and improve health outcome in acutely presenting older patients.

[Comprehensive geriatric assessment: unfeasible and undesirable]. / Uitgebreide geriatrische assessment: nu onhaalbaar en ongewenst.

The new clinical practice guideline on Comprehensive Geriatric Assessment (CGA) issued by the Dutch Geriatrics Society aims to optimise the diagnostic strategy in secondary care geriatric patients in order to achieve a treatment plan that will retain self-reliance and quality of life of these patients for as long as possible. An extensive listing of all somatic, psychological and social factors that could affect the health and welfare of all frail patients forms the basis of this guideline. This is actually an essential goal for any patient, regardless of age and condition. Knowledge of the optimal diagnostic tests and therapy for elderly patients, and a financial evaluation of such assessments are still lacking. Moreover, it remains to be seen if such a thorough assessment by a medical specialist is feasible and desired. The authors suggest using the proposed CGA as a starting point for a broad discussion between geriatric specialists, other medical specialists and general practitioners before implementing this as a general guideline.

Reproducibility of wall shear stress assessment with the paraboloid method in the internal carotid artery with velocity encoded MRI in healthy young individuals.

PURPOSE: To verify whether wall shear stress (WSS) can be assessed in a reproducible manner using automatic model-based segmentation of phase-contrast MR images by determination of flow volume and maximum flow velocity (Vmax) in cross-sections of these vessels. MATERIALS AND METHODS: The approach is based on fitting a 3D paraboloid to the actual velocity profiles and on determining Vmax. WSS was measured in the internal carotid arteries of two groups of healthy young volunteers. The reproducibility of rescanning and repositioning was studied in the first group. In the second group a 1-week and a 1-month interval was investigated. Reproducibility was calculated by the intraclass correlation (ICC). RESULTS: The flow volume, Vmax, and WSS averaged over the cardiac cycle were found to be 287.8 +/- 29.7 mL/min, 37.0 +/- 4.6 cm/s, and 1.13 +/- 0.16 Pa, respectively. The diastolic WSS varied between 1.00 +/- 0.21 Pa without averaging to 0.88 +/- 0.16 Pa with temporal and spatial averaging. Systolic WSS was 1.67 +/- 0.33 Pa without averaging and 1.67 +/- 0.25 Pa with averaging. ICC varied between 0.58 and 0.87 without averaging and between 0.75 and 0.90 with averaging for WSS. CONCLUSION: WSS in MR images of the internal carotid artery can be assessed semiautomatically with good to excellent reproducibility without inter- or intraobserver variability using model-based postprocessing.