The global syndemic of metabolic diseases in the young adult population: A consortium of trends and projections from the Global Burden of Disease 2000-2019.

BACKGROUND: A significant proportion of premature deaths globally are related to metabolic diseases in young adults. We examined the global trends and mortality of metabolic diseases in individuals aged below 40 years using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019. METHODS: From 2000 to 2019, global estimates of deaths and disability-adjusted life years (DALYs) were described for metabolic diseases (type 2 diabetes mellitus [T2DM], hyperlipidemia, hypertension, obesity, non-alcoholic fatty liver disease [NAFLD]). Subgroup analyses were performed based on sex, geographical regions and Socio-Demographic Index (SDI). Age-standardised death and DALYs were presented per 100,000 population with 95 % uncertainty intervals (UI). Projections of mortality and DALYs were estimated using regression models based on the GBD 2019 data and combining them with Institute for Health Metrics and Evaluation projection counts for years up to 2050. RESULTS: In 2019, the highest age-standardised death rates were observed in hypertension (133·88 [121·25-155·73]), followed by obesity (62·59 [39·92-89·13]), hyperlipidemia (56·51 [41·83-73·62]), T2DM (18·49 [17·18-19·66]) and NAFLD (2·09 [1·61-2·60]). Similarly, obesity (1932·54 [1276·61-2639·74]) had the highest age-standardised DALYs, followed by hypertension (2885·57 [2580·75-3201·05]), hyperlipidemia (1207·15 [975·07-1461·11]), T2DM (801·55 [670·58-954·43]) and NAFLD (53·33 [40·73-68·29]). Mortality rates decreased over time in hyperlipidemia (-0·6 %), hypertension (-0·47 %), NAFLD (-0·31 %) and T2DM (-0·20 %), but not in obesity (1·07 % increase). The highest metabolic-related mortality was observed in Eastern Mediterranean and low SDI countries. By 2050, obesity is projected to contribute to the largest number of deaths (102·8 % increase from 2019), followed by hypertension (61·4 % increase), hyperlipidemia (60·8 % increase), T2DM (158·6 % increase) and NAFLD (158·4 % increase), with males continuing to bear the greatest burden across all metabolic diseases. CONCLUSION: The growing burden of metabolic diseases, increasing obesity-related mortality trends, and the sex-regional-socioeconomic disparities evident in young adulthood, underlie the concerning growing global burden of metabolic diseases now and in future.

Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study.

BACKGROUND: Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study's primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient's prognosis during and after the ICU admission. METHODS: A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model. RESULTS: A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ≤9.7 g/dL), moderate risk (haemoglobin between 9.8-12 g/dL), and low risk (haemoglobin > 12 g/dL). CONCLUSION: The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient's acute kidney injury risk.

Development of a standardised Occupational Therapy--Driver Off-Road Assessment Battery to assess older and/or functionally impaired drivers.

INTRODUCTION: Research has been conducted over several years to develop a new off-road assessment battery referred to as the Occupational Therapy - Driver Off-Road Assessment Battery. This article documents the development of the Battery, and provides preliminary research evidence to support its content and predictive validity. METHODS: Literature reviews and a focus group with nine driver assessor occupational therapists were undertaken, as well as data collection using the Occupational Therapy - Driver Off-Road Assessment Battery with 246 clients. A Classification and Regression Tree model was constructed to ascertain the predictive validity of the Battery, with fitness-to-drive as the outcome. RESULTS: Twenty-one physical, 13 sensory and seven assessments of cognition/perception were identified as being reflective of the skills required for driving. Following rating of their psychometric properties, the best assessments were presented to focus group members. The driver assessors supported the inclusion of several assessments and encouraged the development of new assessments. A draft version of the Occupational Therapy - Driver Off-Road Assessment Battery was tested and found to have excellent predictive validity for client on-road performance of 82.6%. The Classification and Regression Tree model showed that client performance on tests included in the Battery should be used together, rather than in isolation, to support fitness-to-drive recommendations. CONCLUSION: This research identified the most suitable physical, sensory and cognitive assessments to include in the Occupational Therapy - Driver Off-Road Assessment Battery, and provided support for its validity. The development of this standardised battery assists driver assessors to accurately and consistently assess and report the off-road driving capacity of clients.

Resource consumption in hospitalised, frail older patients.

INTRODUCTION: The objective of this study was to determine factors, other than the Diagnostic Related Grouping (DRG), that can explain the variation in the cost of hospitalisation and length of hospital stay (LOS) in older patients. MATERIALS AND METHODS: This was a prospective, observational cohort study involving 397 patients, aged 65 years and above. Data collected include demographic information, admission functional and cognitive status, overall illness severity score, number of referral to therapists, referral to medical social worker, cost of hospitalisation, actual LOS, discharge DRG codes and their corresponding trimmed average length of stay (ALOS). RESULTS: The mean age of the cohort was 80.2 years. The DRG's trimmed ALOS alone explained 21% of the variation in the cost of hospitalisation and actual LOS. Incorporation of an illness severity score, number of referral to therapists and referral to medical social worker into the trimmed ALOS explained 30% and 31% of the variation in the cost and actual LOS, respectively. CONCLUSION: The DRG model is able to explain 21% of the variation in the cost of hospitalisation and actual LOS in older patients. Other factors that determined the variation in the cost of hospitalisation and LOS include the degree of illness severity, the number of referral to therapists and referral to medical social worker.

A review of clinical pathway data of 1,663 total knee arthroplasties in a tertiary institution in Singapore.

INTRODUCTION AND OBJECTIVES: A total knee arthroplasty (TKA) clinical pathway database has been used in our institution since the year 2000. The primary aim of this study was to review the patient epidemiology, postoperative complications and factors influencing hospital length of stay following TKA. The clinical outcomes and cost-savings between elective and same day admissions for TKA patients were also reviewed. MATERIALS AND METHODS: The study cohort retrieved from the database comprised 1,371 patients (1,663 knees) who underwent total knee replacement over a 6-year time period. The following variables were reviewed: epidemiological data, admission data (elective admission [EA] versus same day admission [SDA]), hospital length of stay (LOS), and complication rates. RESULTS: The mean age of patients undergoing TKA is 65.2 years (range, 22 to 90). Osteoarthritis was the main surgical indication in 96% of the study cohort. Overall, there was a gradual decline in the hospital length of stay for the study cohort for the 6-year time period. The overall complication rate was 2% and the 3 most common complications were deep vein thrombosis, pulmonary embolism and urinary tract infection. CONCLUSION: With an increasing elderly population there will be an annual increase in the number of TKAs. In our local population TKAs are performed primarily for the Chinese female in the 7th decade. The overall complication rate of TKA remains low with a mortality rate of <1%.

Quality of life in an urban Asian population: the impact of ethnicity and socio-economic status.

The relationships between ethnicity, socio-economic status (SES) and health-related quality of life (HRQoL) have not been well characterised in most Asian populations. We therefore studied the influence of ethnicity and SES on HRQoL in a multi-ethnic urban Asian population, adjusting for the influence of other known determinants of HRQoL. In a disproportionately stratified, cross-sectional, population-based survey, Chinese, Malay and Indian subjects in Singapore completed the Short Form 36 Health Survey (SF-36) HRQoL measure and were assessed to determine demographic, socio-economic, psychosocial and other characteristics. Multiple linear regression models were used to study the influence of ethnicity and SES on SF-36 scores while adjusting for the influence of other determinants of HRQoL. The survey participation rate was 92.8%. Ethnic differences in HRQoL were present for all 8 SF-36 scales (p<0.001 for all scales except General Health) among the 4122 Chinese, Malays and Indians surveyed. These ethnic groups also differed in several known determinants of HRQoL (e.g., Chinese had more years of education and Indians had more chronic medical conditions). After adjusting for the influence of these factors, ethnicity and SES independently influenced HRQoL, with mean differences in SF-36 scores due to ethnicity ranging from 1.4 to 13.1 points. Educational level and housing type (markers of SES) were also associated with SF-36 scores (0.5-0.6 point increase per year of education and 3.5-4.0 point increase with better housing type, respectively). Better HRQoL was also associated with better family support, and poorer HRQoL with acute and chronic medical conditions and sick days. The study concludes that ethnicity and SES are associated with clinically important differences in HRQoL in a multi-ethnic, urban Asian population.