Estimation of adherence to urate-lowering therapy in people living with gout using Australia's Pharmaceutical Benefits Scheme and patient-reported dosing.

AIMS: The aim of this study was to estimate adherence to urate-lowering therapy (ULT), predominately allopurinol, from Australia's Pharmaceutical Benefits Scheme (PBS) claims database in association with (1) patient-reported doses and (2) World Health Organization's (WHO) defined daily doses (DDD), namely, allopurinol (400 mg/day) or febuxostat (80 mg/day). METHODS: Proportion of days covered (PDC) was calculated in 108 Gout App (Gout APP) trial participants with at least two recorded ULT dispensings in an approximately 12-month period before provision of intervention or control apps. Adherence was defined as PDC ≥80%. We measured the correlation between the two methods of calculating PDC using a Wilcoxon signed rank test. Agreement between ULT-taking status (self-reports) and ULT-dispensed status (PBS records) was tested with Cohen's kappa (κ), and positive and negative percent agreement. RESULTS: Allopurinol was prescribed in 93.5% of participants taking ULT. Their self-reported mean daily dose (SD) was 291 (167) mg/day. Mean PDC (SD) for allopurinol was 83% (21%) calculated using self-reported dose, and 63% (24%) using WHO's DDD. Sixty-three percent of allopurinol users were identified as adherent (PDC ≥80%) using self-reported dose. There was good agreement between self-reported ULT use and PBS dispensing claims (κ = 0.708, P < .001; positive percent agreement = 90%, negative percent agreement = 82%). CONCLUSIONS: Participant-reported allopurinol daily doses, in addition to PBS dispensing claims, may enhance confidence in estimating PDC and adherence compared to using DDD. This approach improves adherence estimations from pharmaceutical claims datasets for medications where daily doses vary between individuals or where there is a wide therapeutic dose range.

Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries.

Importance: Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. Objective: To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries. Design, Setting, and Participants: Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years. Exposures: Countries' per capita income levels and world region; individuals' socioeconomic demographics. Main Outcomes and Measures: Self-reported use of aspirin for secondary prevention of CVD. Results: The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries. Conclusion and Relevance: Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.

Self-reported incidents of violence towards nurses working in acute psychiatric units.

BACKGROUND:  Acute psychiatric units are found to be stressful working environments because of the nature of illness patients present with. OBJECTIVES:  This study aimed to determine self-reported incidents of physical and verbal violence towards nurses working in acute psychiatric units in Western Cape, South Africa. METHOD:  A questionnaire was used to collect data. Chi-square test was performed to determine association between gender, category and experience of violence. Mann-Whitney U test was carried out to determine associations between years of employment and the likelihood of experiencing physical violence and verbal abuse. RESULTS:  Overall physical violence 35 (34.3%) and verbal abuse 83 (83%) incidents. Most female respondents reported both physical violence (74.2%, n = 26) and verbal abuse (72.2%, n = 60), with (56.2%, n = 18) professional nurses reporting physical violence. Years of employment was statistically significantly associated with the likelihood of nurses experiencing physical violence (p = 0.007). CONCLUSION:  Most respondents (74.2%, n = 26) were females and they mostly experienced physical violence and verbal abuse while 28.2% (n = 29) were males. Years of service were associated with the likelihood of experiencing physical violence.Contribution: The knowledge gained will add on existing knowledge about the challenge of violence experienced by nurses in the workplace and might have an influence on policymakers.

COVID-19 Testing Practices, Preventive Behaviors, and Factors Associated With Test Positivity: Population-Based Statewide Survey Study.

BACKGROUND: The COVID-19 pandemic has challenged public health efforts globally. Timely population-based surveillance is crucial to support public health programs and policies to limit the spread of COVID-19. The South Carolina (SC) Sampling and Testing Representative Outreach for Novel Coronavirus Guidance (SC STRONG) statewide initiative was established to estimate population-level prevalence and immunity and characterize the transmission dynamics of SARS-CoV-2 using community testing and online surveys. OBJECTIVE: This paper aimed to leverage the survey data collected as part of the initiative to understand risk perceptions, testing practices, and preventive behaviors and identify risk factors for COVID-19 test positivity in SC over time. METHODS: Probability proportionate to size cluster random sampling was used to select SC residents to participate in testing for COVID-19 infection and antibodies and to complete an online survey. This paper focuses on data from the online surveys completed between November 2020 and June 2021. Descriptive statistics were used to describe risk perceptions, attitudes and behaviors, and associated changes over time. Univariate and multivariate logistic regression models were used to identify factors associated with self-reported COVID-19 test positivity. RESULTS: Among the 7170 online survey respondents, 58.7% (4213/7170) self-reported ever testing for COVID-19. The most commonly cited barriers to testing were inconvenient dates, time, and location, as well as discomfort. Overall, 18.7% (790/7170) of respondents reported a history of COVID-19 test positivity. Multivariate logistic regression results indicated that individuals who were aged 50 years or older, self-identified as Black/African American, were obese, and were employed as frontline health care workers or nursing home staff were more likely to self-report COVID-19 test positivity. By contrast, there was a decreased likelihood of test positivity among respondents who were concerned about the burden of COVID-19 in their community and about being infected. CONCLUSIONS: Strategies to remove testing barriers should be implemented to improve access. Our findings provide insights on statewide testing patterns, adoption of prevention behaviors, and risk factors for infection and may inform public health strategies to curb transmission.

Short report: relationship between self-reported sleep characteristics and falls-associated fractures in elderly individuals: a population-based study.

Currently, the data for effect of sleep on falls-associated fractures in elderly individuals are still limited. This current study was aimed to assess the link between self-reported sleep characteristics and falls-associated fractures in elderly individuals. This study included a total of 20,497 participants from National Health and Nutritional Examination Survey (NHANES) 2005-2008, and 6,174 participants aged 45 years and older were identified. Self-reported sleep characteristics and conditions of falls-associated fractures of individuals were obtained via the method of personal questionnaires. In a total of 610 participants with exact history of fractures, 168 individuals with falls-associated fractures were identified, and the prevalence was 27.5%. The mean age of falls-associated fractures group was (72.1 ± 8.8) years, and the female (P < 0.001) occupied a higher proportion. Factors of living alone (P = 0.003), combined with hypertension (P = 0.003) and osteoporosis (P < 0.001), sleeping less or more (P = 0.009), and frequent snoring (P = 0.007) were linked to falls-associated fractures. Compared with sleep duration of 6 to 8 h/night, sleep duration of ≤4 h/night (odds ratio [OR] 1.858, 95% confidence interval [CI] 1.115-3.094) and of ≥9 h/night (OR 1.932, 95% CI 1.195-3.123) were related to an increased risk of falls-associated fractures. Collectively, our nationwide data noted that sleep characteristics were closely related to falls-associated fractures in elderly individuals, and a longer sleep duration may exhibit a protective effect against the falls-associated fractures, but it should be limited within 9 h/night.

Relationship between self-reported and objectively measured physical fitness in young men and women.

Self-reported physical fitness has advantages in cost and time over objective methods, but previous studies demonstrate equivocal conclusions regarding validity. Methods for self-reporting are usually based on subjective judgements, while another approach includes performing field tests at home. The Norwegian military relies on the latter method for conscript selection, but its validity is unknown and should be investigated. In total 14,166 young men and women were included in the study. During conscript selection step one, the subjects were requested to perform 3,000 m run, push-up, pull-up and standing long jump tests at home, and report the results online ("self-reported measurements"). Step two took place at a conscript selection centre 1-18 months later. Here, the subjects completed a maximal treadmill test, seated medicine ball throw, pull-up and standing long jump tests ("objective measurements"). The results demonstrated correlation coefficients from 0.29 to 0.82 (P < 0.05) for self-reported vs. objective measurements, with the highest association found for self-reported and objectively measured pull-ups. Kappa values ranged from 0.05 to 0.34 (P < 0.05), with pull-ups demonstrating the highest agreement. More women than men over-reported their physical fitness. Among men and women indicating similar self-reported fitness, men's objective fitness was higher for all objective tests (effect sizes from 0.5 to 3.0). In conclusion, large variations in correlation coefficients were observed between self-reported and objectively measured physical fitness, while the kappa values indicated poor to fair agreement. The finding that more women than men over-reported their fitness level contradicts most previous studies.Highlights Low, moderate, and high correlations, and poor to fair agreements (kappa values), were observed between self-reported and objectively measured endurance and muscle strength variables.More women than men overreported their actual fitness level.Self-reported fitness based on performing field tests at home may be a feasible alternative to traditional methods which rely on self-perceived fitness.

Full endoscopic versus open discectomy for sciatica: randomised controlled non-inferiority trial.

OBJECTIVE: To assess whether percutaneous transforaminal endoscopic discectomy (PTED) is non-inferior to conventional open microdiscectomy in reduction of leg pain caused by lumbar disc herniation. DESIGN: Multicentre randomised controlled trial with non-inferiority design. SETTING: Four hospitals in the Netherlands. PARTICIPANTS: 613 patients aged 18-70 years with at least six weeks of radiating leg pain caused by lumbar disc herniation. The trial included a predetermined set of 125 patients receiving PTED who were the learning curve cases performed by surgeons who did not do PTED before the trial. INTERVENTIONS: PTED (n=179) compared with open microdiscectomy (n=309). MAIN OUTCOME MEASURES: The primary outcome was self-reported leg pain measured by a 0-100 visual analogue scale at 12 months, assuming a non-inferiority margin of 5.0. Secondary outcomes included complications, reoperations, self-reported functional status as measured with the Oswestry Disability Index, visual analogue scale for back pain, health related quality of life, and self-perceived recovery. Outcomes were measured until one year after surgery and were longitudinally analysed according to the intention-to-treat principle. Patients belonging to the PTED learning curve were omitted from the primary analyses. RESULTS: At 12 months, patients who were randomised to PTED had a statistically significantly lower visual analogue scale score for leg pain (median 7.0, interquartile range 1.0-30.0) compared with patients randomised to open microdiscectomy (16.0, 2.0-53.5) (between group difference of 7.1, 95% confidence interval 2.8 to 11.3). Blood loss was less, length of hospital admission was shorter, and timing of postoperative mobilisation was earlier in the PTED group than in the open microdiscectomy group. Secondary patient reported outcomes such as the Oswestry Disability Index, visual analogue scale for back pain, health related quality of life, and self-perceived recovery, were similarly in favour of PTED. Within one year, nine (5%) in the PTED group compared with 14 (6%) in the open microdiscectomy group had repeated surgery. Per protocol analysis and sensitivity analyses including the patients of the learning curve resulted in similar outcomes to the primary analysis. CONCLUSIONS: PTED was non-inferior to open microdiscectomy in reduction of leg pain. PTED resulted in more favourable results for self-reported leg pain, back pain, functional status, quality of life, and recovery. These differences, however, were small and may not reach clinical relevance. PTED can be considered as an effective alternative to open microdiscectomy in treating sciatica. TRIAL REGISTRATION: NCT02602093ClinicalTrials.gov NCT02602093.

Using language in social media posts to study the network dynamics of depression longitudinally.

Network theory of mental illness posits that causal interactions between symptoms give rise to mental health disorders. Increasing evidence suggests that depression network connectivity may be a risk factor for transitioning and sustaining a depressive state. Here we analysed social media (Twitter) data from 946 participants who retrospectively self-reported the dates of any depressive episodes in the past 12 months and current depressive symptom severity. We construct personalised, within-subject, networks based on depression-related linguistic features. We show an association existed between current depression severity and 8 out of 9 text features examined. Individuals with greater depression severity had higher overall network connectivity between depression-relevant linguistic features than those with lesser severity. We observed within-subject changes in overall network connectivity associated with the dates of a self-reported depressive episode. The connectivity within personalized networks of depression-associated linguistic features may change dynamically with changes in current depression symptoms.

Disparities in Hypoxemia Detection by Pulse Oximetry Across Self-Identified Racial Groups and Associations With Clinical Outcomes.

OBJECTIVES: To assess disparities in hypoxemia detection by pulse oximetry across self-identified racial groups and associations with clinical outcomes. DESIGN: Observational cohort study from May 5, 2018, to December 31, 2020. SETTING: Three academic medical centers in the United States. PATIENTS: Adults greater than or equal to 18 years who self-identified as White, Black, Asian, or American Indian admitted to the ICU or undergoing surgery during inpatient hospitalization with simultaneous measurements of pulse oximetry-estimated oxygen saturation and arterial blood gas-derived oxygen saturation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Multivariable models were employed to assess the relationships between race, occult hypoxemia (i.e., arterial blood gas-derived oxygen saturation < 88% despite pulse oximetry-estimated oxygen saturation ≥ 92%), and clinical outcomes of hospital mortality and hospital-free days. One-hundred twenty-eight-thousand two-hundred eighty-five paired pulse oximetry-estimated oxygen saturation-arterial blood gas-derived oxygen saturation measurements were included from 26,603 patients. Pulse oximetry-estimated oxygen saturation on average overestimated arterial blood gas-derived oxygen saturation by 1.57% (1.54-1.61%). Black, Asian, and American Indian patients were more likely to experience occult hypoxemia during hospitalization (estimated probability 6.2% [5.1-7.6%], 6.6% [4.9-8.8%], and 6.6% [4.4-10.0%], respectively) compared with White patients (3.6% [3.4-3.8%]). Black patients had increased odds of occult hypoxemia compared with White patients after adjustment (odds ratio, 1.65; 1.28-2.14; p < 0.001). Differences in occult hypoxemia between Asian and American Indian patients compared with White patients were not significant after adjustment (odds ratio, 1.53; 0.95-2.47; p = 0.077 and odds ratio, 1.31; 0.80-2.16; p = 0.288, respectively). Occult hypoxemia was associated with increased odds of mortality in surgical (odds ratio, 2.96; 1.20-7.28; p = 0.019) and ICU patients (1.36; 1.03-1.80; p = 0.033). Occult hypoxemia was associated with fewer hospital-free days in surgical (-2.5 d [-3.9 to -1.2 d]; p < 0.001) but not ICU patients (0.4 d [-0.7 to 1.4 d]; p = 0.500). CONCLUSIONS: Occult hypoxemia is more common in Black patients compared with White patients and is associated with increased mortality, suggesting potentially important outcome implications for undetected hypoxemia. It is imperative to validate pulse oximetry with expanded racial inclusion.

Timing of Pubertal Development and Midlife Blood Pressure in Men and Women: A Mendelian Randomization Study.

INTRODUCTION: Observational studies suggest earlier puberty is associated with higher adulthood blood pressure (BP), but these findings have not been replicated using Mendelian randomization (MR). We examined this question sex-specifically using larger genome-wide association studies (GWAS) with more extensive measures of pubertal timing. METHODS: We obtained genetic instruments proxying pubertal maturation (age at menarche [AAM] or voice breaking [AVB]) from the largest published GWAS. We applied them to summary sex-specific genetic associations with systolic and diastolic BP z-scores, and self-reported hypertension in women (n = 194 174) and men (n = 167 020) from the UK Biobank, using inverse-variance weighted meta-analysis. We conducted sensitivity analyses using other MR methods, including multivariable MR adjusted for childhood obesity proxied by body mass index (BMI). We used late pubertal growth as a validation outcome. RESULTS: AAM (beta per 1-year later = -0.030 [95% confidence interval, -0.055 to -0.005] and AVB (beta -0.058 [95% CI, -0.100 to -0.015]) were inversely associated with systolic BP independent of childhood BMI, as were diastolic BP (-0.035 [95% CI, -0.060 to -0.009] for AAM and -0.046 [95% CI, -0.089 to -0.004] for AVB) and self-reported hypertension (odds ratio 0.89 [95% CI, 0.84-0.95] for AAM and 0.87 [95% CI, 0.79-0.96] for AVB). AAM and AVB were positively associated with late pubertal growth, as expected. The results were robust to sensitivity analysis using other MR methods. CONCLUSION: Timing of pubertal maturation was associated with adulthood BP independent of childhood BMI, highlighting the role of pubertal maturation timing in midlife BP.

Severe Hypoglycemia and Incident Heart Failure Among Adults With Type 2 Diabetes.

CONTEXT: The association of severe hypoglycemia on the incidence of heart failure (HF) is unclear. OBJECTIVE: We evaluated the association of severe hypoglycemia with incident HF among individuals with type 2 diabetes. METHODS: We included participants with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Severe hypoglycemia episodes were assessed during the initial 24 months following randomization and defined using 2 methods: (1) symptomatic, severe hypoglycemic event requiring medical assistance (first definition); or (2) requiring any assistance (second definition). Participants without HF at baseline and during the first 24 months of the study were prospectively followed for incident HF hospitalization. Multivariable Cox regression was used to generate adjusted hazard ratios (HR) for the association of severe hypoglycemia and incident HF. RESULTS: Among 9208 participants (mean age 63 years, 38% female, 62% White), 365 had ≥ 1 episode of severe hypoglycemic. Over a median follow-up duration of 3 years, there were 249 incident HF events. After multivariable adjustment for relevant confounders, participants with severe hypoglycemia requiring medical assistance had a 68% higher relative risk of incident HF (HR 1.68; 95% CI, 1.06-2.66), as compared with individuals who never experienced any episode of hypoglycemia. Severe hypoglycemia requiring any assistance was also associated with a 49% higher relative risk of HF (HR 1.49; 95% CI, 1.01-2.21). CONCLUSION: In a large cohort of adults with type 2 diabetes, severe hypoglycemia was independently associated with greater risk of incident HF.

Musculoskeletal Features in Adults With X-linked Hypophosphatemia: An Analysis of Clinical Trial and Survey Data.

CONTEXT: Patients with X-linked hypophosphatemia (XLH) experience multiple musculoskeletal manifestations throughout adulthood. OBJECTIVE: To describe the burden of musculoskeletal features and associated surgeries across the lifespan of adults with XLH. METHODS: Three groups of adults were analyzed: subjects of a clinical trial, participants in an online survey, and a subgroup of the online survey participants considered comparable to the clinical trial subjects (according to Brief Pain Inventory worst pain scores of ≥ 4). In each group, the adults were categorized by age: 18-29, 30-39, 40-49, 50-59, and ≥ 60 years. Rates of 5 prespecified musculoskeletal features and associated surgeries were investigated across these age bands for the 3 groups. RESULTS: Data from 336 adults were analyzed. In all 3 groups, 43% to 47% had a history of fracture, with the proportions increasing with age. The overall prevalence of osteoarthritis was > 50% in all 3 groups, with a rate of 23% to 37% in the 18- to 29-year-old group, and increasing with age. Similar patterns were observed for osteophytes and enthesopathy. Hip and knee arthroplasty was reported even in adults in their 30s. Spinal stenosis was present at a low prevalence, increasing with age. The proportion of adults with ≥ 2 musculoskeletal features was 59.1%, 55.0%, and 61.3% in the clinical trial group, survey group, and survey pain subgroup, respectively. CONCLUSION: This analysis confirmed high rates of multiple musculoskeletal features beginning as early as age 20 years among adults with XLH and gradually accumulating with age.

Time-Related Changes in Patient Reported Bladder Symptoms and Satisfaction after Spinal Cord Injury.

PURPOSE: Increased time after spinal cord injury (SCI) is associated with a migration to bladder managements with higher morbidity such as indwelling catheter (IDC). Still, it is unclear how this affects bladder-related quality of life (QoL). We hypothesized that time from injury (TFI) would be associated with changes in bladder management, symptoms and satisfaction. MATERIALS AND METHODS: Cross-sectional analysis of time-related changes in patient-reported bladder management, symptoms and satisfaction using the Neurogenic Bladder Research Group SCI Registry. Outcomes included Neurogenic Bladder Symptom Score (NBSS) and bladder-related satisfaction (NBSS-satisfaction). Multivariable regression was performed to assess associations between TFI and outcomes, adjusting for participant characteristics, injury specifics, and psychosocial aspects of health-related QoL. Participants with TFI <1 year were excluded and TFI was categorized 1-5 (reference), 6-10, 11-15, 16-20 and >20 years. RESULTS: Of 1,420 participants mean age at injury was 29.7 years (SD 13.4) and mean TFI was 15.2 years (SD 11.6). Participants grouped by TFI included 298 (21%) 1-5, 340 (24%) 6-10, 198 (14%) 11-15, 149 (10%) 16-20 and 435 (31%) >20 years. As TFI increased, clean intermittent catheterization (CIC) declined (55% 1-5 vs 45% >20 years, p <0.001) and IDC increased (16% 1-5 vs 21% >20 years, p <0.001). On multivariable analysis, increased TFI was associated with fewer bladder symptoms at >20 years from injury (-3.21 [CI -1.29, -5.14, p <0.001]) and better satisfaction (6-10 years -0.20 [CI -0.41, 0.01, p=0.070], 11-15 years -0.36 [CI -0.60, -0.11, p=0.002], 16-20 years -0.59 [CI -0.86, -0.32, p <0.001], >20 years -0.85 [CI -1.07, -0.63, <0.001]). CONCLUSIONS: After SCI, CIC decreases and IDC increases over time; however, increasing TFI is associated with reduced urinary symptoms and improved bladder-related satisfaction.

Organizational Justice and Long-term Metabolic Trajectories: A 25-Year Follow-up of the Whitehall II Cohort.

CONTEXT: Organizational justice has been linked to lower risk of several chronic conditions among employees, but less is known about the long-term mechanisms underlying this risk reduction. OBJECTIVE: To assess whether self-reported organizational justice is associated with individual and composite long-term metabolic trajectories. DESIGN: Twenty-five-year follow-up of the Whitehall II prospective cohort study. SETTING: Middle-aged public servants from the United Kingdom. PARTICIPANTS: Data on 8182 participants were used. MAIN OUTCOME MEASURES: Levels of 11 anthropometric, glycemic, lipid, and blood pressure biomarkers were measured at 5 timepoints (1991-2013). We used generalized estimating equations and group-based trajectory modeling to investigate the relationship between organizational justice and biomarker trajectories. RESULTS: High vs low organizational justice were associated with lower waist (-1.7 cm) and hip (-1 cm) circumference, body mass index (-0.6 kg/m2), triglycerides (-1.07 mmol/L), and fasting insulin (-1.08 µIU/mL) trajectories. Two latent metabolic trajectory clusters were identified: a high- and a low-risk cluster. High organizational justice (vs low) were associated with belonging to the low-risk cluster (pooled odds ratio = 1.47). The low-risk cluster demonstrated lower baseline levels of most biomarkers and better glycemic control, whereas the high-risk cluster showed higher baseline levels of most biomarkers, glycemic deterioration, but also greater improvements in lipid levels over time. CONCLUSIONS: People with high organizational justice had more favorable long-term cardiometabolic biomarker patterns than those with low organizational justice, indicating a potential mechanism contributing to the lower risk of chronic diseases in the first group. Further intervention studies are warranted to determine whether improvement of organizational justice might improve long-term health.

U-shaped Association Between Dietary Zinc Intake and New-onset Diabetes: A Nationwide Cohort Study in China.

AIMS: We aimed to investigate the relationship of dietary zinc intake with new-onset diabetes among Chinese adults. MATERIALS AND METHODS: A total of 16 257 participants who were free of diabetes at baseline from the China Health and Nutrition Survey were included. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. Participants with self-reported physician-diagnosed diabetes, or fasting glucose ≥ 7.0 mmol/L, or glycated hemoglobin ≥ 6.5% during the follow-up were defined as having new-onset diabetes. RESULTS: A total of 1097 participants developed new-onset diabetes during a median follow-up duration of 9.0 years. Overall, the association between dietary zinc intake and new-onset diabetes followed a U-shape (P for nonlinearity < 0.001). The risk of new-onset diabetes was significantly lower in participants with zinc intake < 9.1 mg/day (per mg/day: hazard ratio [HR], 0.73; 95% CI, 0.60-0.88), and higher in those with zinc intake ≥ 9.1 mg/day (per mg/day: HR, 1.10; 95% CI, 1.07-1.13). Consistently, when dietary zinc intake was assessed as deciles, compared with those in deciles 2-8 (8.9 -<12.2 mg/day), the risk of new-onset diabetes was higher for decile 1 (<8.9 mg/day: HR, 1.29; 95% CI, 1.04-1.62), and deciles 9 to 10 (≥12.2 mg/day: HR, 1.62; 95% CI, 1.38-1.90). Similar U-shaped relations were found for plant-derived or animal-derived zinc intake with new-onset diabetes (all P for nonlinearity < 0.001). CONCLUSIONS: There was a U-shaped association between dietary zinc intake and new-onset diabetes in general Chinese adults, with an inflection point at about 9.1 mg/day.

Differences in Psychometric Properties of Clinician- and Patient-Reported Outcome Measures for Atopic Dermatitis by Race and Skin Tone: A Systematic Review.

The psychometric validity and reliability of widely used atopic dermatitis (AD) outcome measures across different races and ethnicities are unclear. We describe the rates of reporting race, ethnicity, and skin tone in studies testing the psychometric properties of AD outcome measures and compare the psychometric analyses across race, ethnicity, and skin tone. We systematically reviewed MEDLINE and EMBASE for studies reporting psychometric properties of clinician-reported or patient-reported outcome measures in AD (International Prospective Register of Systematic Reviews: CRD42021239614). Overall, 16,100 nonduplicate articles were screened; 165 met inclusion criteria. Race and/or ethnicity were reported in 55 (33.3%) studies; of those, race was assessed by self-report in 10 studies (6.1%) or was unspecified in 45 (27.3%). A total of 16 studies (9.7%) evaluated psychometric property differences by race, and only five (4.4%) of those did not recognize it as a limitation. Properties assessed across race, ethnicity, or skin tone were differential item functioning, convergent validity feasibility, inter-rater reliability, intrarater reliability, test‒retest reliability, and known-groups validity. Multiple instruments demonstrated performance differences across ethnoracial groups. This review highlights the paucity of race/ethnicity consideration for psychometric property testing in AD outcome measurement instruments. More AD outcomes instruments should be validated in diverse populations.

Patient-Reported Outcomes Following Total Thyroidectomy for Graves' Disease.

Background: Graves' disease accounts for ∼80% of all cases of hyperthyroidism and is associated with significant morbidity and decreased quality of life. Understanding the association of total thyroidectomy with patient-reported quality-of-life and thyroid-specific symptoms is critical to shared decision-making and high-quality care. We estimate the change in patient-reported outcomes (PROs) before and after surgery for patients with Graves' disease to inform the expectations of patients and their physicians. Methods: PROs using the MD Anderson Symptom Inventory (MDASI) validated questionnaire were collected prospectively from adult patients with Graves' disease from January 1, 2015, to November 20, 2020, on a longitudinal basis. Survey responses were categorized as before surgery (≤120 days), short term after surgery (<30 days; ST), and long term after surgery (≥30 days; LT). Negative binomial regression was used to estimate the association of select covariates with PROs. Results: Eighty-five patients with Graves' disease were included. The majority were female (83.5%); 47.1% were non-Hispanic white and 35.3% were non-Hispanic black. The median thyrotropin (TSH) value before surgery was 0.05, which increased to 0.82 in ST and 1.57 in LT. In bivariate analysis, the Total Symptom Burden Score, a composite of all patient-reported burden, significantly reduced shortly after surgery (before surgery mean of 56.88 vs. ST 39.60, p < 0.001), demonstrating improvement in PROs. Furthermore, both the Thyroid Symptoms Score, including patient-reported thermoregulation, palpitations, and dysphagia, and the Quality-of-Life Symptom Score improved in ST and LT (thyroid symptoms, before surgery 13.88 vs. ST 8.62 and LT 7.29; quality of life, before surgery 16.16 vs. ST 9.14 and LT 10.04, all p < 0.05). After multivariate adjustment, the patient-reported burden in the Thyroid Symptom Score and the Quality-of-Life Symptom Score exhibited reduction in ST (thyroid symptoms, rate ratio [RR] 0.55, confidence interval [CI]: 0.42-0.72; quality of life, RR 0.57, CI: 0.40-0.81) and LT (thyroid symptoms, RR 0.59, CI: 0.44-0.79; quality of Life, RR 0.43, CI: 0.28-0.65). Conclusions: Quality of life and thyroid-specific symptoms of Graves' patients improved significantly from their baseline before surgery to both shortly after and longer after surgery. This work can be used to guide clinicians and patients with Graves' disease on the expected outcomes following total thyroidectomy.

Resident- and Institutional-Level Factors, Frailty, and Nursing Homes Residents.

BACKGROUND: Frailty is a major cause of adverse health outcomes, such as hospitalization, falls, disability, and morbidity, among older adults; the elucidation of factors affecting frailty trends over time may facilitate the development of effective interventions. OBJECTIVES: This study aimed to examine the trend of frailty over time (at baseline, 6-month follow-up, and 12-month follow-up) among Chinese nursing home residents and identify associated resident- and institutional-level factors. METHODS: This longitudinal study included 353 residents who were admitted into 27 nursing homes in Jinan, China. Frailty was defined based on the seven self-reported components of the FRAIL-NH scale, which was designed for nursing home residents. Information was gathered using scales that assessed resident-level (sociodemographic characteristics and physical, psychological, and social factors) and institutional-level characteristics (hospital affiliation, fitness sites, green space, occupancy percentage, staff-resident ratio, and staff turnover rate). These data were subjected to a multilevel linear analysis. RESULTS: Frailty was identified in 49.7% of residents at baseline and exhibited a progressively worsening trend over 1 year. Among institutional-level characteristics, the provision of fitness sites in nursing homes was a protective factor for frailty. Among resident-level characteristics, undernutrition was a significant independent risk factor and played a key role in increasing frailty over time. Other risk factors for frailty included younger age, poorer self-rated health, lower physical function, chewing difficulty, loneliness, anxiety, and being less active in leisure activities. DISCUSSION: Frailty was highly prevalent among Chinese nursing home residents and gradually increased over time. The results of this study could be used to inform the development of interventions targeted at modifiable risk factors and shape public health policies aimed at promoting healthy aging and delaying frailty and its adverse outcomes.