Consumption of coffee and tea with all-cause and cause-specific mortality: a prospective cohort study.

BACKGROUND: Previous studies suggested that moderate coffee and tea consumption are associated with lower risk of mortality. However, the association between the combination of coffee and tea consumption with the risk of mortality remains unclear. This study aimed to evaluate the separate and combined associations of coffee and tea consumption with all-cause and cause-specific mortality. METHODS: This prospective cohort study included 498,158 participants (37-73 years) from the UK Biobank between 2006 and 2010. Coffee and tea consumption were assessed at baseline using a self-reported questionnaire. All-cause and cause-specific mortalities, including cardiovascular disease (CVD), respiratory disease, and digestive disease mortality, were obtained from the national death registries. Cox regression analyses were conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: After a median follow-up of 12.1 years, 34,699 deaths were identified. The associations of coffee and tea consumption with all-cause and cause-specific mortality attributable to CVD, respiratory disease, and digestive disease were nonlinear (all P nonlinear < 0.001). The association between separate coffee consumption and the risk of all-cause mortality was J-shaped, whereas that of separate tea consumption was reverse J-shaped. Drinking one cup of coffee or three cups of tea per day seemed to link with the lowest risk of mortality. In joint analyses, compared to neither coffee nor tea consumption, the combination of < 1-2 cups/day of coffee and 2-4 cups/day of tea had lower mortality risks for all-cause (HR, 0.78; 95% CI: 0.73-0.85), CVD (HR, 0.76; 95% CI: 0.64-0.91), and respiratory disease (HR, 0.69; 95% CI: 0.57-0.83) mortality. Nevertheless, the lowest HR (95% CI) of drinking both < 1-2 cup/day of coffee and ≥ 5 cups/day of tea for digestive disease mortality was 0.42 (0.34-0.53). CONCLUSIONS: In this large prospective study, separate and combined coffee and tea consumption were inversely associated with all-cause and cause-specific mortality.

Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas Disease.

American trypanosomiasis (Chagas disease, CD) affects circa 7 million persons worldwide. While of those persons present the asymptomatic, indeterminate chronic form (ICF), many will eventually progress to cardiac or digestive disorders. We studied a nonconcurrent (retrospective) cohort of patients attending an outpatient CD clinic in Southeastern Brazil, who were admitted while presenting the ICF in the period from 1998 through 2018 and followed until 2019. The outcomes of interest were the progression to cardiac or digestive CD forms. We were also interested in analyzing the impact of Benznidazole therapy on the progression of the disease. Extensive review of medical charts and laboratory files was conducted, collecting data up to year 2019. Demographics (upon inclusion), body mass index, comorbidities (including the Charlson index) and use of Benznidazole were recorded. The outcomes were defined by abnormalities in those test that could not be attributed to other causes. Statistical analysis included univariate and multivariable Cox regression models. Among 379 subjects included in the study, 87 (22.9%) and 100 (26.4%) progressed to cardiac and digestive forms, respectively. In the final multivariable model, cardiac disorders were positively associated with previous coronary syndrome (Hazzard Ratio [HR], 2.42; 95% Confidence Interval [CI], 1.53-3.81) and negatively associated with Benznidazole therapy (HR, 0.26; 95%CI, 0.11-0.60). On the other hand, female gender was the only independent predictor of progression to digestive forms (HR, 1.56; 95%CI, 1.03-2.38). Our results point to the impact of comorbidities on progression do cardiac CD, with possible benefit of the use of Benznidazole.

Factores pronósticos de mortalidad en pacientes graves con sangramiento digestivo alto no variceal / Prognostic factors of mortality in seriously-III patients with high nonvariceal gastrointestinal bleeding

Introducción: El pronóstico de morir por sangrado digestivo permite individualizar el tratamiento y disminuir la letalidad. Objetivos: Identificar los factores pronósticos de mortalidad por sangramiento digestivo no variceal en pacientes graves. Métodos: Se estudiaron casos y controles en pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Docente Clínico Quirúrgico Joaquín Albarrán Domínguez entre el 1ro de enero 2018 al 31 de diciembre de 2019. El universo estuvo constituido por 1060 pacientes, se seleccionaron 154 pacientes (137 controles y 17 casos). Se aplicó el Chi cuadrado y el Odds ratio (IC= 95 por ciento). Resultados: Del total de pacientes estudiados, 11,3 por ciento fallecieron, la edad promedio fue 69 ± 11,58 (grupo control) y 75± 11,42 (grupo casos). Las alteraciones del equilibrio ácido-base tuvieron 7,4 riesgo de morir con (IC 95 por ciento 2,5-21,9), la hipoxia 1,1 (IC 95 por ciento 0,41-3,2), las variaciones del potasio 4,9 (IC 95 por ciento 1,54-16,1), hiperlactemia 16,9 (IC 95 por ciento 5,3-52,0), las desviaciones del sodio 6,5 (IC 95 % 0,8-51,4). Con ventilación mecánica 2,17 (IC 95 por ciento 0,6-7,0), el apoyo de aminas vasoactivas 16,9 (IC 95 por ciento5,30-52,0), la trasfusión de glóbulos rojos, 11,7 (IC 95 por ciento 3,1-4,3) y con tratamiento dialítico 47,5 (IC 95 por ciento 8,6-258.0), las complicaciones 3,4 (IC 95 por ciento 1,15-10,4). El tratamiento endoscópico fue 93,5 por ciento de grupo control y 41,3 por ciento del grupo de casos, con OR en 0,04 (IC 95 por ciento 0,01-0,15). Conclusiones: Los factores pronósticos identificados fueron: alteraciones del pH, del sodio, el potasio, elevación del lactato, la ventilación mecánica, transfusiones más de 250 mL de glóbulos rojos, apoyo de aminas vasoactivas, tratamiento dialítico, y complicaciones relacionadas con el sangrado. El tratamiento endoscópico fue un factor de protección(AU)

Introduction: The prognosis of dying from digestive bleeding allows individualizing treatment and reducing mortality. Objectives: To identify the prognostic factors of mortality due to nonvariceal gastrointestinal bleeding in seriously-ill patients. Methods: Cases and controls were studied in patients admitted to the intensive care unit of Joaquín Albarrán Domínguez Clinical-Surgical Teaching Hospital, between January 1, 2018 and December 31, 2019. The universe consisted of 1060 patients, 154 of which were selected to make up the sample (137 controls and 17 cases). Chi-square and odds ratio (CI: 95 percent) were applied. Results: Of the total of patients studied, 11.3 percent died, the average age was 69±11.58 (control group) and 75±11.42 (case group). Alterations in acid-base balance accounted for 7.4 as risk of dying (CI: 95 percent; 2.5-21.9), hypoxia accounted for 1.1 (CI: 95 percent; 0.41-3.2), variations in potassium accounted for 4.9 (CI: 95 percent; 1.54-16.1), hyperlacthemia accounted for 16.9 (CI: 95 percent; 5.3-52.0), and sodium deviations accounted for 6.5 (CI: 95 percent; 0.8-51, 4), mechanical ventilation accounted for 2.17 (CI: 95 percent; 0.6-7.0), vasoactive amines support accounted for 16.9 (CI: 95 percent; 5.30-52.0), red blood cell transfusion accounted for 11.7 (CI: 95 percent; 3.1-4.3), dialysis treatment accounted for 47.5 (CI: 95 percent; 8.6-258.0), and complications accounted for 3.4 (CI: 95 percent; 1.15-10.4). Endoscopic treatment was 93.5 percent in the control group and 41.3 percent in the case group, with odds ratio at 0.04 (CI: 95 percent; 0.01-0.15). Conclusions: The prognostic factors identified were alterations in pH, sodium, potassium, elevated lactate, mechanical ventilation, transfusions of more than 250 mL of red blood cells, vasoactive amine support, dialysis treatment, and complications related to bleeding. Endoscopic treatment was a protective factor(AU)

Postoperative complications and mortality following emergency digestive surgery during the COVID-19 pandemic: A multicenter collaborative retrospective cohort study protocol (COVID-CIR).

ABSTRACT: Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).

Opioid Use Disorder is Associated With Complications and Increased Length of Stay After Major Abdominal Surgery.

OBJECTIVE: The objective of this study was to determine the impact of opioid use disorder (OUD) on perioperative outcomes after major upper abdominal surgeries. SUMMARY OF BACKGROUND DATA: OUD, defined as dependence/abuse, is a national health epidemic. Its impact on outcomes after major abdominal surgery has not been well characterized. METHODS: Patients who underwent elective esophagectomy, total/partial gastrectomy, major hepatectomy, and pancreatectomy were identified using the National Inpatient Sample (2003-2015). Propensity score matching by baseline characteristics was performed for patients with and without OUD. Outcomes measured were in-hospital complications, mortality, length of stay (LOS), and discharge disposition. RESULTS: Of 376,467 patients, 1096 (0.3%) had OUD. Patients with OUD were younger (mean 53 vs 61 years, P < 0.001) and more often male (55.1% vs 53.2%, P < 0.001), black (15.0% vs 7.6%, P < 0.001), Medicaid beneficiaries (22.0% vs 6.4%, P < 0.001), and in the lowest income quartile (32.6% vs 21.3%, P < 0.001). They also had a higher rate of alcohol (17.2% vs 2.8%, P < 0.001) and nonopioid drug (2.2% vs 0.2%, P = 0.023) dependence/abuse. After matching (N = 1077 OUD, N = 2164 no OUD), OUD was associated with a higher complication rate (52.9% vs 37.3%, P < 0.001), including increased pain [odds ratio (OR) 3.5, P < 0.001], delirium (OR 3.0, P = 0.004), and pulmonary complications (OR 2.0, P = 0.006). Additionally, OUD was associated with increased LOS (mean 12.4 vs 10.6 days, P = 0.015) and nonroutine discharge (OR 1.6, P < 0.001). In-hospital mortality did not differ (OR 2.4, P = 0.10). CONCLUSION: Patients with OUD more frequently experienced complications and increased LOS. Close postoperative monitoring may mitigate adverse outcomes.

Impact of Multidisciplinary Audit of Enhanced Recovery After Surgery (ERAS)® Programs at a Single Institution.

BACKGROUND: As Enhanced Recovery After Surgery (ERAS®) programs expand across numerous subspecialties, growth and sustainability on a system level becomes increasingly important and may benefit from reporting multidisciplinary and financial data. However, the literature on multidisciplinary outcome analysis in ERAS is sparse. This study aims to demonstrate the impact of multidisciplinary ERAS auditing in a hospital system. Additionally, we describe developing a financial metric for use in gaining support for system-wide ERAS adoption and sustainability. METHODS: Data from HPB, colorectal and urology ERAS programs at a single institution were analyzed from a prospective ERAS Interactive Audit System (EIAS) database from September 2015 to June 2019. Clinical 30-day outcomes for the ERAS cohort (n = 1374) were compared to the EIAS pre-ERAS control (n = 311). Association between improved ERAS compliance and improved outcomes were also assessed for the ERAS cohort. The potential multidisciplinary financial impact was estimated from hospital bed charges. RESULTS: Multidisciplinary auditing demonstrated a significant reduction in postoperative length of stay (LOS) (1.5 days, p < 0.001) for ERAS patients in aggregate and improved ERAS compliance was associated with reduced LOS (coefficient - 0.04, p = 0.004). Improved ERAS compliance in aggregate also significantly associated with improved 30-day survival (odds ratio 1.04, p = 0.001). Multidisciplinary analysis also demonstrated a potential financial impact of 44% savings (p < 0.001) by reducing hospital bed charges across all specialties. CONCLUSIONS: Multidisciplinary auditing of ERAS programs may improve ERAS program support and expansion. Analysis across subspecialties demonstrated associations between improved ERAS compliance and postoperative LOS as well as 30-day survival, and further suggested a substantial combined financial impact.

Incidencia de la patología abdominal quirúrgica urgente durante la pandemia por SARS-CoV-2 / Incidence of surgical abdominal emergencies during SARS-CoV-2 pandemic

INTRODUCCIÓN: Desde la aparición en diciembre de 2019 del SARS-CoV-2 en la ciudad de Wuhan, China, hemos experimentado un descenso en los ingresos en nuestro Servicio y disminución de la actividad quirúrgica urgente. Por ello, el objetivo de este estudio fue analizar la incidencia de la patología abdominal urgente potencialmente quirúrgica en nuestro centro durante la epidemia por COVID-19. MÉTODOS: Se diseñó un estudio retrospectivo que incluyó a todos los pacientes ingresados por patología abdominal urgente potencialmente quirúrgica en nuestro Servicio de Cirugía General y del Aparato Digestivo desde el 24 de febrero de 2020 hasta el 19 de abril de 2020. RESULTADOS: Se incluyeron 89 pacientes con una edad media de 58,85 ± 22,2. La mediana de tiempo transcurrido desde el inicio de los síntomas hasta la consulta en el Servicio de Urgencias fue de 48 (P25-P75 = 24-96) horas. A su llegada a Urgencias 18 (20%) pacientes presentaban criterios de síndrome de respuesta inflamatoria sistémica (SRIS). Se realizaron 51 (57%) intervenciones quirúrgicas. La tasa de complicaciones postquirúrgicas a los 30 días fue del 31% y la tasa de mortalidad de 2%. Con respecto al mismo período de los años 2017 a 2019, la media de ingresos desde Urgencias en nuestro Servicio descendió un 14% durante el período de epidemia. CONCLUSIONES: Se ha producido un descenso en el número de pacientes que son ingresados por patología abdominal urgente potencialmente quirúrgica durante la epidemia por COVID-19 en nuestro centro

INTRODUCTION: Since the appearance of SARS-CoV-2 in December 2019 in the Chinese city of Wuhan, we have experienced a reduction in admissions in our Service and a decrease in urgent surgical activity. Therefore, this study aimed to assess the incidence of potentially surgical abdominal emergency in our center during the epidemic of COVID-19. METHODS: A retrospective study was designed. It included all patients admitted for urgent abdominal pathology with potential surgical treatment in our General and Digestive Surgery Department from February 24, 2020 to April 19, 2020. RESULTS: Eighty-nine patients with a mean age of 58.85±22.2 were included. The median time from symptom onset to the Emergency Department (ED) visit was 48 (P25-P75 = 24-96) hours. On arrival at the ED, 18 (20%) patients presented with systemic inflammatory response syndrome criteria. Fifty-one (57%) surgical procedures were performed. The rate of post-surgical complications at 30 days was 31% and the mortality rate was 2%. Concerning the same period from 2017 to 2019, the mean number of admissions from the ED to our Department decreased by 14% during the epidemic period. CONCLUSION: There has been a decrease in the number of patients admitted for urgent, potentially surgical, abdominal pathology during the period of the COVID-19 epidemic in our center

Análise do perfil socioeconômico, demográfico e epidemiológico da população do município de Feira de Santana (BA) / Analysis of the socioeconomic, demographic and epidemiological profile of the population of Feira de Santana, Bahia / Análisis del perfil socioeconómico, demográfico y epidemiológico de la población de la cuidad de Feria de Santana, BA, Brasil

O conhecimento do perfil populacional, com suas características demográficas, sociais, econômicas e epidemiológicas, é importante para elaboração e avaliação da efetividade de políticas públicas, auxiliando também no planejamento, dimensionamento das demandas por serviços e destinação de recursos financeiros. Dessa forma, este estudo teve como objetivo analisar o perfil socioeconômico, demográfico e epidemiológico da população do município de Feira de Santana (BA). Trata-se de um estudo ecológico que utilizou dados secundários de domínio público, referentes ao período de janeiro de 2000 a dezembro de 2019. As análises dos dados foram descritivas, mediante cálculo dos indicadores, distribuição de frequências e percentuais, com organização dos resultados em tabelas e gráficos, comparando-os com a literatura específica. Os resultados apresentaram que a cobertura de esgotamento sanitário foi inferior a 50% dos domicílios. Do total de estabelecimentos de saúde existentes, 71% eram da rede privada. A principal causa de morbidade foram as doenças do aparelho digestivo. As causas mal definidas constituíram a principal causa de mortalidade. Destaca-se a importância da qualificação e corresponsabilização das equipes de saúde para a relevância da notificação e preenchimento de informações referentes à construção dos indicadores de saúde, que devem representar a realidade do município, intensificando, assim, as ações de vigilância em saúde.

Knowledge of the population profile, covering its demographic, social, economic, and epidemiological characteristics, is crucial for elaborating and evaluating the effectiveness of public policies, and in planning and sizing demands for services and allocation of financial resources. As such, this ecological study analyzes the socioeconomic, demographic and epidemiological profile of the population of Feira de Santana, Bahia, Brazil. The public domain secondary data collected from January 2000 to December 2019 underwent descriptive analysis, by calculating indicators, frequencies and percentage distributions. Results were organized in tables and charts and later compared with the specific literature. The findings showed that less than 50% of the households have sanitary sewage. Of the total number of healthcare facilities, 71% were private. Main cause of morbidity were digestive tract diseases. Poorly defined causes were the leading cause of mortality. In conclusion, health teams must be qualified and sensitize to the relevance of notifying and filling in information related to the construction of health indicators, which should represent the reality of the municipality, thus improving health surveillance actions.

El conocimiento del perfil de la población, con sus características demográficas, sociales, económicas y epidemiológicas es importante para el desarrollo y la evaluación de la efectividad de políticas públicas, asistiendo también en la planificación, dimensionamiento de las demandas de servicios y la asignación de recursos financieros. Así, este estudio tuvo como objetivo analizar el perfil económico, demográfico, epidemiológico de la población de la ciudad de Feria de Santana, en Bahía, Brasil. Se Trata de un estudio ecológico, que utilizó datos secundarios de dominio público, referente al período de enero de 2000 a diciembre de 2019. El análisis de los datos fue descriptivo mediante el cálculo de los indicadores, de distribución de la frecuencia y el porcentaje, con la organización de los resultados en tablas y gráficos, comparándolos con la literatura específica. Los resultados mostraron que la cobertura de aguas residuales era inferior al 50% de los hogares. De todos los establecimientos de salud existentes, el 71% eran de la red privada. La principal causa de morbilidad fue las enfermedades del sistema digestivo. Las causas mal definidas fueron la principal causa de mortalidad. Se destaca la importancia de calificar a los equipos de salud para que sean conscientes de la importancia de la notificación y la presentación de información relativa a la construcción de los indicadores de salud, que deben representar la realidad de la ciudad, mejorando así las acciones de vigilancia sanitaria.

[Current trends in emergency abdominal surgery in the Russian Federation]. / Sovremennye tendentsii v neotlozhnoi abdominal'noi khirurgii v Rossiiskoi Federatsii.

OBJECTIVE: To analyze morbidity and factors affecting mortality in emergency abdominal surgery in the Russian Federation. MATERIAL AND METHODS: The study included patients with acute abdominal diseases aged 18 years and older. All patients were hospitalized in emergency surgical care departments of 3.194 state healthcare institutions in 84 regions of the Russian Federation in 2018. Morbidity, surgical activity and mortality were analyzed. RESULTS: There were 680.337 cases of hospitalization in emergency surgical department, morbidity rate was 582 cases per 100 000. The most common emergency surgical diseases were acute appendicitis (142.3 cases per 100 000), acute cholecystitis (139.0 cases per 100 000) and acute pancreatitis (131.2 cases per 100 000). Surgery was performed in 399.051 (58.7%) patients. In-hospital mortality rate was 2.4% (16 051 cases). CONCLUSION: There are certain factors affecting mortality rate in acute abdominal diseases. The leading problems in organizing emergency surgical care in Russia are insufficient equipment of rural and small municipal surgical hospitals, different staffing with surgeons in rural areas and large cities and late hospitalization of patients.

Outcome of interventional radiology for delayed postoperative hemorrhage in hepatobiliary and pancreatic surgery.

BACKGROUND AND AIM: Postoperative hemorrhage is a rare but potentially lethal complication of hepatobiliary and pancreatic surgeries. This study aimed to retrospectively evaluate the clinical outcome of patients with delayed postoperative hemorrhage and compare the results according to the surgical procedure. METHODS: Overall, 4220 patients underwent surgery for hepatobiliary and pancreatic diseases. Delayed postoperative hemorrhage (observed more than 24 h postoperatively) occurred in 62 patients. Of these, 61 underwent interventional radiology to achieve hemostasis. Patients' clinical data were analyzed retrospectively. The chi-squared or Fisher's exact test was used in data analysis. RESULTS: A total of 62 patients (1.5%) developed delayed postoperative hemorrhage; 61 (1.4%) of them underwent interventional radiology to achieve hemostasis. Median duration from surgery to interventional radiology was 19 days (range: 5-252 days). Sentinel bleeding was detected in 31 patients; Clinical success was achieved in 54 patients (88.5%) by interventional radiology. Overall mortality rate was 26.2%. Causes of 16 in-hospital deaths were uncontrollable hemorrhage (n = 4) and worsening of general condition after hemostasis (n = 12). Mortality rates were 50.0% (11/22) and 12.8% (5/39) after hepatobiliary surgery and pancreatic resection, respectively. Mortality rate was significantly higher after hepatobiliary surgery than after pancreatic surgery (P = 0.002). CONCLUSIONS: Interventional radiology can be successfully performed to achieve hemostasis for delayed hemorrhage after hepatobiliary and pancreatic surgeries. Because successful interventional radiology does not necessarily lead to survival, particularly after hepatobiliary surgery, meticulous attention to prevent surgical complications and intensive treatments before and after interventional radiology are required to improve outcomes.

Associations of regular glucosamine use with all-cause and cause-specific mortality: a large prospective cohort study.

OBJECTIVES: To evaluate the associations of regular glucosamine use with all-cause and cause-specific mortality in a large prospective cohort. METHODS: This population-based prospective cohort study included 495 077 women and men (mean (SD) age, 56.6 (8.1) years) from the UK Biobank study. Participants were recruited from 2006 to 2010 and were followed up through 2018. We evaluated all-cause mortality and mortality due to cardiovascular disease (CVD), cancer, respiratory and digestive disease. HRs and 95% CIs for all-cause and cause-specific mortality were calculated using Cox proportional hazards models with adjustment for potential confounding variables. RESULTS: At baseline, 19.1% of the participants reported regular use of glucosamine supplements. During a median follow-up of 8.9 years (IQR 8.3-9.7 years), 19 882 all-cause deaths were recorded, including 3802 CVD deaths, 8090 cancer deaths, 3380 respiratory disease deaths and 1061 digestive disease deaths. In multivariable adjusted analyses, the HRs associated with glucosamine use were 0.85 (95% CI 0.82 to 0.89) for all-cause mortality, 0.82 (95% CI 0.74 to 0.90) for CVD mortality, 0.94 (95% CI 0.88 to 0.99) for cancer mortality, 0.73 (95% CI 0.66 to 0.81) for respiratory mortality and 0.74 (95% CI 0.62 to 0.90) for digestive mortality. The inverse associations of glucosamine use with all-cause mortality seemed to be somewhat stronger among current than non-current smokers (p for interaction=0.00080). CONCLUSIONS: Regular glucosamine supplementation was associated with lower mortality due to all causes, cancer, CVD, respiratory and digestive diseases.

Changes in inequalities of mortality by education level in Lithuania between 2001 and 2014.

OBJECTIVE: The aim of the study is to analyse the changes in inequalities of mortality by education level in Lithuania between 2001 and 2014. STUDY DESIGN: This is a record-linked cohort study. METHODS: Information on deaths (in the population aged ≥30 years) from all causes and cardiovascular diseases, cancer, external causes and diseases of the digestive system was obtained from Statistics Lithuania. Mortality rates for these causes were calculated by the level of education per 100,000 person-years. Inequalities in mortality were assessed using a rate ratio and a relative index of inequality with 95% confidence intervals (CIs). Joinpoint regression analysis was used to assess inequality trends between 2001 and 2014. RESULTS: During the study period, mortality from all causes and from cardiovascular diseases, cancer, external causes and diseases of the digestive system was statistically significantly higher in the group with less education for both men and women, with the exception for female mortality from cancer in 2001. The highest decline was observed in the inequalities of mortality from external causes, whereas a major increase was observed in the inequalities of mortality from diseases of the digestive system. A large increase in inequalities was observed in mortality from external causes for men (on average by 3.5% per year [95% CI = 2-5.1]), whereas, for women, the highest increase in inequalities was observed in mortality from diseases of the digestive system (on average by 3% per year [95% CI = 0.6-5.5]). The slowest increase in mortality inequalities was noted for cardiovascular diseases for both men (on average by 1.1% per year [95% CI = 0.4-1.9]) and women (on average by 0.8% per year [95% CI = 0.3-1.3]). CONCLUSION: Between 2001 and 2014, the inequalities in mortality by level of education in Lithuania significantly increased in terms of mortality from all causes, cardiovascular diseases, cancer, external causes and diseases of the digestive system.

Circulating 25-hydroxyvitamin D concentration and cause-specific mortality in the Melbourne Collaborative Cohort Study.

Vitamin D deficiency is associated with higher all-cause mortality, but associations with specific causes of death are unclear. We investigated the association between circulating 25-hydroxyvitamin D (25(OH)D) concentration and cause-specific mortality using a case-cohort study within the Melbourne Collaborative Cohort Study (MCCS). Eligibility for the case-cohort study was restricted to participants with baseline dried blood spot samples and no pre-baseline diagnosis of cancer. These analyses included participants who died (n = 2307) during a mean follow-up of 14 years and a sex-stratified random sample of eligible cohort participants ('subcohort', n = 2923). Concentration of 25(OH)D was measured using liquid chromatography-tandem mass spectrometry. Cox regression, with Barlow weights and robust standard errors to account for the case-cohort design, was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for cause-specific mortality in relation to 25(OH)D concentration with adjustment for confounders. Circulating 25(OH)D concentration was inversely associated with risk of death due to cancer (HR per 25 nmol/L increment = 0.88, 95 % CI 0.78-0.99), particularly colorectal cancer (HR = 0.75, 95 % CI 0.57-0.99). Higher 25(OH)D concentrations were also associated with a lower risk of death due to diseases of the respiratory system (HR = 0.62, 95 % CI 0.43-0.88), particularly chronic obstructive pulmonary disease (HR = 0.53, 95 % CI 0.30-0.94), and diseases of the digestive system (HR = 0.44, 95 % CI 0.26-0.76). Estimates for diabetes mortality (HR = 0.64, 95 % CI 0.33-1.26) and cardiovascular disease mortality (HR = 0.90, 95 % CI 0.76-1.07) lacked precision. The findings suggest that vitamin D might be important for preventing death due to some cancers, respiratory diseases, and digestive diseases.

The Urgent Surgery Elderly Mortality risk score: a simple mortality score

Introduction: an increasing number of elderly patients undergo urgent abdominal surgery and this population has a higher risk of mortality. The main objective of the study was to identify mortality-associated factors in elderly patients undergoing abdominal surgery and to design a mortality scoring tool, the Urgent Surgery Elderly Mortality risk score (the USEM score). Patients and methods: this was a retrospective study using a prospective database. Patients > 65 years old that underwent urgent abdominal surgery were included. Risk factors for 30-day mortality were identified using multivariate regression analysis and weights assigned using the odds ratios (OR). A mortality score was derived from the aggregate of weighted scores. Model calibration and discrimination were judged using the receiver operating characteristics curves and the Hosmer-Lemeshow test. Results: in the present study, 4,255 patients were included with an 8.5% mortality rate. The risk factors significantly associated with mortality were American Society of Anesthesiologists (ASA) score, age, preoperative diagnosis (OR: 37.82 for intestinal ischemia, OR: 5.01 for colorectal perforation, OR: 6.73 for intestinal obstruction), surgical wound classification and open or laparoscopic surgery. A risk score was devised from these data for the estimation of the probability of survival in each patient. The area under the ROC curve (AUROC) for this score was 0.84 (95% CI: 0.82-0.86) and the AUROC correct was 0.83 (0.81-0.85). Conclusions: a simple score that uses five clinical variables predicts 30-day mortality. This model can assist surgeons in the initial evaluation of an elderly patient undergoing urgent abdominal surgery

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Years of life lost due to diseases of the digestive system in Poland according to socioeconomic factors: a cross-sectional study.

OBJECTIVES: To analyse years of life lost (YLLs) due to digestive diseases in Poland according to: marital status, education, working status and place of residence. DESIGN: A cross-sectional study. SETTING: The study was based on a dataset containing information from death certificates of Poles who died in 2002 and in 2011. PARTICIPANTS: The analysis covered records with codes K00-K93 according to the International Classification of Diseases and Related Health Problems, 10th Revision. OUTCOME MEASURES: YLL values were calculated using the Standard Expected Years of Life Lost measure. For each socioeconomic variable, the rate ratio (RR) was calculated as the quotient of YLLs in the less privileged group to the more privileged group. RESULTS: Among the categories of marital status, the smallest YLL values (per 10 000) were recorded among singles (men: 100.63 years in 2002, 121.10 years in 2011; women: 26.99, 33.33, respectively), and the most among divorced men (657.87, 689.32) and widowed women (173.97, 169.46). YLL analysis according to education level revealed the lowest values in people with higher education (men: 54.20, 57.66; women: 17.31, 18.31) and the highest in people with lower than secondary education (men: 178.85, 198.32; women: 104.95, 125.76). Being economically active was associated with a smaller YLL score (men: 39.93, 59.51; women: 10.31, 14.96) than being inactive (men: 340.54, 219.93; women: 126.86, 96.80). Urban residents had higher YLL score (men: 159.46, 174.18, women: 73.03, 78.12) than rural ones (men: 126.83, 137.11, women: 57.32, 57.56).In both sexes, RR according to education level and place of residence increased, and those according to marital status and working status decreased with time. CONCLUSIONS: Activities aimed at reducing health inequalities in terms of YLL due to digestive diseases should be primarily addressed to inhabitants with lower than secondary education, divorced and widowed people, urban residents and those who are economically inactive.

Increased mortality from somatic multimorbidity in patients with schizophrenia: a Danish nationwide cohort study.

OBJECTIVE: To investigate the association of single- and multimorbidity with mortality rates in patients with schizophrenia compared to the general population. METHOD: A nationwide cohort study including residents in Denmark between 1995 and 2015. The cohort was dichotomously divided by a diagnosis of schizophrenia. Somatic diseases included infections, cancer, endocrine, neurologic, cardiovascular, respiratory, digestive, skin, musculoskeletal, and urogenital diseases. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated. RESULTS: The cohort included 30 210 patients with schizophrenia [mean age (SD) = 32.6 (11.4), males = 57.2%], and 5 402 611 from the general population [mean age (SD) = 33.0 (14.5), males = 50.4%]. All number of somatic diseases were associated with an increased mortality in schizophrenia [HR = 16.3 (95% CI = 15.4-17.3) for 1 disease to 21.0 (95% CI = 19.1-23.0) for ≥5 diseases], using the general population with no somatic disease as reference. Across all somatic diseases, patients with schizophrenia showed a HR > 2, compared to the general population, and respiratory (PAF = 9.3%), digestive (PAF = 8.2%), and cardiovascular (PAF = 7.9%) diseases showed largest contributions to death. CONCLUSIONS: Patients with schizophrenia showed higher mortality on all levels of multimorbidity, and a doubled mortality rate across all somatic diseases, compared to the general population. The findings suggest that the clusters and trajectories of symptoms associated with schizophrenia is the main driver of the excess mortality.

Cause-Specific Mortality in Gout: Novel Findings of Elevated Risk of Non-Cardiovascular-Related Deaths.

OBJECTIVE: To examine cause-specific mortality beyond cardiovascular diseases (CVDs) in patients with gout compared to the general population. METHODS: We included all residents of Skåne (Sweden) age ≥18 years in the year 2002. Using the Skåne Healthcare Register, we identified subjects with a new diagnosis of gout (2003-2013) and matched each person with gout with 10 comparators free of gout, by age and sex. We used information on the underlying cause of death from the Swedish Cause of Death Register (through December 31, 2014) to estimate hazard ratios (HRs, with 95% confidence intervals [95% CIs]) of mortality for specific causes of death in a multi-state Cox model, with adjustment for potential confounders. RESULTS: Among 832,258 persons, 19,497 had a new diagnosis of gout (32% women) and were matched with 194,947 comparators. Subjects with gout had higher prevalence of chronic kidney disease, metabolic disease, and CVD. Gout was associated with 17% increased hazard of all-cause mortality overall (HR 1.17 [95% CI 1.14-1.21]), 23% in women (HR 1.23 [95% CI 1.17-1.30]), and 15% in men (HR 1.15 [95% CI 1.10-1.19]). In terms of cause-specific mortality, the strongest associations were seen in the relationship of gout to the risk of death due to renal disease (HR 1.78 [95% CI 1.34-2.35]), diseases of the digestive system (HR 1.56 [95% 1.34-1.83]), CVD (HR 1.27 [95% CI 1.22-1.33]), infections (HR 1.20 [95% CI 1.06-1.35]), and dementia (HR 0.83 [95% CI 0.72-0.97]). CONCLUSION: Several non-CV causes of mortality are increased in persons with gout, emphasizing the need for improved management of comorbidities.

Associations between coffee consumption and all-cause and cause-specific mortality in a Japanese city: the Takayama study.

OBJECTIVE: Epidemiological studies suggest that coffee consumption is inversely associated with all-cause and cause-specific mortality. Evidence from studies targeting non-white, non-Western populations is still sparse, although coffee is popular and widely consumed in Asian countries. DESIGN: Population-based, prospective cohort study. We used Cox proportional hazards models with adjustment for dietary and lifestyle factors to estimate associations between coffee consumption and all-cause and cause-specific mortality. Dietary intake including coffee consumption was assessed only at baseline using a validated FFQ. SETTING: A Japanese city. PARTICIPANTS: Individuals aged 35 years or older without cancer, CHD and stroke at baseline (n 29 079) and followed from 1992 to 2008. RESULTS: From 410 352 person-years, 5339 deaths were identified (mean follow-up = 14·1 years). Coffee consumption was inversely associated with mortality from all causes and CVD among all participants, but not from cancer. Compared with the category of 'none', the multivariate hazard ratio (95 % CI) for all-cause mortality was 0·93 (0·86, 1·00) for <1 cup/d, 0·84 (0·76, 0·93) for 1 cup/d and 0·81 (0·71, 0·92) for 2-3 cups/d. The multivariate hazard ratio (95 % CI) for cardiovascular mortality were 0·87 (0·77, 0·99) for <1 cup/d, 0·76 (0·63, 0·92) for 1 cup/d and 0·67 (0·50, 0·89) for 2-3 cups/d. Inverse associations were also observed for mortality from other causes, specifically infectious and digestive diseases. CONCLUSION: Drinking coffee, even 1 cup/d, was inversely associated with all-cause mortality and mortality from cardiovascular, infectious and digestive diseases.