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To investigate whether uncertainty surrounding the death is associated with the inaccurate reporting of intellectual disability as the underlying cause of death.
National Vital Statistics System 2005-2017 US Multiple Cause-of-Death Mortality files.
USA.
Adults with an intellectual disability reported on their death certificate, aged 18 and over at the time of death. The study population included 26 555 adults who died in their state of residence between 1 January 2005 and 31 December 2017.
Decedents with intellectual disability reported on their death certificate were identified using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for intellectual disability (F70-79). Bivariate analysis and multilevel logistic regression models were used to investigate whether individual-level and state-level characteristics indicative of increased uncertainty at the time of death were associated with the inaccurate reporting of intellectual disability as the death certificate.
It is imperative that medical personnel not let increased uncertainty lead to the inaccurate reporting of intellectual disability as the underlying cause of death as this practice obscures cause of death trends for this population. Instead, even in instances when increased uncertainty surrounds the death, certifiers should strive to accurately identify the disease or injury causing death, and report the disability in Part II of the death certificate.
To determine if obesity and diabetes are risk factors for severe outcomes in COVID-19 and to compare patient outcomes in those two conditions.
Retrospective cohort study.
Urban tertiary care center in New York City.
302 patients admitted in an inpatient setting, ≥18 years old, with a laboratory-confirmed diagnosis of COVID-19 via nasal PCR swab were randomly selected. Patients were separated into two cohorts based on their body mass index and hemoglobin A1c. 150 patients were placed in the non-obese, non-diabetic cohort and 152 patients were placed in the corresponding cohort (obesity alone, obesity and diabetes, and diabetes alone).
Primary outcomes were development of acute kidney injury, commencement of renal replacement therapy, aminotransferase elevation, troponin elevation, lactic acidosis, development of septic shock, use of vasopressors, presence of acute respiratory distress syndrome (ARDS) and intubation. The secondary outcomes were length of stay in days and mortality.
Patients with obeications, but had negligible differences in mortality. This highlights the importance of close monitoring of patients with these conditions and additional areas of research needed to explain the mortality findings.
Children born moderate to late preterm (MLP, 32-36 weeks' gestation) account for approximately 85% of all preterm births globally. Compared with children born at term, children born MLP are at increased risk of poor neurodevelopmental outcomes. Despite making up the largest group of preterm children, developmental outcomes of children born MLP are less well studied than in other preterm groups. This study aimed to (1) compare neurodevelopmental, respiratory health and brain magnetic resonance imaging (MRI) outcomes between children born MLP and term at 9 years of age; (2) examine the differences in brain growth trajectory from infancy to 9 years between children born MLP and term; and in children born MLP; (3) examine the relationship between brain development and neurodevelopment at 9 years; and (4) identify risk factors for poorer outcomes at 9 years.
The "LaPrem" (
te
term
RI Study) study is a longitudinal cohort study of children born MLP and term controls, born at the Royal Women's Hospital in Mutcomes will be disseminated through peer-reviewed publications, conference presentations and social media.
Some studies have identified tumour-infiltrating lymphocytes (TILs) in H&E-stained sections of gastric cancer, but the prognostic and clinicopathological significance of this remains unclear. The objective of this study is to evaluate the associations between H&E-based TIL density and prognosis and clinicopathological characteristics of patients with gastric cancer.
Systematic review and meta-analysis.
Cochrane Library, PubMed and Embase databases were searched through 25 February 2020.
Studies evaluating the correlations between TILs assessed by H&E-stained sections and prognosis and clinicopathological characteristics of gastric cancer were included.
Relevant data were extracted and risks of bias were assessed independently by two reviewers. HR and relative risk (RR) with 95% CI were pooled by random-effect models to estimate the associations between TIL density and overall survival (OS) and clinicopathological characteristics, respectively.
We enrolled nine studies including 2835 cases for the present meta-analysis. High TILs were associated with superior OS (HR=0.68, 95% CI 0.52 to 0.87, p=0.003) compared with low TILs. High TILs were significantly associated with lower depth of invasion (T3-T4 vs T1-T2) (RR=0.58, 95% CI 0.50 to 0.66, p<0.001), less lymph node involvement (presence vs absence) (RR=0.68, 95% CI 0.56 to 0.81, p<0.001) and earlier TNM (tumour, node, metastasis) stage (III-IV vs I-II) (RR=0.68, 95% CI 0.55 to 0.83, p<0.001). TIL density was not associated with age, gender, Lauren classification or histological grade. The methodology for evaluating TIL and its cut-off value varied across different studies, which might affect the results of our meta-analysis.
Our meta-analysis suggests that H&E-based TIL density is a reliable biomarker to predict the clinical outcomes of patients with gastric cancer. Multicentre, prospective studies are needed to further confirm our findings.
CRD42020169877.
CRD42020169877.
We aimed to evaluate the association between metabolic syndrome (MetS) and two latest optimised indices, waist divided by height
(WHT.5R) and body mass index (BMI) multiply by the square root of BMI and waist circumference (BMI√WC), and to comprehensively compare the ability of 10 anthropometric indices to identify MetS, including BMI√WC, WHT.5R, abdominal volume index (AVI), waist-to-height ratio (WHtR), Body Roundness Index (BRI).
Cross-sectional study.
Ningxia, China.
A total of 3860 adults aged 18-88 years from Ningxia, China were recruited by a single stratified cluster random sampling method.
ORs and 95% CIs for associations between indices and MetS were calculated using binary logistic regression, and areas under the receiver operating characteristic (ROC) curves (AUCs) were performed to compare their predictive capacity for MetS. All results for men and women were analysed and presented separately.
The highest adjusted ORs for MetS were observed for the following indices AVI (OR 15.22, 95% CI 10.88 to 21.30), WHT.5R (OR 13.83, 95% CI 9.89 to 19.35) and BMI√WC (OR 12.14, 95% CI 8.79 to 16.76) in men, whereas BRI, WHtR (both OR 14.91, 95% CI 10.39 to 21.4), WHT.5R (OR 14.22, 95% CI 9.96 to 20.29) and AVI (OR 14.03, 95% CI 9.91 to 19.87) in women. In ROC analysis, AVI (AUC 0.767 for men and 0.749 for women) and WHT.5R (AUC 0.761 for men and 0.747 for women) showed the highest predictive ability for MetS.
BMI√WC and WHT.5R were significantly positively associated with MetS, and AVI and WHT.5R could be useful screening tools for identifying MetS in both sexes.
BMI√WC and WHT.5R were significantly positively associated with MetS, and AVI and WHT.5R could be useful screening tools for identifying MetS in both sexes.
To determine the association of long-term use of antipsychotics with the risk of dyslipidaemia.
A hospital-based cohort study.
Electronic health record data of adult mental health inpatients in all 19 specialised psychiatric hospitals in Beijing from 1 January 2005 to 31 December 2018 was obtained.
Participants were inpatients aged 18 years or older with at least two admissions, excluding those with diagnosed dyslipidaemia and fatty liver at the first admission. We included 22 329 adult inpatients with no dyslipidaemia and fatty liver at baseline. The exposure was antipsychotics use, defined as antipsychotics prescription in the treatment procedures of medical record preceding dyslipidaemia diagnosis during the follow-up period. 15 930 (71.34%) had antipsychotics use, and 6399 (28.66%) never had antipsychotics use. We used the length of follow-up as proxy for the duration of antipsychotics exposure.
The primary outcome was newly recorded dyslipidaemia defined by International Classification of Diseas use was associated with higher risk of dyslipidaemia among Chinese inpatients with mental illness. Dyslipidaemia was especially prominent in young patients and those without hypertension.
Older emergency department (ED) patients are at high risk of mortality, and it is important to predict which patients are at highest risk. Biomarkers such as lactate, high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), D-dimer and procalcitonin may be able to identify those at risk. We aimed to assess the discriminatory value of these biomarkers for 30-day mortality and other adverse outcomes.
Prospective cohort study. On arrival of patients, five biomarkers were measured. Area under the curves (AUCs) and interval likelihood ratios (LRs) were calculated to investigate the discriminatory value of the biomarkers.
ED in the Netherlands.
Older (≥65 years) medical ED patients, referred for internal medicine or gastroenterology.
30-day mortality was the primary outcome measure, while other adverse outcomes (intensive care unit/medium care unit admission, prolonged length of hospital stay, loss of independent living and unplanned readmission) were the composite secondary outcome measure.
The median age of the 450 included patients was 79 years (IQR 73-85). In total, 51 (11.3%) patients died within 30 days. The AUCs of all biomarkers for prediction of mortality were sufficient to good, with the highest AUC of 0.73 for hs-cTnT and NT-proBNP. Only for the highest lactate values, the LR was high enough (29.0) to be applicable for clinical decision making, but this applied to a minority of patients. The AUC for the composite secondary outcome (intensive and medium care admission, length of hospital stay >7 days, loss of independent living and unplanned readmission within 30 days) was lower, ranging between 0.58 and 0.67.
Although all five biomarkers predict 30-day mortality in older medical ED patients, their individual discriminatory value was not high enough to contribute to clinical decision making.
NCT02946398; Results.
NCT02946398; Results.
We hypothesised that (1) the prevalent cardiovascular disease (CVD) is associated with global electrical heterogeneity (GEH) after adjustment for demographic, anthropometric, socioeconomic and traditional cardiovascular risk factors, (2) there are sex differences in GEH and (3) sex modifies an association of prevalent CVD with GEH.
Cross-sectional, cohort study.
Prospective African-American The Jackson Heart Study (JHS) with a nested family cohort in 2000-2004 enrolled residents of the Jackson, Mississippi metropolitan area.
Participants from the JHS with analysable ECGs recorded in 2009-2013 (n=3679; 62±12 y; 36% men; 863 family units). QRS, T and spatial ventricular gradient (SVG) vectors' magnitude and direction, spatial QRS-T angle and sum absolute QRST integral (SAI QRST) were measured.
Prevalent CVD was defined as the history of (1) coronary heart disease defined as diagnosed/silent myocardial infarction, or (2) revascularisation procedure defined as prior coronary/peripheral arterial revascularisation, or (3) carotid angioplasty/carotid endarterectomy, or (4) stroke.
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