Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden

IntroductionCompression neuropathies (CN) in the upper extremity, the most common being carpal tunnel syndrome (CTS) and ulnar nerve entrapment (UNE), are frequent among patients with diabetes mellitus (DM). Earlier studies have shown contradicting results regarding DM as a risk factor for CN. Thus, the aim of the present population-based, longitudinal study was to explore potential associations between DM, CTS, and UNE during long-term follow-up.Research design and methodsA total of 30 466 participants aged 46–73 years, included in the population-based Malmö Diet and Cancer Study during 1991–1996, were followed up in Swedish national registries regarding incident CTS and UNE until 2016. Associations between prevalent DM at baseline and incident CTS or UNE were calculated using Cox proportional hazard models, adjusted for baseline confounders, such as sex, age at study entry, smoking, hypertension, use of antihypertensive treatment, alcohol consumption, and body mass index (BMI). HbA1c and fasting plasma glucose levels had been measured at baseline in a subgroup of 5508 participants and were related to incident CTS and UNE in age and sex-adjusted binary logistic regression models.ResultsA total of 1081 participants developed CTS and 223 participants developed UNE during a median follow-up of 21 years. Participants with incident CTS or UNE had higher prevalence of DM and higher BMI at baseline. Using multivariate Cox regression models, prevalent DM at baseline was independently associated with both incident CTS (HR 2.10; 95% CI 1.65 to 2.70, p<0.0001) and incident UNE (HR 2.20; 95% CI 1.30 to 3.74, p=0.003). Higher levels of HbA1c and plasma glucose were associated with an increased risk for CTS, but not for UNE.ConclusionThis study establishes DM as a major risk factor in the development of both CTS and UNE. Furthermore, a higher BMI is associated with both CTS and UNE. Finally, hyperglycemia seems to affect the median and ulnar nerves differently.

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Headache as a risk factor for dementia: A prospective population-based study

Cephalalgia ◽

10.1177/0333102413513181 ◽

2013 ◽

Vol 34 (5) ◽

pp. 327-335 ◽

Cited By ~ 22

Author(s):

Knut Hagen ◽

Eystein Stordal ◽

Mattias Linde ◽

Timothy J Steiner ◽

John-Anker Zwart ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Cox Regression ◽

Subsequent Development ◽

Population Based ◽

Health Study ◽

Cox Regression Analysis ◽

Hazard Ratios ◽

Increased Risk

Background Headache has not been established as a risk factor for dementia. The aim of this study was to determine whether any headache was associated with subsequent development of vascular dementia (VaD), Alzheimer’s disease (AD) or other types of dementia. Methods This prospective population-based cohort study used baseline data from the Nord-Trøndelag Health Study (HUNT 2) performed during 1995–1997 and, from the same Norwegian county, a register of cases diagnosed with dementia during 1997–2010. Participants aged ≥20 years who responded to headache questions in HUNT 2 were categorized (headache free; with any headache; with migraine; with nonmigrainous headache). Hazard ratios (HRs) for later inclusion in the dementia register were estimated using Cox regression analysis. Results Of 51,383 participants providing headache data in HUNT 2, 378 appeared in the dementia register during the follow-up period. Compared to those who were headache free, participants with any headache had increased risk of VaD ( n = 63) (multivariate-adjusted HR = 2.3, 95% CI 1.4–3.8, p = 0.002) and of mixed dementia (VaD and AD ( n = 52)) (adjusted HR = 2.0, 95% CI 1.1–3.5, p = 0.018). There was no association between any headache and later development of AD ( n = 180). Conclusion In this prospective population-based cohort study, any headache was a risk factor for development of VaD.

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Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999–2015

International Journal of Epidemiology ◽

10.1093/ije/dyaa263 ◽

2020 ◽

Author(s):

Kosuke Inoue ◽

Roch Nianogo ◽

Donatello Telesca ◽

Atsushi Goto ◽

Vahe Khachadourian ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Regression Models ◽

Machine Learning Algorithms ◽

Logistic Regression Models ◽

Health And Nutrition ◽

Increased Risk ◽

The Us ◽

All Cause Mortality ◽

Hba1c Levels

Abstract Objective It is unclear whether relatively low glycated haemoglobin (HbA1c) levels are beneficial or harmful for the long-term health outcomes among people without diabetes. We aimed to investigate the association between low HbA1c levels and mortality among the US general population. Methods This study includes a nationally representative sample of 39 453 US adults from the National Health and Nutrition Examination Surveys 1999–2014, linked to mortality data through 2015. We employed the parametric g-formula with pooled logistic regression models and the ensemble machine learning algorithms to estimate the time-varying risk of all-cause and cardiovascular mortality by HbA1c categories (low, 4.0 to <5.0%; mid-level, 5.0 to <5.7%; prediabetes, 5.7 to <6.5%; and diabetes, ≥6.5% or taking antidiabetic medication), adjusting for 72 potential confounders including demographic characteristics, lifestyle, biomarkers, comorbidities and medications. Results Over a median follow-up of 7.5 years, 5118 (13%) all-cause deaths, and 1116 (3%) cardiovascular deaths were observed. Logistic regression models and machine learning algorithms showed nearly identical predictive performance of death and risk estimates. Compared with mid-level HbA1c, low HbA1c was associated with a 30% (95% CI, 16 to 48) and a 12% (95% CI, 3 to 22) increased risk of all-cause mortality at 5 years and 10 years of follow-up, respectively. We found no evidence that low HbA1c levels were associated with cardiovascular mortality risk. The diabetes group, but not the prediabetes group, also showed an increased risk of all-cause mortality. Conclusions Using the US national database and adjusting for an extensive set of potential confounders with flexible modelling, we found that adults with low HbA1c were at increased risk of all-cause mortality. Further evaluation and careful monitoring of low HbA1c levels need to be considered.

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Changes in insomnia as a risk factor for the incidence and persistence of anxiety and depression: a longitudinal community study

Sleep Science and Practice ◽

10.1186/s41606-020-00053-z ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Magnus Johansson ◽

Markus Jansson-Fröjmark ◽

Annika Norell-Clarke ◽

Steven J. Linton

Keyword(s):

Risk Factor ◽

Depression Scale ◽

Binary Logistic Regression ◽

Anxiety And Depression ◽

Hospital Anxiety ◽

Dynamic Risk ◽

Increased Risk ◽

Longitudinal Association ◽

Development Of Anxiety

Abstract Background The aim of this investigation was to examine the longitudinal association between change in insomnia status and the development of anxiety and depression in the general population. Methods A survey was mailed to 5000 randomly selected individuals (aged 18–70 years) in two Swedish counties. After 6 months, a follow-up survey was sent to those (n = 2333) who answered the first questionnaire. The follow-up survey was completed by 1887 individuals (80.9%). The survey consisted of questions indexing insomnia symptomatology, socio-demographic parameters, and the Hospital Anxiety and Depression Scale. Change in insomnia status was assessed by determining insomnia at the two time-points and then calculating a change index reflecting incidence (from non-insomnia to insomnia), remission (from insomnia to non-insomnia), or status quo (no change). Multivariate binary logistic regression analyses were used to examine the aim. Results Incident insomnia was significantly associated with an increased risk for the development of new cases of both anxiety (OR = 0.32, p < .05) and depression (OR = 0.43, p < .05) 6 months later. Incident insomnia emerged also as significantly associated with an elevated risk for the persistence of depression (OR = 0.30, p < .05), but not for anxiety. Conclusions This study extends previous research in that incidence in insomnia was shown to independently increase the risk for the development of anxiety and depression as well as for the maintenance of depression. The findings imply that insomnia may be viewed as a dynamic risk factor for anxiety and depression, which might have implications for preventative work.

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Dietary and lifestyle inflammatory scores are associated with increased risk of metabolic syndrome in Iranian adults

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00648-1 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Hossein Farhadnejad ◽

Karim Parastouei ◽

Hosein Rostami ◽

Parvin Mirmiran ◽

Fereidoun Azizi

Keyword(s):

Metabolic Syndrome ◽

Positive Association ◽

Population Based ◽

Population Based Study ◽

Logistic Regression Models ◽

Increased Risk ◽

Confounding Variables ◽

Adjusted Model ◽

Diet And Lifestyle

Abstract Background In the current study, we aimed to investigate the association of dietary inflammation scores (DIS) and lifestyle inflammation scores (LIS) with the risk of metabolic syndrome (MetS) in a prospective population-based study. Methods A total of 1625 participants without MetS were recruited from among participants of the Tehran Lipid and Glucose Study(2006–2008) and followed a mean of 6.1 years. Dietary data of subjects were collected using a food frequency questionnaire at baseline to determine LIS and DIS. Multivariable logistic regression models, were used to calculate the odds ratio (ORs) and 95 % confidence interval (CI) of MetS across tertiles of DIS and LIS. Results Mean ± SD age of individuals (45.8 % men) was 37.5 ± 13.4 years. Median (25–75 interquartile range) DIS and LIS for all participants was 0.80 (− 2.94, 3.64) and 0.48 (− 0.18, − 0.89), respectively. During the study follow-up, 291 (17.9 %) new cases of MetS were identified. Based on the age and sex-adjusted model, a positive association was found between LIS (OR = 7.56; 95% CI 5.10–11.22, P for trend < 0.001) and risk of MetS, however, the association of DIS and risk of MetS development was not statistically significant (OR = 1.30;95% CI 0.93–1.80, P for trend = 0.127). In the multivariable model, after adjustment for confounding variables, including age, sex, body mass index, physical activity, smoking, and energy intake, the risk of MetS is increased across tertiles of DIS (OR = 1.59; 95% CI 1.09–2.33, P for trend = 0.015) and LIS(OR = 8.38; 95% CI 5.51–12.7, P for trend < 0.001). Conclusions The findings of the current study showed that greater adherence to LIS and DIS, determined to indicate the inflammatory potential of diet and lifestyle, are associated with increased the risk of MetS.

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Women’s Autonomy and Support for Wife Beating: Findings From a Population-Based Survey in Jordan

Violence and Victims ◽

10.1891/0886-6708.25.3.409 ◽

2010 ◽

Vol 25 (3) ◽

pp. 409-419 ◽

Cited By ~ 25

Author(s):

Natalia Linos ◽

Marwan Khawaja ◽

Mohannad Al-Nsour

Keyword(s):

Regression Models ◽

Binary Logistic Regression ◽

Population Based ◽

Married Women ◽

Wife Beating ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Logistic Regression Models ◽

Hypothetical Scenario ◽

Population Based Survey

The aim of this study is to examine attitudes among married women toward wife beating and to investigate the hypothesis that female individual empowerment is associated with such attitudes within a broader context of societal patriarchy in Jordan. The study uses data from a cross-sectional survey of a representative sample of married women (n = 5,390) conducted in 2002. Associations between acceptance of wife beating and several women’s empowerment variables, including decision-making power, as well as other risk factors were assessed, using odds ratios from binary logistic regression models. The key finding is that the vast majority (87.5%) of Jordanian women believe that wife beating is justified in at least one hypothetical scenario, and justification is negatively associated with empowerment variables and some demographic, geographic, and socioeconomic factors.

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Abstract P060: Plasma Osteocalcin And Incident Diabetes Mellitus: The Atherosclerosis Risk In Communities (ARIC) Study

Circulation ◽

10.1161/circ.143.suppl_1.p060 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Jeffrey R Misialek ◽

Elizabeth R Stremke ◽

Elizabeth Selvin ◽

Sanaz Sedaghat ◽

James S Pankow ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cox Regression ◽

Self Report ◽

Incident Diabetes ◽

Blood Levels ◽

Total Plasma ◽

Phone Calls ◽

Increased Risk ◽

Primary Model

Introduction: Diabetes is a major risk factor for cardiovascular disease. Osteocalcin is a vitamin K-dependent, bone-derived hormone that functions as an endocrine regulator of energy metabolism, male fertility, and cognition. Early studies of endocrine effects of osteocalcin have shown that genomic deletion of osteocalcin in mice resulted in a diabetic phenotype (i.e. glucose intolerance, and insulin resistance). However, results from clinical studies have shown mixed associations between blood levels of osteocalcin and risk of incident type 2 diabetes mellitus. Hypothesis: Lower values of plasma osteocalcin would be associated with an increased risk of diabetes. Methods: A total of 11,557 ARIC participants without diabetes at baseline were followed from ARIC visit 3 (1993-1995) through 2018. Diabetes cases were identified through self-report on annual and semi-annual follow-up phone calls. Plasma osteocalcin data was measured using an aptamer-based proteomic profiling platform (SomaLogic). We used Cox regression to evaluate the association of quintiles of plasma osteocalcin and incident diabetes. The primary model adjusted for age, sex, and race-center. Results: Participants were age 60 ± 5.6 years at visit 3, 56% identified as female, 21% identified as Black. There were 3,031 incident diabetes cases over a median follow-up of 17.9 years. Mean ± SD was 10.053 ± 0.775. When comparing the highest quintile of plasma osteocalcin (values 10.42 to 14.66) to the lowest quintile (values 9.03 to 9.52), there was no association with incident diabetes (HRs [95% CIs]: 0.92 [0.81, 1.02]). There was also no significant trend across the quintiles (p = 0.19). Results were similar when adjusting for additional potential confounders, and when limiting the follow-up time to 10 years. Conclusions: These data do not support the hypothesis that total plasma osteocalcin, as measured by Somalogic proteomic panel, is a biomarker associated with diabetes risk. It is possible that total plasma or serum osteocalcin and/or other isoforms of osteocalcin protein (i.e. gamma carboxylated or uncarboxylated osteocalcin) measured via other validated methodologies may be linked to diabetes.

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Long term perspective with LBBB: role of stress echocardiography

European Heart Journal ◽

10.1093/ehjci/ehaa946.0020 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Dedic ◽

N Boskovic ◽

V Giga ◽

M Tesic ◽

S Aleksandric ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Left Bundle Branch Block ◽

Stress Echocardiography ◽

Cox Regression ◽

Survival Curve ◽

Bundle Branch Block ◽

Cox Regression Analysis ◽

Increased Risk

Abstract Background Previous studies have shown that left bundle branch block (LBBB), as a relatively common electrocardiographic (ECG) abnormality, represents the condition with often non benign and sometimes adverse outcome. Purpose The Aim of our study was to determine the predictive value of a stress echocardiography test in patients with LBBB. Methods Our study population included 189 patients (88 male, 46.6%, mean age 63.08±9.65) with diagnosed left bundle branch block who performed stress echocardiography (SECHO) according to Bruce protocol. Median follow-up of the patients was 56 months (IQR 48–71 months) for the occurrence of cardiovascular death and non-fatal myocardial infarction, repeat revascularization (coronary artery bypass grafting-CABG or percutaneous coronary intervention-PCI). Results Out of 189 patients, 32 (16.9%) patients had positive, while 157 (83.1%) patients had negative SECHO test. During the follow up period 28 patients had major adverse cardiac event: 1 nonfatal myocardial infarction, 6 heart failure hospitalizations, 5 CABGs, 8 PCIs, while 8 patients had cardiac death. Using the Cox regression analysis, univariate predictors of adverse cardiac events were diabetes mellitus (HR 4.530 [95% CI 1.355–15.141], p=0.014), PCI (HR 4.288 [95% [95% CI 2.010–9.144], p<0.001) and positive SECHO test (HR 2.289 [95% CI 1.006–5207], p=0.048). In the multivariate analysis only previous PCI remained independent predictor of adverse events (HR 3.650 [95% CI 1.665–8.003], p=0.001). p=0.048). Using the Kaplan-Meier survival curve the patients with negative SECHO had better outcome compared to patients with positive SECHO (140/160; 87,5% vs 21/29; 72.4%, p=0.035) and much longer event-free time (77.4±1.6 months vs 67.1±5.4 months, Log Rank 4.136, p=0.042) Conclusion Patients with LBBB and negative SEHO test have good prognosis. Patients with history of CAD and diabetes mellitus and LBBB are at increased risk for future events and need periodical reassessment. Funding Acknowledgement Type of funding source: None

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Association between pulse pressure and ischaemic stroke in elderly patients with hypertension

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137357 ◽

2020 ◽

pp. postgradmedj-2019-137357

Author(s):

Jiayi Huang ◽

Lin Liu ◽

Yu-Qing Huang ◽

Kenneth Lo ◽

Yu-Ling Yu ◽

...

Keyword(s):

Ischaemic Stroke ◽

Pulse Pressure ◽

Regression Models ◽

Cox Regression ◽

Antihypertensive Drugs ◽

Uncontrolled Blood Pressure ◽

Increased Risk ◽

Elderly Hypertensive ◽

Male Patients

BackgroundThe association between pulse pressure (PP) and the risk of first ischaemic stroke (IS) is inconsistent. Therefore, we evaluated the association between PP and the risk of first IS among elderly hypertensive population in China.MethodsThis was a retrospective cohort study. Patients with hypertension and aged ≥60 years were recruited. Multivariate Cox regression was performed to evaluate the association between PP and the risk of IS. We further stratified the regression models into subgroups and test for interaction to assess whether the associations were modified by other covariates.ResultsA total of 3315 patients with hypertension (44.49% male; mean age 71.41±7.20 years) were included, and 206 cases of IS occurred with a median follow-up of 5.5 years. The results showed that per SD mm Hg increment in PP was associated with a 17% (95% CI 1.05 to 1.40, p=0.0172) increased risk of IS. Moreover, the HR of IS for the highest quartile of PP was 1.46 (95% CI 1.18 to 1.73, p=0.0011, p for trend <0.001) comparing with the lowest quartile of PP. Subgroup analysis showed that population aged ≥70 years, male, patients with smoking or drinking habit, diabetes at baseline, being overweight, with uncontrolled blood pressure or did not take antihypertensive drugs have a higher risk for IS.ConclusionsWe found that PP was significantly associated with IS and was an independent risk factor for IS.

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Does Flipping the Tubercle for Improved Cartilage Repair Exposure Increase the Risk for Arthrofibrosis?

Cartilage ◽

10.1177/1947603520968209 ◽

2020 ◽

pp. 194760352096820

Author(s):

Gergo Merkely ◽

Jakob Ackermann ◽

Emily Sheehy ◽

Andreas H. Gomoll

Keyword(s):

Logistic Regression ◽

Cartilage Repair ◽

Regression Models ◽

Case Control Study ◽

Level Of Evidence ◽

Logistic Regression Models ◽

Increased Risk ◽

Repair Procedure ◽

Control Study

Objective We sought to determine whether rates of postoperative arthrofibrosis following tibial tuberosity osteotomy (TTO) with complete mobilization of the fragment (TTO-HD) are comparable to TTOs where the hinge remained intact (TTO-HI). Design Patients who underwent TTO with concomitant cartilage repair procedure between January 2007 and May 2017, with at least 2 years of follow-up were included in this study. Postoperative reinterventions following TTO-HD and TTO-HI were assessed and multivariant logistic regression models were used to identify whether postoperative reinterventions can be attributed to either technique when controlled for defect size or defect number. Results A total of 127 patients (TTO-HD, n = 80; TTO-HI, n = 47) were included in this study. Significantly more patients in the TTO-HD group (31.2%) developed postoperative arthrofibrosis compared with TTO-HI (6.4%; P < 0.05). Multivariant logistic regression revealed that TTO-HD is an independent risk factor for predicting postoperative arthrofibrosis (OR 6.5, CI = 1.7-24.2, P < 0.05). Conclusion Patients who underwent TTO with distal hinge detachment and a proximally flipped tubercle for better exposure during concomitant cartilage repair were at a significantly higher risk of postoperative arthrofibrosis than patients with similar size and number of defects treated without mobilization of the tubercle. While certain procedures can benefit from larger exposure, surgeons should be aware of the increased risk of postoperative arthrofibrosis. Level of Evidence Level III, case-control study.

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Convexity subarachnoid hemorrhage in lobar intracerebral hemorrhage

Neurology ◽

10.1212/wnl.0000000000009036 ◽

2020 ◽

Vol 94 (9) ◽

pp. e968-e977 ◽

Cited By ~ 1

Author(s):

Nicolas Raposo ◽

Andreas Charidimou ◽

Duangnapa Roongpiboonsopit ◽

Michelle Onyekaba ◽

M. Edip Gurol ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Regression Models ◽

Cox Regression ◽

Bleeding Risk ◽

Superficial Siderosis ◽

Amyloid Angiopathy ◽

Increased Risk ◽

Cortical Superficial Siderosis

ObjectiveTo investigate whether acute convexity subarachnoid hemorrhage (cSAH) associated with acute lobar intracerebral hemorrhage (ICH) increases the risk of ICH recurrence in patients with cerebral amyloid angiopathy (CAA).MethodsWe analyzed data from a prospective cohort of consecutive survivors of acute spontaneous lobar ICH fulfilling the Boston criteria for possible or probable CAA (CAA-ICH). We analyzed baseline clinical and MRI data, including cSAH (categorized as adjacent or remote from ICH on a standardized scale), cortical superficial siderosis (cSS), and other CAA MRI markers. Multivariable Cox regression models were used to assess the association between cSAH and recurrent symptomatic ICH during follow-up.ResultsWe included 261 CAA-ICH survivors (mean age 76.2 ± 8.7 years). Of them, 166 (63.6%, 95% confidence interval [CI] 57.7%–69.5%) had cSAH on baseline MRI. During a median follow-up of 28.3 (interquartile range 7.2–57.0) months, 54 (20.7%) patients experienced a recurrent lobar ICH. In Cox regression, any cSAH, adjacent cSAH, and remote cSAH were independent predictors of recurrent ICH after adjustment for other confounders, including cSS. Incidence rate of recurrent ICH in patients with cSAH was 9.9 per 100 person-years (95% CI 7.3–13.0) compared with 1.2 per 100 person-years (95% CI 0.3–3.2) in those without cSAH (adjusted hazard ratio 7.5, 95% CI 2.6–21.1).ConclusionIn patients with CAA-related acute ICH, cSAH (adjacent or remote from lobar ICH) is commonly observed and heralds an increased risk of recurrent ICH. cSAH may help stratify bleeding risk and should be assessed along with cSS for prognosis and clinical management.

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