Semiquantitative assessed proteinuria and risk of heart failure: Analysis of a nationwide epidemiological database

Background Heart failure (HF) is increasing in prevalence worldwide. We explored whether adults with trace and positive proteinuria were at a high risk for incident HF compared with those with negative proteinuria using a nationwide epidemiological database. Methods This is an obserevational cohort study using the JMDC Claims Database collected between 2005 and 2020. This is a population-based sample (n = 1,021,943; median age [interquartile range], 44 [37-52] years; 54.8% men). No participants had a known history of cardiovascular disease. Each participant was categorized into three groups according to the urine dipstick test results: negative proteinuria (n = 902,273), trace proteinuria (n = 89,599), and positive proteinuria (≥1+) (n = 30,071). The primary outcome was HF. The secondary outcomes were myocardial infarction, stroke, and atrial fibrillation. We performed multivariable Cox regression analyses to identify the association between the proteinuria category and incient HF and other cardiovascular disease events. Results Over a mean follow-up of 1,150 ± 920 days, 17,182 incident HF events occurred. After multivariable adjustment, hazard ratios (HRs) for HF events were 1.09 (95% confidence interval [CI], 1.03-1.15) and 1.59 (95% CI, 1.49-1.70) for trace proteinuria and positive proteinuria vs. negative proteinuria, respectively. This association was present irrespective of clinical characteristics. A stepwise increase in the risk of myocardial infarction, stroke, and atrial fibrillation with proteinuria category was also observed. Our primary results were confirmed in participants after multiple imputation for missing values and in those having no medications for hypertension, diabetes mellitus, and dyslipidemia. Discriminative predictive value for HF events improved by adding the results of urine dipstick test to traditional risk factors (net reclassification improvement 0.0497, 95% CI 0.0346-0.0648, p < 0.001). Conclusions Not only positive proteinuria but also trace proteinuria was associated with a greater incidence of HF in the general population. Semiquantitative assessment of proteinuria would be informative for the risk stratification of HF.

Fasting Plasma Glucose and Incident Colorectal Cancer: Analysis of a Nationwide Epidemiological Database Fasting Plasma Glucose and Colorectal Cancer

Context Although diabetes mellitus (DM) was reported to be associated with incident colorectal cancer (CRC), the detailed association between fasting plasma glucose (FPG) and incident CRC has not been fully understood. Objective We assessed whether hyperglycemia is associated with a higher risk for CRC. Design Analyses were conducted using the JMDC Claims Database (n=1,441,311; median age [IQR], 46 [40–54] years; 56.6% men). None of the participants were taking antidiabetic medication or had a history of CRC, colorectal polyps, or inflammatory bowel disease. Participants were categorized as normal FPG, FPG level<100 mg/dL (1,125,647 individuals); normal-high FPG, FPG level=100–109 mg/dL (210,365 individuals); impaired fasting glucose (IFG), FPG level=110–125 mg/dL (74,836 individuals); and DM, FPG level≥126 mg/dL (30,463 individuals). Results Over a mean follow-up of 1,137±824 days, 5,566 CRC events occurred. After multivariable adjustment, the hazard ratios for CRC events were 1.10 (95% CI,1.03–1.18) for normal-high FPG, 1.24 (95% CI, 1.13–1.37) for IFG, and 1.36 (95% CI, 1.19–1.55) for DM vs. normal FPG. We confirmed this association in sensitivity analyses excluding those with a follow-up of< 365 days, and or with obese participants. Conclusion The risk of CRC increased with elevated FPG category. FPG measurements would help identifying people at high-risk for future CRC.

Built Environment Factors Influencing Prevalence of Hypertension at Community Level in China: The Case of Wuhan

This paper studies the correlation between built environment factors and the prevalence of hypertension in Wuhan, a typical city in central China. Data were obtained from a regional epidemiological database, which is the 2015 Epidemiological Survey of people under 65 years in 144 communities. The prevalence of hypertension was analyzed in five components based on the WHO framework (land use, transport, accessibility, green space, and socioeconomic status). Results indicated built environment factors have significant correlations with the prevalence of hypertension (p < 0.01). The road network density, gymnasium cost, income, medical facilities cost, walkability index, and land use mix (LUM) were statistically significant. Other indicators did not pass the significance test. The spatial models fit better than the multivariate linear model.

Sex Differences in the Incidence and Risk of Ankle-Foot Complex Stress Fractures Among U.S. Military Personnel

Background: The objective of this study was to evaluate sex differences in the incidence and risk of ankle–foot complex (AFC) stress fractures among U.S. military personnel, which could assist in developing management strategies as females assume a greater role in U.S. military operations. Methods: The Defense Medical Epidemiological Database was used to identify all diagnosed AFC stress fractures in military personnel from 2006 to 2015. Cumulative incidence of AFC stress fractures was calculated and compared by year, service branch, and military rank. Sex differences in the risk of AFC stress fractures by occupation were examined, and integrated (i.e., male and female) occupations were compared with non-integrated (i.e., male–only) occupations. Results: A total of 43,990 AFC stress fractures were identified. The overall incidence rate was 2.76 per 1,000 person-years for males and 5.78 per 1,000 person-years for females. Females consistently had higher incidence of AFC stress fractures across all subgroups, particularly among enlisted personnel. Female enlisted service members had the highest risk of AFC stress fractures in aviation [relative risk (RR) = 5.74; 95% confidence interval [CI] 4.80–6.87] and artillery/gunnery (RR = 5.15; 95% CI 4.62–5.75) occupations. Females in integrated occupations had significantly higher rates of AFC stress fractures than males in both integrated and non-integrated occupations (i.e., special forces, infantry, and mechanized/armor). Conclusions: Females in the U.S. military have a higher risk of AFC stress fractures than males. As integration of females into previously sex-restricted occupations continues, focused prevention efforts may be needed to reduce injury burden and maximize medical readiness.

Radiology Perspective One-Year Study of Hirschsprung Disease

Hirschsprung disease is a rare developmental disorder of the enteric nervous system. This researched purpose to give an epidemiological database and current trend analysis from radiological perspective of Hirschsprung disease at our center. A prospective descriptive study was conducted for a year in 2017 at Sanglah Public General Hospital Bali. Colon in loop examination using either water-soluble or barium was conducted. All baseline characteristics, contras media used, and HD type were the parameter being evaluated in this study. Hirschsprung accounted for 2.16% from all 1018 newborn. Male is 3.4 times more prone to Hirschsprung disease. Age distribution predominant during 0 – 4 weeks after birth (36.4%). Ultrashort, short, long segments were 45.5%, 45.5%, and 9% respectively. Contras media used was mainly barium rather than water soluble 8:3, due to standard operating procedure adapted by some pediatric surgeon. Ultrashort and short segment HD has the same contribution. Barium is dominated at our center although water soluble is chosen in most literature for infant, due to its ability as diagnostic as well as therapeutic. Hence further research should be done to support and change the perspective in making the diagnosis.