Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery: An Individual Patient Data Meta-Analysis.

Importance: Postoperative delirium (POD) is a common and serious complication after surgery. Various predisposing factors are associated with POD, but their magnitude and importance using an individual patient data (IPD) meta-analysis have not been assessed. Objective: To identify perioperative factors associated with POD and assess their relative prognostic value among adults undergoing noncardiac surgery. Data Sources: MEDLINE, EMBASE, and CINAHL from inception to May 2020. Study Selection: Studies were included that (1) enrolled adult patients undergoing noncardiac surgery, (2) assessed perioperative risk factors for POD, and (3) measured the incidence of delirium (measured using a validated approach). Data were analyzed in 2020. Data Extraction and Synthesis: Individual patient data were pooled from 21 studies and 1-stage meta-analysis was performed using multilevel mixed-effects logistic regression after a multivariable imputation via chained equations model to impute missing data. Main Outcomes and Measures: The end point of interest was POD diagnosed up to 10 days after a procedure. A wide range of perioperative risk factors was considered as potentially associated with POD. Results: A total of 192 studies met the eligibility criteria, and IPD were acquired from 21 studies that enrolled 8382 patients. Almost 1 in 5 patients developed POD (18%), and an increased risk of POD was associated with American Society of Anesthesiologists (ASA) status 4 (odds ratio [OR], 2.43; 95% CI, 1.42-4.14), older age (OR for 65-85 years, 2.67; 95% CI, 2.16-3.29; OR for >85 years, 6.24; 95% CI, 4.65-8.37), low body mass index (OR for body mass index <18.5, 2.25; 95% CI, 1.64-3.09), history of delirium (OR, 3.9; 95% CI, 2.69-5.66), preoperative cognitive impairment (OR, 3.99; 95% CI, 2.94-5.43), and preoperative C-reactive protein levels (OR for 5-10 mg/dL, 2.35; 95% CI, 1.59-3.50; OR for >10 mg/dL, 3.56; 95% CI, 2.46-5.17). Completing a college degree or higher was associated with a decreased likelihood of developing POD (OR 0.45; 95% CI, 0.28-0.72). Conclusions and Relevance: In this systematic review and meta-analysis of individual patient data, several important factors associated with POD were found that may help identify patients at high risk and may have utility in clinical practice to inform patients and caregivers about the expected risk of developing delirium after surgery. Future studies should explore strategies to reduce delirium after surgery.

The Effect of Occupational Noise Exposure on Serum Cortisol Concentration of Night-shift Industrial Workers: A Field Study.

BACKGROUND: In both developed and developing countries, noise is regarded as the most common occupational hazard in various industries. The present study aimed to examine the effect of sound pressure level (SPL) on serum cortisol concentration in three different times during the night shift. METHODS: This case-control study was conducted among 75 workers of an industrial and mining firm in 2017. The participants were assigned to one of the three groups (one control and two case groups), with an equal number of workers (25 participants) in each group. Following the ISO 9612 standard, dosimetry was adopted to evaluate equivalent SPL using a TES-1345 dosimeter. The influence of SPL on serum cortisol concentration was measured during the night shift. The serum cortisol concentration was measured using a radioimmunoassay (RIA) test in the laboratory. Repeated measure analysis of variance and linear mixed models were used with α = 0.05. RESULTS: The results indicated a downward trend in the serum cortisol concentration of the three groups during the night shift. Both SPL and exposure time significantly affected cortisol concentration (p < 0.0001, p < 0.0001). Conversely, age and body mass index had no significant influence on cortisol concentration (p = 0.360, p = 0.62). CONCLUSION: Based on the obtained results, increasing SPL will lead to enhancement of serum cortisol concentration. Given that cortisol concentration varies while workers are exposed to different SPLs, this hormone can be used as a biomarker to study the effect of noise-induced stress.

Comparison of Double and Single Leg Weight-Bearing Radiography in Determining Knee Alignment.

BACKGROUND: Knee malalignment is an important modifiable cause of osteoarthritis (OA). Surgical therapeutic procedures depend on proper knee alignment assessment. The purpose of this study was to compare knee alignment parameters between double and single leg weight-bearing radiographs and to evaluate the reproducibility of inter- and intra-observer measurements. METHODS: One hundred eight patients (59 male and 49 female) with knee deformity visited at Kerman Knee Clinic were selected. Full limb anteroposterior (AP) Radiographs were taken for each participant in double and single leg weight-bearing positions. Hip-Knee-Ankle Angle (HKAA), Medial-Proximal-Tibial Angle (MPTA), Lateral-Distal-Femoral Angle (LDFA) and Joint-Line-Convergence Angle (JLCA) measured. Images stored on PC were examined by three observers to assess inter and intra observer reproducibility. Data analysis was done by SPSS software. RESULTS: The mean age of patients was 48.4 (±6.84) years, mean BMI was 26.55 (±1.94) Kg/m2. The mean HKAA and JLCA were significantly different between double and single leg weight-bearing radiographs. Intraclass correlation coefficient (ICC) test showed high (0.99) inter-reproducibility between three observers in all cases, except one (ICC=0.92). Intra-observer reproducibility indicated a strong correlation between the observer's measurements at different times (ICC > 0.99). CONCLUSION: HKAA and JLCA were affected by the patient's position. Observer and time interval had no effect on either of HKAA, MPTA, LDFA, and JLCA. Also the measurement of knee alignment parameters was not dependent on observer's experience. In conclusion single leg weight-bearing radiography is more representative of knee alignment and is inter and intra-observer reproducible.

Body image and body change: predictive factors in an Iranian population.

BACKGROUND: Body concerns and its health consequences such as eating disorders and harmful body change activities are mentioned in Asian countries. This study evaluates factors contributing to body image/shape changes in an Iranian population. METHODS: In this cross-sectional study we focused on four main body change activity (diet, exercise, substance use, and surgery) and their risk factors such as demographic variables, Body Mass Index (BMI), Media, Body-Esteem, Perceived Socio-cultural Pressure, Body dissatisfaction and, Self-Esteem. Approximately, 1,200 individuals between 14-55 years old participated in this study. We used a multistage sampling method. In each region, the first household was selected at random. The probability of outcomes was estimated from logistic models. RESULTS: About 54.3% of respondents were females. The mean (SD) of age was 31.06 (10.24) years. Variables such as gender, age, BMI, use of media and socio cultural factors as, body dissatisfaction, body-esteem and pressure by relatives were the main factors that influenced body change methods. In particular we have seen that male are 53% less likely to follow surgical treatments, but 125% were more likely to use substances. CONCLUSIONS: Investigation of body concern and its health related problem should be assessed in cultural context. For effectiveness of interventional programs and reducing harmful body image/shape changes activities, socio-cultural background should be noted.