Investigation of simple, objective, and effective indicators for predicting acute paraquat poisoning outcomes.

Initial symptoms of paraquat (PQ) toxicity are often not obvious, and the lack of advanced testing equipment and medical conditions in the primary hospital make it difficult to provide early diagnosis and timely treatment. To explore simple, objective, and effective indicators of prognosis for primary clinicians, we retrospectively analyzed acute PQ poisoning in 190 patients admitted to our hospital from 2008 to 2017. Based on their condition at the time of discharge, patients were categorized into either the survival group (n = 71) or the mortality group (n = 119). Age, PQ ingested amount, urinary PQ, urinary protein, white blood cell (WBC), and serum creatinine (Cr) were the key factors associated with the prognosis for PQ poisoning. We identified specific diagnostic thresholds for these key indicators of PQ poisoning: PQ ingested amount (36.50 mL), urinary PQ (semiquantitative result "++"), urinary protein (semiquantitative result "±"), WBC (16.50 × 109/L), and serum Cr (102.10 µmol/L). Combining these five indicators to identify poisoning outcomes was considered objective, accurate, and convenient. When the combined score was <1, the predicted probability of patient death was 6%. When the combined score was ≥3, the predicted probability of patient death was 96%. These findings provide metrics to assist primary clinicians in predicting outcomes of acute PQ poisoning at earlier stages, a basis for administering treatment.

Ambient fine particulate matter and ozone higher than certain thresholds associated with myopia in the elderly aged 50 years and above.

Although myopia has been largely ignored among the elderly population, there is an increased risk of myopia with advancing age. Ambient air pollution is one potential contributor to vision impairments, but few epidemiological studies have demonstrated such an association. This cross-sectional survey collected the information of 33,626 subjects aged ≥50 years in six developing countries during 2007-2010. Myopia was identified based on questions related to symptoms of myopia. The annual concentrations of fine particulate matter (PM2.5) and ozone (O3) were estimated with the satellite data and chemical transport model. We examined the associations between the two pollutants and myopia using mixed-effect Poisson regression models with robust variance estimation (sandwich estimation). We observed J-shaped associations between the two pollutants and myopia, and identified 12 and 54 µg/m3 as the threshold concentrations. The adjusted prevalence ratio was 1.12 (95% CI: 1.05, 1.21) and 1.26 (95% CI: 1.14, 1.38) for each standard deviation (SD) increase in PM2.5 and O3 concentrations above their threshold, respectively. In addition, the interaction analysis suggested a synergistic interaction of these two pollutants on myopia in the additive model, with a synergistic index of 1.81 (Bootstrapping 95% CI: 0.92, 4.94). Our results indicate that long-term exposures to PM2.5 and O3 might be important environmental risk factors of myopia in the elderly, and suggest that more efforts should be taken to reduce airborne PM2.5 and O3 levels to protect vision health.

Ambient PM2.5 and O3 and their combined effects on prevalence of presbyopia among the elderly: A cross-sectional study in six low- and middle-income countries.

BACKGROUND: Ambient air pollutant directly contacts with the eyes, however, the effect of ambient fine particulate matter (PM2.5) and ozone (O3) on vision impairment, such as presbyopia, has been kept largely unknown. METHODS: We surveyed a total of 36,620 participants aged 50 years and above in six low- and middle-income countries. Ambient annual concentrations of PM2.5 and O3 for the residential community were estimated using satellite data and chemical transport model. A mixed effects model was utilized to assess the effects of ambient PM2.5 and O3 on presbyopia, as well as their combined effects. RESULTS: A total of 13,841 presbyopia cases were identified among the participants with a prevalence rate of 41.17%. For both PM2.5 and O3, we found a J-shaped exposure-response relationship with the threshold being identified at 15 µg/m3 for PM2.5 and 55 µg/m3 for O3. The odds ratio (OR) of presbyopia was 1.15 (95% CI: 1.09, 1.21) for each 10 µg/m3 increase in PM2.5 above 15 µg/m3 and 1.37 (95% CI: 1.23, 1.54) for O3 above 55 µg/m3 after adjusting for various potential confounding factors. There appeared to be a synergistic interaction between ambient PM2.5 and O3 on presbyopia in the additive model, the combined effect was significantly larger than the sum of their individual effects, with a synergistic index of 2.39. CONCLUSION: This study supports that exposures to ambient PM2.5 and O3 might be important risk factors of presbyopia among old adults, and simultaneously exposure to high level of the two pollutants could intensify their individual effects.

Exposure to ambient air pollution and blood lipids in adults: The 33 Communities Chinese Health Study.

BACKGROUND: Little information exists on the lipidemic effects of air pollution, particularly in developing countries. We aimed to investigate the associations of long-term exposure to ambient air pollutants with lipid levels and dyslipidemias in China. METHODS: In 2009, a total of 15,477 participants aged 18-74 years were recruited from the 33 Communities Chinese Health Study conducted in three Northeastern China cities. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured in participants' blood specimens. Three year (2006-08) average air pollution concentrations were assessed using data from 33 communities (particles with diameters ≤1.0 µm (PM1) and ≤2.5 µm (PM2.5) were predicted using a spatial statistical model) or 11 air monitoring stations (particles with diameters ≤10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3)). Associations were evaluated by two-level logistic and generalized linear regression models. RESULTS: We detected many significant associations between exposure to air pollutants (especially for PM1 and PM2.5) and blood lipid levels. Most of the associations suggested deleterious effects on blood lipid markers (e.g., a 10 µg/m3 increase in PM1 was associated with 1.6% (95% confidence interval (CI): 1.1, 2.0), 2.9% (95% CI: -3.3, 9.3), and 3.2% (95% CI: 2.6, 3.9) higher levels of TC, TG, and LDL-C, respectively, but 1.4% (95% CI: -1.8, -0.9) lower HDL-C levels), although beneficial associations were found for O3. In analysis with dyslipidemias, all the observed associations suggested deleterious lipidemic effects of air pollutants, and no significant beneficial association was observed for O3. Stratified analyses showed that the associations were stronger in overweight or obese participants; sex and age modified the associations, but the pattern of effects was mixed. CONCLUSIONS: Long-term ambient air pollution was associated with both altered lipid profiles and dyslipidemias, especially among overweight or obese participants.

Long-term exposure to ambient PM2.5 associated with fall-related injury in six low- and middle-income countries.

Exposure to ambient air pollution has been linked with adverse health outcomes of the circulatory and nervous systems. Given that falls are closely related to circulatory and nervous health, we hypothesize that air pollution may adversely affect fall-related injury. We employed Wave 1 data from 36,662 participants aged ≥50 years in WHO's Study on Global AGEing and Adult Health in six low- and middle-income countries. Ambient annual concentration of PM2.5 was estimated using satellite data. A three-level logistic regression model was applied to examine the long-term association between ambient PM2.5 and the prevalence of fall-related injury, and associated disease burden, as well as the potential effect modification of consumption of fruit and vegetables. Ambient PM2.5 was found to be significantly associated with the risk of fall-related injury. Each 10 µg/m3 increase corresponded to 18% (OR = 1.18, 95% CI: 1.09, 1.28) increase in fall-related injury after adjusting for various covariates. The association was relatively stronger among participants with lower consumption of fruit (OR = 1.22, 95% CI: 1.12, 1.33) than higher consumption (OR = 1.06, 95% CI: 0.92, 1.23), and among those with lower vegetable consumption (OR = 1.18, 95% CI: 1.08, 1.28) than higher consumption (OR = 1.08, 95% CI: 0.91, 1.27). Our study suggests that ambient PM2.5 may be one risk factor for fall-related injury and that higher consumption of fruit and vegetables could alleviate this effect.

Long-Term Effects of Ambient PM2.5 on Hypertension and Blood Pressure and Attributable Risk Among Older Chinese Adults.

Long-term exposure to ambient fine particulate pollution (PM2.5) has been associated with cardiovascular diseases. Hypertension, a major risk factor for cardiovascular diseases, has also been hypothesized to be linked to PM2.5 However, epidemiological evidence has been mixed. We examined long-term association between ambient PM2.5 and hypertension and blood pressure. We interviewed 12 665 participants aged 50 years and older and measured their blood pressures. Annual average PM2.5 concentrations were estimated for each community using satellite data. We applied 2-level logistic regression models to examine the associations and estimated hypertension burden attributable to ambient PM2.5 For each 10 µg/m3 increase in ambient PM2.5, the adjusted odds ratio of hypertension was 1.14 (95% confidence interval, 1.07-1.22). Stratified analyses found that overweight and obesity could enhance the association, and consumption of fruit was associated with lower risk. We further estimated that 11.75% (95% confidence interval, 5.82%-18.53%) of the hypertension cases (corresponding to 914, 95% confidence interval, 453-1442 cases) could be attributable to ambient PM2.5 in the study population. Findings suggest that long-term exposure to ambient PM2.5 might be an important risk factor of hypertension and is responsible for significant hypertension burden in adults in China. A higher consumption of fruit may mitigate, whereas overweight and obesity could enhance this effect.

Trends and correlates of marijuana use among late middle-aged and older adults in the United States, 2002-2014.

BACKGROUND: Recent trend studies suggest that marijuana use is on the rise among the general population of adults ages 18 and older in the United States. However, little is known about the trends in marijuana use and marijuana-specific risk/protective factors among American adults during the latter part of adulthood. METHOD: Findings are based on repeated, cross-sectional data collected from late middle-aged (ages 50-64) and older adults (ages 65 and older) surveyed as part of the National Survey on Drug Use and Health between 2002 and 2014. RESULTS: The prevalence of past-year marijuana use among late middle-aged adults increased significantly from a low of 2.95% in 2003 to a high of 9.08% in 2014. Similarly, the prevalence of marijuana use increased significantly among older adults from a low of 0.15% in 2003 to a high of 2.04% in 2014. Notably, the upward trends in marijuana use remained significant even when accounting for sociodemographic, substance use, behavioral, and health-related factors. We also found that decreases in marijuana-specific protective factors were associated with the observed trend changes in marijuana use among late middle-aged and older adults, and observed a weakening of the association between late-middle aged marijuana use and risk propensity, other illicit drug use, and criminal justice system involvement over the course of the study. CONCLUSIONS: Findings from the present study provide robust evidence indicating that marijuana use among older Americans has increased markedly in recent years, with the most evident changes observed between 2008 and 2014.

Veterans Affairs Saint Louis University Mental Status examination compared with the Montreal Cognitive Assessment and the Short Test of Mental Status.

OBJECTIVES: To compare the ability of the Veterans Affairs Saint Louis University Mental Status (SLUMS) examination to detect mild cognitive impairment (MCI) and dementia according to the Clinical Dementia Rating Scale (CDR) with that of two other well-known screening instruments, the Montreal Cognitive Assessment (MoCA) and the Short Test of Mental Status (STMS). DESIGN: Cross-sectional validation study. SETTING: Saint Louis Veterans Affairs Medical Center Geriatric Research Education and Clinical Center. PARTICIPANTS: Veterans aged 60 and older (median 78.5) with a high school education or more (n = 136). MEASUREMENTS: Participants were administered the SLUMS examination, the MoCA, and the STMS in random order. A blinded test administrator administered the CDR in a separate session. Receiver operating characteristic (ROC) curves were used to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the SLUMS examination, the MoCA, and the STMS for MCI, dementia, and MCI or dementia. ROC contrasts were used to statistically compare the area under the ROC curve (AUC) for the screening tests' ability to detect cognitive dysfunction according to the CDR. RESULTS: ROC contrasts demonstrated that the AUCs for detecting MCI (SLUMS examination 0.74, MoCA 0.77, STMS 0.77), dementia (SLUMS examination 0.98, MoCA 0.96, STMS 0.97), and MCI or dementia (SLUMS examination 0.82, MoCA 0.83, STMS 0.84) were equivalent. Sensitivity, specificity, PPV, and NPV were similar across measures of MCI, dementia, and MCI or dementia according to the CDR. CONCLUSION: The SLUMS examination has validity similar to that of the MoCA and STMS for the detection of MCI, dementia, and MCI or dementia according to the CDR.

Falls, osteoporosis, and hip fractures.

Osteoporosis and falls are distinct conditions that share the potential clinical endpoint of fracture. This article explores the associations between osteoporosis and falls by examining the epidemiology, risk factors, risk prevention, and treatments. It outlines the evidence on falls prevention, osteoporosis diagnosis, and fracture risk assessment. It includes several studies that challenge the common view on the use of fall prevention tools, dual energy X-ray absorptiometry testing, and postfracture bisphosphonate treatment. By understanding the evidence, it becomes clearer how to target populations at risk, interpret screening methods, and promote disease prevention and treatment.

Testosterone is not associated with mortality in older African-American males.

INTRODUCTION. Although testosterone and its association with disease progression and mortality is a widely studied topic, no studies have evaluated mortality risks related to testosterone levels in an older African-American population. The mechanisms for known racial differences in mortality risk for certain cancers and cardiovascular risk factors are largely unknown. Elucidating a mortality risk associated with testosterone levels may give insight into the elevated risk for certain diseases in African-Americans. METHODS AND RESULTS. Study data were derived from a cohort 622 African-Americans (age 80.05  ±â€Š 6.4, range 68-102) from Saint Louis, Missouri that includes 190 males (age 79.38  ±â€Š 6.2, range 70-102). The eligible sample for this report includes 56 of the 190 males (age 78.89  ±  6.9, range 70-102) who donated blood at baseline in 1992-1994 and subsequently tested for total testosterone and bioavailable testosterone. Covariates for adjusted analyses were lower body functional limitations, physician visits and comorbidities, also collected at baseline. Males' mean bioavailable testosterone levels (ng/dl) were 33.33  ±â€Š 24.4 (n above 70 ng/dl = 5) and mean total testosterone levels (ng/dl) were 246.63  ±â€Š 118.7 (n above 300 ng/dl = 20). Vital status was determined through 2002; 41 males (73%) were deceased and 15 were alive. Mortality did not differ among males with testosterone levels <300 versus 300+ (p = 0.42) or with bioavailable testosterone levels <70 versus > 70 (p  =  0.34). Total testosterone levels did not predict mortality when adjusted for age (Adjusted Hazard Ratio [AHR] = 0.998; 95% confidence interval [CI] 0.995-1.001; p = 0.28) or adjusted for age and other covariates (AHR  =  0.099; 95% CI 0.996, 1.002; p  =  0.35). Bioavailable testosterone levels did not predict mortality when adjusted for age (AHR  =  0.992; 95% CI .977-1.007; p  =  0.30) or when adjusted for age and other covariates (AHR 0.991; 95% CI .976-1.006; p  =  0.261). CONCLUSION. In older African-American males, total and bioavailable testosterone levels, with and without adjustment for covariates, are not independently associated with mortality risk.