The impact of cognitive functioning on mortality and the development of functional disability in older adults with diabetes: the second longitudinal study on aging

BACKGROUND: For older adults without diabetes, cognitive functioning has been implicated as a predictor of death and functional disability for older adults and those with mild to severe cognitive impairment. However, little is known about the relationship between cognition functioning on mortality and the development of functional disability in late life for persons with diabetes. We examined the relative contribution of cognitive functioning to mortality and functional disability over a 2-year period in a sample of nationally representative older US adults with diabetes who were free from cognitive impairment through secondary data analyses of the Second Longitudinal Study of Aging (LSOA II). METHODS: Participants included 559 US adults (232 males and 327 females) ≥ 70 years old who had diabetes and who were free from cognitive impairment were examined using an adapted Telephone Interview of Cognitive Status (TICS), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL). RESULTS: Multivariate logistic regression was conducted to investigate the independent contribution of cognitive functioning to three mutually exclusive outcomes of death and two measures of functional disability status. The covariates included in the model were participants' sex, age, race, marital status, educational level, duration of diabetes, cardiovascular disease (CVD) status, and self-rated health. Persons with diabetes who had the lowest levels of cognitive functioning relative to the highest level of cognitive functioning had a greater odds of dying (AOR = 0.80, 95% CI = 0.67–0.96) or becoming disabled (AOR = 0.87, 95% CI = 0.78–0.97) compared to those people who were disability free. CONCLUSION: Older adults with diabetes and low normal levels of cognition, yet within normal ranges, were approximately 20% more likely to die and 13% more likely to become disabled than those with higher levels of cognitive functioning over a 2-year period. Brief screening measures of cognitive functioning could be used to identify older adults with diabetes who are at increased risk for mortality and functional disability, as well as those who may benefit from interventions to prevent or minimize further disablement and declines in cognitive functioning

Periodontal disease and risk of subsequent cardiovascular disease in U.S. male physicians

AbstractOBJECTIVESWe sought to prospectively assess whether self-reported periodontal disease is associated with subsequent risk of cardiovascular disease in a large population of male physicians.BACKGROUNDPeriodontal disease, the result of a complex interplay of bacterial infection and chronic inflammation, has been suggested to be a predictor of cardiovascular disease.METHODSPhysicians’ Health Study I was a randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in 22,071 U.S. male physicians. A total of 22,037 physicians provided self-reports of presence or absence of periodontal disease at study entry and were included in this analysis.RESULTSA total of 2,653 physicians reported a personal history of periodontal disease at baseline. During an average of 12.3 years of follow-up, there were 797 nonfatal myocardial infarctions, 631 nonfatal strokes and 614 cardiovascular deaths. Thus, for each end point, the study had >90% power to detect a clinically important increased risk of 50%. In Cox proportional hazards regression analysis adjusted for age and treatment assignment, physicians who reported periodontal disease at baseline had slightly elevated, but statistically nonsignificant, relative risks (RR) of nonfatal myocardial infarction, (RR, 1.12; 95% confidence interval [CI], 0.92 to 1.36), nonfatal stroke (RR, 1.10; CI, 0.88 to 1.37) and cardiovascular death (RR, 1.20; CI, 0.97 to 1.49). Relative risk for a combined end point of all important cardiovascular events (first occurrence of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death) was 1.13 (CI, 0.99 to 1.28). After adjustment for other cardiovascular risk factors, RRs were all attenuated and nonsignificant.CONCLUSIONSThese prospective data suggest that self-reported periodontal disease is not an independent predictor of subsequent cardiovascular disease in middle-aged to elderly men

Light-to-moderate alcohol consumption and mortality in the physicians’ health study enrollment cohort

AbstractOBJECTIVESThis study examined the relationship between light-to-moderate alcohol consumption and cause-specific mortality.BACKGROUNDPrevious studies suggest a J-shaped relation between alcohol and total mortality in men. A decrease in cardiovascular disease (CVD) mortality without a significant increase in other causes of mortality may explain the overall risk reduction at light-to-moderate levels.METHODSWe conducted a prospective cohort study of 89,299 U.S. men from the Physicians’ Health Study enrollment cohort who were 40 to 84 years old in 1982 and free of known myocardial infarction, stroke, cancer or liver disease at baseline. Usual alcohol consumption was estimated by a limited food frequency questionnaire.RESULTSThere were 3,216 deaths over 5.5 years of follow-up. We observed a U-shaped relationship between alcohol consumption and total mortality. Compared with rarely/never drinkers, consumers of 1, 2 to 4 and 5 to 6 drinks per week and 1 drink per day had significant reductions in risk of death (multivariate relative risks [RRs] of 0.74, 0.77, 0.78 and 0.82, respectively) with no overall benefit or harm detected at the ≥2 drinks per day level (RR = 0.95; 95% confidence interval (CI), 0.79 to 1.14). The relationship with CVD mortality was inverse or L-shaped with apparent risk reductions even in the highest category of ≥2 drinks per day (RR = 0.76; 95% CI, 0.57 to 1.01). We found no clear harm or benefit for total or common site-specific cancers. For remaining other cancers, there was a nonsignificant 28% increased risk for those consuming ≥2 drinks per day.CONCLUSIONSThese data support a U-shaped relation between alcohol and total mortality among light-to-moderate drinking men. The U-shaped curve may reflect an inverse association for CVD mortality, no association for common site-specific cancers and a possible positive association for less common cancers

Comparison of Aberration Detection Algorithms for Biosurveillance Systems

We compared several aberration detection algorithms using data from the Biosense 1.0 system account for total facility visits and background day-of-week effects

Comparison of Aberration Detection Algorithms for Biosurveillance Systems

We compared several aberration detection algorithms using data from the Biosense 1.0 system account for total facility visits and background day-of-week effects

Use of Syndromic Data for Enhanced Surveillance: MERS Like-Syndrome

The goal is to identify and monitor MERS like syndrome cases in the syndromic surveillance system. In consultation with the state and local jurisdictions, five case definitions were developed to monitor MERS like syndromes. From May through July, 2014 fifteen reporting jurisdictions participated in MERS enhanced surveillance. . During this enhanced surveillance time period 171 probable MERS cases were identified and all of them were ruled out. The MERS collaborative efforts between BioSense programs, CDC subject matter experts and jurisdictions will help develop more comprehensive definitions to conduct enhanced surveillance at the national level using multiple syndromic surveillance systems

Overcoming Operational Differences to Attain a National Picture for Novel Threats

Soon after discovery of a MERS case in Indiana, CDC through its BioSense Syndromic Surveillance (SyS) Program joined with certain public health jurisdictions to improve the national-level MERS surveillance picture. Activities were undertaken to bolster local surveillance efforts, despite jurisdictions use of differing SyS tools. This resulted in the ability to generate periodic reports of aggregated MERS-like surveillance data. Many seem to see this initiative to enhance the national MERS surveillance picture as a model to build upon, and a success that can help improve trust and generate hope for creating a meaningful national SyS picture

Coding of Electronic Laboratory Reports for Biosurveillance, Selected United States Hospitals, 2011

ObjectiveElectronic laboratory reporting has been promoted as a public health priority. The Office of the U.S. National Coordinator for Health Information Technology has endorsed two coding systems: Logical Observation Identifiers Names and Codes (LOINC) for laboratory test orders and Systemized Nomenclature of Medicine-Clinical Terms (SNOMED CT) for test results.  Materials and MethodsWe examined LOINC and SNOMED CT code use in electronic laboratory data reported in 2011 by 63 non-federal hospitals to BioSense electronic syndromic surveillance system.  We analyzed the frequencies, characteristics, and code concepts of test orders and results.ResultsA total of 14,028,774 laboratory test orders or results were reported. No test orders used SNOMED CT codes. To describe test orders, 77% used a LOINC code, 17% had no value, and 6% had a non-informative value, “OTH”. Thirty-three percent (33%) of test results had missing or non-informative codes. For test results with at least one informative value, 91.8% had only LOINC codes, 0.7% had only SNOMED codes, and 7.4% had both. Of 108 SNOMED CT codes reported without LOINC codes, 45% could be matched to at least one LOINC code.ConclusionMissing or non-informative codes comprised almost a quarter of laboratory test orders and a third of test results reported to BioSense by non-federal hospitals. Use of LOINC codes for laboratory test results was more common than use of SNOMED CT. Complete and standardized coding could improve the usefulness of laboratory data for public health surveillance and response