426 research outputs found

    Prevalence of Diagnosed Ocular Disease in Veterans with Serious Mental Illness

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    Objective To compare the prevalence of diagnosed ocular disease and eye disease treatment between VA patients with and without serious mental illness (SMI). Methods Retrospective comparison of diagnosed ocular disease and treatment prevalence among patients with and without diagnosed SMI in fiscal year (FY) 2011 in the VA Capitol Health Care System (VISN 5). Results We identified 6,462 VA patients with SMI and 137,933 without SMI. The prevalence of diagnosed ocular disease was 22.7% in SMI patients and 35.4% in non-SMI patients (P <0.001). Those with serious mental illness had a higher prevalence of glaucoma (10.2% vs. 7.1% P < 0.0001), cataract (12.6% vs. 9.2% P < 0.0001), and dry eye (4.0% vs. 2.7% P < 0.0001). 34.3% of SMI subjects had been seen in ophthalmology or optometry vs. 23.0% of controls (P < 0.0001). Conclusion VA patients with SMI have a greater prevalence of diagnosed ocular disease, particularly cataract, glaucoma, and dry eye. While SMI patients utilize eye care services at a higher rate than the general VA population, the majority of subjects with serious mental illness do not get recommended annual eye examinations. More consistent annual ocular screening among VA patients with SMI may be indicated

    Teriparatide seems to improve recovery after pertrochanteric hip fracture : Comparison with risedronate in a randomized, controlled trial

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    To compare the effects on fracture recovery of 26 wks' therapy with an oral antiresorptive (risedronate: RIS 35 mg QW) or a bone forming drug (teriparatide: TPTD 20 ug QD) started within 2 wks after osteosynthesis in a pertrochanteric hip fracture in patients with low bone mass. Methods: 224 patients were randomized to study drug and an oral/injectable placebo plus calcium/vitD3 in an osteoporosis trial. The primary outcome was bone mineral density which will be reported elsewhere. We report secondary (Timed Up-and-Go [TUG] test, hip pain, SF-36, safety) and exploratory (radiography) endpoints. Efficacy analyses of the TUG test, patient-rated health status, and hip pain 100 mm Visual Analog Scale were performed with a Mixed-effects Model for Repeated Measures. Results: Mean age was 77 years and 77% were female. The teriparatide group completed the TUG test in a shorter time (LS means 5.7, 4.4, 3.1, and 3.1 seconds less at 6, 12, 18, and 24 wks; overall difference p = 0.021) and reported less hip pain during the test (LS means 8.7, 10.6, 11.9, and 10.2 mm differences at 6, 12, 18, and 26 wks; overall difference p = 0.032). No significant between-group differences in SF-36, Charnley hip pain score, ability to walk or walking aids during follow-up. No patient was radiographically healed at 6 wks, and 90% were healed at 12 wks in both groups. Implant failure (TPTD:7, RIS:8), loss of reduction (TPTD:2, RIS:4) or non-union (0 cases) showed no significant differences. Mild hypercalcemia and hyperuricemia were more frequent with teriparatide. Conclusions: Patients treated with teriparatide reported less hip pain and shorter time to complete the TUG test than RIS between 6-26 wks. These outcomes were secondary

    Life\u27s Essential 8: Optimizing Health in Older Adults

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    The population worldwide is getting older as a result of advances in public health, medicine, and technology. Older individuals are living longer with a higher prevalence of subclinical and clinical cardiovascular disease (CVD). In 2010, the American Heart Association introduced a list of key prevention targets, known as Life\u27s Simple 7 to increase CVD-free survival, longevity, and quality of life. In 2022, sleep health was added to expand the recommendations to Life\u27s Essential 8 (eat better, be more active, stop smoking, get adequate sleep, manage weight, manage cholesterol, manage blood pressure, and manage diabetes). These prevention targets are intended to apply regardless of chronologic age. During this same time, the understanding of aging biology and goals of care for older adults further enhanced the relevance of prevention across the range of functions. From a biological perspective, aging is a complex cellular process characterized by genomic instability, telomere attrition, loss of proteostasis, inflammation, deregulated nutrient-sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. These aging hallmarks are triggered by and enhanced by traditional CVD risk factors leading to geriatric syndromes (eg, frailty, sarcopenia, functional limitation, and cognitive impairment) which complicate efforts toward prevention. Therefore, we review Life\u27s Essential 8 through the lens of aging biology, geroscience, and geriatric precepts to guide clinicians taking care of older adults

    Romosozumab (sclerostin monoclonal antibody) versus teriparatide in postmenopausal women with osteoporosis transitioning from oral bisphosphonate therapy : a randomised, open-label, phase 3 trial

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    Background: Previous bisphosphonate treatment attenuates the bone-forming effect of teriparatide. We compared the effects of 12 months of romosozumab (AMG 785), a sclerostin monoclonal antibody, versus teriparatide on bone mineral density (BMD) in women with postmenopausal osteoporosis transitioning from bisphosphonate therapy. Methods: This randomised, phase 3, open-label, active-controlled study was done at 46 sites in North America, Latin America, and Europe. We enrolled women (aged >= 55 to <= 90 years) with postmenopausal osteoporosis who had taken an oral bisphosphonate for at least 3 years before screening and alendronate the year before screening; an areal BMD T score of -2.5 or lower at the total hip, femoral neck, or lumbar spine; and a history of fracture. Patients were randomly assigned (1:1) via an interactive voice response system to receive subcutaneous romosozumab (210 mg once monthly) or subcutaneous teriparatide (20 mu g once daily). The primary endpoint was percentage change from baseline in areal BMD by dual-energy x-ray absorptiometry at the total hip through month 12 (mean of months 6 and 12), which used a linear mixed effects model for repeated measures and represented the mean treatment effect at months 6 and 12. All randomised patients with a baseline measurement and at least one post-baseline measurement were included in the efficacy analysis. This trial is registered with ClinicalTrials.gov, number NCT01796301. Findings: Between Jan 31, 2013, and April 29, 2014, 436 patients were randomly assigned to romosozumab (n=218) or teriparatide (n=218). 206 patients in the romosozumab group and 209 in the teriparatide group were included in the primary efficacy analysis. Through 12 months, the mean percentage change from baseline in total hip areal BMD was 2.6% (95% CI 2.2 to 3.0) in the romosozumab group and -0.6% (-1.0 to -0.2) in the teriparatide group; difference 3.2% (95% CI 2.7 to 3.8; p<0.0001). The frequency of adverse events was generally balanced between treatment groups. The most frequently reported adverse events were nasopharyngitis (28 [13%] of 218 in the romosozumab group vs 22 [10%] of 214 in the teriparatide group), hypercalcaemia (two [<1%] vs 22 [10%]), and arthralgia (22 [10%] vs 13 [6%]). Serious adverse events were reported in 17 (8%) patients on romosozumab and in 23 (11%) on teriparatide; none were judged treatment related. There were six (3%) patients in the romosozumab group compared with 12 (6%) in the teriparatide group with adverse events leading to investigational product withdrawal. Interpretation: Transition to a bone-forming agent is common practice in patients treated with bisphosphonates, such as those who fracture while on therapy. In such patients, romosozumab led to gains in hip BMD that were not observed with teriparatide. These data could inform clinical decisions for patients at high risk of fracture

    Association of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT - A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party

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    Elevated serum ferritin levels occur due to iron overload or during inflammation and macrophage activation. A correlation of high serum ferritin levels with increased mortality after alloSCT has been suggested by several retrospective analyses as well as by two smaller prospective studies. This prospective multicentric study aimed to study the association of ferritin serum levels before start of conditioning with alloSCT outcome. Patients with acute leukemia, lymphoma or MDS receiving a matched sibling alloSCT for the first time were considered for inclusion, regardless of conditioning. A comparison of outcomes between patients with high and low ferritin level was performed using univariate analysis and multivariate analysis using cause-specific Cox model. Twenty centers reported data on 298 alloSCT recipients. The ferritin cut off point was determined at 1500 mu g/l (median of measured ferritin levels). In alloSCT recipients with ferritin levels above cut off measured before the start of conditioning, overall survival (HR = 2.5, CI = 1.5-4.1, p = 0.0005) and progression-free survival (HR = 2.4, CI = 1.6-3.8, p <0.0001) were inferior. Excess mortality in the high ferritin group was due to both higher relapse incidence (HR = 2.2, CI = 1.2-3.8, p = 0.007) and increased non-relapse mortality (NRM) (HR = 3.1, CI = 1.5-6.4, p = 0.002). NRM was driven by significantly higher infection-related mortality in the high ferritin group (HR = 3.9, CI = 1.6-9.7, p = 0.003). Acute and chronic GVHD incidence or severity were not associated to serum ferritin levels. We conclude that ferritin levels can serve as routine laboratory biomarker for mortality risk assessment before alloSCT.Peer reviewe
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