Assessing heterogeneity in meta-analysis: Q statistic or I2 index?

In meta-analysis, the usual way of assessing whether a set of single studies is homogeneous is by means of the Q test. However, the Q test only informs meta-analysts about the presence versus the absence of heterogeneity, but it does not report on the extent of such heterogeneity. Recently, the I² index has been proposed to quantify the degree of heterogeneity in a meta-analysis. In this article, the performances of the Q test and the confidence interval around the I² index are compared by means of a Monte Carlo simulation. The results show the utility of the I² index as a complement to the Q test, although it has the same problems of power with a small number of studies

Trends in incidence of proximal humerus fractures, surgical procedures and outcomes among elderly hospitalized patients with and without type 2 diabetes in Spain (2001–2013)

Abstract Background Several studies have reported that diabetic persons have an increased risk for fractures than non-diabetes patients. The association between proximal humerus fractures and type 2 diabetes (T2DM) is unclear and some studies point to insulin treatment, hypoglycaemic episodes consequently to inadequate control of diabetes or, more recently, to an alteration of trabecular bone. We examined trends in the incidence of proximal humerus fractures, surgical procedures and outcomes among hospitalized patients aged ≥65 years, with and without T2DM in Spain, 2001–2013. Methods This retrospective, observational study was conducted using the Spanish National Hospital Discharge Database to select all hospital admissions with proximal humerus fracture. We calculated incidences overall and stratified by diabetes status, year and sex. We analyzed surgical procedures, comorbidities, length of stay, in-hospital complications and in-hospital mortality. Results We identified 43,872 patients with proximal humerus fracture (18.3% had a T2DM diagnosis). Age-adjusted incidence rates elevated steadily over the study period for men and women with and without T2DM, independently of diabetes status, although we found a stable trend in the later years. Patients with T2DM had lower relative risk of proximal humeral fracture incidence: 0.87 (95%IC 0.82–0.93) for men and 0.97 (95%IC 0.95–1.00) for women. In-hospital complications were 4.0% of diabetic men vs. 2.6% in non-diabetic (p < 0.001) and 2.9% among T2DM women vs. 1.7% in those without (p < 0.05). The use of open reduction of fracture with internal fixation and arthroplasty is increasing overtime and closed reduction with internal fixation is decreasing. Presence of T2DM in women was associated with higher in-hospital mortality (OR 1.67; 95%CI 1.29–2.15). Comorbidities, in-hospital complications and older age were predictors of higher in-hospital mortality in both sexes. Conclusions The incidence of proximal humerus fractures seems to be increasing in Spain. The incidence is lower among men with than without T2DM. T2DM is associated to higher in-hospital complications in both sexes. The use of open reduction of fracture with internal fixation and arthroplasty is increasing overtime beside diabetes status. Women with T2DM have higher in-hospital mortality than those without the disease

La chasse au pivert / par Bonnaud-Blès

Avec mode text

Migraine in adults with diabetes; is there an association? Results of a population-based study

Ana L&oacute;pez-de-Andr&eacute;s,1 Jos&eacute; Luis del Barrio,1 Valent&iacute;n Hern&aacute;ndez-Barrera,1 Javier de Miguel-D&iacute;ez,2 Isabel Jimenez-Trujillo,1 Mar&iacute;a Angeles Martinez-Huedo,3 Rodrigo Jimenez-Garc&iacute;a1 1Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorc&oacute;n, Madrid, Spain; 2Respiratory Department, Hospital General Universitario Gregorio Mara&ntilde;&oacute;n, Madrid, Spain; 3Preventive Medicine and Public Health Department, Teaching and Research Unit, University Hospital La Paz, Madrid, Spain Aims: To investigate the association between migraine and diabetes mellitus while controlling for several socio-demographic characteristics, comorbidities, and lifestyle variables. We also aimed to identify which of these variables are associated with migraine among diabetics.Patients and methods: We conducted a cross-sectional study using data taken from the European Health Interview Surveys for Spain conducted in 2009/10 (n=22,188) and 2014 (n=22,842). We selected those subjects &ge;40 years of age. Diabetes status was self-reported. One non-diabetic control was matched by the year of survey, age, and sex for each diabetic case. The presence of migraine was defined as the affirmative answer to both of the following questions: &ldquo;Have you suffered migraine or frequent headaches over the last 12 months?&rdquo; and &ldquo;Has your physician confirmed the diagnosis?&rdquo;. Independent variables included demographic and socio-economic characteristics, health status variables, lifestyle, and pain characteristics.Results: The prevalence of migraine was significantly higher among those suffering from diabetes (14.9% vs. 13.0%; p=0.021). The multivariable analysis showed that diabetes was not associated with a higher risk of migraine (adjusted OR 1.06; 95%CI 0.89&ndash;1.25). Among diabetic subjects, female sex, suffering concomitant mental disorders, respiratory disorders, neck pain, and low back pain were variables associated with suffering from migraine.Conclusion: We found no significant differences in the prevalence of migraine between &shy;diabetics and non-diabetic age- and sex-matched controls after controlling for possible confounders. Keywords: diabetes, headache, survey, self-rated health, comorbidities, pain medicatio

Is there an association between diabetes and neck pain and lower back pain? Results of a population-based study

Rodrigo Jimenez-Garcia,1 Jos&eacute; Luis del Barrio,1 Valent&iacute;n Hernandez-Barrera,1 Javier de Miguel-D&iacute;ez,2 Isabel Jimenez-Trujillo,1 Mar&iacute;a Angeles Martinez-Huedo,3 Ana Lopez-de-Andres1 1Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorc&oacute;n, Madrid, Spain; 2Respiratory Department, Hospital General Universitario Gregorio Mara&ntilde;&oacute;n, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigaci&oacute;n Sanitaria Gregorio Mara&ntilde;&oacute;n (IiSGM), Madrid, Spain; 3Preventive Medicine and Public Health, Unidad de Docencia, Hospital Universitario La Paz, Madrid, Spain Background: The objective of the study was to study the association between low back pain (LBP), neck pain (NP), and diabetes while controlling for many sociodemographic characteristics, comorbidities, and lifestyle variables. The study also aimed to identify which of these variables is independently associated with LBP and NP among diabetes sufferers. Methods: A case&ndash;control study using data taken from the European Health Interview Surveys for Spain was conducted in 2009/2010 (n=22,188) and 2014 (n=22,842). We selected subjects &ge;40 years of age. Diabetes status was self-reported. One non-diabetic control was matched by the year of survey, age, and sex for each diabetic case. The presence of LBP and NP was defined as the affirmative answer to both of the questions: &ldquo;Have you suffered chronic LBP/NP over the last 12 months?&rdquo; and &ldquo;Has your physician confirmed the diagnosis?&rdquo; Independent variables included demographic and socioeconomic characteristics, health status variables, lifestyles, and pain characteristics. Results: The prevalence of NP (32.2% vs 26.8%) and LBP (37.1% vs 30.3%) was significantly higher among those suffering from diabetes. Multivariable analysis showed that diabetes was associated with a 1.19 (95% CI 1.04&ndash;1.36) and 1.20 (95% CI 1.06&ndash;1.35) higher risk of NP and LBP. Among diabetic subjects, being female, concomitant mental or respiratory disorders, being obese, and physically inactive are variables associated with suffering from these pains. Those suffering NP had 8 times higher risk of reporting LBP than those without NP and the same association is found among those suffering from LBP. Conclusion: The prevalence and intensity of NP and LBP are high among people with diabetes, affecting them significantly more than their age- and sex-matched non-diabetic controls. Specific preventive and educational strategies must be implemented to reduce the incidence, severity, and negative effect on the quality of NP and LBP among diabetic patients. Keywords: low back pain, neck pain, diabetes, surve

Decreasing influenza vaccine coverage among adults with high-risk chronic diseases in Spain from 2014 to 2017

The objectives of this study were to estimate coverage of influenza vaccination in Spain among adults suffering chronic conditions, to assess time trends from 2014 to 2017 and to identify vaccine uptake predictors. We used individualized data of persons ≥15 y interviewed in the 2017 Spanish National Health Survey. Vaccine uptake and the presence of the chronic conditions analyzed (diabetes; cancer; chronic respiratory disease; chronic heart disease and cerebrovascular disease) were self-reported. Independent variables included sex, age and nationality. In 2017 overall influenza vaccination uptake among subjects with high-risk chronic conditions remained low (40.3%) and decreased significantly from 2014 (41.7%, adjusted OR 0.98 95%CI 0.84–0.98). The highest coverage was found among those with cerebrovascular disease (52.2%), diabetes (51.5%) and heart disease (51.4%) and the lowest figures for those suffering cancer (34.9%) and respiratory disease (35.1%). Coverage for cancer patients declined a 25% from 2014 to 2017. Older persons had higher coverages whereas females and immigrant population had lower uptakes. We conclude that influenza vaccination coverage among the high-risk population in Spain for suffering chronic conditions remains at a low level and has decreased significantly from 2014 to 2017, this affects more intensely to females and immigrants