The Prevalence of Cardio-Metabolic Conditions (Diabetes, Hypertension, and Obesity) Before and During COVID-19 and Association with Health and Sociodemographic Factors

Cardiometabolic conditions, including hypertension, diabetes, and obesity are associated with adverse health outcomes, including increased rates of hospitalization and deaths in patients who are diagnosed with COVID-19. However, little to no evidence is known currently on the cardiometabolic conditions before and during the COVID-19 pandemic. This study utilizes a nationally representative sample of adults in the United States (U.S.) to estimate the prevalence of cardiometabolic conditions, focusing on diabetes, hypertension, and obesity, and determine their prevalence and absolute and relative rates before and during COVID-19 pandemic declaration. Furthermore, the study aims to determine the association between these cardiometabolic conditions and physical activity, tobacco use, anxiety/depression, and sociodemographic characteristics among U.S. adults during the COVID-19 pandemic. Data from the 2019 (N = 5359) and 2020 (N = 3830) Health Information National Trends Surveys (HINTS) on adults were utilized. Dependent variable was cardiometabolic conditions and the main explanatory variable was response before and during the COVID-19 pandemic. We conducted weighted descriptive and multivariable logistic regression controlling for confounders such as age, sex, and intensity of physical activity. While there was a slight increase in the prevalence of cardiometabolic conditions during the pandemic (56.09%) compared to before (54.96%), there was only a slight increase in the prevalence of diabetes (18.10% vs 17.28%) and obesity (34.68% vs 34.18%) and a slight decrease in the prevalence of hypertension (36.38% vs 36.36%). Results showed an increase in the prevalence of cardiometabolic conditions among former smokers (67.91% vs 63.86%), and current cigarette smokers (59.39% vs 55.43%), current e-cigarette users (37.24% vs 28.66%), individuals with mild (59.62% vs 55.43%), or moderate (61.98% vs 57.83%) anxiety/depression, sexual minority (53.50% vs 51.12%) and heterosexual (56.45% vs 54.96%) individuals during the pandemic, compared to before the pandemic. Additionally, people with mild anxiety/depression had higher odds of cardiometabolic conditions during the pandemic (AOR = 1.55, 95% CI = 1.01, 2.38), compared to before (AOR = 1.52, 95% CI =1.06, 2.19), relative to those without anxiety/depression. Similarly, former smokers had higher odds of cardiometabolic outcomes before and during the pandemic (AOR = 1.38, 95% CI = 1.01, 1.87 vs AOR = 1.57, 95% CI = 1.10, 2.25), when compared to never smokers. Odds were lower for current e-cigarette users (AOR = 0.44, 95% CI = 0.23, 0.85) compared to never e-cigarette users before the pandemic. There were no significant differences in odds of cardiometabolic conditions between sexual minorities and heterosexual individuals before and during the pandemic. In conclusion, increased risk for adverse cardiometabolic conditions was higher for individuals with cigarette use and mental health diagnoses during the COVID-19 pandemic, suggesting the critical need for smoking cessation and programs to support behavioral health

Efficacy and Safety of Intravenous Meloxicam in Subjects with Moderate-to-severe Pain Following Abdominoplasty

Background:. A nanocrystal intravenous (IV) formulation of meloxicam is being studied with the aim of providing postoperative analgesia. Methods:. This randomized, multicenter, double-blind, placebo-controlled trial evaluated meloxicam IV 30 mg or placebo (≤ 3 doses) in 219 subjects undergoing abdominoplasty. The primary endpoint was the summed pain intensity difference over 24 hours postdose (SPID24). Results:. Meloxicam IV–treated subjects had a statistically significant reduction in the least squares mean of SPID24 compared with placebo-treated subjects (−4,262.1 versus −3,535.7; P = 0.0145). Meloxicam IV was associated with statistically significant differences over placebo on several other secondary endpoints, including other SPID intervals (ie, SPID12, SPID48, and SPID24–48), achievement of perceptible pain relief, the proportion of subjects with a ≥ 30% improvement in the first 24 hours, and Patient Global Assessment of pain at hour 48. Meloxicam IV was also associated with a reduction in the number of subjects receiving opioid rescue medication during hours 24–48 and the total number of doses of opioid rescue analgesia. Meloxicam IV was generally well tolerated, with the numbers and frequencies of adverse events similar to that of the placebo group. There was no evidence of an increased risk of adverse events commonly associated with nonsteroidal anti-inflammatory drugs including bleeding, thrombotic, cardiovascular, renal, hepatic, cardiovascular, injection site, and wound healing events. Conclusion:. Meloxicam IV provided sustained pain relief and generally was well tolerated in subjects with moderate-to-severe pain following abdominoplasty

An Analytical Framework for Delirium Research in Palliative Care Settings: Integrated Epidemiologic, Clinician-Researcher, and Knowledge User Perspectives Europe PMC Funders Group Europe PMC Funders Author Manuscripts

Abstract Context-Delirium often presents difficult management challenges in the context of goals of care in palliative care settings. Objectives-The aim was to formulate an analytical framework for further research on delirium in palliative care settings, prioritize the associated research questions, discuss the inherent methodological challenges associated with relevant studies, and outline the next steps in a program of delirium research. Methods-We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting, relevant literature searches, focused input of epidemiologic expertise, and a meeting participant and coauthor survey to formulate a conceptual research framework and prioritize research questions. Results-Our proposed framework incorporates three main groups of research questions: the first was predominantly epidemiologic, such as delirium occurrence rates, risk factor evaluation, screening, and diagnosis; the second covers pragmatic management questions; and the third relates to the development of predictive models for delirium outcomes. Based on aggregated survey responses to each research question or domain, the combined modal ratings of "very" or "extremely" important confirmed their priority. Conclusion-Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework's research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings