1. Residents of retirement homes had higher rates of emergency department visits, hospital admissions, alternate levels of care days, and specialist physician visits than residents of long-term care homes
2. Residents of retirement homes had lower rates of primary care visits than residents of long-term care homes
Evidence Rating Level: 2 (Good)
Long-term care homes provide access to 24-hour nursing and personal care and operate at full capacity in Ontario. Alternatively, retirement homes, also called assisted-living facilities, offer private, congregate living environments that deliver supportive care to adults 65 years of age and older. Typically, retirement homes operate on a private, for-profit business model. In Ontario, retirement homes are regulated through an independent, not-for-profit regulator, called Retirement Homes Regulatory Authority (RHRA), and are primarily geared toward individuals who do not require full-time nursing care. No standardized reporting system is available to identify and describe residents of retirement homes and there are currently no Canadian studies on characteristics and use of health services by older adults living in retirement homes. Consequently, this population-based retrospective cohort study sought to evaluate rates of health services utilization by residents of retirement homes relative to residents of long-term care homes and other populations of older adults in Ontario. Adults, aged 65 and older, who had a postal code that matched a registered retirement home, were identified between January 1 and December, 2018. Residents of long-term care homes and community-dwelling older adults were also identified. The outcome measures were rates of emergency department visits, hospital admissions, alternate levels of care (ALC) days, primary care visits, and specialist physician visits in 2018. A total of 54 733 residents of 757 retirement homes (mean age 86.7 years, 69.0% female) and 2 354 385 residents of other settings were included. Residents of retirement homes were found to have significantly higher rates per 1000 person months of emergency department visits (10.62 v. 4.48, adjusted relative rate [RR] 2.61, 95% confidence interval [CI] 2.55 to 2.67), hospital admissions (5.42 v. 2.08, adjusted RR 2.77, 95% CI 2.71 to 2.82), ALC days (6.01 v. 2.96, adjusted RR 1.51, 95% CI 1.48 to 1.54), and specialist physician visits (6.27 v. 3.21, adjusted RR 1.64, 95% CI 1.61 to 1.68) compared to residents of long-term care homes. However, those living in retirement homes had a significantly lower rate of primary care visits than those living in long-term care homes (16.71 v. 108.47, adjusted RR 0.13, 95% CI 0.13 to 0.14). This study concluded that residents of retirement homes have higher rates of hospital-based care, which may help inform policy discussions.
1. Lower handgrip strength was associated with increased risk of cardiometabolic multimorbidity
2. Lower handgrip strength was associated with increased risk of all-cause mortality among individuals with cardiometabolic multimorbidity
Evidence Rating Level: 2 (Good)
Multimorbidity is defined as the coexistence of at least two chronic disease in an individual and causes significant burdens on patients, families, and society. Cardiometabolic multimorbidity (CM), which refers to having more than one of coronary heart disease, stroke, and type 2 diabetes, is the most common and harmful pattern of multimorbidity. Nevertheless, existing studies generally focus on individual cardiometabolic diseases. Handgrip strength (HGS) is a conventional measure of muscle strength and declines have been related to various adverse health events, including increased risks of individual cardiometabolic diseases and associated morbidity and mortality. However, few studies have explored the role of HGS in CM progression. Consequently, this prospective cohort study aimed to investigate the relation between HGS and the risk of CM and examine the association of HGS with all-cause mortality risk among patients with CM. Between March 2006 and July 2010, a total of 493 774 United Kingdom-based community-dwelling individuals, aged 37-73 years, were included. CM was defined as the simultaneous occurrence of two or more of either coronary heart disease, stroke, or type 2 diabetes. Cox proportional hazards models were used. At study start, 441 868 participants did not have any cardiometabolic disease at baseline. Over a median follow-up period of 12.1 years, 4701 (1.06%) of these participants developed CM. Lower HGS was positively associated with increased risk of CM among this group (HR: 1.17, 95% CI: 1.14–1.21). Among 6594 individuals with CM at baseline, men were more likely to experience CM than women and 1826 (27.69%) died over a median follow-up period of 11.7 years. Low HGS was associated with a high risk of all-cause mortality among patients with CM. These findings suggest that HGS may be a modifiable factor in the development and progression of CM. Future studies in this area are warranted.
1. Prenatal triptan exposure did not increase risk of attention-deficit/hyperactivity disorder in offspring
Evidence Rating Level: 2 (Good)
Triptans are a common medication for the treatment of migraine, a chronic disorder characterized by moderate to severe headache. Migraine is particularly prevalent among women of reproductive age, yet information about the safety of triptans during pregnancy is limited and contradictory. This study aimed to investigate the association between prenatal exposure to triptans and development of attention-deficit/hyperactivity disorder (ADHD), a common behavioural disorder, among offspring. Data from the Norwegian Mother, Father, and Child Cohort Study (MoBa) was used. Live-born singleton children born to women with migraine before or during pregnancy were included. Triptan use was self-reported and exposed children were compared with two groups of unexposed children whose mothers reported migraine before or during pregnancy only. Two analytical samples were defined, one to assess ADHD diagnosis and one to assess ADHD symptoms, as measured by Conners’ Parent Rating Scale. Cox proportional hazards regression models and generalized linear models were used for analysis. There were 10 167 children (mean [SD] maternal age, 30.2 [4.6] years; 5231 boys [51.5%]) who had a diagnosis of ADHD. The ADHD symptoms sample comprised of 4367 children (mean [SD] maternal age, 30.6 [4.4] years; 2191 boys [50.2%]). Children were followed for an average of 10.6 (2.2) years. Prenatal exposure to triptans was not associated with an increased risk of ADHD compared with unexposed children whose mothers had migraine during pregnancy (weighted HR, 1.16; 95% CI, 0.78-1.74) and compared with unexposed children whose mothers had migraine only before pregnancy (weighted HR, 1.28; 95% CI, 0.84-1.94). There were no differences in ADHD symptom scores between exposed and unexposed children. These findings suggest that prenatal triptan use does not increase risk of ADHD among offspring.
1. The mean maximal activation ratio showed higher variance among nulliparous patients than multiparous patients, implying existence of myometrial memory enabling faster labor progression among those who have given birth before
Evidence Rating Level: 2 (Good)
During pregnancy, the human uterus expands up to 500-fold, remains inactive for 9 months as a fetus develops, generates forceful contractions at term, and then returns to its pre-pregnancy state. It is unclear how the uterus accomplishes these tasks. Recently developed electromyometrial imaging (EMMI) may allow for quantitation of various understudied uterine parameters. Consequently, this prospective cohort study, performed between August 9, 2017 and June 21, 2021 in the Midwest US, aimed to explore term human labor with new EMMI-derived electrophysiological indices of uterine activity. A total of 18 women with uncomplicated singleton pregnancies were enrolled. Participants at 36 to 38 weeks’ gestation underwent magnetic resonance imaging to obtain patient-specific uterine geometry. Once in active labour (≥5 cm dilated with regular contractions), up to 192 electrodes placed on the patient’s abdomen and back, recorded body surface potentials for approximately 1 hour. The primary EMMI outcome was maximal activation ratio (MAR). The study population included 11 nulliparous patients (mean [SD] age at delivery, 27.4 [5.5] years; mean [SD] body mass index at last prenatal visit, 30.1 [3.5]; mean [SD] birth weight, 3347  g) and 7 multiparous patients (mean [SD] age at delivery, 24.9 [4.3] years; mean [SD] body mass index at last prenatal visit, 29.7 [3.8]; mean [SD] birth weight, 3414  g). Among all patients, the average MAR in 11 nulliparous patients showed higher variance compared with the average MAR in 7 multiparous patients (ratio of variance, 5.5; 95% CI, 1.0-22.4; P = .04). This electrophysiological difference may indicate existence of myometrial memory, leading to more rapid labor progression in multiparous patients than nulliparous patients.
1. Predictors of recurrent stroke included previous stroke or transient ischemic attack, creatinine clearance ≤50 mL/min, male sex, and CHA2DS2‐VASc ≥4
Evidence Rating Level: 1 (Excellent)
Embolic strokes of undetermined source (ESUS) are a subset of strokes and are defined as non-lacunar infarcts without a definitive cardioembolic source. ESUS generally affect a relatively younger population and manifest with milder symptoms. There is limited information about predictors of stroke recurrence among patients with ESUS. Consequently, this analysis evaluated recurrent stroke predictors among patients enrolled in RE-SPECT ESUS (Randomized, Double-Blind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate Versus Acetylsalicylic Acid in Patients with Embolic Stroke of Undetermined Source) trial. The RE-SPECT ESUS trial compared dabigatran 150 mg twice daily with aspirin 100 mg daily among those ≥60 years within 3 months of an ischemic stroke categorized as ESUS. The primary outcome of first recurrent stroke was determined by adjudication committee. A total of 5390 patients (mean age 64.2 years; 63.1% men) at 564 international sites were enrolled. During a median follow-up period of 19 months, 384 (annual rate, 4.5%) participants had recurrent stroke. Independent predictors for recurrent stroke included stroke or transient ischemic attack before the index event (hazard ratio [HR], 2.27 [95% CI, 1.83–2.82]), creatinine clearance <50 mL/min (HR, 1.69 [95% CI, 1.23–2.32]), male sex (HR, 1.60 [95% CI, 1.27–2.02]), and CHA2DS2‐VASc ≥4 (HR, 1.55 [95% CI, 1.15–2.08] and HR, 1.66 [95% CI, 1.21–2.26] for scores of 4 and ≥5, respectively). These findings help define groups at high risk for subsequent stroke.
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