Sandovalgiles0516

We examined the influence of confounding due to pre-existing diseases in prospective studies on sedentary behavior and all-cause mortality.

We analyzed 25 studies included in systematic reviews. The risk of confounding due to pre-existing diseases was assessed by five methodologic characteristics.

Sedentary behavior was associated with higher all-cause mortality. Studies with short average follow-up length had stronger magnitudes of association 1 to less than 5years (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.28-1.94), 5 to 9years (HR, 1.24; 95% CI, 1.16-1.31), and 10years or more of follow-up (HR, 1.20; 95% CI, 1.10-1.31). Studies that did not adjust for diseases at baseline, did not exclude deaths in the first years of follow-up, and did not exclude participants with diseases/conditions showed stronger associations. Studies with higher risk of confounding because of pre-existing diseases (HR, 1.40; 95% CI, 1.27-1.54) showed stronger association than lower risk studies (HR, 1.18; 95% CI, 1.10-1.27). Studies excluding participants with diseases at baseline had weaker associations compared with studies adjusting for diseases in models.

Sedentary behavior was associated with increased all-cause mortality, although confounding due to pre-existing diseases may bias the magnitude of the association.

Sedentary behavior was associated with increased all-cause mortality, although confounding due to pre-existing diseases may bias the magnitude of the association.

Prognostic studies derived from samples of patients managed in tertiary hospitals are subject to referral bias. We aimed to characterize this bias using the example of infective endocarditis.

We analyzed data from a French population-based cohort, which included 497 patients with infective endocarditis. Patients were admitted directly to a tertiary hospital (Group T), admitted to a non-tertiary hospital and referred to a tertiary hospital (Group NTT) or not (Group NT). We compared patients' characteristics, survival rates and prognostic factors between groups.

Compared with Group T (n=291), NTT patients (n=144) were more often males (81.3% vs. 72.5%; P=.046), injection drug users (9.7% vs. 4.5%; P=.033), and had more frequent surgical indications (78.5% vs. 64.3%; P=.003). Compared with Group NT (n=62), NTT patients were more often males (81.3% vs. 67.7%; P=.034) and had surgical indications more often (78.5% vs. 19.4%; P<.001). One-year survival was higher in NTT+ T patients than in NT patients (73.0% vs. 56.1%; P=.01). Prognostic factors and hazard ratios estimates varied across groups.

When derived from samples mixing patients admitted directly and those referred to tertiary hospitals, validity of characteristics description, survival estimates, and hazard ratios is threatened by referral bias.

When derived from samples mixing patients admitted directly and those referred to tertiary hospitals, validity of characteristics description, survival estimates, and hazard ratios is threatened by referral bias.

This study examined the effect of hypertensive disorders during pregnancy on trajectories of emotional and behavioral problems in offspring.

We used data from the Avon Longitudinal Study of Parents and Children, a prospective birth cohort study in Avon, United Kingdom. A group-based trajectory modeling was used to identify the distinct trajectories of emotional and behavioral problems in children at four time points at age 3.5, 6.75, 9, and 11years. Multinomial logistic regression analyses were used to examine the association between hypertensive disorders during pregnancy and trajectories of emotional and behavioral problems.

We identified four trajectories of offspring emotional and behavioral problems normal (42.6%), borderline decreasing (40.6%), borderline stable (10.0%), and persistently elevated (6.8%). find more We found that children exposed to maternal pre-eclampsia were more likely to be in the persistently elevated symptom trajectory (OR=2.72; 95% CI 1.10-6.74) than in the normal trajectory group. We found no associations between maternal gestational hypertension and trajectories of offspring emotional and behavioral problems.

Maternal pre-eclampsia, but not gestational hypertension was associated with persistently elevated trajectory of offspring emotional and behavioral problems. Our findings highlight that the antenatal environment is important for children's behavioral and emotional development.

Maternal pre-eclampsia, but not gestational hypertension was associated with persistently elevated trajectory of offspring emotional and behavioral problems. Our findings highlight that the antenatal environment is important for children's behavioral and emotional development.

Individuals with poor physical and mental health may face elevated risk for suicide, particularly suicide by firearm.

This retrospective cohort study used statewide, longitudinally linked emergency department (ED) patient record and mortality data to examine 12-month incidence of firearm suicide among ED patients presenting with a range of physical health problems. Participants included all residents presenting to a California ED in 2009-2013 with nonfatal visits for somatic diagnoses hypothesized to increase suicide risk, including myocardial infarction, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes, cancer, back pain, headache, joint disorder, and injuries. For each patient diagnostic group, we calculated rates of firearm suicide per 100,000 person-years and standardized mortality ratios (SMRs) relative to the demographically matched California population.

Firearm suicide rates per 100,000 person-years ranged from 9.6 (among patients presenting with unintentional injury) to 55.1 (patients with cancer diagnoses), with SMRs from 1.48 to 7.45 (all p<0.05). SMRs for patients with cardiovascular conditions ranged from 2.45 to 5.10. Men and older individuals had higher firearm suicide rates, and there was substantial between-group variability in the proportion of suicide decedents who used a firearm.

ED patients presenting with deliberate self-harm injuries, substance use, and cancer were especially at risk for firearm suicide. To avoid missed suicide prevention opportunities, EDs should implement evidence-based suicide interventions as a best practice for their patients.

ED patients presenting with deliberate self-harm injuries, substance use, and cancer were especially at risk for firearm suicide. To avoid missed suicide prevention opportunities, EDs should implement evidence-based suicide interventions as a best practice for their patients.