Risultati per: Come il corpo usa il grasso per combattere le infezioni

Objectives
To examine the associations between antidiabetic medication type and a new episode of depression using 100% Texas Medicare database during 2009 and 2018.

Design
A retrospective cohort study.

Setting
A population-based study using the Texas Medicare data.

Interventions
11 common antihyperglycaemic medication types, alone and in combinations: metformin-only, five non-metformin-containing regimens (dipeptidyl peptidase-4 inhibitor (DPP4i) only, sulfonylureas (SU) only, thiazolidinediones (TZD) only, SU/DPP4i and SU/TZD) and five metformin-containing combination treatments (metformin/DPP4i, metformin/SU, metformin/TZD, metformin/SU/DPP4i and metformin/SU/TZD).

Participants
This study included 59 057 type 2 diabetes (T2D) patients from a cohort of Texas Medicare beneficiaries who were aged ≥66 years, had consistent diabetes medication intake, were not diagnosed with depression or prescribed antidepressants during the 2-year look-back period and received regular care from Medicare providers.

Main outcomes and measures
The main outcome was a new episode of depression, identified by a new depression diagnosis during the follow-up period.

Results
A total of 59 057 T2D patients (mean (SD) age, 75.4 (6.4) years; 30 798 (52.1%) female) were followed up to 96 months. Of these, 22.5% patients had a new episode of depression at the 5-year follow-up. Compared with the metformin-only group, patients in the non-metformin-containing regimens had a higher risk of new episode depression (HR: 1.17, 95% CI 1.05 to 1.30 for DPP4i-only; HR: 1.06, 95% CI 1.01 to 1.12 for SU-only), but there was no significant difference among patients receiving metformin-containing combination therapy. Metformin/TZD and metformin/SU/DPP4i combination treatments had a lower risk of new episodes of depression than metformin-only (HR: 0.88, 95% CI 0.78 to 0.99 and HR: 0.83, 95% CI 0.71 to 0.98 separately). The same direction of association was observed in sensitivity analyses.

Conclusions
This retrospective cohort study found that T2D patients treated with metformin/TZD and metformin/SU/DPP4i had the lowest risk of new episodes of depression. These findings suggest that certain combinations of metformin with other antidiabetic medications may be associated with a reduced risk of new-onset depression. Therefore, it could be beneficial to incorporate depression risk evaluation into routine diabetes care and consider it in the decision-making process for diabetes medication types, especially when deprescribing metformin.

The five identified subgroups of adults hospitalised with influenza had varying distributions of age, comorbid conditions, and clinical courses characterized by new complications versus exacerbations of existing conditions. Stratifying by these subgroups may strengthen analyses that assess the impact of influenza vaccination and antiviral treatment on risk of severe disease. Limitations included that results were based on a convenience sample within FluSurv-NET sites and were likely not representative of all adults hospitalised with influenza in the United States.

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Introduction
Cardiac inotrope medications administered to cardiac surgical patients carry steep risk–benefit trade-offs, yet wide inter-institutional variation exists in inotrope practices. Despite known wide variation in use of any inotrope for cardiac surgery, limited multicentre data exist regarding determinants of inotrope selection and time course for use. Additionally, the reasons that underpin how clinicians decide on inotrope usage and the factors that influence inotrope practice change are not well understood.

Methods and analysis
This is an investigator-initiated, multicentre mixed methods study. Quantitative data will include electronic health records from an observational cohort of adult cardiac procedures within the Multicenter Perioperative Outcomes Group (MPOG) database, comprising cardiac surgical procedures from over 30 US academic and community hospitals. Additional quantitative data will be collected via surveys of clinicians involved in inotrope decision-making, contacted through an existing multicentre research and quality improvement infrastructure with engaged clinician representatives participating across MPOG hospitals. Qualitative data will be collected from open-ended questions within surveys, as well as semi-structured interviews with surveyed clinicians, sampled across approximately six institutions selected for diversity of settings and inotrope practices. An explanatory sequential mixed methods design will merge quantitative and qualitative data to develop meta-inferences explaining inotrope practices, as guided by an existing framework for characterising clinical practice variation and levers for practice change.

Ethics and dissemination
The study is approved by the institutional review board at the University of Michigan Medical School (HUM00245353). Findings will be disseminated through peer-reviewed journals, conference proceedings and quality improvement forums. The study began in February 2025 and will continue until 2028.

Introduction
Cardiac inotrope medications administered to cardiac surgical patients carry steep risk–benefit trade-offs, yet wide inter-institutional variation exists in inotrope practices. Despite known wide variation in use of any inotrope for cardiac surgery, limited multicentre data exist regarding determinants of inotrope selection and time course for use. Additionally, the reasons that underpin how clinicians decide on inotrope usage and the factors that influence inotrope practice change are not well understood.

Methods and analysis
This is an investigator-initiated, multicentre mixed methods study. Quantitative data will include electronic health records from an observational cohort of adult cardiac procedures within the Multicenter Perioperative Outcomes Group (MPOG) database, comprising cardiac surgical procedures from over 30 US academic and community hospitals. Additional quantitative data will be collected via surveys of clinicians involved in inotrope decision-making, contacted through an existing multicentre research and quality improvement infrastructure with engaged clinician representatives participating across MPOG hospitals. Qualitative data will be collected from open-ended questions within surveys, as well as semi-structured interviews with surveyed clinicians, sampled across approximately six institutions selected for diversity of settings and inotrope practices. An explanatory sequential mixed methods design will merge quantitative and qualitative data to develop meta-inferences explaining inotrope practices, as guided by an existing framework for characterising clinical practice variation and levers for practice change.

Ethics and dissemination
The study is approved by the institutional review board at the University of Michigan Medical School (HUM00245353). Findings will be disseminated through peer-reviewed journals, conference proceedings and quality improvement forums. The study began in February 2025 and will continue until 2028.

Objectives
To investigate long-acting injectable (LAI) antipsychotic prescribing patterns and their associations with transition and continuation of care and healthcare resource utilisation (HCRU) for patients with schizophrenia in the USA.

Design
A retrospective cohort study.

Setting
Electronic health record data from adults in the USA with schizophrenia were extracted from the NeuroBlu Database V.21R2.

Participants
Adults (aged ≥18 years) with a schizophrenia diagnosis who initiated LAI antipsychotic treatment during psychiatric inpatient admission. The index date was the date of LAI initiation. Patients who had ≥1 primary, secondary or tertiary ICD-9/10 (International Classification of Diseases) diagnosis of schizophrenia at clinical sites that had both inpatient and outpatient facilities were included.

Primary outcome measures
Transition-of-care (eg, risk of rehospitalisation, number of hospital readmissions, number of outpatient visits post discharge), continuation-of-care (eg, first treatment path after discharge, time to index LAI discontinuation and number of patients who restarted LAIs after discontinuation) and HCRU endpoints (eg, length of stay of index hospitalisation and estimated cost for psychiatric outpatient visits pre-index and post-index) were the primary outcome measures.

Results
A total of 1197 patients were included who initiated an LAI in an inpatient setting. Of 339 patients with ≥3 months pre-index and post-index data, median time to rehospitalisation was 135 days. Patients discharged taking an LAI alone had lower frequency of rehospitalisation (incidence rate ratio (IRR)=0.62 (95% CI, 0.46 to 0.84)), lower risk of longer hospital stays (IRR=0.60 (95% CI, 0.43 to 0.84)), lower risk of becoming rehospitalised (HR=0.49 (95% CI, 0.35 to 0.69)) and lower risk of outpatient visits (IRR=0.50 (95% CI, 0.36 to 0.70)) versus patients co-prescribed an oral antipsychotic (LAI+OA). Patients discharged taking an LAI dosed once every 1–2 months or once every 2 weeks had lower frequency of rehospitalisation (IRR=0.85 (95% CI, 0.64 to 1.14)), lower risk of longer hospital stays (IRR=0.90 (95% CI, 0.70 to 1.15)) and lower risk of becoming rehospitalised versus an LAI dosed once every 2 weeks; risk of becoming rehospitalised was no different (HR=1.00 (95% CI, 0.76 to 1.32)) and risk of outpatient visits was greater (IRR=1.25 (95% CI, 0.96 to 1.63)). During hospitalisation, 73.4% of patients were co-prescribed an OA, most frequently risperidone, with their index LAI. From pre-admission to post-discharge, psychiatric clinic costs significantly increased (US$14 231, p

Nel 2019 il marito tentò di ucciderla dandole fuoco

Objectives
This study explores the drug use behaviour in the US general population in the early days of the COVID-19 pandemic with a focus on the relationship between sociopsychological factors, mobility restrictions from March to June 2020 and mental health conditions.

Design
A retrospective anonymous online survey representing a cross-section of the US population in 2020.

Setting
A qualified panel of 500 000 Qualtrics participants stratified by gender, race, age and geographical region to represent the US population.

Participants
3340 participants voluntarily consented to respond.

Measures
Outcome measure for illicit and non-medical use of prescription drugs based on the National Institute on Drug Abuse-Modified Alcohol, Smoking and Substance Involvement Screening Test Level-2 Substance Use for Adult Questionnaire and predictor measures include self-reports of mobility behaviours, demographics and mental states using psychometrically validated scales.

Results
2 tests showed that those who stayed home reported higher odds (p

Objective
This study investigated how workplace culture may affect the development of lifestyle medicine (LM) programming in health systems to inform the successful growth of LM programs. No study has examined how the impact of workplace culture (shared knowledge, values and behaviours within an organisation) affects practitioners’ abilities to engage in LM.

Design
A cross-sectional, multiple case study investigation of the implementation of LM in five health systems was conducted by administering semi-structured in-depth interviews (n=45) from May 2022 to January 2023. Following the transcription of interviews verbatim, narrative reports depicting each health system’s experience with LM were drafted and collectively reviewed by the research team who discussed emerging themes.

Setting
Five health systems across the USA that have implemented LM were selected based on diversity in size, location, payer model, and patient population.

Participants
Administrative leaders, physicians and other personnel involved in the LM programming from selected health systems were invited to participate.

Results
The implementation of LM is facilitated when practices such as forming social groups, visually advertising LM and offering plant-based cafeteria items are present to support core values, such as trust, gratitude, collaboration and optimism.

Conclusions
LM implementation can be supported by health system clinicians and administrators striving to make their workplaces more supportive and synergetic so that they can take advantage of all available resources. Future research should further explore this relationship between cultural factors and resource availability.