Myopia prevalence and risk factors in children

Christos Theophanous,1 Bobeck S Modjtahedi,2,3 Michael Batech,4 David S Marlin,1 Tiffany Q Luong,4 Donald S Fong2–4 1Department of Ophthalmology, Southern California Medical Group, Los Angeles, CA, USA; 2Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA; 3Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA; 4Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA Purpose: To evaluate the prevalence and risk factors for pediatric myopia in a contemporary American cohort. Methods: A cross-sectional study of pediatric patients enrolled in the Kaiser Permanente Southern California health plan was done. Eligible patients were 5- to 19-years old between January 1, 2008, through December 31, 2013, and received an ophthalmologic or optometric refraction. Electronic medical records were reviewed for demographic data, refraction results, and exercise data. Prevalence and relative risks of myopia (defined as ≤-1.0 diopter) were characterized. Age, sex, race/ethnicity, median neighborhood income, and minutes of exercise per day were examined as risk factors. Results: There were 60,789 patients who met the inclusion criteria, of which 41.9% had myopia. Myopia was more common in older children (14.8% in 5- to 7-year olds, 59.0% in 17- to 19-year olds). Asian/Pacific Islander patients (OR 1.64, CI 1.58–1.70) had an increased rate of myopia compared to White patients as did African Americans to a lesser extent (OR 1.08, CI 1.03–1.13). Median neighborhood household income of 25,000–40,000 was associated with lower rates of myopia (OR 0.90, CI 0.83–0.97) compared to median neighborhood household incomes less than 25,000. Having at least 60 min of daily exercise was associated with lower prevalence of myopia (OR 0.87, CI 0.85–0.89). Discussion: Myopia was common in this large and diverse Southern Californian pediatric cohort. The prevalence of myopia increases with age. Asian children are at highest risk for myopia. Exercise is associated with a lower rate of myopia and represents an important potentially modifiable risk factor that may be a target for future public health efforts. Keywords: children, epidemiology, exercise, refractive error, myopia, pediatrics, prevalence, public healt

Influence of body mass index and serum lipids on the cholesterol-lowering effects of almonds in free-living individuals. Nutr Metab Cardiovasc Dis 2011;21 (suppl 1):S7–13

Abstract Background and aims: Short-term (4e9 weeks) human feeding trials have shown nut consumption to reduce serum total cholesterol (TC) and LDL-cholesterol (LDL). We hypothesized that individual levels of BMI, LDL, TC and triglycerides modify the cholesterol-lowering effect of almonds in a 24-week almond supplementation trial in a free-living population. Methods and results: We performed secondary analysis on data from a previously published study. Using a sequential study design, all participants followed their habitual diets during the first six months (control), and then consumed an almond-supplemented diet (habitual þ almonds) for another six months. 100 adults enrolled; 19 were lost to attrition. Those who completed the study were men (n Z 43) and women (n Z 38) with mean (SD) age 49.4 (13.6) years. During almond supplementation, we found statistically significant changes in TC (À0.22 mmol/L), LDL (À0.22 mmol/L), TC:HDL (À0.35), and LDL:HDL (À0.28) in participants with baseline LDL levels ! 3.30 mmol/L, but not among normocholesterolemic individuals. Direction and magnitude of change were similar among individuals with TC ! 5.20 mmol/L but not in the lower strata. Tests of interaction (diet  TC and diet  LDL) were significant. Reductions in the ratios TC:HDL, and LDL:HDL were significant among those with BMI < 25 kg/m 2 , but not in heavier individuals; however, formal tests of interaction did not reach significance. Conclusions: We provide strong evidence that the cholesterol-lowering effect of almonds is responsive among hypercholesterolemic individuals, and weak evidence that BMI modifies the effect of almonds on serum lipids.

Perioperative Morbidity in Cirrhotic Patients Undergoing Orthopedic Surgery

Background/Aims: Previous studies have shown an increased risk of morbidity and mortality in cirrhotic patients undergoing surgery. However, there is a paucity of studies evaluating the perioperative risks of cirrhotics who undergo orthopedic surgery. The aim of this study was to examine outcomes in cirrhotic patients who have undergone orthopedic surgery. Methods: This is a retrospective matched-cohort study using data from Kaiser Permanente Southern California. Study participants received a diagnosis for cirrhosis from 1/1/2003 through 12/31/2013, and initial case selection criteria included age \u3e 18 years, ≥ 6 months continuous health plan membership, and a procedure code for orthopedic surgery. At least 3 and up to 5 controls were optimally matched based on age, gender and cirrhosis diagnosis date. Data abstraction and summary were subsequently performed for demographic, socioeconomic, comorbid history and decompensation events data. Decompensation events included new onset ascites, variceal bleeding and hepatic encephalopathy. Multivariable conditional logistic regression estimated the risk of decompensation from surgery. Results: We matched 4,263 eligible controls with 853 cirrhotic surgical patients. Mean age of the cohort was 60.5 (standard deviation: 11.44) years and 52.2% were female. Within 90 days after surgery, cases had more decompensation events compared to matched controls (24.1% vs. 19.1%). Discussion: In this large database study including patients from a large managed care organization, cirrhotics experienced more decompensation within 90 days after orthopedic surgery compared to matched controls. Decompensation events result in significant increases in health care costs and utilization. Further, the increased morbidity seen in cirrhotics is a potential cause of quality issues for the managed care organization. Examination and mitigation of the factors, such as surgery, that can result in decompensation may help improve systems for better quality of care

Serum phosphorus and association with anemia among a large diverse population with and without chronic kidney disease.

BackgroundWe hypothesized that phosphorus has an effect on anemia in both normal kidney function and early chronic kidney disease (CKD). We sought to determine whether higher phosphorus levels are associated with anemia in a large diverse population without CKD and early CKD.MethodsThis study is a historical population-based study within the Kaiser Permanente Southern California health system (1 January 1998 to 31 December 2013) among individuals aged 18 years and older with estimated glomerular filtration rate >30 mL/min/1.73 m(2) and measurements of serum phosphorus, creatinine and hemoglobin. Individuals were excluded if they had secondary causes of anemia. Odds ratio (OR) estimated for moderate anemia defined as hemoglobin <11 g/dL for both sexes. Mild anemia was defined as <12 g/dL (females) and <13 g/dL (males).ResultsAmong 155 974 individuals, 4.1% had moderate anemia and 12.9% had mild anemia. Serum phosphorus levels ≥3.5 mg/dL were associated with both mild and moderate anemia. Moderate anemia OR (95% confidence interval) was 1.16 (1.04-1.29) for every 0.5 mg/dL phosphorus increase and 1.26 (1.07-1.48) in the highest versus middle phosphorus tertile. Additional independent anemia risk factors, including female sex, Asian race, diabetes, low albumin and low iron saturation, were observed, but did not alter the anemia-phosphorus association.ConclusionsHigher phosphorus levels were associated with a greater likelihood for anemia in a population with early CKD and normal kidney function. Phosphorus may be a biomarker for anemia and may affect aspects of hematopoiesis