Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest

ObjectiveIt remains unknown whether patient socioeconomic factors affect interventions and survival after out-of-hospital cardiac arrest (OHCA), and whether a socioeconomic effect on bystander interventions affects survival. Therefore, this study examined patient socioeconomic disparities in prehospital factors and survival.MethodsFrom the Danish Cardiac Arrest Registry, patients with OHCA ≥30 years were identified, 2001–2014, and divided into quartiles of household income (highest, high, low, lowest). Associations between income and bystander cardiopulmonary resuscitation (CPR) and 30-day survival with bystander CPR as mediator were analysed by logistic regression and mediation analysis in private witnessed, public witnessed, private unwitnessed and public unwitnessed arrests, adjusted for confounders.ResultsWe included 21 480 patients. Highest income patients were younger, had higher education and were less comorbid relative to lowest income patients. They had higher odds for bystander CPR with the biggest difference in private unwitnessed arrests (OR 1.74, 95% CI 1.47 to 2.05). For 30-day survival, the biggest differences were in public witnessed arrests with 26.0% (95% CI 22.4% to 29.7%) higher survival in highest income compared with lowest income patients. Had bystander CPR been the same for lowest income as for highest income patients, then survival would be 25.3% (95% CI 21.5% to 29.0%) higher in highest income compared with lowest income patients, resulting in elimination of 0.79% (95% CI 0.08% to 1.50%) of the income disparity in survival. Similar trends but smaller were observed in low and high-income patients, the other three subgroups and with education instead of income. From 2002 to 2014, increases were observed in both CPR and survival in all income groups.ConclusionOverall, lower socioeconomic status was associated with poorer prehospital factors and survival after OHCA that was not explained by patient or cardiac arrest-related factors.

Is Romosozumab better than Teriparatide for the treatment of osteoporosis? A meta-analysis through a grade analysis of evidence

Background Osteoporosis is a common systemic skeletal disease. With an ageing population, the socioeconomic effect of osteoporosis will remarkably improve. Romosozumab (EVENITYTM) is a new osteoanabolic drug, which is a humanised monoclonal antibody against sclerostin, and received its first global approval for the treatment of osteoporosis in patients at high risk of fracture in Japan on January 8, 2019. Teriparatide is the first osteoanabolic drug. However, there is no comprehensive analysis and systematic review about the efficacy and safety of the two treatment. Method Randomized controlled trials (RCTs) about our analysis were searched from electronic database, including Pubmed (1996 to June 2019), Embase (1980 to June 2019), Cochrane Library (CENTRAL, June 2019), Web of Science (1998 to June 2019) and others. Four studies were included in our meta-analysis. Results Four studies containing 1304 patients meet our selection criteria. Our result of analysis indicated that Romosozumab showed better effects in improving BMD of lumbar spine (month 6: MD=3.54, 95% CI [3.13, 3.94], P<0.00001; month 12: MD=4.93, 95% CI [4.21, 5.64], P<0.00001), total hip (month 6: MD=2.27, 95% CI [0.62, 3.91], P=0.007; month 12: MD=3.17, 95% CI [2.68, 3.65], P<0.00001) and femoral neck (month 6: MD=2.30, 95% CI [0.51, 4.08], P=0.01; month 12: MD=3.04, 95% CI [2.29, 3.78], P<0.00001). And the injection-site reaction was fewer (month 12: RR=2.84, 95% CI [1.22, 6.59], P=0.02).But there were no significant differences in the incidence of serious adverse events (month 12: RR=0.78, 95% CI [0.46, 1.33], P=0.37), and death (month 12: RR=0.61, 95% CI [0.08, 4.62], P=0.63). Conclusion Based on the available studies, our current results demonstrated that Romosozumab was better than Teriparatide both in terms of efficacy and side effects.

Migraine and Tension-Type Headache

Migraine and tension-type headache (TTH) are common primary disorders that carry significant morbidity and socioeconomic effect. In this article, we will review the epidemiology, presentation, and diagnosis of these disorders. First-line acute treatment for migraine consists of analgesics, triptans, and antiemetics, while nonsteroidal anti-inflammatory drugs are the mainstay treatment for TTH. Patients with frequent or chronic headaches warrant prophylactic therapy. For migraine, various classes of preventives can be used (β-blockers, tricyclics, antiepileptics, botulinum toxin), with the choice of therapy tailored to the patient's risk factors and symptoms. For TTH, tricyclics have the most evidence as prophylactic therapy. A new class of medication, monoclonal antibodies to calcitonin gene receptor peptide or its receptor, became available in 2018, and is the first class of medication specifically designed to treat migraine. In addition to pharmacotherapy, we will also review nonpharmacologic interventions as well as neuromodulation for migraine.

Race and socioeconomic effect on sarcopenia and sarcopenic obesity in the Louisiana Osteoporosis Study (LOS)

BACKGROUNDSarcopenia and sarcopenic obesity are emerging public health issues. True prevalence rates are unknown and estimates differ substantially between studies. No large-scale single study has compared prevalence rates between whites, blacks, Asians, and Hispanics, as we intend to do here. This study also examined the effects of race and socioeconomic factors on sarcopenia and sarcopenic obesity. METHODSThis study included 10,325 participants from Louisiana. Appendicular lean mass, measured through DXA scans, was divided by height squared (ASM/h2) to define sarcopenia. Sarcopenic obesity was defined as sarcopenia plus obesity (waist-to-hip ratio). RESULTSOverall sarcopenia and sarcopenic obesity rates were 17.6% and 7.0% for males, and 13.7% and 2.5% for females, respectively. The highest sarcopenia and sarcopenic obesity rates were found in Asian males (40.6%, 14.4%) and females (30.1%, 8.0%). The lowest sarcopenic obesity rates were observed in black males (3.7%) and females (0.9%). We found significant associations with sarcopenic obesity in males for age, race, and income; in females, for age, race, and education. CONCLUSIONSUnder one diagnostic definition, the prevalence of sarcopenia and sarcopenic obesity is highest among Asians and lowest amongst blacks. Income and education had significant associations with sarcopenia and sarcopenic obesity, in males and females, respectively.