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OBJECTIVES Determine the incidence rates of frailty among community-dwelling older veterans. DESIGN Population-based retrospective cohort study. SETTING AND PARTICIPANTS Veterans Health Administration Medical Center study included community-dwelling veterans 60 years and older with determinations of frailty from 2013 to 2014 and followed until September 2019. METHODS A 31-item frailty index was generated at baseline and during each subsequent primary care encounters as a proportion of potential variables from electronic health record data. Period prevalence was calculated by dividing total number of cases of frailty during the baseline period. After adjusting for covariates, the association of frailty with mortality was determined using a multivariate Cox regression model. Using baseline and follow-up data, incidence rates of frailty per 1000 person/years based on event rates and mean duration of follow-up were calculated, including survivor and entire cohorts. RESULTS Patients in this cohort were 16,761 veterans, mean age 72.18 (9.32) years, 74.00% Caucasian, 90.75% non-Hispanic, and 97.78% male. The period prevalence of frailty in this cohort was 20.84%. Over a median follow-up of 3.96 (interquartile range = 3.73) years, 25.86% of the baseline population died during follow up. Veterans with frailty had a higher all-cause mortality during follow up, adjusted hazard ratio = 3.12 (95% confidence interval 2.87-3.38), P value of < .0005. Among 10,513 veterans who survived a median follow-up of 4.81 (interquartile range = 3.12) years, 29.84% became frail. The incidence rate of frailty was 75.05 cases per 1000 person-years. Among the entire cohort of 13,268 nonfrail veterans, 29.93% became frail. The incidence rate of frailty was 84.03 cases per 1000 person-years. CONCLUSIONS AND IMPLICATIONS This study shows high incidence of frailty in community dwelling older US veterans. Future studies should be done for identification, implementation of adequate interventions aimed at preventing frailty or reducing frailty-related complications in community dwelling older individuals.

Introduction Chronic liver disease (CLD) causes more than 1 million deaths every year and remains a pandemic in the last decade affecting more than 600,000 patients in the United States. Previous studies found patients with CLD had increased risk of osteoporosis, so fractures were inferred to be complications of this condition. The aim of this meta-analysis is to summarize the best evidence that correlates CLD patients and the risk to develop osteoporotic fractures versus control patients without CLD. Methods A review of the literature using MEDLINE and EMBASE database was performed during December 2017. We included cross-sectional and cohort studies that reported relative risks (RR), odds ratios (OR) and hazard ratios (HR) comparing the risk of developing osteoporotic fractures among patients with CLD versus patients without CLD. Pooled OR and 95% confidence interval (CI) were calculated using generic inverse- variance method. The Newcastle-Ottawa scale was used to determine the quality of the studies. Effect estimates from the individual study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results After the review of the literature, seven studies fulfilled the eligibility criteria established during the analysis. Significant association was found between CLD and osteoporotic fractures with a pooled OR of 2.13 (95% CI, 1.79 - 2.52). High heterogeneity among the studies was found (I2=88.5). No publication bias was found using Egger regression test (p=0.44). Conclusion We found a significant association between CLD and the risk of developing osteoporotic fractures. The calculated risk was 2.13 times higher for patients with CLD when compared with controls. The results showed high heterogeneity but no publication bias. More prospective studies are needed to fully understand the mechanisms involved in loss of bone density and osteoporotic fractures in order to improve the morbidity associated with this disease.

Introduction Several studies have found celiac disease may be associated with a variety of cardiac manifestations. Atrial fibrillation (AF) is one of the most common arrhythmias that can cause significant morbidity. However, the risk of atrial fibrillation in patients with celiac disease according to epidemiological studies remains unclear. The aim of this meta-analysis study is to assess the risk of atrial fibrillation in patients diagnosed with celiac disease compared to controls. Methods A systematic literature review was conducted in MEDLINE, EMBASE, Cochrane databases from inception through December 2017 to identify studies that evaluated the risk of atrial fibrillation in patients with celiac disease. We included randomized controlled trial, cross sectional and cohort studies that reported the odds ratio, relative risk, hazard ratio, and standardized incidence ratio comparing the risk of developing atrial fibrillation among patients with celiac disease, versus patients without celiac disease as control. The Newcastle-Ottawa scale was used to determine the quality of the studies. Effect estimates from individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Results Celiac disease is an autoimmune condition. This inflammatory state predisposes patients to develop AF. After a review of the literature, four observational studies with a total of 64,397 participants were enrolled. The association between celiac disease and increased risk of atrial fibrillation was significant, with a pooled OR of 1.38 (95% CI: 1.01-1.88). No publication bias as assessed by the funnel plots and Egger's regression asymmetry test with p = 0.54. However, the heterogeneity of the included studies was high (I2 = 96). Conclusion A significant association between celiac disease and risk of atrial fibrillation was reported in this study. There is a 38% increased risk of atrial fibrillation. Additional studies are needed to clarify the mechanistic link between atrial fibrillation and celiac disease. Some of the limitations of this study are that all were observational studies, some were medical registry-based and there was high heterogeneity between studies.

Background: Breast cancer is a major health burden mainly in the developed countries but its rates are also increasing in the developing countries. With such increasing rates of breast cancer it is imperative that the general population is aware of its risk factors, early screening methods and the preventive measures that can be undertaken before its development.Objective: To assess the awareness of breast-self-examination (BSE) & screening among the mothers belonging to different socioeconomic groups in Karachi, Pakistan. To assess the awareness of breast lump & its relation with breast cancer in mothers.Methods: This is a cross sectional research study constituting on a sample size of 284 people. The data was collected using a self administered questionnaire which was designed after detailed literature review. The date was collected from all 5 districts of Karachi, Pakistan. The duration of data collection was from April 2013 to November 2013. The data was analyzed using spss 19 with a 95% confidence interval and a 5% margin of error. A p-value of .05 or less was considered significant.Results: The results showed that most of the women (81%) have sufficient general knowledge about breast cancer and its outcomes but the awareness regarding the risk factors was limited. Only 38% were aware that old age is a risk factor, 34.9% knew that null parity is a risk factor while 57.7% believed that trauma to the breast, for example child hitting the breast, cause breast disease. The women were only partially aware of the screening methods available, only 53.2% of women knew how to self-examine their breast and 69% of them were not aware of the fact that mammography is the basic screening procedure. Results are similar for knowledge about signs and symptoms and only 46.8% were aware that bloody discharge and inward retraction of nipple may be due to breast cancer. Despite the limited current awareness about the breast diseases most women (82.4%) showed interest in learning more information about breast diseases and how might they be prevented.Conclusions: The study concluded that though the mothers were aware of breast cancer they still require sufficient knowledge regarding its risks, methods of screening and means to prevent it. In accordance with this need more initiatives should be undertaken to spread more awareness regarding this through media or other useful sources. But increasing awareness alone cannot deliver the desired results and there is a parallel need to increase the facilities and to make them accessible for all. Steps should also be undertaken to educate the women about their misconceptions regarding breast cancer and to make them free from unnecessary barriers as many women do not seek clinical advice due to these barriers.