Outdoor Illumination Tied to AMD

 Exposure to artificial outdoor lighting at night was associated with increased risk for age-related macular degeneration (AMD), Korean researchers found in a case-control study, with a pronounced dose-response relationship.

When examined by degree of exposure, each jump from one quartile to the next was associated with a 67% increase in risk for new-onset exudative ("wet") AMD (95% CI 56-78), according to Ahnul Ha, MD, of Jeju National University in Korea, and colleagues.

The risk was apparent primarily in urban areas, where individuals in the highest quartile faced a nearly 3.5-fold higher AMD incidence than those in the lowest (HR 3.42, 95% CI 2.67-4.39), the researchers reported in JAMA Network Openopens in a new tab or window.

"These findings align with the increasing body of evidence that emphasizes the negative impact of OALAN [outdoor artificial light at night] on health, further implicating OALAN as a potential risk factor for [exudative] AMD," Ha and colleagues wrote. "Further studies incorporating comprehensive information on exposure, individual adaptive behaviors, and potential mediators are recommended to deepen our understanding in this area."

Also called light pollution, humans' eagerness for nighttime illumination has previously been linked to a host of adverse health effects: not merely inhibiting sleep but also contributing to obesity, cancer, cardiovascular disease, and psychiatric disorders, Ha's group noted. It made sense to take a look at AMD because light obviously affects the ocular system and, they suggested, unnatural daily rhythms in exposure may be damaging in previously unappreciated ways.

Using Korea's comprehensive national insurance data, the researchers identified 4,078 who were diagnosed with wet AMD during 2010-2011; each was matched by age and sex with 30 people with no record of AMD through 2020 who served as controls. Outdoor nighttime light exposure for each case and control was estimated from satellite data for 2008-2009 with a resolution of about 1 square kilometer.

Medians for light exposure within each quartile ranged from 8.1 nW/cm²/sr in the lowest to 92.7 nW/cm²/sr in the highest. The same quartile definitions were used when examining urban and rural residents separately. As one might expect, more than half of rural residents were in the lowest quartile for nighttime light exposure, whereas 41% of urban dwellers were in the highest, and another 29% were in quartile 3. There were also small but statistically significant differences between urban and rural residents for other potential factors such as traffic noise and air pollution.

There was virtually no relationship between degrees of light exposure and wet AMD rates in the rural population: Ha and colleagues calculated a risk increase of just 1% per increment in exposure quartile, after adjustment for numerous covariates. Among the 10,395 rural participants in quartile 3 for exposure, wet AMD was diagnosed at a rate just 4% greater than for quartile 1 (there were only five rural residents in quartile 4, with no AMD diagnoses).

For specific mechanisms by which light exposure might trigger wet AMD, Ha and colleagues suggested that retinal pigment epithelial (RPE) cells, which help maintain healthy ocular function, are a likely target. The researchers cited previous lab studies showing that ultraviolet light is lethal to these cells. Moreover, they added, "[e]xcessive light exposure, particularly long-term blue light exposure, has been shown to disrupt mitochondrial dynamics, promote fragmentation, and cause oxidative stress, ultimately decreasing the viability of RPE cells by nearly 40%."

Finally, Ha's team suggested that disruption in circadian rhythms may also contribute to AMD, insofar as important housekeeping functions for photoreceptors are tied to these diurnal variations. As well, animal studies have indicated that altered circadian rhythms can promote angiogenesis, the pathology underlying wet AMD.

Ha and colleagues acknowledged several limitations to the study, such as the relative coarse resolution for light exposure data; the satellite data did not necessarily capture fluctuations in lighting patterns over time in a given area. Perhaps more importantly, the analysis did not address contributions from nighttime indoor light.

Disclosures

The Korean government funded the study. Authors declared they had no relevant financial interests.

Primary Source

JAMA Network Open

Source Reference: opens in a new tab or windowKim SH, et al "Nighttime outdoor artificial light and risk of age-related macular degeneration" JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2023.51650.

https://www.medpagetoday.com/ophthalmology/generalophthalmology/108262

'Hormonal and reproductive factors in relation to the risk of rheumatoid arthritis in women'

 

Ling-Qiong Jiang1,2, 

Ruo-Di Zhang1,2, 

Harry Asena Musonye1,2, 

Hao-Yun Zhao3, 

Yi-Sheng He1,2, 

Chan-Na Zhao1,2, 

Tian He1,2, 

Tian Tian1, 

Zhao-Xing Gao1,2, 

Yang Fang1,2, 

Peng Wang4, 

http://orcid.org/0000-0001-8218-5747Jing Ni1,2 and 

http://orcid.org/0000-0001-8218-5747Hai-Feng Pan1,2

Abstract

Objective This study aimed to examine rheumatoid arthritis (RA) risk associated with hormonal and reproductive factors in women from the large cohort of the UK Biobank.

Methods Data on hormonal and reproductive factors in women were collected from a prospective cohort of 223 526 UK Biobank participants. The potential relationship between reproductive factors and RA risk was assessed using restricted cubic spline. Hazard ratios (HR) were estimated using Cox proportional hazard regressions.

Results During a median follow-up of 12.39 years, 3313 women with RA were identified. Age at menarche >14 years was associated with a greater RA risk (HR 1.13, 95% CI 1.02 to 1.26) compared with menarche at 13. The multiple adjusted HR for RA in women with menopause at <45 years was 1.46. Reproductive years <33 increased the risk of RA (HR 1.39, 95% CI 1.21 to 1.59). Compared with those with 2 children, women with ≥4 children were associated with a higher risk of RA (HR 1.18, 95% CI 1.04 to 1.34). Women who had a hysterectomy (HR 1.40, 95% CI 1.25 to 1.56) or oophorectomy (HR 1.21, 95% CI 1.08 to 1.35) had a higher risk of RA than those without a hysterectomy or oophorectomy. Both hormone replacement therapy (HRT) use (HR 1.46, 95% CI 1.35 to 1.57) and HRT duration (HR 1.02, 95% CI 1.01 to 1.03) were associated with a higher risk of RA.

Conclusions Some hormonal and reproductive factors were associated with a higher risk of RA. Hormonal and reproductive factors should be considered in risk assessment and formulating management plans in female patients with RA.

https://rmdopen.bmj.com/content/10/1/e003338

Mortality Due to Hyperglycemic Crises in the US, 1999-2022

 Matthew A. Crane, BS¹; Audrey Lam, BS²; Emil Ekanayake, BS²; et al

doi:10.1001/jama.2023.26174

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state are 2 forms of hyperglycemic crisis presenting as acute complications of diabetes. These conditions represent a substantial source of morbidity and medical expenditure in the US, accounting for approximately 231 000 hospitalizations in 2019.¹ Prior research reported a declining mortality rate in these conditions from 1985 to 2002.² Given trends of worsening diabetes control and increasing diabetes-related complications beginning in the early 2010s, patterns of mortality due to hyperglycemic crises may have evolved over time.^3,4 This study analyzed trends in US mortality attributed to both DKA and hyperosmolar hyperglycemic state from 1999 to 2022.

Methods

We examined CDC WONDER for multiple cause-of-death International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes on death certificates associated with hyperglycemic crises from 1999 to 2022.⁵ Data from 2022 are provisional. The ICD-10 codes aligned with prior research.² We examined mortality overall and by age group. We also used the Neighborhood Atlas Area Deprivation Index (ADI), a validated tool constructed from American Community Survey data, to rank all US counties by disadvantage and created 3 tertiles composed of equal numbers of counties for analysis. We selected age group and ADI as subgroup analyses given the potential role of these characteristics in accounting for changing trends in diabetes control.³ Overall and ADI analyses were age-adjusted using the direct method. Age-stratified analyses examined crude mortality within age groups.⁵

Trends from 1999 to 2019 were characterized using Joinpoint Regression Program, version 5.0.2 (National Cancer Institute). Changes in 2020, 2021, and 2022 were examined descriptively because of the COVID-19 pandemic. This program uses Monte Carlo Permutation, seeking to fit trends to the smallest number of statistically significant joinpoints. Stata, version 14.0 (StataCorp), was used for logistic regression. We defined significance as 2-sided P < .05. This study was determined to not constitute human participant research by the Johns Hopkins Medicine Institutional Review Board. Additional details including multiple cause-of-death certificate methods are provided in Supplement 1.

Results

Between 1999 and 2019, mortality due to hyperglycemic crises increased overall from 3306 deaths and an age-adjusted mortality rate (AAMR) of 1.211 per 100 000 population (95% CI, 1.170-1.253) in 1999 to 6051 deaths and an AAMR of 1.636 (95% CI, 1.594-1.679) in 2019 (Figure, A). Joinpoint analysis found decreasing AAMRs from 2001 to 2008 with annual percentage change (APC) of −2.8% (95% CI, −4.1% to −1.6%; P = .001), followed by increases from 2008 to 2015 (APC, 3.1%; 95% CI, 1.8%-4.3%; P < .001) and 2015 to 2019 (APC, 6.1%; 95% CI, 3.9%-8.3%; P < .001) (Table).

Age-specific mortality rates (ASMR) were highest in adults aged 65 years or older (4.736 per 100 000 in 2019; 95% CI, 4.552-4.919) and adults aged 45 to 64 years (2.726 in 2019; 95% CI, 2.613-2.838) (Figure, B). The ASMRs in adults aged 65 years or older decreased from 2001 to 2006 and stabilized from 2006 to 2014, followed by an increase from 2014 to 2019 (APC, 6.0%; 95% CI, 3.3%-8.7%; P < .001). High ADI counties experienced decreasing AAMRs from 1999 to 2010, with increasing AAMRs from 2010 to 2019 (APC, 5.6%; 95% CI, 4.3%-7.0%; P < .001) (Table). From logistic regression, the AAMR in high ADI counties (2.214 per 100 000; 95% CI, 2.025–2.402) was greater than low ADI counties (1.461; 95% CI, 1.414-1.509; P < .001) in 2019 (Figure, C).

Mortality increased following onset of the COVID-19 pandemic in 2020 and 2021 overall and among all subgroups and decreased in 2022. Mortality peaked in 2021 with 10 230 deaths (AAMR, 2.710 deaths per 100 000; 95% CI, 2.656-2.764) overall and decreased to 8707 deaths in 2022 (AAMR, 2.307; 95% CI, 2.258-2.357).

Discussion

Mortality due to DKA and hyperosmolar hyperglycemic state increased from 1999 to 2019 with disparities by age and area deprivation. The etiology of this upward trend in mortality is likely multifactorial, and interpretation of 2020 to 2022 data is complicated by the COVID-19 pandemic. Inadequate preventive care, disproportionately affecting disadvantaged populations and exacerbated by the pandemic, likely contributes to these findings. Recent practice trends seeking to avoid hypoglycemia by relaxing glycemic targets may have led to an increased risk of hyperglycemia.^3,4 Sodium-glucose cotransporter 2 inhibitors, first approved in 2013, are associated with increased risk of DKA and may also play a role in these results.⁶

This analysis is limited by a reliance on death certificates, which may be miscoded. These findings suggest a need for further investigation to understand the causes behind increasing deaths due to hyperglycemic crisis.

https://jamanetwork.com/journals/jama/fullarticle/2814078

Health officials warn of possible measles exposure at Dulles, Ronald Reagan airports

Health officials in the nation’s capital are warning thousands of a possible measles exposure Tuesday after a person with a "confirmed case" traveled through two of the busiest airports in the region while returning home from an international trip. 

DC Health says the potential exposure occurred in the international arrivals area of the main terminal at Dulles International Airport between 4 and 8 p.m. on Wednesday, Jan. 3, then at terminal A at Ronald Reagan Washington National Airport the following day from 2:30 to 6:30 p.m. 

"DC Health has been notified of a confirmed case of measles in a person who traveled through DC area airports when returning from international travel," the agency said in a statement. "While the threat of transmission is low, DC Health is notifying District residents who were at these locations about their possible exposure." 

The Virginia Department of Health issued a similar warning days earlier. Hundreds of flights involving thousands of travelers arrive and depart at both airports daily. 

"Measles is a highly contagious illness that can spread easily through the air when an infected person breathes, coughs, or sneezes. Measles symptoms usually appear in two stages. In the first stage, most people have a fever of greater than 101 degrees, runny nose, watery red eyes, and a cough. These symptoms usually start 7 to 14 days after being exposed," the Virginia Department of Health said in a statement. 

"The second stage starts 3 to 5 days after symptoms start, when a rash begins to appear on the face and spread to the rest of the body. People with measles are contagious from 4 days before the rash appears through 4 days after the rash appeared," it added. 

It is unclear what airline the person with measles was traveling on. 

Both health agencies say anyone who was exposed and is at risk of developing measles should be on alert for symptoms until Jan. 25. 

"If you notice symptoms of measles, immediately isolate yourself by staying home and away from others. Contact your healthcare provider right away," they both add. "Call ahead before going to your healthcare provider’s office or the emergency room to notify them that you may have been exposed to measles and ask them to call the health department. This will help protect other patients and staff." 

https://www.foxnews.com/health/health-officials-warn-possible-measles-exposure-dulles-ronald-reagan-airports

Personal use of corporate jets has soared 50% as companies spend $65M on perk for execs

 Executives using corporate jets for personal travel has soared 50% since the pandemic — a free perk that has cost their companies millions of dollars.

Companies in the S&P 500 spent $65 million for their high-ranking execs to use corporate jets for personal travel in 2022, according to the Wall Street Journal.

Early signs suggest the trend continued in 2023, a Wall Street Journal analysis found, though executive pay and perks aren’t typically reported until spring.

Operating a private jet is a costly endeavor, running companies anywhere from $1,100 to $1,900 per flight hour, not including maintenance fees and costs associated with storage and crews, according to private jet charter company LunaJets.

Despite the hefty bill, the number of big companies providing the perk has risen about 14% since 2019, The Journal reported.

As of 2022, 216 companies listed on the S&P 500 were offering corporate jets for executives’ personal use, per the outlet, citing figures from executive data firm Equilar show.

3

Companies in the S&P 500 spent $65 million for personal travel on corporate jets — a 50% increase since 2019, according to The Wall Street Journal.Christopher Sadowski

The number of executives receiving free flights also grew nearly 25%, to 427, year-over-year in 2022.

Among the companies spending big bucks on corporate jets, Meta Platforms topped the list in 2022, spending $6.6 million on the perk for personal flights for its chief executive Mark Zuckerberg and his then-lieutenant, Sheryl Sandberg, The Journal found.

The figure marks a 55% increase from 2019.

Zuckerberg has been criticized for his company jet’s carbon footprint, though Meta has said that the private plane is necessary for “maintaining Mark’s safety while enabling him to go about his life with minimal disruption.”

Casino giant Las Vegas Sands had the second-largest bill, spending $3.2 million on flights for four C-suite honchos — more than double its annual expense in any year since 2015, per The Journal.

In addition, public utility company Exelon — owner of Chicago’s Commonwealth Edison utility — more than tripled its spending on freebie flights for executives since 2019.

3

Mark Zuckerberg’s Meta reportedly spent the most, or $6.6 million, on private plane trips for the CEO and his then-lieutenant, Sheryl Sandberg.AP

Aerospace company Lockheed Martin, Modelo Especial parent Constellation Brands and Tyson Foods also paid out handsome sums for personal flights in company aircraft soar in 2022 — $2.1 million, $1.9 million, and $1.8 million, respectively, The Journal reported.

These so-called “personal flights” reportedly include trips companies can’t classify as business-related, such as flights to board meetings for other companies or commuting from faraway residences.

Some companies give their executives a fixed allowance for these flights, in hours or dollars — typically $25,000 per year — and require reimbursement beyond that threshold, according to the Journal.

PepsiCo is one of the companies that uses this model.

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The number of executives being offered corporate plane use as a perk has grown nearly 25% year-over-year in 2022, The Journal reported. (Pictured: Zuckerberg’s private plane)@JxckSweeney

The New York-based food and beverage corporation spent $776,000 on personal flights for five executives in 2022 — double what it paid in 2019, The Journal reported, though two-thirds of 2022’s trips were subsidized by CEO Ramon Laguarta.

However, the sums have little financial impact on most giant corporations, the outlet said. For reference, Meta’s revenue in 2022 came in at $116 billion, meaning Zuckerberg and Sandberg’s $6.6 million worth of flights made a measly less-than-1% dent.

There was only one company in The Journal’s analysis whose spending on corporate jets was whittled down to $0 in 2022: Match Group, which named a new CEO earlier this month as it struggles with a decline in paying users.

Its most popular subsidiary, Tinder, has seen a churn in each of the last four quarters, which has cut into its bottom line.

https://nypost.com/2024/01/16/business/personal-use-of-corporate-jets-has-soared-50-costs-companies-65m/