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Context: Primary hyperparathyroidism (PHPT) is associated with an increased risk of kidney stones. Few studies account for PHPT severity or stone risk when comparing stone events after parathyroidectomy vs nonoperative management. Objective: Compare the incidence of kidney stone events in PHPT patients treated with parathyroidectomy vs nonoperative management. Design: Longitudinal cohort study with propensity score inverse probability weighting and multivariable Cox proportional hazards regression. Setting: Veterans Health Administration integrated health care system. Patients: A total of 44 978 patients with > 2 years follow-up after PHPT diagnosis (2000-2018); 5244 patients (11.7%) were treated with parathyroidectomy. Main outcomes measure: Clinically significant kidney stone event. Results: The cohort had a mean age of 66.0 years, was 87.8% male, and 66.4% White. Patients treated with parathyroidectomy had higher mean serum calcium (11.2 vs 10.8mg/dL) and were more likely to have a history of kidney stone events. Among patients with baseline history of kidney stones, the unadjusted incidence of = 1 kidney stone event was 30.5% in patients managed with parathyroidectomy (mean follow-up, 5.6 years) compared with 18.0% in those managed nonoperatively (mean follow-up, 5.0 years). Patients treated with parathyroidectomy had a higher adjusted hazard of recurrent kidney stone events (hazard ratio [HR], 1.98; 95% CI, 1.56-2.51); however, this association declined over time (parathyroidectomy × time: HR, 0.80; 95% CI, 0.73-0.87). Conclusion: In this predominantly male cohort with PHPT, patients treated with parathyroidectomy continued to be at higher risk of kidney stone events in the immediate years after treatment than patients managed nonoperatively, although the adjusted risk of stone events declined with time, suggesting a benefit to surgical treatment. [ABSTRACT FROM AUTHOR]

Background Environmental and behavioural factors are thought to contribute to all-cause mortality. Here, we develop a method to systematically screen and validate the potential independent contributions to all-cause mortality of 249 environmental and behavioural factors in the National Health and Nutrition Examination Survey (NHANES).Methods We used Cox proportional hazards regression to associate 249 factors with all-cause mortality while adjusting for sociodemographic factors on data in the 1999–2000 and 2001–02 surveys (median 5.5 follow-up years). We controlled for multiple comparisons with the false discovery rate (FDR) and validated significant findings in the 2003–04 survey (median 2.8 follow-up years). We selected 249 factors from a set of all possible factors based on their presence in both the 1999–2002 and 2003–04 surveys and linkage with at least 20 deceased participants. We evaluated the correlation pattern of validated factors and built a multivariable model to identify their independent contribution to mortality.Results We identified seven environmental and behavioural factors associated with all-cause mortality, including serum and urinary cadmium, serum lycopene levels, smoking (3-level factor) and physical activity. In a multivariable model, only physical activity, past smoking, smoking in participant’s home and lycopene were independently associated with mortality. These three factors explained 2.1% of the variance of all-cause mortality after adjusting for demographic and socio-economic factors.Conclusions Our association study suggests that, of the set of 249 factors in NHANES, physical activity, smoking, serum lycopene and serum/urinary cadmium are associated with all-cause mortality as identified in previous studies and after controlling for multiple hypotheses and validation in an independent survey. Whereas other NHANES factors may be associated with mortality, they may require larger cohorts with longer time of follow-up to detect. It is possible to use a systematic association study to prioritize risk factors for further investigation. [ABSTRACT FROM PUBLISHER]

Introduction Erectile dysfunction ( ED) is more common in men with type 2 diabetes mellitus ( T2DM), obesity, and/or the metabolic syndrome ( MetS). Aim The aim of this study is to investigate the associations among proxy measures of diabetic severity and the presence of MetS with ED in a nationally representative U. S. data sample. Methods We performed a cross-sectional analysis of adult participants in the 2001-2004 National Health and Nutrition Examination Survey. Main Outcome Measures ED was ascertained by self-report. T2DM severity was defined by calculated measures of glycemic control and insulin resistance ( IR). IR was estimated using fasting plasma insulin ( FPI) levels and the homeostasis model assessment of IR ( HOMA-IR) definition. We classified glycemic control using hemoglobin- A1c ( HbA1c) and fasting plasma glucose ( FPG) levels. MetS was defined by the American Heart Association and National Heart, Lung, and Blood Institute criteria. Logistic regression models, adjusted for sociodemographics, risk factors, and comorbidities, were fitted for each measure of T2DM severity, MetS, and the presence of ED. Results Proxy measures of glycemic control and IR were associated with ED. Participants with FPG between 100-126 mg/ dL (5.6-7 mmol/ L) and ≥126 mg/ dL (>7 mmol/ L) had higher odds of ED, odds ratio ( OR) 1.22 (confidence interval or CI, 0.83-1.80), and OR 2.68 ( CI, 1.48-4.86), respectively. Participants with HbA1c 5.7-6.4% (38.8-46.4 mmol/mol) and ≥6.5% (47.5 mmol/mol) had higher odds of ED ( OR 1.73 [ CI, 1.08-2.76] and 3.70 [ CI, 2.19-6.27], respectively). When FPI and HOMA-IR were evaluated by tertiles, there was a graded relation among participants in the top tertile. In multivariable models, a strong association remained between HbA1c and ED ( OR 3.19 [ CI,1.13-9.01]). MetS was associated with >2.5-fold increased odds of self reported ED ( OR 2.55 [ CI, 1.85-3.52]). Conclusions Poor glycemic control, impaired insulin sensitivity, and the MetS are associated with a heightened risk of ED. Weinberg AE, Eisenberg M, Patel CJ, Chertow GM, and Leppert JT. Diabetes severity, metabolic syndrome, and the risk of erectile dysfunction. J Sex Med 2013;10:3102-3109. [ABSTRACT FROM AUTHOR]