bluuebunny/crossref_metadata_2025 huggingface dataset:
Using latent class analysis to inform the design of an EHR-based national chronic disease surveillance model
Authors: Nasuti Laura , Andrews Bonnie , Li Wenjun , Wiltz Jennifer , Hohman Katherine H , Patanian Miriam
Published: May 2022

The Multi-state EHR-based Network for Disease Surveillance (MENDS) developed a pilot electronic health record (EHR) surveillance system capable of providing national chronic disease estimates. To strategically engage partner sites, MENDS conducted a latent class analysis (LCA) and grouped states by similarities in socioeconomics, demographics, chronic disease and behavioral risk factor prevalence, health outcomes, and health insurance coverage. Three latent classes of states were identified, which inform the recruitment of additional partner sites in conjunction with additional factors (e.g. partner site capacity and data availability, information technology infrastructure). This methodology can be used to inform other public health surveillance modernization efforts that leverage timely EHR data to address gaps, use existing technology, and advance surveillance.
Managing a new diagnosis of interstitial lung disease in pregnancy
Authors: Platts Sophie , Thomas Gavin , Allen Rebecca
Published: May 2022

Interstitial lung disease (ILD) presents rarely in pregnancy. Reports have associated disease activity with higher rates of preeclampsia, preterm births and fetal loss. This case report describes a patient presenting in her fifth pregnancy with worsening dyspnoea. She was treated with tacrolimus, prednisolone and post-partum methylprednisolone and ultimately had a successful outcome of childbirth.
A COVID-19 outbreak among migrants in a hosting facility in Greece, April 2020
Authors: Mellou Kassiani , Gkolfinopoulou Kassiani , Andreopoulou Anastasia , Tsekou Aikaterini , Papadima Kalliopi , Stamoulis Konstantinos , Kossyvakis Athanasios , Mentis Andreas , Maltezou Helena C
Published: May 2022

In April 2020, a coronavirus disease 2019 outbreak was identified among migrants/refugees in Greece. Overall, 155 of 450 hosted migrants and two of 46 employees were infected (attack rates: 34.4% and 4.3%, respectively). The mean age of infected migrants was 24.9 years (3 days-68 years). In addition, 177 community contacts were tested negative. Cases were cohorted in separate rooms from people tested negative. Surfaces were cleaned and disinfected daily. The implementation of measures for the containment of the outbreak was challenging due to language barriers and lack of space for cohorting. At that time, there was no official recommendation to the general population regarding the use of masks or other personal protective equipment. Extensive testing of vulnerable populations and building trust in order to report symptoms and comply with the recommendations are essential.
Evaluating Factors Associated With Continuous Glucose Monitoring Utilization With the Type 1 Diabetes Exchange Registry
Authors: Bailey Richard , Donthi Sriya , Markt Sarah , Drummond Colin , Cullen Jennifer
Published: May 2022

Background:

The 2022 American Diabetes Association (ADA) Standards of Care recommends considering use of continuous glucose monitoring (CGM) for insulin-managed diabetes mellitus (DM), but equitable access remains challenging. This study evaluates socioeconomic and demographic metrics associated with CGM use.

Methods:

RStudio 2021.09.1+372 was utilized to perform uni- and bivariable analysis, as well as binomial logistic regression modeling for categorical CGM use (yes/no) on the most recent cross-section from the Type 1 Diabetes Exchange (T1DX) Registry 2016-2018 cohort ( n = 22 418).

Results:

Compared with White Non-Hispanic participants, Black Non-Hispanic (OR = 0.45, CI = 0.36-0.57, P < 0.001) and American Indian/Alaskan Native individuals (OR = 0.33, CI = 0.14-0.70, P = 0.008) had lower odds of CGM use. Compared with private insurance, government insurance had reduced odds of CGM use (OR = 0.59, CI = 0.52-0.66, P < 0.001). Individuals earning $100,000 or more were twice as likely to use CGMs (OR = 2.06, CI = 1.75-2.45, P < 0.001) compared with those earning <$25,000 annually. Subgroup analysis based on income bracket demonstrated that government insured individuals earning <$25,000 annually were the least likely to use CGMs (OR = 0.44, CI = 0.32-0.61, P < 0.001), as compared with private insurance.

Conclusions:

T1DX Registry data demonstrate that CGM use follows the inverse care law, with health technology utilization inversely related to disease burden. Federal policies promoting CGM use in Medicare and Medicaid populations can facilitate the ADA’s recommendation for patients with insulin-managed diabetes mellitus.
Nine Years of Retrospective Study of Mandibular Fractures in Semi-urban Teaching Hospital, Shimla, Himachal Pradesh, India
Authors: Ghezta Narotam K. , Bhardwaj Yogesh , Ram Rangila , Parmar Monika , Basi Rowena N. , Thakur Pooja
Published: May 2022

Study Design

Retrospective study.

Objective

To evaluate current trends in maxillofacial trauma, a retrospective study of mandibular fractures at Government Dental College and Hospital Shimla H.P was carried out.

Methods

In this retrospective study, records of 910 patients with mandibular fractures were reviewed between 2007 and 2015 in the Department of Oral and Maxillofacial Surgery out of total 1656 facial fractures. These mandibular fractures were assessed according to age, sex, aetiology in addition to monthly and yearly distribution. Post-operative complications such as malocclusion, neurosensory disturbances and infection were recorded.

Results

It was observed that mandibular fractures were most frequent in males (67.5%) and in the age group of 21–30 years; accidental fall was the most common etiological factor (43.8%) in the present study and in stark difference to already published reports. The most common fracture site was that of condylar region 239 (26.2%). Open reduction and internal fixation (ORIF) were done in 67.3% cases whereas 32.6% were managed by maxillomandibular fixation and circummandibular wiring. Miniplate osteosynthesis was the most favoured technique. The complication with ORIF was 16%.

Conclusions

To treat mandibular fractures, currently there are many techniques. However, in minimizing complications and in achieving satisfactory functional and aesthetic results experienced surgical team plays an important role.
Myosteatosis as an independent predictor of short-term mortality in successfully reperfused acute ischemic stroke
Authors: Bonatti Matteo , Lombardo Fabio , Valletta Riccardo , Comai Alessio , Petralia Benedetto , Avesani Giacomo , Franchini Enrica , Rossi Andrea , De Santis Nicoletta , Guerriero Massimo , Ferro Federica
Published: May 2022

Background and purpose

Poor clinical outcomes are still common in successfully reperfused acute ischemic stroke patients. The aim of our study was to assess the impact of sarcopenia and myosteatosis on neurological outcomes and mortality in successfully reperfused acute ischemic stroke patients.

Materials and methods

We included in our retrospective observational study 166 consecutive patients who underwent technically successful mechanical thrombectomy for anterior circulation acute ischemic stroke between Jan 2016 and Dec 2019. ASPECTS and collateral score were assessed on pre-operative CT/CTA. Masseter muscles area and attenuation were measured on CTA images. Clinical and radiological variables were tested in multivariate logistic models to predict the probability of death and, among survivors, of incurring poor outcome.

Results

At admission, mean NIHSS was 19 (SD = 6.5), mean body mass index 25.5 (SD = 4.4) kg/m2, and mean ASPECTS 8.0 (SD = 1.9). Of all, 48.2% patients showed good collaterals, 38.5% intermediate collaterals, and 13.3% poor collaterals. Overall, 90 days mRS was ≤2 in 48.2% of the patients, 3–5 in 30.7%, and 6 in 21.1%. At multivariate logistic regression, age (OR = 1.08, p = 0.036), ASPECTS (OR = 0.59, p = 0.013), and masseter muscles attenuation (OR = 0.93, p = 0.010) were independent predictors of mortality, whereas sex (OR = 7.15, p = 0.043), age (OR = 1.05, p = 0.042), body mass index (OR = 1.35, p = 0.013), NIHSS (OR = 1.12, p = 0.012), and ASPECTS (OR = 0.64, p = 0.024) were independent predictors of poor neurological outcome (mRS 3–5).

Conclusion

Beyond other well-known variables, low masseter attenuation, indicating myosteatosis, represents an independent negative prognostic factor for 90 days mortality in patients successfully reperfused after anterior circulation stroke.
The Cathinone Hydra: Increased Cathinone and caffeine adulteration in the English MDMA market after Brexit and COVID-19 lockdowns
Authors: MJ Pascoe , S Radley , HTD Simmons , F Measham
Published: May 2022

Adulteration poses additional unknown risks to the health of people who use illicit drugs. In this study, we sought to determine the extent and nature of adulteration of ‘MDMA’ in circulation at English summer music festivals in 2021, following Brexit, COVID-19 lockdowns and various regulatory changes overseas. At three festivals in 2019 and 2021, 1648 surrendered substances were analysed with Fourier-transform infrared spectroscopy and colourimetric reagents in a mobile laboratory as part of a harm reduction project. Form, mass, appearance and main psychoactive component were recorded. Analytical results were compared to a parallel self-report survey with 1124 attendees at the same events, as part of the annual English Festival Study. In 2019 and 2021, 417 and 377 samples strongly resembling MDMA (e.g. ecstasy tablets) were tested. Detection of MDMA in such samples decreased from 93% to 55% between the two years. Whilst virtually absent in 2019, synthetic cathinones and caffeine each constituted approximately one fifth of 2021 samples. 4-Chloromethcathinone (4-CMC), 3-methylmethcathinone (3-MMC) and N-ethylbutylone (eutylone) were the most prevalent cathinones detected. In both years, >35% of survey respondents reported use and/or intention to use MDMA on the fieldwork day; ≤1% reported cathinone or caffeine use, suggesting their consumption was predominantly unintentional. The sharp rise in synthetic cathinone prevalence in the summer 2021 UK market coincided with a unique combination of events including Brexit and the reopening of nightlife after 16 months of lockdowns, months ahead of other European nations. Echoing similar periods over the past decade, the cathinone hydra reared its head to satisfy the buoyant demand for MDMA at a time of scarcity, through substitution with substances legally obtainable in the Netherlands at the time of data collection. Alerts issued on social media led to >360,000 engagements, demonstrating extensive public engagement with illicit market monitoring and harm reduction advice.
Researching COVID-19 in progressive MS requires a globally coordinated, multi-disciplinary and multi-stakeholder approach—perspectives from the International Progressive MS Alliance
Authors: Zaratin Paola , Banwell Brenda , Coetzee Timothy , Comi Giancarlo , Feinstein Anthony , Hyde Robert , Salvetti Marco , Smith Kathryn
Published: May 2022

Background

The COVID-19 pandemic has reinforced the importance of research for the health of our society and highlighted the need for stakeholders of the health research and care continuum to form a collaborative and interdependent ecosystem.

Objective

With the world still reeling from waves of the COVID-19 pandemic and adapting to the vaccine rollout at widely different rates, the International Progressive MS Alliance (hereafter Alliance) organized a meeting (April 2021) to consider how the Covid-19 pandemic impacts the health and well-being of people with progressive Multiple Sclerosis (MS).

Methods

We invited the Alliance stakeholders and experts to present what they have learned about SARS-CoV-2 infection and progressive MS and to define future scientific priorities.

Results

The meeting highlighted three priorities for additional focus: (1) the impact of Disease Modifying Therapies (DMTs) on the risk of COVID-19 and on the efficacy of COVID-19 vaccines in people with progressive MS; (2) the long-term impact of COVID-19 and COVID-19 vaccines on the biology of progressive MS; and (3) the impact on well-being of people with progressive MS.

Conclusion

This paper's calls to action could represent a path toward a shared research agenda. Multi-stakeholder and long-term investigations will be required to drive and evolve such an agenda.
Postsecondary Transition Experiences of Young Women Who Are Deaf and Hard of Hearing in Saudi Arabia
Authors: Alsalamah Anwar A. , Poppen Marcus I.
Published: May 2022

This study explored the postsecondary transition experiences of young women who were deaf and hard of hearing (DHH) at a higher education institution in the Kingdom of Saudi Arabia (KSA). Data were collected using semi-structured interviews with 17 undergraduate women who were DHH and enrolled in a higher education institution in the KSA. The data were analyzed thematically and inductively using qualitative analyses software. Eight themes emerged from the data analysis. These themes reflected a wide range of transition experiences among students who were DHH, including their previous experiences in high school, their current experiences in higher education, and preparation to make the transition from college to work. Implications for future research and practice are discussed and include further exploration about the impacts of postsecondary education programs in supporting positive outcomes and working to close the gaps between policy and practice.
Improving Food Insecurity Education in Medical School Through Integrative Service Learning
Authors: Rea Samantha , Jarodiya Jay , Berschback Madeline , Levine Diane
Published: May 2022

Introduction

The COVID-19 pandemic has left more than 38% of households food insecure in the United States. Improved education of food security topics in medical school can improve screening for food insecurity and improve health outcomes. The first aim of this study was to address if participation in an experiential integrative service learning program improved medical students’ understanding of food insecurity. The second aim was to compare knowledge of food insecurity between the general body of medical students and those who participated in the service learning program.

Methods

This was a cohort study at a large medical school in southeast Michigan in 2019–2020. We administered the Food Insecurity for Health Professionals (FISHP) survey to medical student participants; higher scores on the FISHP survey suggest higher knowledge and comfort with food security topics. We administered online Qualtrics surveys to the volunteer group before and after volunteering 12 hours at an urban farm. We also administered a one-time survey to a control group of medical students. We performed univariable and bivariable statistical analyses with StataSE 16. The study was exempted by the institutional IRB.

Results

Medical students in the volunteer group (n = 18) and the control group (n = 66) completed online surveys. Participants in the volunteer group had increased knowledge of food security after volunteering in the service learning program (p = .03). There was a statistically significant difference between the mean FISHP scores for the control group and the volunteer group (p = .001).

Conclusion

Medical student participation in an experiential integrative service learning program improved knowledge of food security topics and increased comfort discussing food insecurity with patients, compared to students who did not participate. Experiential integrative service learning may improve holistic patient care through physician recognition of food insecurity and other social determinants of health.
Sex Differences in Moderate to Severe Psoriasis: Analysis of the Psoriasis Longitudinal Assessment and Registry
Authors: Goldburg Samantha , Chen Rebecca , Langholff Wayne , Lafferty Kimberly Parnell , Gooderham Melinda , de Jong Elke MGJ , Strober Bruce
Published: May 2022

Background: Patterns of psoriasis characteristics by sex are not fully understood. Objective: Evaluate patient characteristics by sex at enrollment in the Psoriasis Longitudinal Assessment and Registry (PSOLAR). Methods: Two PSOLAR cohorts were evaluated by sex: patients who were biologic-naïve (n = 3329) and patients who were systemic therapy-naïve (n = 1290) at entry. Baseline demographic and disease characteristics, medical history, social activity, and lifestyle risk factors were collected for all patients and were compared between males and females using an independent samples t-test for continuous variables and chi-square tests for categorical variables. Results: In both cohorts, disease duration was similar for males and females; however, disease severity based on baseline Physician Global Assessment and body surface area of psoriasis was greater in males versus females ( P < .05). Baseline Dermatology Life Quality Index scores were higher for biologic-naïve females than for males ( P = .008). In both cohorts, females were significantly more likely than males to have a history of anxiety, depression, and cancer excluding nonmelanoma skin cancer, to have received systemic steroid therapy, and to have health insurance; males were significantly more likely than females to have a history of cardiovascular disease, smoking, and alcohol consumption, and to work full time. Conclusions: Based on patient data obtained at entry into PSOLAR, significant differences in psoriasis disease characteristics, and medical, family, and social history-related variables were observed between males and females. Among systemic therapy-naïve patients, there was a greater negative impact on quality of life for females compared with males, despite generally lower objective disease severity for females.
Microstructures, Thermal and Mechanical Properties of Pure Tungsten—A Comparison Between Selective Laser Melting and Hot Rolling
Authors: Wang Chong , Chen Daobing , Zhou Yan , Xie Zhuoming , Fang Qianfeng , Wen Shifeng , Yan Chunze
Published: May 2022

A comparative study on the influence of different manufacturing methods (selective laser melting and hot rolling) on the microstructure, mechanical and thermal behaviours of tungsten (W) was presented for the first time. The results indicated that the selective laser melting (SLM) W exhibited a finer grain sizes, a lower strength ductility, hardness and thermal conductivity compared to hot-rolled W. The main reason for this result was that the laser underwent rapid heating and cooling when it was used to melt W powder with high energy density, resulting in large internal stress in the sample after manufacturing. Subsequently, the internal stress was released, leading to the generation of micro-cracks at the grain boundaries, thereby affecting the performance of SLM W samples. In addition, the higher fraction of high-angle grain boundaries (HAGBs) of SLM W was found to be the key factor for intrinsic brittleness. Because the HAGBs are the preferred crack paths, which could promote crack propagation and decrease fracture energy.
Establishment of Dynamic Model for Axle Box Bearing of High-Speed Trains Under Variable Speed Conditions
Authors: Liu Yongqiang , Wang Baosen , Zhang Bin , Yang Shaopu
Published: May 2022

In this study, a dynamic model for the bearing rotor system of a high-speed train under variable speed conditions is established. In contrast to previous studies, the contact stress is simplified in the proposed model and the compensation balance excitation caused by the rotor mass eccentricity considered. The angle iteration method is used to overcome the challenge posed by the inability to determine the roller space position during bearing rotation. The simulation results show that the model accurately describes the dynamics of bearings under varying speed profiles that contain acceleration, deceleration, and speed oscillation stages. The order ratio spectrum of the bearing vibration signal indicates that both the single and multiple frequencies in the simulation results are consistent with the theoretical results. Experiments on bearings with outer and inner ring faults under various operating conditions are performed to verify the developed model.
Genome wide association study on development and evolution of glutinous rice
Authors: Jiang Conghui , Rashid Muhammad Abdul Rehman , Zhang Yanhong , Zhao Yan , Pan Yinghua
Published: May 2022

Background

Glutinous rice as a special endosperm type is consumed as a staple food in East Asian countries by consumers’ preference. Genetic studies on glutinous rice could be conducive to improve rice quality and understand its development and evolution. Therefor, we sought to explore more genes related to glutinous by genome wide association study and research the formation history for glutinous.

Results

Here, genome-wide association study was performed to explore the associated loci/genes underlying glutinous rice by using 2108 rice accessions. Combining the expression patterns analysis, 127, 81, and 48 candidate genes were identified to be associated with endosperm type in whole rice panel, indica, and japonica sub-populations. There were 32 genes, including three starch synthesis-related genes Wx, SSG6, and OsSSIIa, detected simultaneously in the whole rice panel and subpopulations, playing important role in determining glutinous rice. The combined haplotype analyses revealed that the waxy haplotypes combination of three genes mainly distributed in Southeast Asia (SEA), SEA islands (SER) and East Asia islands (EAR). Through population structure and genetic differentiation, we suggest that waxy haplotypes of the three genes firstly evolved or were directly inherited from wild rice in japonica, and then introgressed into indica in SER, SEA and EAR.

Conclusions

The cloning and natural variation analysis of waxy-related genes are of great significance for the genetic improvement of quality breeding and comprehend the history in glutinous rice. This work provides valuable information for further gene discovery and understanding the evolution and formation for glutinous rice in SEA, SER and EAR.
P. aeruginosa type III and type VI secretion systems modulate early response gene expression in type II pneumocytes in vitro
Authors: Sen-Kilic Emel , Huckaby Annalisa B. , Damron F. Heath , Barbier Mariette
Published: May 2022

Background

Lung airway epithelial cells are part of innate immunity and the frontline of defense against bacterial infections. During infection, airway epithelial cells secrete proinflammatory mediators that participate in the recruitment of immune cells. Virulence factors expressed by bacterial pathogens can alter epithelial cell gene expression and modulate this response. Pseudomonas aeruginosa, a Gram-negative opportunistic pathogen, expresses numerous virulence factors to facilitate establishment of infection and evade the host immune response. This study focused on identifying the role of two major P. aeruginosa virulence factors, type III (T3SS) and type VI (T6SS) secretion systems, on the early transcriptome response of airway epithelial cells in vitro.

Results

We performed RNA-seq analysis of the transcriptome response of type II pneumocytes during infection with P. aeruginosa in vitro. We observed that P. aeruginosa differentially upregulates immediate-early response genes and transcription factors that induce proinflammatory responses in type II pneumocytes. P. aeruginosa infection of type II pneumocytes was characterized by up-regulation of proinflammatory networks, including MAPK, TNF, and IL-17 signaling pathways. We also identified early response genes and proinflammatory signaling pathways whose expression change in response to infection with P. aeruginosa T3SS and T6SS mutants in type II pneumocytes. We determined that T3SS and T6SS modulate the expression of EGR1, FOS, and numerous genes that are involved in proinflammatory responses in epithelial cells during infection. T3SS and T6SS were associated with two distinct transcriptomic signatures related to the activation of transcription factors such as AP1, STAT1, and SP1, and the secretion of pro-inflammatory cytokines such as IL-6 and IL-8.

Conclusions

Taken together, transcriptomic analysis of epithelial cells indicates that the expression of immediate-early response genes quickly changes upon infection with P. aeruginosa and this response varies depending on bacterial viability and injectosomes. These data shed light on how P. aeruginosa modulates host epithelial transcriptome response during infection using T3SS and T6SS.
Magnetically controlled capsule endoscopy in one-time gastro-small intestinal joint examination: a two-centre experience
Authors: Liu Ya-Wei , Wang Yuan-Chen , Zhu Jia-Hui , Jiang Xi , Zhou Wei , Zhang Jie , Liao Zhuan , Linghu En-Qiang
Published: May 2022

Background

The lesions of certain diseases are widely distributed in both stomach and small intestine, while the step-by-step strategy of gastroscopy followed by enteroscopy can be burdensome and costly. We aimed to determine if magnetically controlled capsule endoscopy (MCE) could be used in one-time gastro-small intestine (GSI) joint examination.

Methods

In this study, data of patients in Chinese PLA General Hospital and Changhai Hospital who underwent MCE GSI examination from January 2020 to August 2021 were retrospectively analysed. The primary outcome of this study was the success rate of one-time GSI joint examination, and secondary outcomes included visualization and cleanliness of gastrointestinal tract, gastrointestinal transit times, diagnostic yield and safety of MCE examination.

Results

A total of 768 patients were included. The success rate of one-time GSI joint examination was 92.58%. There were 94.92% MCEs observed > 90% gastric mucosa in the 6 anatomic landmarks. The rate of complete small bowel examination was 97.40%. The median gastric examination time, gastric transit time and small intestine transit time were 8.18 min, 63.89 min and 4.89 h, respectively. Magnetic steering of MCE significantly decreased gastric transit time (8.92 min vs. 79.68 min, P = 0.001) and increased duodenal lesion detection rate (13.47% vs. 6.26%, P = 0.001) when compared with non-magnetic steering group. Two capsules were retained and were removed by enteroscopy or spontaneously excreted.

Conclusions

MCE is feasible to complete GSI joint examination and the detection of both gastric and small intestinal diseases can be achieved simultaneously.

Trial registration Clinical Trial Registration ClinicalTrials.gov, ID: NCT05069233.
Novel subgroups of functional ability in older adults and their associations with adverse outcomes
Authors: Han Ying , Zhang Liangwen , Fang Ya
Published: May 2022

Background

There is no general agreement on a standard form of functional classification in older adults and is mainly assessed by Activities of Daily Living (ADL) and/or Instrument Activity of Daily Living. A refined classification based on evaluation the limitations of intrinsic capacity, environment and social interaction, could provide a basis to predict the future disability and identify individuals with increased risk of adverse outcomes.

Methods

A new functional classification among older adults aged 60 and over was conducted by latent class analysis and compared with the traditional classifications, based on the China Health and Retirement Longitudinal Study. To further investigate the scientific validity of this new classification, associations with 7-year mortality and ADLs impairments among categories were tested by using Survival curves and Cox proportional hazard models. This was followed by the confirmatory analysis related to the prospective data. Competing risk analysis was also performed to analysis the sensitivity to further support our conclusions.

Results

Five categories were identified among 5,992 older adults which gave the best fitting, yielding a significant Bootstrap Likelihood Ratio Test (p < 0.001) and Lo-Mendell-Rubin adjusted likelihood ratio test (p < 0.001), with an entropy over 0.80. The presence of five categories: “health” (34.0%), “sub-disorder status” (36.6%), “acute diseases” (10.3%), “somatic functional disorder” (7.7%), and “viability disorder” (11.4%), which matched well with the functional independence rates by the international classifications. Among them, those in “sub-disorder status” were considered as an intermediate status between disability and health. The findings also revealed that those who were in “acute disease”, “somatic functional disorders”, “health” and “sub-disorder status” had a significant lower risk of mortality and ADLs limitations than “viability disorder”. And the risks gradually increased towards the less functionally independent end of the classification. However, the distribution of characteristics among five categories were in a synchronous change, indicating a stable classification.

Conclusions

A new classification representing the functional heterogeneity of older adults could effectively stratify the risk of mortality and ADLs limitations. Identifying the clusters of functional decline might be useful in predicting subsequent ageing trends, designing personalized intervention, and delaying the progression of disability and preventing its occurrence.
Development, validation, and visualization of a web-based nomogram to predict 5-year mortality risk in older adults with hypertension
Authors: Zhang Huanrui , Tian Wen , Sun Yujiao
Published: May 2022

Background

Hypertension-related mortality has been increasing in older adults, resulting in serious burden to society and individual. However, how to identify older adults with hypertension at high-risk mortality remains a great challenge. The purpose of this study is to develop and validate the prediction nomogram for 5-year all-cause mortality in older adults with hypertension.

Methods

Data were extracted from National Health and Nutrition Examination Survey (NHANES). We recruited 2691 participants aged 65 years and over with hypertension in the NHANES 1999-2006 cycles (training cohort) and 1737 participants in the NHANES 2007-2010 cycles (validation cohort). The cohorts were selected to provide at least 5 years follow-up for evaluating all-cause mortality by linking National Death Index through December 31, 2015. We developed a web-based dynamic nomogram for predicting 5-year risk of all-cause mortality based on a logistic regression model in training cohort. We conducted internal validation by 1000 bootstrapping resamples and external validation in validation cohort. The discrimination and calibration of nomogram were evaluated using concordance index (C-index) and calibration curves.

Results

The final model included eleven independent predictors: age, sex, diabetes, cardiovascular disease, body mass index, smoking, lipid-lowering drugs, systolic blood pressure, hemoglobin, albumin, and blood urea nitrogen. The C-index of model in training and validation cohort were 0.759 (bootstrap-corrected C-index 0.750) and 0.740, respectively. The calibration curves also indicated that the model had satisfactory consistence in two cohorts. A web-based nomogram was established (https://hrzhang1993.shinyapps.io/dynnomapp).

Conclusions

The novel developed nomogram is a useful tool to accurately predict 5-year all-cause mortality in older adults with hypertension, and can provide valuable information to make individualized intervention.
Impact of low-level viremia with drug resistance on CD4 cell counts among people living with HIV on antiretroviral treatment in China
Authors: Liu Pengtao , You Yinghui , Liao Lingjie , Feng Yi , Shao Yiming , Xing Hui , Lan Guanghua , Li Jianjun , Ruan Yuhua , Li Dan
Published: May 2022

Background

Maintaining plasma HIV RNA suppression below the limit of quantification is the goal of antiretroviral therapy (ART). When viral loads (VL) remain in low-level viremia (LLV), or between 201 and 999 copies/mL, the clinical consequences are still not clear. We investigated the occurrence of LLV with drug resistance and its effect on CD4 cell counts in a large Chinese cohort.

Methods

We analysed data of 6,530 ART-experienced patients (42.1 ± 10.9 years; 37.3% female) from the China’s national HIV drug resistance (HIVDR) surveillance database. Participants were followed up for 32.9 (IQR 16.7–50.5) months. LLV was defined as the occurrence of at least one viral load (VL) measurement of 50–200 copies/mL during ART. Outcomes were drug resistance associated mutations (DRAM) and CD4 cell counts levels.

Results

Among 6530 patients, 58.0% patients achieved VL less than 50 copies/mL, 27.8% with VL between 50 and 999 copies/mL (8.6% experienced LLV), and 14.2% had a VL ≥ 1000 copies/mL. Of 1818 patients with VL 50–999 copies/mL, 182 (10.0%) experienced HIVDR, the most common DRAM were M184I/V 28.6%, K103N 19.2%, and V181C/I/V 10.4% (multidrug resistance: 27.5%), and patients with HIVDR had a higher risk of CD4 cell counts < 200 cells/μL (AOR 3.8, 95% CI 2.6–5.5, p < 0.01) comparing with those without HIVDR. Of 925 patients with VL ≥ 1000 copies/mL, 495 (53.5%) acquired HIVDR, the most common DRAM were K103N 43.8%, M184I/V 43.2%, M41L 19.0%, D67N/G 16.4%, V181C/I/V 14.5%, G190A/S 13.9% and K101E 13.7% (multidrug resistance: 75.8%), and patients with HIVDR had a higher risk of CD4 cell counts < 200 cells/μL (AOR 5.8, 95% CI 4.6–7.4, p < 0.01) comparing with those without HIVDR.

Conclusion

Persistent with VL 50–999 copies/mL on ART is associated with emerging DRAM for all drug classes, and patients in this setting were at increased risk of CD4 cell counts < 200 cells/μL, which suggest resistance monitoring and ART optimization be earlier considered.
Measles immunity in medical center staff after changes in national and local hospital vaccination policies
Authors: Lin Meng-Yu , Shao Hsin-Hui , Tsou Meng-Ting
Published: May 2022

Background

Measles vaccination was introduced in Taiwan in 1978, and the disease was declared eliminated in Taiwan in 2007. However, new cases have been reported unpredictably since then. Hospital medical staff are at particularly high risk for measles. We evaluated the immunity status of hospital medical staff after changes in national and local hospital vaccination policies.

Methods

This retrospective study was conducted in a tertiary care medical center from January 2008 to June 2018. Data were retrieved from all healthcare workers receiving employment medical examinations. Those with a full medical record including the geometrical mean titer (GMT) of anti-measles IgG were included. Age and sex differences in the GMT were analyzed by Student’s t-tests and Chi-squared tests. Univariate and multivariate logistic regression analysis were used to determine the odds of immunity.

Results

The IgG positive rate increased with age group (p < 0.001). Seropositive rates for the birth before 1977 and after 1978 groups were 94.8% and 70.2% (p < 0.001). The odds ratio was also significantly different between both cohorts (1.000 vs. 0.423, p = 0.002). Staff in the examination department showed the lowest positive percentage of 70.3% (95% CI: 66.9–73.7%), whereas staff in preventive and long-term care services disclosed the highest positive percentage of 83.2% (95% CI: 76.1–90.2%). Subgroups 2015, 2017, and 2018 (p = 0.046, 0.046, 0.049), after the vaccination booster policy was launched, showed significant increases in seropositivity.

Conclusions

Immunity efficacy is better in birth groups before 1977, which was highly related to natural infection before national policy launched. The policy of vaccination is an effective method, but medical staff attains inadequate protective antibody levels for maintenance of herd immunity. A pre-employment policy of screening a third booster vaccine of measles (or MMR) is recommended to lower the incidence of disease spreading and avoid outbreaks.
Temperate climate malaria in nineteenth century Denmark
Authors: Ingholt Mathias Mølbak , Chen Tzu Tung , Hildebrandt Franziska , Pedersen Rasmus Kristoffer , Simonsen Lone
Published: May 2022

Background

Plasmodium vivax was endemic in northern Europe until the early twentieth century. Considering climate change and the recent emergence of other vector borne diseases in Europe, historical insight into the relationship between malaria and environmental factors in northern Europe is needed. This article describes malaria epidemiology in late-nineteenth century Denmark.

Methods

We described the seasonality and spatial patterns of malaria, and the relationship of the disease with environmental factors such as soil types, clay content and elevation for the period 1862–1914. We studied demographic and seasonal patterns and malaria mortality in the high-morbidity period of 1862–1880. Finally, we studied the relationship between malaria seasonality and temperature and precipitation using a Spearman correlation test.

Results

We found that the highest incidence occurred in eastern Denmark. Lolland-Falster medical region experienced the highest incidence (14.5 cases per 1000 pop.) and Bornholm medical region experienced the lowest incidence (0.57 cases per 1000 pop.). Areas with high malaria incidence also had high soil clay content, high agricultural production, and Lolland-Falster furthermore has a low elevation. Malaria incidence typically peaked in May and was associated with high temperatures in July and August of the previous year but not with precipitation. The case fatality rate was 0.17%, and the disease affected both sexes and all age groups except for infants. In 1873, a large epidemic occurred following flooding from a storm surge in November 1872.

Conclusions

Malaria gradually declined in Denmark during our study period and had essentially disappeared by 1900. The high adult and low child morbidity in 1862–1880 indicates that malaria was not highly endemic in this period, as malaria is most frequent among children in highly endemic areas today. The association of high malaria incidence in spring with warmer temperatures in the previous summer suggests that transmission took place in the previous summers. The close geographical connection between malaria and soil types, agricultural production and elevation suggests that these factors are detrimental to sustain endemic malaria. Our findings of a close connection between malaria and environmental factors such as climate and geography provides insights to address potential reintroduction of malaria in temperate climates.
Digital phenotyping in young breast cancer patients treated with neoadjuvant chemotherapy (the NeoFit Trial): protocol for a national, multicenter single-arm trial
Authors: Delrieu Lidia , Hamy Anne-Sophie , Coussy Florence , Kassara Amyn , Asselain Bernard , Antero Juliana , De Villèle Paul , Dumas Elise , Forstmann Nicolas , Guérin Julien , Hotton Judicael , Jouannaud Christelle , Milder Maud , Leopold Armand , Sedeaud Adrien , Soibinet Pauline , Toussaint Jean-François , Vercamer Vincent , Laas Enora , Reyal Fabien
Published: May 2022

Background

Breast cancer (BC) has particular characteristics in young women, with diagnosis at more advanced stages, a poorer prognosis and highly aggressive tumors. In NeoFit, we will use an activity tracker to identify and describe various digital profiles (heart rate, physical activity, and sleep patterns) in women below the age of 45 years on neoadjuvant chemotherapy for BC.

Methods

NeoFit is a prospective, national, multicenter, single-arm open-label study. It will include 300 women below the age of 45 years treated with neoadjuvant chemotherapy for BC. Participants will be asked to wear a Withing Steel HR activity tracker round the clock for 12 months. The principal assessments will be performed at baseline, at the end of neoadjuvant chemotherapy and at 12 months. We will evaluate clinical parameters, such as toxicity and the efficacy of chemotherapy, together with quality of life, fatigue, and parameters relating to lifestyle and physical activity. The women will complete REDCap form questionnaires via a secure internet link.

Discussion

In this study, the use of an activity tracker will enable us to visualize changes in the lifestyle of young women on neoadjuvant chemotherapy for BC, over the course of a one-year period. This exploratory study will provide crucial insight into the digital phenotypes of young BC patients on neoadjuvant chemotherapy and the relationship between these phenotypes and the toxicity and efficacy of treatment. This trial will pave the way for interventional studies involving sleep and physical activity interventions.

Trial registration

Clinicaltrials.gov identifier: NCT05011721. Registration date: 18/08/2021.
Trends, correlates, and disease patterns of sedative-hypnotic use among elderly persons in Taiwan
Authors: Kuo Chia-Lun , Chien I-Chia , Lin Ching-Heng
Published: May 2022

Objective

The population-based National Health Insurance database was adopted to investigate the prevalence, correlates, and disease patterns of sedative-hypnotic use in elderly persons in Taiwan.

Methods

The National Health Research Institutes provided a database of 1,000,000 random subjects in the National Health Insurance program. We adopted this sample of subjects who were older than 65 years from 1997 to 2005 and examined the proportions of psychiatric and nonpsychiatric disorders with regard to sedative-hypnotic use.

Results

The 1-year prevalence of sedative-hypnotic use in elderly individuals increased from 1.7% in 1997 to 5.5% in 2005. The 1-year prevalence rates of benzodiazepine (BZD) and non-BZD hypnotics were 3.2 and 3.1%, respectively, in 2005. The overall hypnotic use was highest in ≥85-year-olds, males, those with lower amounts of insurance or higher Charlson Comorbidity Index scores and those living in eastern Taiwan. Both BZD and non-BZD hypnotic use were most commonly used in nonpsychiatric disorders instead of psychiatric disorders. Among the psychiatric disorders, the disorders that accounted for higher BZD and non-BZD hypnotic use were senile and presenile organic psychotic conditions (3.4 and 3.4%, respectively). Higher BZD and non-BZD use was for diseases of the respiratory system (30.4 and 17.8%, respectively), the circulatory system (20.4 and 22.4%, respectively), and neoplasms (12.6 and 13.8%, respectively).

Conclusion

The prevalence rates of both BZD and non-BZD sedative-hypnotic use increased from 1997 to 2005 in the elderly. The risk factors for sedative-hypnotic use were aging, male sex, lower insurance amount, and higher Charlson Comorbidity Index scores. Most BZD and non-BZD sedative-hypnotic users were persons with nonpsychiatric disorders.
Air pollution, residential greenness, and metabolic dysfunction biomarkers: analyses in the Chinese Longitudinal Healthy Longevity Survey
Authors: Liu Linxin , Yan Lijing L. , Lv Yuebin , Zhang Yi , Li Tiantian , Huang Cunrui , Kan Haidong , Zhang Junfeng , Zeng Yi , Shi Xiaoming , Ji John S.
Published: May 2022

Background

We hypothesize higher air pollution and fewer greenness exposures jointly contribute to metabolic syndrome (MetS), as mechanisms on cardiometabolic mortality.

Methods

We studied the samples in the Chinese Longitudinal Healthy Longevity Survey. We included 1755 participants in 2012, among which 1073 were followed up in 2014 and 561 in 2017. We used cross-sectional analysis for baseline data and the generalized estimating equations (GEE) model in a longitudinal analysis. We examined the independent and interactive effects of fine particulate matter (PM2.5) and Normalized Difference Vegetation Index (NDVI) on MetS. Adjustment covariates included biomarker measurement year, baseline age, sex, ethnicity, education, marriage, residence, exercise, smoking, alcohol drinking, and GDP per capita.

Results

At baseline, the average age of participants was 85.6 (SD: 12.2; range: 65–112). Greenness was slightly higher in rural areas than urban areas (NDVI mean: 0.496 vs. 0.444; range: 0.151–0.698 vs. 0.133–0.644). Ambient air pollution was similar between rural and urban areas (PM2.5 mean: 49.0 vs. 49.1; range: 16.2–65.3 vs. 18.3–64.2). Both the cross-sectional and longitudinal analysis showed positive associations of PM2.5 with prevalent abdominal obesity (AO) and MetS, and a negative association of NDVI with prevalent AO. In the longitudinal data, the odds ratio (OR, 95% confidence interval-CI) of PM2.5 (per 10 μg/m3 increase) were 1.19 (1.12, 1.27), 1.16 (1.08, 1.24), and 1.14 (1.07, 1.21) for AO, MetS and reduced high-density lipoprotein cholesterol (HDL-C), respectively. NDVI (per 0.1 unit increase) was associated with lower AO prevalence [OR (95% CI): 0.79 (0.71, 0.88)], but not significantly associated with MetS [OR (95% CI): 0.93 (0.84, 1.04)]. PM2.5 and NDVI had a statistically significant interaction on AO prevalence (pinteraction: 0.025). The association between PM2.5 and MetS, AO, elevated fasting glucose and reduced HDL-C were only significant in rural areas, not in urban areas. The association between NDVI and AO was only significant in areas with low PM2.5, not under high PM2.5.

Conclusions

We found air pollution and greenness had independent and interactive effect on MetS components, which may ultimately manifest in pre-mature mortality. These study findings call for green space planning in urban areas and air pollution mitigation in rural areas.
A state-wide education program on opioid use disorder: influential community members’ knowledge, beliefs, and opportunities for coalition development
Authors: Hohmann Lindsey , Phillippe Haley , Marlowe Karen , Jeminiwa Ruth , Hohmann Natalie , Westrick Salisa , Fowler Amanda , Fox Brent
Published: May 2022

Background

Deep South states, particularly Alabama, experience disproportionately higher opioid prescribing rates versus national rates. Considering limited opioid use disorder (OUD) providers in this region, collaborative efforts between non-healthcare professionals is critical in mitigating overdose mortality. The Alabama Opioid Training Institute (OTI) was created in 2019 to empower community members to take action in combatting OUD in local regions. The OTI included: 1) eight full-day in-person conferences; and 2) an interactive mobile-enabled website (https://alabamaoti.org). This study assessed the impact of the OTI on influential community members’ knowledge, abilities, concerns, readiness, and intended actions regarding OUD and opioid overdose mitigation.

Methods

A one-group prospective cohort design was utilized. Alabama community leaders were purposively recruited via email, billboards, television, and social media advertisements. Outcome measures were assessed via online survey at baseline and post-conference, including: OUD knowledge (percent correct); abilities, concerns, and readiness regarding overdose management (7-point Likert-type scale, 1 = strongly disagree to 7 = strongly agree); and actions/intended actions over the past/next 6 months (8-item index from 0 to 100% of the time). Conference satisfaction was also assessed. Changes were analyzed using McNemar or Marginal Homogeneity tests for categorical variables and two-sided paired t-tests for continuous variables (alpha = 0.05).

Results

Overall, 413 influential community members participated, most of whom were social workers (25.7%), female (86.4%), and White (65.7%). Community members’ OUD knowledge increased from mean [SD] 71.00% [13.32] pre-conference to 83.75% [9.91] post-conference (p < 0.001). Compared to pre-conference, mean [SD] ability scale scores increased (3.72 [1.55] to 5.15 [1.11], p < 0.001) and concerns decreased (3.19 [1.30] to 2.64 [1.17], p < 0.001) post-conference. Readiness was unchanged post-conference. Attendees’ intended OUD-mitigating actions in the next 6 months exceeded their self-reported actions in the past 6 months, and 92% recommended the OTI to others.

Conclusions

The Alabama OTI improved community leaders’ knowledge, abilities, and concerns regarding OUD management. Similar programs combining live education and interactive web-based platforms can be replicated in other states.