Adult Population Research Articles

Cardiometabolic factors and vitamin D deficiency in pediatric patients with chronic kidney disease

BackgroundPatients with chronic kidney disease (CKD) are at increased risk for cardiovascular disease. Up to 80% of patients with CKD may exhibit inadequate vitamin D (VD) levels, which have been linked to the presence of cardiometabolic factors (CFs) in the adult population. However, research on this association in the pediatric population is limited.ObjectiveTo analyze the effects of 25-hydroxyvitamin D3 (25-[OH]D) levels and status on the presence of CFs in children receiving kidney replacement therapy (KRT).Materials and methodsThis cross-sectional study included pediatric patients receiving KRT, aged 8–17 years, who were receiving hemodialysis or peritoneal dialysis from January 2021 to March 2024. We conducted anthropometric measurements, blood pressure assessments, and glucose, 25-(OH)D, and lipid profiling for all participants. The daily dose of cholecalciferol supplementation, as well as other medications affecting bone and lipid metabolism and antihypertensive drugs, were documented. Statistical analyses were performed using Student’s t-tests and chi-square tests to compare the CFs between groups with and without VD deficiency.ResultsThe study involved 156 patients with an average age of 12.9 years and a mean serum VD level of 22.5 ng/dL. Patients with VD deficiency presented higher levels of total cholesterol and diastolic blood pressure (p < 0.05). No statistically significant differences were found in other biochemical profile variables or in the frequency of cardiometabolic factors.ConclusionVitamin D deficiency seems to increase the risk of dyslipidemia and uncontrolled hypertension in children and adolescents with end-stage CKD.

Five-year changes in retinal nerve fibre layer thickness in the adult population: a population-based cohort study.

Distinguishing between the pathological thinning of the retinal nerve fibre layer (RNFL) and age-related reduction requires a comprehensive understanding of the longitudinal changes in RNFL thickness within a healthy population. To determine five-year changes in RNFL thickness and associated factors in people aged 45-69 years. This report pertains to the second and third phases of the Shahroud Eye Cohort Study. Participants were recruited by a multi-stage cluster sampling in Shahroud, Iran. Data on demographic details, visual acuity, non-cycloplegic refraction, and slit-lamp biomicroscopy were collected. High-definition optical coherence tomography was employed for retinal imaging. A total of 1,524 eyes from 908 participants were examined. The average RNFL thickness was 92.2 ± 8.5 (95% CI: 91.6 to 92.8) and 93.1 ± 8.7 μm (95% CI: 92.5 to 93.7) in the first and second phases with a five-year mean change of 0.95 ± 4.15 μm (95% CI: 0.70 to 1.20). The RNFL thickness mean changes in the superior, inferior, nasal, and temporal quadrants were 2.51 ± 7.86 (95% CI: 2.01 to 3.02), 2.93 ± 7.39 (95% CI: 2.56 to 3.29), -0.53 ± 6.15 (95% CI: -0.84 to -0.21), and -1.01 ± 4.67 μm (95% CI: -1.27 to -0.75), respectively. The five-year changes in average RNFL thickness were inversely correlated with axial length (β = -0.69, p < 0.001), mean keratometry (β = -0.37, p = 0.017), and baseline RNFL thickness (β = -0.617, p < 0.001). In hyperopic individuals, the increase in average RNFL thickness (β = 0.65, p = 0.012) was significantly greater than in those with emmetropia. Macular volume (β = 1.65, p < 0.001) showed a direct association with five-year changes in average RNFL thickness. Over 5 years, RNFL thickness changes were clinically insignificant in the normal population. The mean RNFL thickness seems to remain stable unless there is ocular disease. However, increased axial length and steeper keratometric readings were linked to RNFL thinning. Those with thicker RNFL measurements were at higher risk of thinning over time.

Comparative effectiveness of endoscopic plantar fasciotomy, needle knife therapy, and conventional painkillers in the treatment of plantar fasciitis: a real-world evidence study.

Plantar fascia (PF) is the commonest causes of foot pain in the adult population. Several surgical treatments are available to treat PF. This study was aimed to investigate the clinical efficacy of three different treatments for plantar fasciitis. It was conducted among 60 patients, divided equally into three treatment groups named Needle Knife Therapy, Endoscopic Plantar Fasciotomy, and Conventional Painkillers. Descriptive and analytical analysis were done by using SPSS 25 software. VAS and AOFAS scores were analyzed. The maximum (n = 31) participants were in 41-60 year age range group with normal BMI. These differences of mean VAS and AOFAS pain scores between different treatment groups were statistically significant (One-way ANOVA, p < 0.01). Both scores found lower in the Endoscopic Plantar Fasciotomy group. This study opens a new window of knowledge to achieve sustained pain relief and functional improvement. Moreover, the superiority of Endoscopic Plantar Fasciotomy in treating plantar fasciitis compared to Needle Knife Therapy and Conventional Painkillers was explored.

Effects of acceptance and commitment therapy on trauma-related symptoms: A systematic review and meta-analysis.

Acceptance and commitment therapy (ACT) is a third-wave cognitive behavioral therapy that has shown promise as an effective treatment for reducing trauma-related symptoms. Although there have been systematic reviews on the clinical effectiveness of ACT for posttraumatic stress disorder, there are no known meta-analyses published on the impact of ACT in adult populations with trauma-related symptoms. Hence, the purpose of this meta-analysis and systematic review was to update the literature and assess the effectiveness of ACT interventions for decreasing trauma-related distress in adults who have developed trauma symptoms following exposure to one or more traumatic events. A systematic review of the literature was completed, and between-groups random effects meta-analysis was conducted assessing trauma symptom reduction at the initial posttest. Subgroup analyses were also performed to assess differences between groups based on research design, type of trauma, and comparator group. A meta-analysis of 11 studies revealed a moderate and statistically significant overall effect of ACT on symptom reduction at immediate posttest (Hedges' g = -.423, 95% CI [-.605, -.240]; I² = 25.75%), indicating that on average, those who received ACT interventions reported fewer trauma symptoms postintervention than those in various comparison groups. Ultimately, this research provides additional evidence supporting the effectiveness of ACT interventions for clients reporting trauma-related concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Chemical Characterization and Assessment of Public Health Risk due to Inhalation of PM2.5 in the City of Salamanca, Guanajuato.

In this study, we conducted an analysis of health risks faced by residents of Salamanca, Mexico, who were exposed to fine particulate matter with a diameter of 2.5μm (PM2.5) through inhalation. The characterization and analysis of these particulate matter samples were undertaken. A total of 131 samples were collected from two different sites: 65 from the Red Cross site (RC) and 66 from the Integral Family Development site (DIF) in 2014-2015. These samples were analyzed for a set of chemical components, including metals and ions. Non-cancerous health risk levels associated with PM2.5 exposure through the human respiratory system, as per the WHO benchmark (assigned a value of 1), revealed notable risk values for two elements: Manganese (Mn) with a range of 1.19-2.12 in the adult population and 1.59-2.84 in the child population, and Nickel (Ni) with a uniform risk value of 1.39 for both evaluated population groups. However, concerns arose regarding potential non-cancerous effects as the cumulative risk levels for various assessed elements showed elevated indices. These ranged from 3.81 to 4.4 in adults and 4.48-5.24 in children. This study provided comprehensive data on composition and its potential impact on human health, offering valuable insights for the implementation of mitigation measures aimed at reducing inhalation-related exposure.

8576 Genomic and Transcriptomic Characterization of Pediatric Thyroid Cancers

Abstract Disclosure: J.C. Ricarte-Filho: None. E.R. Reichenberger: None. K. Hinkle: None. A.R. Isaza: None. A.J. Bauer: None. A.T. Franco: None. Background: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer in both pediatric and adult populations. Recent genomic profiling of papillary thyroid cancers, including that of the Cancer Genome Atlas, has uncovered the genetic alterations and molecular mechanisms driving thyroid cancer. However, these studies were primarily focused on adult patients. Despite their favorable prognosis, pediatric PTCs have higher rates of metastasis and recurrence than adult PTCs, but the molecular characterization of these tumors have been comparatively lacking. Methods: Here we explore the genomic and transcriptomic landscape of pediatric PTCs from 126 patients, including 107 primary tumors and 19 lymph node metastases (non-paired) using whole-exome sequencing and RNA sequencing. Thirteen primary tumors also had a paired lymph node metastasis analyzed. Results: We found driver alterations in 113 of 126 (90%) of the PTCs investigated, including the identification of a novel receptor tyrosine kinase (RTK) fusion not previously reported in thyroid cancer. Genetic drivers were predominantly kinase fusions (48%), most commonly fusions of RET (22%), NTRK3 (10%), ALK (5%) and NTRK1 (5%). The most common point mutations were BRAF p.V600E (21%), NRAS p.Q61R/K (9%) and hotspot mutations in DICER1 (4%). We found genetic alterations in 12 of the 13 paired lymph node metastasis. In all 12 cases the metastatic tissue harbored the same alterations found in the primary tumor. Eight out of 12 cases had fusions (3 RET, 3 NTRK3 and 2 NTRK1), and the additional 4 cases had point mutations (3 BRAFV600E and 1 TSHRM543T). Fourteen patients (11%) had widely invasive disease with lateral lymph node and distant metastases (N1bM1). Most of these N1bM1 tumors (13/14; 93%) were driven by RTK fusions (5 NTRK3, 3 RET, 3 NTRK1 and 2 ALK). The one case lacking a kinase fusion had a CHEK2 mutation. Conclusion: Our genomic and transcriptomic analysis allowed the detection of driver alterations in ∼90% of the cases, reducing the so-called “dark matter” in our cohort. Our data support that kinase fusions are associated with metastatic disease in pediatric PTC. Patients with RET/NTRK/ALK fusions have worse outcomes than those with BRAF p.V600E mutation and RAS-like alterations (NRAS, DICER1, non-V600 BRAF, PTEN). By using the transcriptional profiling generated in this study, we are currently investigating the molecular mechanisms underlying the metastatic behavior of pediatric PTCs harboring oncogenic fusions, including changes in MAPK transcriptional output, differentiation score and recruitment of signaling pathways potentially associated with the metastatic behavior of these tumors. Presentation: 6/3/2024

12349 Increased Total Oxidative Status/Total AntioxidantCapacityandReduced Microparticle Size In Diabetes Kidney Disease

Abstract Disclosure: S.C. Oliveira: None. A. Bridi: None. B.G. Rossato: None. R.N. Moresco: None. J.C. Silveira: None. M.W. Lauria: None. F.V. Comim: None. Diabetic kidney disease (DKD) is an important cause of morbimortality in the adult population with Type 1 Diabetes Mellitus (T1DM). Our cross-sectional study explored the association of abnormalities in extracellular vehicles (EVs) and oxidative stress markers in three distinct groups of clinical outpatients: normal controls, T1DM (without DKD), and DKD. Clinical and biochemical data were obtained from these groups. The isolation and characterization of EVs from serum were obtained through a series of processes, including the ultracentrifugation and characterization of EVs was identified by specific protein markers by western blot morphology checked by Scanning Electron Microscope (FEI Tecnai 20; LAB6 emission; 200 kV). EVs particle size and concentration were determined by NanoSight NS300 instrument (Malvern Panalytical, UK). Total Oxidant Status (TOS), Total Antioxidant Capacity (TAC), Advanced Oxidation of Protein Products (AOPP), (Ferric Reducing Antioxidant Power), C reactive Protein, Uric Acid, Aloxan levels were determined in the serum or the plasma.Overall, 124 patients were evaluated: 61 normal controls, 42 T1DM (without DKD), and 21 DKD defined according the KDIGO guidelines. The three groups were similar regarding age (mean± SD) of 40.3 ± 13.7 years, BMI 25.8 ± 5.1 Kg/m2, and Abdominal Circumference 89.6 ± 12.3 cm. The albumin/creatinine ratio was statistically different among the groups, being its (median [95%CI]) of 4.0 [3.9-5.14] mg/g in Controls, 6.4[5.5-10.0]mg/g in T1DM, and 81.4 [48.5 -1415] mg/g in DKD (p&amp;lt;0.001). The DKD patients exhibited higher SBP and an increased proportion of retinopathy and neuropathy than T1DM, but HBa1c levels were similar between the two diabetes groups. Patients with DKD show an increased TOS/TAC Ratio ( μmol H2O2 Equiv/L /mmol Trolox Equiv/L) (ANOVA p&amp;lt;0.001) superior to T1DM and controls. The mean ± SD was 61.1 ± 31.0 in Controls, 103.0± 68 in T1DM, and 145.0± 62.8 in DKD. Interestingly, T1DM exhibited an increased TOS/TAC Ratio than Controls. No modifications in AOPP or FRAP could be observed among the three groups.There is a gradual decrease in EVs size (but not concentration) in patients with DKD in comparison to T1DM and controls, and T1DM with controls. The mean of the moda size of EVs was (mean + SE) 144.5 ± 3.04 nm in Controls versus 136.14 ± 3.5 nm in T1DM, and 135.4 ± 3.6nm in DKD (ANOVA p=0.04). The concentration was (mean ± SE) 4.57 x109 ± 5.57 x108 particles/mL in Controls, 3.58 x109 ± 2.9 x108 particles/mL in T1DM and 3.94 x109 ± 3.7 x108 particles/mL in DKD (NS).Our results suggest an association of increased oxidative stress status (TOS/TAC ratio) and reduced microvesicles size in the presence of T1DM; both abnormalities progress towards the development of DKD. Presentation: 6/3/2024

8471 A Rare Case of Graves' Disease in a Three-Year-Old

Abstract Disclosure: A. Rajesh: None. A. Ravari: None. L.E. Kimball-Ravari: None. H. Roan: None. Graves’ Disease (GD) is an autoimmune disease that causes hyperfunctioning of the thyroid gland which may be triggered by environmental factors such as infection or stress. Though the leading cause of hyperthyroidism in both adult and pediatric populations is GD, it is extremely rare in children under the age of four years old. Some studies show the incidence to be 1 per 1,000,000 cases[1],2. Detecting GD in children early is very important as untreated GD poses a risk for failure to thrive. There have also been cases of young children suffering from psychomotor delays, craniosynostosis, and language delays because their suspected diagnosis of GD had not been detected for one to two years. In this article, we report the case of a previously healthy three-year-old Caucasian female who presented to the pediatric endocrinologist after collapsing from an episode of hypoglycemia; plasma glucose 47 mg/dL (71-180) . The patient was diagnosed with Graves’ Disease due to her significantly elevated free T3 and T4, decreased TSH, positive thyroid peroxidase (TPO) antibodies, and elevated TSIg. She was started on methimazole treatment; however, she did not respond after six months of ATD and underwent total thyroidectomy. Her hypoglycemia was attributed to abnormal proinsulin processing and glucose metabolism, which has been associated with hyperthyroidism; thyroid hormones can produce increased GLUT2 transporters3. This case report demonstrates the importance of recognizing the signs and symptoms of GD early, as well as discuss the importance of increasing the recognition of autoimmune diseases in the pediatric population.

Domesticity to Autonomy: Women, Pre-Drinking, and the Liminoid Experience

ABSTRACT Drinking before going out, also referred to as ‘pre-drinking’ or ‘pre-loading’, has received little academic attention in adult female populations. This comparative research analyses women’s pre-drinking routines by drawing on ethnographic data from a broader study of women’s wine drinking practices in Australia and England. Informed by Catherine Bell’s ‘ritualised activities’, and the work of Victor Turner on ‘liminoid’ experiences and ‘communitas’, it finds that pre-drinking is a dynamic, ritualised, liminoid experience, with distinct contextual variations. In both groups, pre-drinking acts as a ritual and liminoid event which signifies the cue from ‘domestic’ home roles to ‘free’ social times. However, it finds that for the English women, pre-drinking is typically performed as a solo routine involving construction of idealised gender roles through which self-presentation is performed. In doing so, it supports previous research that posits that women drink wine to feel decadent and sophisticated, as part of a gendered embodiment of femininity. In the case of the Australian women, pre-drinking typically manifests as a feeling of ‘sisterhood’ among friends in an expression of communitas.

7334 Changing Trends In Oral Bisphosphonate Therapy: A 25-Year Surveillance In A US Healthcare System

Abstract Disclosure: J.C. Lo: None. M. Chandra: None. M.M. Khan: None. L.D. Carbone: None. E.A. Garcia: None. G.H. Tabada: None. D. Low: None. R.L. Hui: None. Introduction: Bisphosphonate (BP) drugs remain one of the first line therapies for fracture prevention, but treatment patterns have changed since BPs were first approved for osteoporosis. This study examines trends among adults initiating oral BP in a large US healthcare system over a 25-year period (1988-2022) and in each successive 5-year period. Methods: The study cohort comprised adults aged 50-89y who initiated alendronate, risedronate or oral ibandronate during 1998-2022 in an integrated healthcare delivery system, excluding those with select bone disorders, multiple myeloma, secondary metastatic cancer, end stage renal disease, and receipt of intravenous BP. Covariates included age (proportion age &amp;lt;65y), sex, race and ethnicity, and prior fracture (diagnosed within 5 years) using electronic health record data. Demographic trends and fracture status were examined across time periods. The chi-squared test and Cochrane-Armitage test for trend were used to examine differences and trends. This report extends findings from an earlier report of women initiating oral BP during 2004-2012 in the same healthcare population. Results: Among 208,780 adults (86% women) who initiated BP, including 26,646 (1998-2002, 35% &amp;lt;65y), 44,726 (2003-2007, 35% &amp;lt;65y), 34,005 (2008-2012, 24% &amp;lt;65y), 35,248 (2013-2017, 19% &amp;lt;65y), and 38,743 (2018-2022, 17% &amp;lt;65y) women and 2348 (1998-2002, 28% &amp;lt;65y), 4895 (2003-2007, 26% &amp;lt;65y), 5172 (2008-2012, 17% &amp;lt;65y), 5331 (2013-2017, 13% &amp;lt;65y), and 11,666 (2018-2022, 5% &amp;lt;65y) men in each 5-year period. Over time, an increasing proportion were age ≥65y (p&amp;lt;0.001 for trend), with larger numbers of older adults in later years partly reflecting initiatives targeting secondary fracture prevention (since 2008 for women, 2015 for men) and BMD screening (since 2011 for women, 2017 for men). Among women initiating BP, the proportion with prior fracture increased from 24-30% (pre-2008) to 43-45% (post-2008), partly reflecting secondary fracture prevention initiatives for women. For men, this proportion increased from 33% (1998-2002) to 42% (2003-2007), 47% (2008-2012), and 54% (2013-2017), but fell to 36% (2018-2022) after BMD screening initiatives began in 2017 for older men (primary prevention efforts). Racial and ethnic diversity in treatment also increased, comparing 1988-2002 (75.2% White, 2.5% Black, 8.6% Hispanic, 12.7% Asian/Pacific Islander) to 2018-2022 (61.5% White, 2.9% Black, 12.2% Hispanic, 21.1% Asian/Pacific Islander, p&amp;lt;0.001 for overall differences and % non-White). Conclusions: In a primary care population of adults initiating oral BP, a larger proportion in later years were age &amp;gt;65y, including larger numbers both with and without fracture coinciding with initiatives for fracture prevention. Among those initiating BP, the relative proportions with prior fracture in each period were likely influenced by primary or secondary prevention efforts. Presentation: 6/2/2024

12411 Trends In Metabolic Dysfunction-associated Steatotic Liver Disease(MASLD) By Race/ethnicity: Data From NHANES 1988 To 2018

Abstract Disclosure: M. Shaheen: None. K. Schrode: None. D. Pan: None. S.M. Najjar: None. T.C. Friedman: None. Societies of the liver recommended replacing the term non-alcoholic fatty liver disease (NAFLD) with metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to investigate the trends in the MASLD prevalence by racial/ethnic among the U.S. adult population overtime. We analyzed data from 32,726 adults in National Health and Nutrition Examination Survey 1988-2018. Hepatic steatosis (HS) was diagnosed using the U.S. Fatty Liver Index. MASLD was diagnosed in individuals with both HS and at least one of the following: overweight/obesity, diabetes mellitus, hypertension, high triglyceride or HDL-Cholesterol or in treatment. Logistic regression was used to test for trends over time for the overall sample and for each racial/ethnic group accounting for design and sample weights. Prevalence estimates were age-adjusted using the direct standardization based on census data. We also estimated the percent change in the adjusted prevalence (change in the adjusted prevalence/baseline adjusted prevalence)*100. The study showed that over the study period, the age-adjusted prevalence of MASLD significantly increased from 16% in 1988 to 38% in 2018, representing a 138% percent increase. Concurrently, the age-adjusted prevalence of obesity increased from 23% in 1988 to 40% in 2018 reflecting a 74% increase (p&amp;lt;0.05). Among Mexican Americans, the age-adjusted MASLD prevalence consistently exceeded that of the overall population and other racial/ethnic groups. Significant increase in the percent change of the age-adjusted prevalence of MASLD was observed across all racial/ethnic groups (Mexican Americans=69%; Blacks=117%; Whites=140%) except Other Hispanics (no change). The age adjusted prevalence of obesity also increased significantly in all racial/ethnic groups (% change: Mexican Americans=58%; Other Hispanics=18%; Blacks=59%; Whites=77%) (p&amp;lt;0.05). Our findings indicated an increase in the age-adjusted prevalence of MASLD over time that surpassing the increase in obesity prevalence. These disparities warrant further investigation and targeted interventions to address MASLD effectively. Grants: R01MD012579, R24DA017298, U54MD007598, S21MD000103, UL1TR001881 Presentation: 6/2/2024

Reference equations for pulse wave velocity, augmentation index, amplitude of forward and backward wave in a European general adult population

Pulsatile hemodynamics have been shown to be independent predictors of cardiovascular events. The aim of the current study was to describe four pulsatile hemodynamic markers in a large, well-established, population-based cohort and to provide reference equations for sex- and age-based standardization of these measurements. 6828 adult participants from the Austrian LEAD (Lung, hEart, sociAl, boDy) cohort study, who were free from overt cardiovascular disease, non-diabetic based on blood test results, and had no history of pharmacological treatment for hypertension, dyslipidemia, and diabetes, comprised the “reference population”. Carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx), amplitude of forward wave (Pf), and backward wave (Pb) were described in different age categories for both sexes. Sex-specific reference equations for cfPWV, AIx, Pf, and Pb with age as the predictive variable were created using the Lambda-Mu-Sigma (LMS) method. All four parameters increased with age. CfPWV and Pf were higher in males than females, especially in young and middle-age groups (P < 0.001). AIx was higher in females than males in all age categories (P < 0.001). Pb was also higher in females than males in age groups older than 40 years (P < 0.01). Reference equations for the skewness (Lambda), median (Mu), and coefficient of variation (Sigma) values were determined, enabling the calculation of sex- and age-standardized values (z-scores) for each individual’s pulsatile hemodynamic measurement, and an online application was developed. Reference equations derived from a large population-based dataset constitute a suitable tool for the standardization of pulsatile hemodynamics and for the accurate interpretation of vascular aging.

A cross-sectional study of the correlation of the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) with obstructive sleep apnea (OSA) in adult populations: NHANES (2005–2008 and 2015–2020)

The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol, abbreviated as NHHR, represents a brand-new lipid biomarker for assessing cardiovascular disease risk. Research has suggested a link between lipid metabolism and obstructive sleep apnea (OSA). To delve deeper, this study was carried out using data derived from the NHANES to ascertain whether NHHR and OSA are associated. In this research, a cross-sectional analysis was executed based on data derived from NHANES across the years 2005 to 2008 and 2015 to 2020. After adjusting for confounders such as demographic characteristics, lifestyle, and health status, the link between NHHR and the likelihood of developing OSA was examined via weighted binary logistic regression as well as restricted cubic spline (RCS) models. In addition, subgroup analysis was completed to check if the obtained results were reliable. The study included 16,265 adult participants. Following comprehensive adjustment for confounders, results obtained suggested that, for each additional unit increment of NHHR, there is a 9% increased chance of developing OSA. Compared to the lowest quartile, the highest quartile of NHHR notably increased the risk of developing OSA in the overall population (OR: 1.65; 95% CI: 1.38–1.98; P &lt; .001). The RCS curve indicated a linear positive correlation between NHHR and OSA, which remained significant in subsequent subgroup analyses (all P for interaction &gt; .05). This suggested that the correlation between NHHR and OSA was stable across populations with different characteristics. Confounders such as demographics, lifestyle, and health status did not significantly affect this positive correlation. Findings from this study uncovered a strong connection between NHHR and an increased possibility of developing OSA in American adults. Further exploration of NHHR could offer insights into OSA prevention and treatment. However, owing to the constraints inherent in cross-sectional studies, more studies are required to establish a concrete link between NHHR and OSA.

Treatment Adherence in Pediatric Atopic Dermatitis: A Systematic Review.

Adherence to pediatric atopic dermatitis (AD) treatment regimens can be complex and a major challenge to optimizing treatment outcome. We aimed to review factors associated with nonadherence in pediatric AD and propose interventions to improve adherence. PubMed and EMBASE databases were systematically searched for articles from 2000 to February 2023 related to AD and adherence, with an additional update in December 2023. Non-human studies, reviews, commentaries, and meta-analyses were excluded. Articles were sorted into pediatric versus adult study population based on volume. Herein, we examine the results of papers discussing adherence factors related to pediatric patients. A total of 62 studies met inclusion criteria. Thirty-six studies surveyed patients and caregivers (N = 10,268) to identify barriers to treatment adherence. None of the included studies were specific to systemic medications. Barriers includedpoor caregiver quality of life, inadequate AD-related education, topical corticosteroid (TCS) phobia, unclear therapy-related instructions, and dissatisfaction with physician interaction. Five studies solely measured adherence using medication electronic monitoring systems, Morisky medication adherence scale, or self-reported adherence to measure adherencetotopical medications. Twenty-one studies described interventions involving nurse-led or web-based education programs, text message or email reminders, and TCS education. Adherence was improved with caregiver education programs, daily text-message reminders, eczema action plans, TCS potency "traffic light" color system, and frequent follow-up visits. Adherence to pediatric AD treatment poses a multifactorial challenge for caregivers and patients. This study provides an index of strategies to optimize adherence, as it is essential for prevention of long-term sequela associated with AD in children. As the AD treatment landscape rapidly expands, further studies are vital to assess pediatric adherence to new topical, oral, and injectable medications. PROSPERO: CRD42023488557.

Prevalence of Prolonged Grief Disorder Adult Bereavement in East Asia: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis is derived from a conference paper presented at The Asian Conference on Psychology &amp; the Behavioral Sciences 2024. It's aimed to estimate the prevalence rate of Prolonged Grief Disorder (PGD) in the adult bereaved population of East Asia. A pooled prevalence rate of 8.90% was found, suggesting that nine out of one hundred bereaved adults in East Asia are at risk for PGD. Cultural differences in bereaved cultural values and practices may contribute to this variation, but further research in other East Asian countries is needed to confirm these findings.

Evaluating the effects of dietary patterns on circulating C-reactive protein levels in the general adult population: an umbrella review of meta-analyses of interventional and observational studies.

Adopting a healthy dietary pattern may be an initial step in combating inflammation-related chronic diseases; however, a comprehensive synthesis evaluating current evidence is lacking. This umbrella review aimed to summarise the current evidence on the effects of dietary patterns on circulating C-reactive protein (CRP) levels in adults. We conducted an exhaustive search of the Pubmed, Scopus and Epistemonikos databases, spanning from their inception to November 2023, to identify systematic reviews and meta-analyses across all study designs. Subsequently, we employed a random-effects model to recompute the pooled mean difference. Methodological quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist, and evidence certainty was categorised as non-significant, weak, suggestive, highly suggestive or convincing (PROSPERO: CRD42023484917). We included twenty-seven articles with thirty meta-analyses of seven dietary patterns, fifteen of which (50 %) exhibited high methodological quality. The summary effects of randomised controlled trials (RCT) found that the Mediterranean diet was the most effective in reducing circulating CRP levels, followed by Vegetarian/Vegan and Energy-restricted diets, though the evidence was of weak quality. In contrast, Intermittent Fasting, Ketogenic, Nordic and Paleolithic diets did not show an inverse correlation with circulating CRP levels. Some results from combined interventional and observational studies, as well as solely observational studies, also agreed with these findings. These dietary patterns show the potential in reducing CRP levels in adults, yet the lack of high-quality evidence suggests future studies may alter the summary estimates. Therefore, further well-conducted studies are warranted.

Current approaches to the identification and management of gambling disorder: a narrative review to inform clinical practice in Australia and New Zealand.

Gambling disorder is a recognised psychiatric disorder in the Diagnostic and statistical manual of mental disorders (DSM-5) and is classified as an addiction alongside alcohol and substance use disorders. The DSM-5 describes a past-year timeframe, episodic or persistent specifiers, early or sustained remission specifiers, and three gambling disorder severity specifiers (mild, moderate and severe). Although anyone can develop gambling disorder, there are known risk factors. In studies involving general adult populations, the likelihood of developing the disorder varies with the type of gambling, and is particularly high for internet gambling, casino table games and poker machines. Australia and New Zealand have shifted the focus of gambling disorder to the identification of gambling harm, in recognition that efforts targeting the prevention of harm may be more effective as they potentially influence a larger segment of the population. Temporal categories of gambling harm (crisis harms versus legacy harms) affect help-seeking and need for treatment. Crisis harms often motivate people to change their behaviour or seek help, whereas treatment addresses legacy harms, which emerge or continue to occur after gambling behaviour ceases. The evidence base and clinical guidelines recommend cognitive behavioural therapy and motivational interviewing but there are many gaps in our understanding of treatment for gambling disorder, including an absence of high quality evaluations that assess treatment effectiveness over the longer term, especially for treatment delivered in community settings. There is also an urgent need to understand how, why and for whom treatment works so that interventions can be optimised to individual needs, thereby facilitating client engagement. Because of limited access to health care and poor retention in treatment, in recent years there has been an increase in treatment choices in the form of internet therapies and smartphone applications.

Normative Data for the D-KEFS Color-Word Interference and Trail Making Tests Adapted in Greek Adult Population 20–49 Years Old

Normative Data for the D-KEFS Color-Word Interference and Trail Making Tests Adapted in Greek Adult Population 20–49 Years Old

Pressure and cold pain threshold reference values in a pain-free older adult population

Pressure and cold pain threshold reference values in a pain-free older adult population

Corrigendum: Prevalence and determinants of health literacy among the adult population of Qatar

Corrigendum: Prevalence and determinants of health literacy among the adult population of Qatar