Health Status Categories Research Articles

Abstract 4112652: Impact of metabolic overweight/obesity phenotypes on clinical outcomes of patients with resectable non-small cell lung cancer in an Asian population

Background: Metabolic syndrome and obesity are known to increase the incidence of lung cancer. We investigated the association between metabolic health and overweight/obesity phenotypes and clinical outcomes in patients with resectable non-small cell lung cancer (NSCLC). Methods: This large retrospective cohort study included adult patients who underwent curative upfront surgery for their stage IA-IIIB NSCLC at a tertiary university hospital from January 2010 to December 2020. They were classified into four phenotypes based on the combination of metabolic health status and body mass index categories: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obesity (MHO), metabolically unhealthy overweight/obesity (MUO). The primary outcomes were disease recurrence and death. Results: Of the 1,513 patients (342 with MHNW, 585 with MUNW, 122 with MHO, and 464 with MUO), patients with the phenotype of MHO were less likely to experience recurrence (MHO [13.1%] vs. MHNW [16.1%] vs. MUNW [22.9%] vs. MUO [19.2%], p = 0.018) and death (MHO [15.6%] vs. MHNW [24.6%] vs. MHUW [31.3%] vs. MUO [24.8%], p < 0.001) compared to those with other 3 phenotypes. Similar results were observed in Kaplan-Meier curves for the primary outcomes according to the four phenotypes (all log-rank P < 0.05). In multivariate Cox regression analyses, both MHO and MUO phenotypes did not increase the risk of recurrence compared to the MHNW phenotype and were associated with improved survival (MHO: adjusted hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.36-0.98, p = 0.040; MUO: adjusted HR 0.76, 95% CI 0.60-0.96, p = 0.022). Conclusions: After curative resection for NSCLC, regardless of metabolic health, patients with overweight/obesity were not at an increased risk of recurrence and paradoxically, had favorable overall survival.

Exploring Serum Ferritin's Connection to the Acute Phase Response in Zoo-Managed African Rhinoceroses.

Despite serum ferritin's potential as an iron status indicator, its concentrations vary significantly throughout a black rhinoceros's (Diceros bicornis) life, sometimes irrespective of iron load. We explored acute phase response-related biomarkers, serum amyloid A (SAA) and ceruloplasmin (Cp), to better understand the mechanisms influencing serum ferritin changes in managed black rhinoceroses. The objective was to evaluate the relationships between circulating levels of ferritin, SAA, and Cp in black and white rhinoceroses (Ceratotherium simum). We analyzed banked serum samples collected serially from 11 black (n = 222) and 7 white (n = 134), rhinoceroses (rhinos) and classified samples based on SAA values: clinically healthy (< 1 mg/L), subclinical (1-7 mg/L), or clinically abnormal (> 7 mg/L). In black rhinos, serum ferritin was not different between health status categories (p = 0.5292), nor was it correlated with SAA (p = 0.4164). However, Cp activity was significantly lower in clinically healthy sera (p < 0.0001) and had a moderate positive association with SAA (r = 0.477, p < 0.0001). Among the white rhino samples, only five had SAA values greater than 1 mg/L, limiting the assessment of ferritin and Cp activity in the health context. Minor, yet significant, relationships were observed between serum ferritin and Cp activity, negative in black rhinos (r = -0.206; p = 0.0022) and positive in white rhinos (r = 0.289, p = 0.0008). Cp activity may aid in diagnosing illness in black and white rhinos, based on values observed in sera collected near the time of death. However, acute inflammatory processes do not appear to be one of the primary drivers of the high ferritin concentrations detected in some black rhinos.

An Epidemiological Study of Physical-Mental Multimorbidity in Youth: Une étude épidémiologique de la morbidité physique-mentale chez les jeunes.

This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last ≥6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., ≥1 physical illness and ≥1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness. Data come from 10,303 youth aged 4-17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health. Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose-response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all p < .05). Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional health. Physical-Mental Multimorbidity in Ontario Youth.

Factors Shaping Exercise Patterns and Health Status among the Elderly in Aging Nations: A South Korean Perspective.

The global phenomenon of population aging requires an understanding of the factors influencing the health of the elderly becomes imperative. We aimed to focus on South Korea, a nation set to become an aging society by 2025. The study examined the influence of regular exercise and exercise types on the health of the elderly with particular attention to South Korea's unique sociodemographic context. We targeted individuals aged 50 yr and above. The study was conducted through online surveys from August to September 2023. Utilizing Logistic Regression analysis and Chi-Square tests, the research explored correlations, trends, and influencing factors affecting elderly exercise behaviors, encompassing demographic variables, health status, and exercise types. The analysis of demographic characteristics revealed that marital status, education level, and financial status displayed diverse representations within the sample. Comparisons between health status and exercise groups suggested potential health benefits for the Regular Exercise group. Logistic Regression analysis identified significant influences of gender and financial status on regular exercise engagement. Additionally, a strong relationship between health status and exercise preferences, notably strength training, emerged. Regular exercise and exercise types benefit elderly individuals. Men and those with better financial status are more likely to exercise regularly. Strength training emerges as a significant contributor to better health across various health status categories. Policymakers and healthcare professionals should consider these insights to develop targeted interventions for promoting healthy aging, acknowledging the cultural and socioeconomic factors of South Korea's aging population.

Willingness to take less medication for type 2 diabetes among older patients: The Diabetes & Aging Study.

To examine the willingness of older patients to take less diabetes medication (de-intensify) and to identify characteristics associated with willingness to de-intensify treatment. Survey conducted in 2019 in an age-stratified, random sample of older (65-100 years) adults with diabetes on glucose-lowering medications in the Kaiser Permanente Northern California Diabetes Registry. We classified survey responses to the question: "I would be willing to take less medication for my diabetes" as willing, neutral, or unwilling to de-intensify. Willingness to de-intensify treatment was examined by several clinical characteristics, including American Diabetes Association (ADA) health status categories used for individualizing glycemic targets. Analyses were weighted to account for over-sampling of older individuals. A total of 1337 older adults on glucose-lowering medication(s) were included (age 74.2 ± 6.0 years, 44% female, 54.4% non-Hispanic white). The proportions of participants willing, neutral, or unwilling to take less medication were 51.2%, 27.3%, and 21.5%, respectively. Proportions of willing to take less medication varied by age (65-74 years: 54.2% vs. 85+ years: 38.5%) and duration of diabetes (0-4 years: 61.0% vs. 15+ years: 44.2%), both p < 0.001. Patients on 1-2 medications were more willing to take less medication(s) compared with patients on 10+ medications (62.1% vs. 46.6%, p = 0.03). Similar proportions of willingness to take less medications were seen across ADA health status, and HbA1c. Willingness to take less medication(s) was similar across survey responses to questions about patient-clinician relationships. Clinical guidelines suggest considering treatment de-intensification in older patients with longer duration of diabetes, yet patients with these characteristics are less likely to be willing to take less medication(s).

Average weighted estimate of health of forest trees as a criterion for the sanitary condition of a stand

The issue of using a weighted average assessment of the health of trees condition Kср as a criterion for the sanitary condition of a stand on the example of spruce and birch forests. Based on the growth tables, Kср developed for five categories of tree health status with differentiation of results by age groups and assessment methods (by stock volume or by number of trees). It showed that exceeding Kср of 1.5 is not a sufficient criterion for the unsatisfactory sanitary condition of the stand. For a stand with natural thinning by age the estimations Kср are increase from Ia to V quality of locality and are decrease with age groups. The estimates Kср by number of trees may exceed similar estimates by stock volume by 0.1-0.3 points. For a young and middle age of healthy stands with natural thinning, the evaluations Kср usually exceed 1.5 points. Proposed the criteria Kср with the differentiation on age groups and assessment methods. As rough criterion of unsatisfactory sanitary state it is possible to accept excess of average weighted of estimations (on a stock volume/on number of trees): Kср :in middle-aged stands - 1,7/2,0, in ripening stand - 1,5/1,7, in ripe and maturity and old-growth stand 1,2/1,4. Keywords: CONDITION OF FOREST STAND, WEIGHTED AVERAGE ESTIMATE

Determination of Behavioral Changes Associated with Bovine Respiratory Disease in Australian Feedlots

Accurately identifying bovine respiratory disease is challenging in feedlots, and previous studies suggest behavioral monitoring is important. The study objective was to describe individual differences in physical activity (distance traveled), feeding/watering patterns (proximity to feed and water), and social behavior (average cattle within 3 m) when associated with health status in commercially raised beef cattle during the first 28 days on feed. Data from a previous Australian feedlot study monitoring cattle behavior and associated health outcomes were analyzed. Health status categories were generated for all cattle, and each animal was categorized as known healthy (HLTH), known diseased (SICK), or intermediate/uncertain (INTR). The INTR animals were excluded from the final analysis. Key findings included: differentiation in activity between SICK (n = 138) and HLTH (n = 1508) cattle dependent on time of day, SICK cattle spending more time in water and feeding zones early in the feeding phase (&lt;6 days on feed), SICK cattle spending more time in the water and feeding zone during the overnight hours, and SICK cattle spending more time in groups early in the feeding phase but more time in isolation after the first week on feed. Results illustrate behavioral data were associated with important health outcomes.

Glycemic control and diabetes complications across health status categories in older adults treated with insulin or insulin secretagogues: The Diabetes & Aging Study.

For older adults with type 2 diabetes (T2D) treated with insulin or sulfonylureas, Endocrine Society guideline recommends HbA1c between 7% to <7.5% for those in good health, 7.5% to <8% for those in intermediate health, and 8% to <8.5% for those in poor health. Our aim was to examine associations between attained HbA1c below, within (reference), or above recommended target range and risk of complication or mortality. Retrospective cohort study of adults ≥65 years old with T2D treated with insulin or sulfonylureas from an integrated healthcare delivery system. Cox proportional hazards models of complications during 2019 were adjusted for sociodemographic and clinical variables. Primary outcome was a combined outcome of any microvascular or macrovascular event, severe hypoglycemia, or mortality during 12-month follow-up. Among 63,429 patients (mean age: 74.2 years, 46.8% women), 8773 (13.8%) experienced a complication. Complication risk was significantly elevated for patients in good health (n = 16,895) whose HbA1c was above (HR 1.97, 95% CI 1.62-2.41) or below (HR 1.29, 95% CI 1.02-1.63) compared to within recommended range. Among those in intermediate health (n = 30,129), complication risk was increased for those whose HbA1c was above (HR 1.45, 95% CI 1.30-1.60) but not those below the recommended range (HR 0.99, 95% CI 0.89-1.09). Among those in poor health (n = 16,405), complication risk was not significantly different for those whose HbA1c was below (HR 0.98, 95% CI 0.89-1.09) or above (HR 0.96, 95% CI 0.88-1.06) recommended range. For older adults with T2D in good health, HbA1c below or above the recommended range was associated with significantly elevated complication risk. However, for those in poor health, achieving specific HbA1c levels may not be helpful in reducing the risk of complications.

1356-P: Association of HbA1c with Diabetes Outcomes across Health Status Categories in Older Adults

For older adults with type 2 diabetes (T2D) on insulin/sulfonylureas, Endocrine Society recommends HbA1c between 7-&amp;lt;7.5% for those in good health, 7.5-&amp;lt;8% for those in intermediate health, and 8-&amp;lt;8.5% for those in poor health. We evaluated associations between HbA1c levels and complications in adults age ≥65 yrs with T2D on insulin/sulfonylureas from an integrated healthcare delivery system. Complications included any microvascular or macrovascular events, severe hypoglycemia, or mortality during calendar year 2019. We categorized HbA1c (last result prior to 1/1/2019) as being below (overtreated), within (reference), or above (undertreated) recommended target range. Health status was adapted from the ADA Standards of Care. Cox proportional hazards models of complications were adjusted for sociodemographic and clinical variables. Among 63429 eligible patients (mean age 74.2 yrs, 46.8% women), 8773 (13.8%) experienced a complication. Complication risk was significantly elevated for patients in good health who were overtreated or undertreated (Table). Among those with intermediate health, complication risk was elevated only for those who were undertreated. Among those with poor health, complication risk did not differ significantly by level of attained HbA1c. Factors other than HbA1c level are likely to be more important predictors and/or drivers of complications in patients with T2D and poor health. Disclosure K.J.Lipska: Other Relationship; UpToDate. E.Huang: Advisory Panel; Twin Health, Stock/Shareholder; AbbVie Inc., Cardinal Health, Amgen Inc. J.Liu: None. M.M.Parker: Research Support; Dexcom, Inc. H.H.Moffet: Research Support; Dexcom, Inc. R.W.Grant: None. N.Laiteerapong: None. A.J.Karter: None. Funding National Institute on Aging (R01AG063391, R56AG074986); National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092924, P30DK092949)

Abstract 15064: Health Status Profiles in Patients With New or Worsening Peripheral Artery Disease Symptoms and One-Year Hospitalization Risk

Introduction: Patients with peripheral artery disease (PAD) have an elevated risk of cardiovascular and limb-related events, resulting in increased hospitalizations and costs. In patients with new or worsening PAD symptoms, we used patients’ baseline health status information as a way of identifying patients’ hospitalization. Methods: We included patients enrolled in the United States cohort of the multicenter PORTRAIT Registry from June 2011 and December 2015. PAD-specific health status was assessed at baseline using the Peripheral Artery Questionnaire (PAQ), with scores of 0-100 (higher scores indicating better health status). The primary outcome was 1-year all-cause hospitalizations. The association between PAQ score category (0 to &lt;25, 25 to &lt;50, 50 to &lt;75, and 75-100 used as the reference category) and cumulative hospitalization risk was derived using proportional means models, adjusting for demographics and comorbidities. Results: Of the 797 patients (mean age of 68.6±9.7 years, 41.9% were female), 272 (34%) were admitted over 12 months of follow up. Compared with the best health status (PAQ 75-100), scoring in the lowest health status category (PAQ &lt; 25) was associated with a higher risk of 1-year hospitalization (4.8% vs. 48.6%, adjusted hazard ratio 2.86 [95% confidence interval = 1.61-5.08]). A dose-response relationship was noted for the association between lower health status and increased risk of hospitalization. Similar associations were found for all PAQ domains except symptom stability. Conclusion: In patients with symptomatic PAD, presenting health status profiles were a robust predictor of 1-year hospitalization risk, with a &gt;2-fold difference between those in the lower versus upper scoring segments. Given the potentially modifiable nature of health status, there is a need for monitoring and multicomponent interventions that can improve patients’ health status and potentially also their hospitalization risk.

Analisis Ekonomi Kesehatan Rumah Tangga Indonesia Pada Masa Pandemi Covid-19

The decreasing household access to health services occurred during the Covid-19 pandemic. Observing the health profile of BPS Indonesia (2021), it can be seen that there is a percentage change in the decrease in road treatment and an increase in health complaints. This study aims to present the results of estimating econometric models that explain economic and non-economic variables that can potentially change the opportunities for health demand in Indonesia. The morbidity data for each district and city on the selected island was converted into four categories of health status, namely [1] very healthy, [2] healthy, [3] moderately healthy, and [4] unhealthy. This research is deductive. We use the demand for health theory to identify variables that need to be researched and employ QLDV (qualitative limited dependent variable) to estimate them. The estimation results are conducting to the issue of efforts to increase the chances of household health levels and serial studies starting in 1972. The simulation results with marginal effect predict that the probability of demand for health will increase by 2.71 percent in conditions of inflation of food and health commodities at the level of 6 and 7 percent, children under-five immunization coverage is close to 90 percent, education average is junior high school, income allocation of less than 50 percent, and real income per capita is close to 10 million per year. Regarding the literature series, this study succeeded in showing the significance of health commodity prices which was difficult to display by previous researchers.

Data Balancing Methods on Radiographic Image Classification on Unbalance Dataset

Covid-19 is a disease caused by a corona virus infection that infects the victim's respiratory tract. Covid-19 disease has a high infectious ability and if treated too late can result in death. Covid-19 has been a problem faced by everyone in the world since the end of 2019. Fast and accurate detection can save many lives. This study aims to develop a predictive model of COVID-19 detection based on radiographic images using a machine learning model from 4 categories of health status, namely positive covid, normal, lung opacity sufferers, and viral pneumonia sufferers. Deep learning is based on ResNet50 and MobileNetV2 and trials of undersampling and oversampling data balancing methods, and uses a confusion matrix for the evaluation process of model results. The model with the highest performance achieves 95.58% accuracy in the multi-class classification. Also based on the findings, we provide results from using a different data balancing approach or not using one at all.

Half of the Ancient Trees in Hungary Stand in Human-Altered Environments

Big trees contribute to various ecosystem functions and spiritual values are given to them by local people, yet they are endangered. We compiled the health status, accessibility, and local habitat categories of the 2000 biggest (considering girth) trees in Hungary in 531 settlements. A total of 1550 specimens belong to 29 indigenous species, while 450 are non-indigenous (43 species). Most of them stand in a forest or park (not as a solitary tree), in the North Hungarian Range. Altogether, half of the ancient trees in Hungary stand in human-altered environments. Three-quarters are in a fair health condition. However, only 10.3% of the biggest white willows and 24.5% of the biggest sweet chestnuts are in good or excellent condition. A number of 121 big trees should no longer be listed in the nationwide online database because they died, or no longer reach the girth criteria (e.g., due to breakage). This number proves that any kind of documentation is important. More than half of the trees are easily accessible, while 9% are very difficult to reach. Only a very few big trees receive legal protection at the local or national level, on their own or in the habitat where they stand.

Two-phase non-invasive multi-disease detection via sublingual region.

Non-invasive multi-disease detection is an active technology that detects human diseases automatically. By observing images of the human body, computers can make inferences on disease detection based on artificial intelligence and computer vision techniques. The sublingual vein, lying on the lower part of the human tongue, is a critical identifier in non-invasive multi-disease detection, reflecting health status. However, few studies have fully investigated non-invasive multi-disease detection via the sublingual vein using a quantitative method. In this paper, a two-phase sublingual-based disease detection framework for non-invasive multi-disease detection was proposed. In this framework, sublingual vein region segmentation was performed on each image in the first phase to achieve the region with the highest probability of covering the sublingual vein. In the second phase, features in this region were extracted, and multi-class classification was applied to these features to output a detection result. To better represent the characterisation of the obtained sublingual vein region, multi-feature representations were generated of the sublingual vein region (based on color, texture, shape, and latent representation). The effectiveness of sublingual-based multi-disease detection was quantitatively evaluated, and the proposed framework was based on 1103 sublingual vein images from patients in different health status categories. The best multi-feature representation was generated based on color, texture, and latent representation features with the highest accuracy of 98.05%.

A Population-Based Sex-Stratified Study to Understand How Health Status Preceding Traumatic Brain Injury Affects Functional Outcome

<h3>Research Objectives</h3> To understand how health status preceding traumatic brain injury (TBI) affects relative functional gain after inpatient rehabilitation. <h3>Design</h3> Population-based, sex-stratified, retrospective cohort study using health administrative data. <h3>Setting</h3> Inpatient rehabilitation in Ontario, Canada. <h3>Participants</h3> Patients 14 years or older (N=5,802; 63.4% males) admitted to inpatient rehabilitation within 1 year of a TBI-related acute caredischarge between April 1, 2008, and March 31, 2015. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Relative functional gain (RFG) in percentage. Health status prior to TBI was identified and internally validated using a data mining approach that categorized all International Classification of Diseases, 10th revision, codes for each patient. <h3>Results</h3> The average RFG was 52.8% +/- 27.6% among male patients and 51.6% +/- 27.1% among female patients. Sex-specific Bonferroni adjustedmultivariable linear regressions identified 10 factors of pre-injury health status related to neurology, emergency medicine, cardiology, psychiatry,geriatrics, and gastroenterology that were significantly associated with reduced RFG for male patients. Only 1 pre-injury health statuscategory, geriatrics, was significantly associated with RFG in female patients. <h3>Conclusions</h3> Pre-existing health conditions present up to 5 years preceding the TBI event were significantly associated with RFG. These findingsshould be considered when planning and executing interventions to maximize functional gain and to support an interdisciplinary approach. <h3>Author(s) Disclosures</h3> None.

Individual and Combined Association Between Healthy Lifestyle Habits With Muscle Strength According to Cardiovascular Health Status in Adults and Older Adults.

The authors aimed to identify the effect of adherence to healthy lifestyle habits on muscle strength (MS) according to a distinct health status. Longitudinal analysis using data from 2 population-based cohorts in Brazil (EpiFloripa adult, n = 862, 38.8 [11.4]y-6y of follow-up length; EpiFloripa Aging, n = 1197, 69.7 [7.1]y-5y of follow-up length). MS was assessed by handgrip strength (kgf). Information assessed by questionnaire regarding adequate physical activity levels, regular consumption of fruit and vegetables, low alcohol consumption, and nonsmoking habits were analyzed in the relationship with MS according to the health status. The participants were grouped into 3 health status categories: (1)with cardiovascular disease (CVD); (2)at risk of CVD (abdominal obesity or overweight/obesity, high blood pressure, hyperglycemia, and dyslipidemia); and (3)healthy individuals (without CVD and risk of CVD). Simultaneous adherence of 4 healthy lifestyle habits was directly associated with MS among healthy individuals (β = 10.0, 95% CI, 2.0-18.0, SE = 4.0), at risk of CVD (β = 5.5, 95% CI, 0.3-12.6, SE = 3.6), and those with CVD (β = 11.4, 95% CI, 5.8-16.7, SE = 2.8). Adopting a healthy lifestyle can contribute to increased MS in adults and older adults, regardless of health status.

Risk of arterial stiffness according to metabolically healthy obese phenotype: a combined cross-sectional and longitudinal study in kailuan cohort.

We aim to investigate the risk of incident arterial stiffness according to metabolically healthy obese (MHO) phenotype in Chinese population. 37,180 participants with at least one-time measurement of branchial-ankle pulse wave velocity (baPWV) were included in the cross-sectional analysis, and 16,236 participants with repeated measurement of baPWV during the follow-ups were included in the longitudinal study. Cross-classification of body mass index (BMI) categories and metabolic health status created six groups. Linear and logistic regression analyses were used. The results of cross-sectional and longitudinal investigation were essentially the same, as the abnormality of baPWV increased with BMI categories in metabolically healthy participants, while the increasing tendency disappeared in metabolically unhealthy participants. A 1.4-fold, 2.2-fold increased risk for the new occurrence of arterial stiffness were documented in MHO and metabolically unhealthy obese participants compared to metabolically healthy normal-weight controls in the fully adjusted model. Further stratified analysis showed that metabolic health status was an interaction factor between BMI and arterial stiffness in all study populations (P=0.0001 for cross-sectional study and P=0.0238 for longitudinal study). In conclusion, metabolic health status and BMI categories contribute to the progression of arterial stiffness, while BMI is positively associated with arterial stiffness only in metabolically healthy participants.

American Diabetes Association Framework for Glycemic Control in Older Adults: Implications for Risk of Hospitalization and Mortality.

The 2021 American Diabetes Association (ADA) guidelines recommend different A1C targets in older adults that are based on comorbid health status. We assessed risk of mortality and hospitalizations in older adults with diabetes across glycemic control (A1C <7%, 7 to <8%, ≥8%) and ADA-defined health status (healthy, complex/intermediate, very complex/poor) categories. Prospective cohort analysis of older adults aged 66-90 years with diagnosed diabetes in the Atherosclerosis Risk in Communities (ARIC) study. Of the 1,841 participants (56% women, 29% Black), 32% were classified as healthy, 42% as complex/intermediate, and 27% as very complex/poor health. Over a median 6-year follow-up, there were 409 (22%) deaths and 4,130 hospitalizations (median [25th-75th percentile] 1 per person [0-3]). In the very complex/poor category, individuals with A1C ≥8% (vs. <7%) had higher mortality risk (hazard ratio 1.76 [95% CI 1.15-2.71]), even after adjustment for glucose-lowering medication use. Within the very complex/poor health category, individuals with A1C ≥8% (vs. <7%) had more hospitalizations (incidence rate ratio [IRR] 1.41 [95% CI 1.03-1.94]). In the complex/intermediate group, individuals with A1C ≥8% (vs. <7%) had more hospitalizations, even with adjustment for glucose-lowering medication use (IRR 1.64 [1.21-2.24]). Results were similar, but imprecise, when the analysis was restricted to insulin or sulfonylurea users (n = 663). There were substantial differences in mortality and hospitalizations across ADA health status categories, but older adults with A1C <7% were not at elevated risk, regardless of health status. Our results support the 2021 ADA guidelines and indicate that <7% is a reasonable treatment goal in some older adults with diabetes.

Factors associated with epiphora following orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty.

The aims of the study were to estimate the frequency of epiphora and to identify factors associated with epiphora after orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty (OSOSM-MWFILB). We performed a retrospective cohort study enrolling a sample derived from the patient population undergoing OSM-MWFILB over a 7-year period. The predictor variables were grouped into demographic, related health status, anatomic, tumor-specific, and therapeutic categories. The primary outcome variable was the presence of postmaxillectomy epiphora (PME). Descriptive, univariate, and multivariate regression mixed-effect models were computed. The study sample was composed of 134 patients (46.3% females; 71.6% squamous cell carcinomas) with a mean age of 64.7 ± 12.2 years. There were 23 (17.2%) PME events, which were significantly associated with eight variables: male gender, poor general health (ASA III-IV), large vertical defect (Brown and Shaw's class III-IV), squamous cell carcinoma tumor type, big tumor size (T3-4), cervical lymph node metastasis (N1-2), long operating time > 3 h, and adjuvant radio(chemo)therapy in both univariate mixed regression and multivariate Cox hazards analyses. Healing of PME in irradiated patients was significantly delayed. Ophthalmologic consequences in patients undergoing OSM-MWFILB require particular attention, especially in case of advanced tumors, multiple comorbidities, or long surgery with postoperative radio(chemo)therapy. This emphasizes the importance of appropriate cooperation between the surgeons and ophthalmic colleagues.

Assessing a novel modelling approach with high resolution UAV imagery for monitoring health status in priority riparian forests

BackgroundBlack alder (Alnus glutinosa) forests are in severe decline across their area of distribution due to a disease caused by the soil-borne pathogenic Phytophthora alni species complex (class Oomycetes), “alder Phytopththora”. Mapping of the different types of damages caused by the disease is challenging in high density ecosystems in which spectral variability is high due to canopy heterogeneity. Data obtained by unmanned aerial vehicles (UAVs) may be particularly useful for such tasks due to the high resolution, flexibility of acquisition and cost efficiency of this type of data. In this study, A. glutinosa decline was assessed by considering four categories of tree health status in the field: asymptomatic, dead and defoliation above and below a 50% threshold. A combination of multispectral Parrot Sequoia and UAV unmanned aerial vehicles -red green blue (RGB) data were analysed using classical random forest (RF) and a simple and robust three-step logistic modelling approaches to identify the most important forest health indicators while adhering to the principle of parsimony. A total of 34 remote sensing variables were considered, including a set of vegetation indices, texture features from the normalized difference vegetation index (NDVI) and a digital surface model (DSM), topographic and digital aerial photogrammetry-derived structural data from the DSM at crown level.ResultsThe four categories identified by the RF yielded an overall accuracy of 67%, while aggregation of the legend to three classes (asymptomatic, defoliated, dead) and to two classes (alive, dead) improved the overall accuracy to 72% and 91% respectively. On the other hand, the confusion matrix, computed from the three logistic models by using the leave-out cross-validation method yielded overall accuracies of 75%, 80% and 94% for four-, three- and two-level classifications, respectively.DiscussionThe study findings provide forest managers with an alternative robust classification method for the rapid, effective assessment of areas affected and non-affected by the disease, thus enabling them to identify hotspots for conservation and plan control and restoration measures aimed at preserving black alder forests.