Complete Health Status Research Articles

The association between serum uric acid levels and CVD risk factors in patients with chronic kidney disease in a tertiary care center

Objective: This study aimed to investigate the association between serum uric acid (UA) levels and cardiovascular disease (CVD) risk factors in patients with chronic kidney disease (CKD) among King Abdulaziz University Hospital (KAUH) patients. Methods: This retrospective cross-sectional study collected patient information from the KAUH between January 2010 and December 2022. The study included the history of CKD and documented serum UA levels. Afterward, their demographics, comorbidities, smoking status, CKD stage, electrolytes, renal function test, lipid profile, and complete blood count (CBC), medication, and health status were assessed. Results: A study of 122 patients with CKD, mainly males (68%). CKD stage 5 showed a significant association with serum UA levels (beta = 128, 95% CI, 6.74 to 248, p = 0.041). Most patients were non-smokers (91.5%), with common conditions including heart failure, stroke, peripheral vascular disease, dyslipidemia, and gout. Nine patients died, with septic shock being the leading cause. No significant associations were found between serum UA levels and comorbidities. Calcium channel blockers (beta = 78.4, 95% CI, 32.1 to 125, p = 0.001) and diuretics (beta = 102, 95% CI, 25.8 to 179, p = 0.010) were significantly associated with serum uric acid levels, with a significant correlation observed among patients taking these medications. Conclusion: The study found CKD stage 5 patients had a significant association with elevated serum UA levels, but no correlation was found with CVD risk. The authors recommended prospective cohort studies, larger sample sizes, and extending research to different locations in future studies.

Abstract 13549: Plasma Metabolomics Identify Major Differences in Symptoms and Quality of Life Among Patients With Heart Failure

BACKGROUND: Plasma metabolites predict survival among patients with heart failure (HF), but symptom burden is critical, underpinning functional status and quality of life (QOL). The relationship of plasma metabolome and symptom or QOL phenotypes is not established. AIM: We conducted a latent class analysis to identify plasma metabolite patterns in relation to symptoms and QOL among HF patients. METHOD: A prospective HF registry collected baseline plasma for metabolomics and health status. A total of 13 metabolites (organic acids, amino acids, acylcarnitines) previously shown to predict survival were used in analyses. QOL and symptoms were quantified using the Kansas City Cardiomyopathy Questionnaire. Distinct metabolite patterns were identified using latent class mixture modeling. Linear regression tested the association of metabolite profile with QOL and total symptom scores controlling for age, gender, and NYHA class. One-way ANOVA characterized group differences. Results: A total of 1192 patient participants had complete metabolite and health status data for analysis. Among these patients, 62% were male, 48.5% self-identified as African-American and average age was 68 years (± 12). The majority (58%) were non-ischemic, 56% were NYHA Class I and comorbid conditions were common (90% hypertension, 72% hyperlipidemia, 43% diabetes). Three metabolite latent profiles (MLPs) were identified. MLP 1 had significantly higher NT-proBNP, worse functional class (72% NYHA 3-4) and lower ejection fractions (0.30 vs 0.35) compared with MLP 2 and 3. MLP class predicted symptoms (R 2 =0.39, F(7,1182)=F 107, p=0.006) and total QOL scores (R 2 =0.31, F(7, 1182)=F77.3, p=<0.001) controlling for age, gender and NYHA class. The magnitude of difference was high; among MLP 2 and 3 compared to MLP1, total symptom scores ranged 7-9 points better and QOL 12-15 points better. No differences in age, gender or race were found across MLPs. Conclusion: Three latent metabolite profiles were identified that independently associated with significant differences in symptoms and QOL. Considering a minimal clinically important difference in KCCQ scores is 5 points, our results demonstrated large differences in patient reported outcomes related to plasma metabolite profile.

Data Analytics and Visualization Application for Asset Health Monitoring

Much of the research on predictive maintenance has focused on statistical and machine learning techniques, while there has been significantly less focus on the human computer interaction or visualization aspects of PHM. Human computer interaction and visualization techniques can quickly help identify interesting data sub-domains, both time periods and sensors, provided the data can be queried, retrieved and displayed in a timely manner. Augmenting visualization and interaction with a visual, aggregative fleet-based query system adds a further dimension, highlighting the ability of the fleet to carry out its mission. In the age of big data, effectively visualizing data from an asset with a multitude of sensors can be difficult, and that difficulty is compounded as you add additional assets.
 In this paper, we propose a scalable framework that is capable of visualizing past, current, and prognosticated health from the individual sensor up to the fleet or group level. In addition to viewing near real time sensor data, maintenance logs, fault information, and data aggregations will be merged with the sensor data to make the analysis and visualizations more valuable. This framework is scalable in regard to how much data can be collected, stored, and processed, as well as to the different organizational levels within a fleet of assets. The framework is built as a web-application primarily using the following visualizations: a collapsible tree graph for asset information; 2D charts for temporal sensor data, fault data, and maintenance data; and 3D digital twins of critical components. 
 The current dataset used to build and demonstrate the capability of the web-application has data from over 3000 vehicles and contains approximately 9TB of data. Vehicle information such as model, make, sub-component, and fleet organization are presented in a configurable, collapsible tree structure. This allows the user to visualize the fleet and to select the asset and sensor combinations needed to display the temporal sensor data that will answer the question at hand. Information regarding each vehicle’s health status is displayed then aggregated and displayed for each of the higher tree nodes. A 3D digital twin is also available to highlight sensor locations and current health status of the component. These component models can be viewed and manipulated with and without a virtual reality headset. As health status monitoring for asset subcomponents are developed, they can be added to the system, allowing for complete health status reporting.

Advanced EHR system in homes-in-schools’ automation using internet of things and machine learning

Electronic Health Records (EHRs) are the health data collected and stored electronically for informative purposes in today’s healthcare to handle healthcare in patients’ hands, thereby reducing physical contact between healthcare seekers and providers. This paper reviews a complete health monitoring and health status reporting system using IoT technology to gather vital health statistics and machine learning to design an intelligent system. The proposed system will adopt IoT technology to collect health information from students in their residence and use a machine learning method to predict students’ health status from the institution’s Electronic Health Records before rendering health counselling services to students. It will also allow students to report health conditions to educational authorities on a complex Wireless Body Area Network to deploy Raspberry Pi 4B, sensors, cameras.

Abstract 17: Association Between Age And Health Status In Chronic Coronary Disease With An Initial Invasive Or Conservative Strategy: Insights From The ISCHEMIA Trial

Background: Patients with chronic coronary disease (CCD) and at least moderate ischemia who were randomized in the ISCHEMIA trial to an invasive strategy (INV) had greater benefit in angina-related health status during follow-up than with a conservative strategy (CON). Whether this benefit varies by age is unknown. Methods: Angina-related health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ; score range 0-100; higher score=less angina). Linear regression models assessed the association of treatment strategy (INV vs CON) with 1-year health status, including a treatment-by-age interaction using splines, adjusted for sex, ejection fraction, eGFR, diabetes, and baseline health status. Results: Among 4617 ISCHEMIA patients with complete health status data, mean age was 64±10 years; 2239 (48.5%) were <65, 1713 (37.1%) were 65-74, and 665 (14.4%) were ≥75. Baseline SAQ Summary scores were higher in patients aged 65-74 and ≥75 compared with those <65 (76.2 vs 75.4 vs 71.8 points). At 1 year, an INV strategy resulted in higher mean SAQ Summary Scores for all age groups but with greater benefit in younger patients (<65 vs 65-74 vs ≥75: +5.1 vs +2.5 vs +1.5 points). In adjusted analyses, the largest health status benefits of INV treatment were observed with younger age, with significant interactions between age and treatment strategy for SAQ Summary (p=0.007) and Quality of Life (QOL) scores (p=0.02) ( Figure ). At age 80, the benefits of an INV over CON strategy diminished for SAQ Summary Score, Physical Limitations, and QOL, despite increases in SAQ Angina Frequency scores. Similar trends were observed when patients without angina were excluded. Conclusion: CCD patients of all ages had better health status with an INV vs CON strategy, but these benefits were greater in younger patients and diminished with increasing age. These data suggest an initial CON strategy may be preferred in older patients with CCD, based on goals of care.

A Comparative Health Assessment of Occupationally Lead Exposed Individuals with Blood Lead Levels Range across Upper Acceptable Limit.

Lead (Pb) smelting workers are exposed to high lead levels and its adverse health effects. Despite no biological role, regulatory bodies regard blood lead levels (BLL) ≤40 µg/dL as upper acceptable limit in occupationally lead exposed population. To explore the differences in general health status of individuals with BLL ≤40 µg/dL and >40 µg/dL. All workers (n = 803) of age >18 years employed in a Pb smelting plant were interviewed with a semi-structured questionnaire to obtain sociodemographics, occupational details, followed by detailed clinical examination. 5 ml of venous blood was collected and BLLs were determined as per standard NIOSH method using GF-AAS technic. A complete general health status was performed including hemoglobin and blood pressure (BP). About 47.7% of the participants exhibited high BLL (>40 µg/dL), while the rest 52.3% were identified to have ≤40 µg/dL. Both groups were grossly similar in the majority of demographic and occupational parameters. Interestingly, both groups had substantially higher fraction of workers with elevated BP. Lead exposed workers with BLL ≤40 µg/dL are at equal risk of health hazards as those with BLL >40 µg/dL. There is a need to revisit the current guidelines on the BLL for workers to protect from the hazards of chronic lead exposure.

Complete mental health status and associations with physical activity, screen time, and sleep in youth

ProblemMental well-being can be conceptualized as two intersecting continua: mental illness (presence/absence of psychopathology) and mental health (flourishing/languishing). Together, mental illness and mental health combine to form an individual's complete mental health status (CMHS). The purpose of this study was to examine if CMHS is associated with adherence to the guidelines for moderate-to-vigorous physical activity (MVPA; 60 min), sleep (8–10 h) and recreational screen time (ST; ≤2 h) represented in the Canadian 24-h Movement Guidelines for Children and Youth (“Guidelines”) in adolescents. MethodsThis study reports cross-sectional student-level data from Year 6 (2017–18) of the COMPASS study. Canadian secondary school students (grades 9–12) completed questionnaires assessing their movement behaviours, flourishing/languishing (F/L), and high/low depressive symptoms (+DS/-DS). Students were classified into one of four CMHS groups: F/-DS, F/+DS, L/-DS, L/+DS. Generalized linear models were used to compare adherence to the guidelines between groups. ResultsA total of 29,133 students (49.8% female, Mage = 15.3yrs) were included. For ST and sleep, youth classified as L/+DS were less likely to meet Guidelines than youth categorized as L/-DS, F/+DS, and F/-DS. For MVPA, youth categorized as L/+DS were less likely to meet Guidelines than youth categorized as F/-DS or F/+DS. Individuals classified as L/-DS were less likely to meet the MVPA guidelines compared to L/+DS (ps < .0001). ConclusionThis is the first study examining relationships between CMHS and Guideline adherence. CMHS was associated with both ST and sleep. Youth who self-report flourishing were more likely to achieve MVPA guidelines irrespective of depressive symptoms. Such findings reinforce the need for research considering both mental health and mental illness when examining associations with movement behaviours in youth.

Complete mental health in elementary school children: Understanding youth school functioning and adjustment

Complete mental health is characterized by the presence of well-being and the absence of psychopathological symptoms. Studies on the influence of complete mental health on general school functioning and school adjustment among youth is limited, but existing literature has shown its potential positive effects. The purpose of this study is to investigate how complete mental health status influences school functioning and adjustment among elementary school children. The study included 362 grade 5–8 students (10–14 years of age) from a public school in an urban city of Turkey. A series univariate analysis of variance (ANOVA) was performed to investigate the differential effects of mental health status on youth school functioning and adjustment. The largest proportion of the participants was classified into the complete mental health group (n = 246, 68%), followed by vulnerable, troubled, and symptomatic–but–content groups. Post hoc comparison results showed that the complete mental health group felt greater connection to their school, had better academic functioning, showed more prosocial behaviors, and reported less bullying and victimization in school than the other groups. These results suggest that identifying both psychological distress and wellbeing is integral to understanding the overall adjustment and functioning of students in school settings.

Health status of care home residents: practicality and construct validity of data collection by staff at scale

BackgroundMedical diagnoses and assessed need for care are the prerequisites for planning and delivery of care to residents of care homes. Assessing the effectiveness of care is difficult. The aim...

Efficacy of pentosan polysulfate in in vitro models of lysosomal storage disorders: Fabry and Gaucher Disease.

Gaucher and Fabry diseases are the most prevalent sphingolipidoses. Chronic inflammation is activated in those disorders, which could play a role in pathogenesis. Significant degrees of amelioration occur in patients upon introduction of specific therapies; however, restoration to complete health status is not always achieved. The idea of an adjunctive therapy that targets inflammation may be a suitable option for patients. PPS is a mixture of semisynthetic sulfated polyanions that have been shown to have anti-inflammatory effects in mucopolysaccharidosis type I and II patients and animal models of type I, IIIA and VI. We hypothesized PPS could be a useful adjunctive therapy to inflammation for Gaucher and Fabry diseases. The objective of this work is to analyze the in vitro effect of PPS on inflammatory cytokines in cellular models of Gaucher and Fabry diseases, and to study its effect in Gaucher disease associated in vitro bone alterations. Cultures of peripheral blood mononuclear cells from Fabry and Gaucher patients were exposed to PPS. The secretion of proinflammatory cytokines was significantly reduced. Peripheral blood cells exposed to PPS from Gaucher patients revealed a reduced tendency to differentiate to osteoclasts. Osteoblasts and osteocytes cell lines were incubated with an inhibitor of glucocerebrosidase, and conditioned media was harvested in order to analyze if those cells secrete factors that induce osteoclastogenesis. Conditioned media from this cell cultures exposed to PPS produced lower numbers of osteoclasts. We could demonstrate PPS is an effective molecule to reduce the production of proinflammatory cytokines in in vitro models of Fabry and Gaucher diseases. Moreover, it was effective at ameliorating bone alterations of in vitro models of Gaucher disease. These results serve as preclinical supportive data to start clinical trials in human patients to analyze the effect of PPS as a potential adjunctive therapy for Fabry and Gaucher diseases.

Patient Satisfaction with Collection of Patient-Reported Outcome Measures in Routine Care.

Systematic collection of patient-reported outcome measures (PROMs) during ambulatory clinic visits can enhance communication between patient and provider, and provide the ability to evaluate outcomes of care. Little is known about patient satisfaction of PROM data collection in routine clinical care. To evaluate patient reaction to the routine collection of PROMs in the ambulatory setting. Before all ambulatory clinic visits at our neurological institute, patients electronically complete health status questionnaires. We administered an 8-question patient satisfaction survey to a sample of patients seen across the institute after their clinical visit. Of 343 patients approached, 323 agreed to participate. The majority responded that the questionnaire system was easy to use, was an appropriate length, and benefited their care overall (strongly agree or agree=92.3%, 87.6%, and 77.3%, respectively). Provider review of the PROMs with the patient during the clinic visit was associated with significantly higher positive responses to all questions, even those regarding logistical aspects of the collection process. There were significant age and race differences in response to perceived benefit: those in the Black/other race category had a markedly lower probability of viewing the process favorably with increasing age. Systematic collection of PROMs via an electronic questionnaire appears to be well accepted by patients. A minority of patients did not feel the questionnaire content applied to their appointment or that the system was a beneficial feature of the clinical practice. The provider can significantly improve the patient's perception of PROM collection and the patient-physician encounter by reviewing the questionnaire results with the patient.

Physical health conditions and quality of life in adults with primary immunodeficiency diagnosed during childhood: A French Reference Center for PIDs (CEREDIH) study

Most children with primary immunodeficiencies (PIDs) now reach adulthood. However, few studies have evaluated their health status and health-related quality of life (HRQoL). To investigate long-term morbidity, the French Reference Center for PIDs initiated a prospective multicenter cohort: the French Childhood Immune Deficiency Long-term Cohort. The data collected were used to assess the physical health condition of patients who reached adulthood and the effect on their quality of life. Patients were asked to complete health status questionnaires. Aseverity score (grade 1 [mild] to grade 4 [life-threatening]) was assigned to each health condition. The HRQoL of patients was compared with age- and sex-matched French normal values by using the 36-item Short-Form Survey (SF-36) HRQoL questionnaire. Among 329 participants, the mean age at evaluation was 27.6years, with a 21-year mean follow-up after diagnosis; 43% reported at least 1 grade 4 health condition, and 86% reported at least 1 grade 3 (severe) or 4 health condition. Twenty-five (7.6%) patients had been treated for cancer. Compared with the French normal values, adults with PIDs scored significantly lower for all HRQoL domains. HRQoL was strongly associated with the burden of health conditions. The association with grade 4 or grade 3-4 health conditions was highly significant for all physical and mental domains. Adults with PIDs diagnosed during childhood experienced a heavy burden of health conditions, which affected their HRQoL. Our results emphasize the need to closely monitor this vulnerable population.

El plan de alta de enfermería y su impacto en la disminución de reingresos hospitalarios

En 1984 surgió el plan de alta en enfermería en Estados Unidos. Éste fue incluido dentro del sistema Medicare con el propósito de reducir los costos del sistema de salud, por lo que este se extendió rápidamente a Europa y América Latina. En México existen pocos estudios sobre al plan de alta en enfermería, por lo que es necesario evaluar la trascendencia y el impacto de su aplicación. Material y métodos: Se realizó un estudio transversal, descriptivo y cuantitativo en un hospital de tercer nivel. La población de estudio fueron las enfermeras con licenciatura del turno matutino. El instrumento de recolección estuvo dividido en cuatro apartados (datos generales, elaboración y contenido del plan, así como el impacto de su aplicabilidad). Resultados: Las recomendaciones del plan de alta se centran en: los medicamentos, los signos y síntomas de alarma, los cuidados en el hogar y las medidas higiénico-dietéticas con 81%. Los profesionales de enfermería lo aplican de forma oral y escrita en 79%. Más de 50% no registra esta actividad en el expediente clínico. Su aplicación contribuye con el derecho que tienen los pacientes de estar informados, además del impacto en los reingresos hospitalarios. Conclusiones: La aplicación del plan de alta en enfermería es una de las formas para fomentar la reintegración del paciente a la sociedad, ya que nos proporciona una visión completa, rápida y veraz del estado de salud del paciente.

Prophylaxis and treatment of infections in elderly patients with rheumatism

In general, the risk of serious infections increases with age, mainly explained by immunosenescence and accumulation of comorbidities. Those patients with rheumatoid arthritis who are of advanced age and require treatment with immunosuppressive agents are at particular risk to develop an infectious disease. Actual requirement and kind of treatment on the one hand, and risk of infection on the other hand, have to be considered carefully for each patient. For example, in high-risk patients, it is important to use glucocorticoids in a minimal way, i.e. in low doses and as short as possible. Vaccination, especially against influenza and pneumococci, plays an essential role in preventing infectious diseases, particularly in the elderly. Nevertheless, in cases of suspected bacterial infection, empiric antibiotic therapy should be started promptly. Due to the burden of drugs taken by patients of advanced age, the benefits and possible side effects as well as potential drug interactions have to be carefully considered. In summary, drug treatment of the elderly requires bearing in mind the complete health status of the individual patient.

Patello-femoral cartilage damage: patients with grade 4 chondral defects of the patella have increased disability

Patello-femoral cartilage damage: patients with grade 4 chondral defects of the patella have increased disability

Abstract 15: Temporal Trends of Drug Eluting Stent Use After Myocardial Infarction: Does More Selective Utilization Impact Health Status Outcomes?

BACKGROUND Despite widespread acceptance of drug eluting stents (DES), concerns about cost and safety contributed to lower DES use by late 2006, particularly in off-label scenarios such as acute MI. The population-level impact of this trend on health status is unknown. METHODS We evaluated Seattle Angina Questionnaire (SAQ) scores among patients (pts) undergoing in-hospital PCI in TRIUMPH, a 24-center registry of acute MI. For each 3-month period of enrollment, we calculated the frequency of DES use and the mean 6-month Angina Frequency (SAQ-AF) score for pts treated that quarter. We then constructed a linear regression model to evaluate whether DES use, or time periods of high vs. low DES use, were independently associated with 6-month SAQ-AF scores. RESULTS Among 1744 MI pts undergoing PCI with complete health status assessments, 1033 were treated with DES (59%). DES use decreased significantly in late 2006, but overall 6-month angina burden remained stable ( Figure ). After adjusting for multiple clinical factors, SAQ-AF scores exhibited a borderline association with DES use (ß-coefficient 1.86 ± 1.0, p=0.06). When dichotomizing pts into years with high (2005-06) and low (2007-08) DES use, there was no relationship between high vs. low DES use on SAQ-AF in the multivariable model (ß=0.01 ± 1.0, p=0.99). CONCLUSION More selective use of DES after 2006 has not impacted population-level angina control at 6 months among MI pts treated with PCI. This suggests that clinicians were able to reduce DES use through better selection of those pts most likely to benefit from DES therapy, but further research is needed to better understand the processes of care associated with these findings.

Health Status Adjustment and Income-Related Inequality in Health Care Delivery

The literature on equity in health care delivery agrees that adjusting for “medical need” is a necessary component in assessing whether the delivery of care is equitable, that is, whether it varies with ability to pay. To date, most studies measuring income-related inequality in the delivery of health care have employed crude measures of health status to adjust for medical need and have acknowledged this as a limitation. This study examines how using more complete health status measures affects estimates of income-related inequality for U.S. adults. The findings suggest that previous studies may understate the extent of pro-rich inequality.

Effect of interferon-alpha treatment of chronic hepatitis C on health-related quality of life.

Studies of interferon-alpha (IFN-alpha) therapy for chronic hepatitis C have focused on viral clearance; however, few have evaluated patient's health-related quality of life during therapy. This study evaluates health-related quality of life and the prevalence of anxiety and depression in patients with chronic hepatitis C before, during, and following IFN-alpha therapy. Patients undergoing IFN-alpha therapy for chronic hepatitis C were asked to complete health status measures as well as anxiety and depression inventories before, during, and following IFN-alpha therapy. These measures were compared to the results of healthy adults in the general US population. Thirty-eight of forty-eight eligible patients (79%) with chronic hepatitis C completed the questionnaires. Respondents demonstrated a significant increase in depression during the sixth month of interferon therapy in comparison to pretreatment results. Anxiety scores improved significantly after one month of IFN-alpha in comparison to pretreatment results. Scores on the health status measures did not vary with IFN-alpha therapy. Patient responses were analyzed with respect to biochemical response (normalized transaminases) to IFN-alpha. IFN-alpha responders, who were aware of their transaminase results, exhibited lower scores on anxiety subscales during and after therapy (P = 0.02-0.04). Scores on the health status subscale, role emotional, improved in IFN-alpha responders compared to nonresponders during the sixth month of therapy (P = 0.02). Response to IFN-alpha therapy was not associated with any other differences on subscale analysis. Patients with chronic hepatitis C exhibited health perceptions similar to the general US population, and these were unchanged during IFN-alpha therapy. However, the incidence of depression significantly increased during the sixth month of IFN-alpha therapy. IFN-alpha responders exhibited fewer emotional problems as well as a lower incidence of anxiety during and following therapy.