Chronic Disease Conditions Research Articles

Decomposing differences in the chronic disease condition between rural and urban older adults in China: a cross-sectional analysis.

With the increasing in aging in China, there has been an increase in older adults suffering from chronic diseases. However, little is known about the differences in chronic disease conditions between rural and urban older adults. The objective of this study is to identify chronic disease conditions and investigate the factors that cause differences in chronic disease conditions between urban and rural older adults. The data are from the fourth wave of the China Health and Retirement Longitudinal Study. The coarsened exact matching (CEM) method was used to reduce the biases for a comparative study. After the CEM method, this study included 5,927 participants aged 60 and above. Chronic disease condition was used as the indicator to measure the health of older adults. Specifically, Fairlie's decomposition analysis was carried out to discover the differences in chronic disease conditions between urban and rural older adults. The study showed that the proportion of those suffering from chronic diseases was significantly higher among urban older adults (51.26%) than rural older adults (46.56%). In those suffering from chronic diseases, there were significant differences in gender, education level, minorities, religiosities, duration of sleep, drinking alcohol, social activity, insurance, and socioeconomic status between rural and urban older adults, while in those not suffering from chronic diseases, there were significant differences in age, education level, marital status, drinking alcohol, social activity, insurance, region, and socioeconomic status between rural and urban older adults. For rural older adults, those who were widowers [Odds ratios (OR): 1.267], who drink alcohol (OR: 1.421), and having government medical insurance (OR: 4.869) had higher odds of having chronic diseases. However, those who were in high school and above (OR: 0.802), reporting a duration of sleep of 4-8 h (OR: 0.745) or above 8 h (OR: 0.649), having social activity (OR: 0.778), and having the most affluent socioeconomic status (OR: 0.778) had lower odds of having chronic diseases. As for urban older adults, those who were aged 65-74 years (OR: 1.246) and had government medical insurance (OR: 2.362) had higher odds of having chronic diseases. Fairlie's decomposition analysis indicated that 23.57% of the differences in chronic diseases conditions could be traced to duration of sleep, drinking alcohol, social activity, and region. This study illustrated that the proportion of chronic diseases was higher among urban older adults than rural older adults. Considering duration of sleep, drinking alcohol, region, social activity, and region, the study demonstrated health differences between urban and rural older adults and provided evidence for policy-making to narrow the health gap between urban and rural areas.

Factors Influencing the Use and Demand of New Coronavirus Therapy Drugs Among the Adults During COVID-19 in China.

This alteration in the policy of COVID-19 resulted in widespread infections throughout China. Most people only need some antiviral drugs such as lopinavir/ritonavir or Chinese herbal preparations for treatment. In this context, the lack of drug knowledge and inadequate drug availability are evident. This study aims to explore the factors influencing drug use and demand during the COVID-19 epidemic. This study used quota sampling based on gender, age, and place of residence to perform a cross-sectional survey on a sample of 771 adults. The researchers used chi-square tests to understand differences in drug use and demand across characteristics, and binary logistic regression to analyse the influencing factors. The study revealed that 85.9% of the participants used drugs following the COVID-19 infection. Participants with college and above, (OR=2.49, 95% CI=1.27-4.88) annual personal income between 30,000 and 80,000CNY (OR=2.19, 95% CI=1.35-3.55) and over 80,000CNY (OR=1.96, 95% CI=1.05-3.66) were more knowledgeable about using drugs. Gender, (OR=0.69, 95% CI=0.50-0.95) age, (OR=2.11, 95% CI=1.15-3.88) residence, (OR=1.58, 95% CI=1.06-2.37) chronic disease conditions (OR=0.46, 95% CI=0.27-0.78) and infection symptoms (OR=0.60, 95% CI=0.38-0.93) as factors influencing the need for drug delivery services. (P<0.05). Research has revealed that a significant proportion of infected people in China chose drug treatment during COVID-19. Individuals with severe symptoms use more medication and require more drug delivery and storage. Low-education and low-income populations are lacking in drug knowledge, and older adults with underlying medical conditions are more likely to need drug delivery services. Therefore, governments should prioritize vulnerable groups when formulating drug policies and target drug literacy and guidance. In addition, it is recommended that a drug distribution system be set up within the community so that those in need can have quick and easy access to drugs.

The unsuspected source of oxygen in Crohn´s Disease

Crohn disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. Presenting symptoms are often variable and may include diarrhea, abdominal pain, weight loss, nausea, vomiting, and in certain cases fevers or chills. in some cases, extraintestinal manifestations may develop. The diagnosis is typically made with endoscopic and/or radiologic findings. Disease management is usually with pharmacologic therapy; however, most patients will eventually require surgery for their disease. Crohn disease can affect any part of the gastrointestinal tract. About one-third of patients have small bowel involvement, especially the terminal ileum, another 20% have only colon involvement and about 50% be involved of both the colon and small bowel. So far, there is no cure, and most patients experience bouts of remissions and relapse at unpredictable times. This disease leads to very poor quality of life. Our observation that our body does not take oxygen from the air, but from intracellular water, like plants, implies rethinking the etiopathogenesis of the disease. Crohn's disease, because until now, the interpretation of clinical findings is because we take oxygen from the air, when the purpose of breathing is only to expel the CO2 that is continually formed inside our body.

Variables Associated With Moderate to High Loneliness Among Individuals Living With Spinal Cord Injuries and Disorders

ObjectiveTo identify variables independently associated with moderate to high loneliness in individuals living with Spinal Cord Injuries or Disorders (SCI/D). DesignA cross-sectional, national survey of a random sample of community-dwelling Veterans with SCI/D in the United States. Survey methodology was used to collect data on demographic and injury characteristics, general health, chronic and SCI-secondary conditions, and loneliness. SettingThe VHA SCI/D System of Care including 25 regional SCI/D Centers (or Hubs). ParticipantsAmong 2466 Veterans with SCI/D, 592 completed surveys (24%). Most participants were men (91%), white (81%), not currently married (42%), had tetraplegia (33%), and on average injured for 18 years at the time of data collection (N=562). InterventionsNot applicable. Main Outcome MeasureThe dependent variable, loneliness, was collected using the UCLA-3 instrument. Loneliness was dichotomized into never/low loneliness and moderate/high loneliness (UCLA score ≥ 4). ResultsBivariate analyses assessed unadjusted associations in demographics, injury characteristics, chronic disease, and SCI-secondary conditions. Multivariable logistic regression was used to identify factors independently associated with moderate/high loneliness. Participants had a mean loneliness score of 5.04, SD=1.99. The point prevalence of moderate to high loneliness was 66%. Lower duration of injury, paraplegia, being unmarried, being in fair/poor general health, having dysfunctional sleep, and having a diagnosis of bowel dysfunction were each independently associated with greater odds of moderate/high loneliness. ConclusionsFindings suggest that interventions to reduce/manage loneliness in the Veteran SCI/D population should focus on those who are more newly injured, have paraplegia, currently unmarried, have bowel problems, and experience dysfunctional sleep.

Determinants of Oral Health-Related Quality of Life in Older People with Diabetes Mellitus: A Secondary Analysis of the 8th Korean Longitudinal Study of Aging (KLoSA) Dataset

Purpose : This study aimed to comprehensively evaluate the factors that influence the oral health-related quality of life (OHRQoL) of older adults with diabetes mellitus (DM) using the 8th Korean Longitudinal Study of Aging (KLoSA) dataset. Methods : This secondary analysis utilized the 8th KLoSA dataset from 2020, with a study sample of 1,144 older adults with DM. Dependent variable: OHRQoL; independent variables categorized into socio-demographic, oral health-related, and health-related characteristics. Complex Samples General Linear Model and Bonferroni correction in IBM SPSS/Win 26.0 were employed for assessing factors influencing OHRQoL. Results : The average OHRQoL was 33.96±0.28 points out of 60. Factors influencing OHRQoL included subjective health status (good: t＝3.00, p＝.003; moderate: t＝4.38, p＜.001), wearing dentures (yes) (t＝ -2.89, p＝.004), having heart disease (t＝-2.50, p＝.013), having arthritis (t＝-2.19, p＝.028), and experiencing depression (t＝-4.28, p＜.001). These factors explained approximately 20% of OHRQoL in older adults with DM. Conclusion : To enhance OHRQoL in older adults with DM, it is crucial to consider psychological factors such as depression in the development of continuous oral health management programs. Additional factors to consider include effective denture management and chronic disease conditions.

THE EFFECT OF THE INCLUSION OF FIRST AID IN TEACHER EDUCATION

This article aims to analyze, through a questionnaire, future teachers’ knowledge and opinions regarding first aid, and to assess the inclusion of a mandatory first-aid course, the content of which was influenced by statistical data of the South Bohemian Emergency Medical Service and teachers’ statistics (Hrušková et al., 2022). Students of the Faculty of Education (N=227) from South Bohemia (municipalities with different populations and, with regard to the gender ratio in students, mostly women) filled out questionnaires before and after a first-aid course in 2023. Through the questionnaire survey (a) significant differences were found in the mean values of knowledge of first aid in sum between all subgroups of students (p≤0.05), (b) in the level of knowledge of first aid for cardiopulmonary resuscitation (CPR), traumas, and acute conditions of chronic diseases (p≤0.05), and (c) in the level of knowledge of each first-aid item individually (p≤0.05). In general, completing our first-aid course is essential for all our students (p≤0.05), even for those who have already completed some previous first-aid course.

Prevalence, prescription patterns, and quality of life of anaemia in adults with chronic renal disease

Introduction and aim. Anaemia is a chronic kidney disease (CKD) condition characterised by a decline in glomerular filtration rate (GFR) and impaired kidney function. The aim of this study was to assess the prevalence, prescribing patterns, and quality of life of anaemia in patients with chronic renal disease who were adults (&gt;18 years of age) at a tertiary care hospital. Material and methods. Data on demographic characteristics, laboratory results, medication prescriptions, and quality of life assessments were collected. Statistical tests were performed to determine associations between anaemia prevalence and factors like age, gender, and CKD stage. The study included 132 patients, with a gender distribution of 89 men and 43 women. Results. The most frequently prescribed drugs are epoetin (15.06%), multivitamins (14.82%), iron (10.65%), folic acid (10.22%), calcium carbonate (8.17%), calcitriol (5.6%), and omeprazole (4.22%). The cardiovascular system, blood disorders, and blood-producing organs come after the gastrointestinal tract and metabolism in the first anatomical level of the ATC classification. Conclusion. It suggests hospital audits and recommendations for improved prescription practices. Further investigation into anaemia causes and drug class appropriateness is needed, and implementing improvements could potentially improve health outcomes.

THE BOSTON HOSPITAL-IN-HOME PROGRAM—A LOCAL PERSPECTIVE

Abstract The Hospital-in-Home (HIH) model provides patient centered care, may reduce complications and costs. VA Boston Healthcare System (VABHS) planned its HIH program in 2018 and enrolled its first patient in May 2019. HIH provided care to 45 patients in 2019 which grew to 185 in 2022. The team is comprised of 2 clinicians (a hospitalist physician and a physician assistant), a nurse manager, 5 registered nurses (RN), a social worker and a pharmacist. The program practices complementary HIH (admissions from inpatient care) and substitutive care (all other admissions). At this time, majority of the recruitment comes from the inpatient services, followed by heart failure and primary care clinics. The program catchment area is about 25 miles from the West Roxbury campus of VABHS. A hybrid visit approach is taken for clinician visits - initially, the veteran is seen in person or by video by the clinician on admission to the program. Subsequent visits are done with RN assessments in the home and the clinician conducting the visit by telephone or video. In FY 2021, conditions of patients treated by HIH include congestive heart failure (50%), chronic obstructive pulmonary disease (14%), wound care (6%), diabetes (2%) and other conditions (20%). In FY 2022, the average daily census was 15.9 veterans and average visits per day 4.8. The HIH program outcomes include reduction of bed days of acute care in the hospital and reduction in the use of unnecessary medications through deprescribing which may translate to cost avoidance for the medical center.

Evaluation of Physical Activity Assessment Using a Triaxial Activity Monitor in Community-Dwelling Older Japanese Adults With and Without Lifestyle-Related Diseases

Background: Several previous studies investigated physical activity of older adults using wearable devices, but more studies need to develop normative values for chronic disease conditions. This study aimed to investigate physical activity using a triaxial activity monitor in community-dwelling older Japanese adults with and without lifestyle-related diseases. Methods: Data from a total of 732 community-dwelling older Japanese men and women were collected and analyzed in a cross-sectional study. The participants’ physical activity was assessed for seven consecutive days by a triaxial accelerometer. Physical activity was assessed by number of lifestyle-related diseases and six lifestyle-related diseases categories by gender. Physical activity was assessed separately for total, locomotive, and nonlocomotive physical activity. Results: Participants with multiple (two or more) diseases had significantly lower total light-intensity physical activity (LPA; 278.5 ± 8.4 min/day) and nonlocomotive LPA (226.4 ± 7.0 min/day) versus without diseases in men. Compared in each disease category, total LPA and nonlocomotive LPA was significantly lower in men with hypertension and diabetes. Total sedentary time was significantly higher in men with hypertension, diabetes, and heart disease. Locomotive LPA was significantly lower in men with diabetes. In women, locomotive moderate- to vigorous-intensity physical activity was significantly higher in women with diabetes, and nonlocomotive moderate- to vigorous-intensity physical activity was significantly lower in women with heart disease. Conclusion: This study demonstrated that older Japanese men with multiple lifestyle-related diseases had lower physical activity. In each disease category, hypertension, diabetes, and heart disease affected lower physical activity, especially in men.

Evaluation of Exercise Mobile Applications for Adults with Cardiovascular Disease Risk Factors.

To conduct a systematic review to determine if there are exercise mobile applications (apps) that can produce evidence-based, individualized exercise plans. We searched the Apple Store and Google Play for exercise apps with terms related to exercise and health. Exercise apps were eligible if they: (1) had a ≥4 out of 5 overall rating with ≥1000 reviews; (2) were free to download; and (3) were not gender specific. Exercise apps were evaluated via the evidence-based exercise prescription (ExRx) standards of the American College of Sports Medicine (ACSM) and American Heart Association. For the exercise app evaluation criteria, an app was included if it (1) was evidence-based; (2) contained a preparticipation health screening protocol; (3) built a cardiovascular disease (CVD) risk factor profile; (4) prioritized one chronic disease or health condition to focus on; (5) framed the exercise plan by the frequency, intensity, time, and type principle (FITT) of ExRx; and (6) specified special considerations. Of the 531 potentially qualifying apps, 219 qualified. The qualifying apps were rarely evidenced-based (0.5%) or had a preparticipation screening protocol (3.7%). Only 27.7% built CVD risk factor profiles. Most apps (64.8%) focused on body image and/or athletic performance. Only 4.3% focused on chronic diseases or health conditions, while the remainder (34.5%) did not disclose a focus. No app framed the exercise plans by the FITT of ExRx. Only 1.4% of the apps specified special considerations. There are no commercially available exercise apps that generate an evidence-based, individualized exercise plan for adults with CVD risk factors.

Shared Decision-Making Aids for Pediatric Chronic Hematological and Non-Hematological Conditions: An in-Depth Literature Review

Background: Shared Decision Making (SDM) is a core component of facilitating patient-centered care. When implementing SDM, patients, parents and clinicians make health decisions together, ensuring that families are informed to make decisions based on their values and preferences. This is of particular importance among children and adolescents with chronic conditions, who are often presented with health-related decisions that can have social and psychological implications. Despite increasing recommendations for use of SDM tools, evidence-based recommendations regarding their use in clinical practice are limited. Studies suggest that barriers to SDM implementation include poor quality of information tailored to children and their families, the emotional state of the patients and their families (denial, anxious, overwhelmed, etc.), power imbalance with health care providers, and insufficient time from heavy physicians' workloads. Due to its limited implementation in clinical practice, little is known about proper approaches and outcomes of SDM tools among children and adolescents with chronic conditions. Objectives: To evaluate and summarize the literature related to how SDM tools are being studied and implemented children and adolescents with chronic medical conditions and how they influence decision making and health outcomes. Methods: A literature search was conducted for publications written in English from 2013-2023 using PubMed, MEDLINE, and Google Scholar. Search terms included “shared decision making”, “decision aid,” “pediatrics,” “infant,” “child,” “adolescents,” and “chronic conditions” to ensure adequate representation of the available literature. Relevant articles included those that covering SDM in hematological and non-hematological chronic conditions in pediatrics. Results: Out of 171 studies identified through literature search, 35 were included. Areas in which SDM has been most studied included hematologic and oncologic conditions (n=5), asthma (n=8), autism, other neurodevelopmental disorders (n=6), Obstructive Sleep Apnea (n=4), inflammatory bowel disease (n=1), chronic kidney disease (n=2), and diabetes (n=2), organ failure (n=3), and other conditions (n=4). Of those, 20 studies were descriptive and 15 had an experimental intervention design. Only 4 studies focused on the child's role in SDM while others focused on parent or caregiver role. Implementation of SDM toolkits and patient portals help decrease asthma exacerbations and emergency room visits. Similar toolkits and decision aids developed for decision making in hematologic and respiratory disease have shown reduced decisional conflict regarding treatment choice. In contrast, researched tools developed for diabetes patients did not show improved outcomes but did reduce decisional conflict. Results demonstrate that although patient with greatest functional neurodevelopmental impairment experience less SDM, its use leads to significant improvements in severity of their condition, behavioral, and psychoeducational levels. Research on hematological conditions such as sickle cell, thalassemia, and immune thrombocytopenia all show that their patients are not experiencing SDM, or it's limited to moderate amounts. Both children and parents desire to become more active members of the decision-making progress. Perspective of physicians show that they understand this desire but face barriers such as poor quality of available information, lack of time, or the family's emotional state. Effective training tools are being studied to help enhance SDM care and overcome these obstacles. Conclusions: There is limited evidence for the implementation of pediatric-focused SDM tools in hematological and non-hematological chronic conditions. Published studies in pediatrics have been mostly descriptive and have placed little emphasis on implementation and effectiveness of shared decision-making interventions. Barriers and facilitators to SDM have been explored, but a gap in knowledge still exists regarding the proven methods for SDM. In general, available studies showed benefit in patients' health outcomes, satisfaction with decision making, and treatment adherence. Future research should involve the implementation of patient-centered SDM aids in efforts to overcome known barriers and to establish evidence-based guidelines for their use.

Traceability and Characteristic Investigation of Burkholderia Gladioli Bloodstream Infection in Patients with Hematologic Malignancies

*Drs. Mei Hong and Qiuling Wu are co-corresponding authors Background and aims: Bone marrow suppression and mucosal damage caused by high-dose chemotherapy, and the application of immunosuppressive agents after transplantation lead to immune deficiency of patients with hematologic malignancies, who are susceptibility to opportunistic pathogen infections . Burkholderia gladioli, widely known as B. cocovenenans in the public eye, is an extraordinary Burkholderia specie causing acute lethal food poisoning by producing toxoflavin (TF) and lethal bongkrekic acid (BA). It is also an opportunistic pathogen causing clinical infections in newborn infants and patients with cystic fibrosis, chronic granulomatous disease, mechanical ventilation and other immunocompromising conditions, but its source of infection and pathogenic mechanism are still not clear. This study investigated the source of B. gladioli bloodstream infection in patients with hematologic malignancies and demonstrated the antibiotic sensitivity, biological characteristics, and genetic characteristics of B. gladioli strains, providing guidance for clinical treatment and improving patient prognosis. Methods: Nanopore-targeted sequencing (NTS) was used to rapidly detect pathogens in the peripheral blood of patients, and MALDI-TOF MS was used to identify blood culture pathogens. Samples were taken from locations and things associated with patients including medical equipment, inpatient environment, food, and biological specimens. Multilocus sequence typing (MLST) analysis was used to detect the genotypes of B. gladioliDNA. The K-B assay was used to detect bacterial antibiotic sensitivity. The dilution-coated plate method was used in the in vitro phenotyping experiments. Whole-genome sequencing (WGS) was used for the identification and comparation of B. gladioli strains. Results: In this study, NTS and culture of peripheral blood were routinely carried out in patients with hematological malignancies when they gone through febrile neutropenia due to immune deficiency. When patients confirmed positive for B. gladioli bloodstream infection, traceability sampling and PCR verification were conducted from locations and things associated with patients including medical equipments, inpatient environments, food, and biological specimens. Results showed strong B. gladioli abundance in foods (rice, corn flour), but medical equipment and inpatient environment showed no B. gladioliexistence. Furthermore, MLST sequencing confirmed that B. gladiolibloodstream infections was originated from contaminated foods. More important, WGS analysis found that clinical B. gladioli strains isolated in this study were totally lacked of lethal bongkrekic acid (BA) gene clusters and partially lacked of the toxoflavin gene clusters. Antibiotic susceptibility tests revealed that the clinical strains were susceptible to cefazoxime, ciprofloxacin, levofloxacin, trimethoprim/sulfamethoxazole, cefalexin, cefoperazone/sulbactam, meropenem, imipenem, piperacillin/tazobactam, amikacin, tobramycin, minocycline hydrochloride, tigecycline and resistant to polymyxinB, ampicillin, cefazolin, cefuroxime, aztreonam, and cefoxitin. Phenotyping experiments found that B. gladioli strains didn't induce hemolysis but exhibited stronger thermal stability and ultraviolet (UV) stability compared with the standard B gladioli strain and lethal B gladioli strain. Conclusions: Foodborne B. gladioli strains in this study exhibited low toxicity and high thermal stability and caused opportunistic bloodstream infections of hematologic malignant patients in immunodeficient states, which deserves our attention. Its special biological characteristic might be attributed to whole and partial loss of toxigenic gene clusters. Clinical B gladioli strains are resistant to polymyxinB, but the standard B gladioli strain and lethal B gladioli strain are susceptible to it, indicating acquired resistance during colonization and empirical antibiotic therapy. Clinicians should strengthen the dietary management of inpatients to avoid the occurrence of foodborne infections.

Comparison of different sustained-release opioids and acute respiratory conditions in patients with cancer and chronic kidney disease.

Few data are available on the association between the use of oxycodone in patients with chronic kidney disease (CKD) and acute respiratory conditions. The aim of this study was to investigate whether oxycodone is associated with an increased risk of acute respiratory conditions in patients with cancer and CKD compared with other opioids. The data were obtained from a claims database in Japan. Patients with cancer and CKD who had received sustained-release opioids, including oral oxycodone, oral morphine, or transdermal fentanyl, between April 2014 and May 2021 were selected. The primary outcome was defined as an acute respiratory condition. Data for age and sex, morphine equivalent daily dose, concomitant use of specified medications, comorbidities defined based on the modified Charlson comorbidity index, substance use disorder, and lung cancer or metastatic lung cancer were investigated as covariates. Distribution of acute respiratory conditions was compared among the three sustained-release opioid groups using the log-rank test. Estimates of the incidence of acute respiratory conditions were compared among the groups using a Cox proportional hazards model with time-varying variables. A significant difference in the distribution of acute respiratory conditions was found among the three groups (p < 0.01). Cox regression analysis showed a significantly higher risk of acute respiratory conditions with morphine (hazard ratio [HR]: 3.04, 95% confidence interval [CI]: 1.07-8.65, p = 0.04) compared with oxycodone but no significant difference in risk with oxycodone (HR 0.67, 95% CI: 0.32-1.38, p = 0.27) compared with fentanyl. The findings suggest that the risk of acute respiratory conditions may be lower in patients with CKD who use oxycodone for cancer pain than in those who use morphine. Additionally, no difference in the risk of acute respiratory conditions was found between oxycodone and fentanyl use.

Mapping a comprehensive assessment tool to a holistic definition of health for person-centred care planning in home care: a modified eDelphi study

BackgroundResearchers in the Netherlands proposed the Pillars for Positive Health (PPH) as a broadly encompassing health definition to support more realistic and meaningful care planning for people living with chronic disease and other life-long health conditions. The PPH was subsequently converted to the My Positive Health (MPH) spider web visualization tool. This study sought to identify opportunities for more person-centred care planning at the point of care in home care, using the MPH tool as a framework to link comprehensive assessment and dialogue-based goal-setting.MethodsA modified eDelphi method was used to conduct domain mapping with a purposively sampled expert panel (n = 25). The panel consisted of researchers, health care providers, older adults and caregivers. A two-stage eDelphi process was conducted, with each stage consisting of three survey rounds. In the first stage, participants were asked to map 201 elements of the interRAI Home Care (interRAI HC) comprehensive assessment tool to the six MPH domains or “No pillar of best fit”. The second stage focused on identifying opportunities to adapt or expand comprehensive assessment as it relates to the MPH domains.ResultsIn Stage 1, 189 of 201 elements reached consensus in domain mapping. These included: 80 elements for Bodily Functions, 32 for Daily Functioning, 32 for Mental Wellbeing, 24 for Quality of Life, 10 for Participation, and 1 for Meaningfulness. Ten elements were identified to have no pillar of best fit. The 12 elements that did not reach consensus in Stage 1 formed the basis for Stage 2, where expert panel participants proposed four new assessment elements in Meaningfulness and Participation and 11 additional descriptors across the six MPH domains. Of these, two elements and nine of the 11 descriptors reached consensus.ConclusionFindings show that elements of the interRAI HC are oriented toward the physical, functional, and mental health domains. Consequently, complementary assessment elements and/or tools may be needed to support comprehensive assessment of ‘Meaningfulness’ and ‘Participation’ in person-centred home and community care. Additional descriptors may also be needed to aid communication regarding the understanding and application of MPH domains.

Are people living with HIV have a low vulnerability to omicron variant infection: results from a cross-sectional study in China

BackgroundA surge of more than 80 million Omicron variant infected cases was reported in China less than a month after the "zero COVID" strategy ended on December 7, 2022. In this circumstance, whether people living with HIV (PLWH) in China experience a similar risk is not clear.MethodsA cross-sectional study was conducted in the Wuchang District of Wuhan between December 20, 2022, and January 18, 2023 through a self-administered online survey. PLWH and HIV-negative people aged ≥ 18 years old who volunteered for this survey were eligible. The prevalence of Omicron variant infection between PLWH and HIV-negative people was compared, and the factors associated with the Omicron variant infection among PLWH and HIV-negative people were further evaluated, respectively.ResultsIn total, 890 PLWH and 1,364 HIV-negative adults from Wuchang District were enrolled. Among these participants, 690 PLWH (77.5%) and 1163 HIV-negative people (85.3%) reported SARS-CoV-2 infection. Gender, chronic disease conditions, and COVID-19 vaccination status significantly differed between the two groups. After adjusting gender, age, comorbidities, and COVID-19 vaccination status, the risk of SARS-CoV-2 infection among PLWH was significantly lower than among HIV-negative people (aOR 0.56, 95%CI 0.42–0.76). Multivariable logistic regression analysis showed that PLWH with older age and detectable HIV-viral load (HIV-VL) had decreased risk of SARS-CoV-2 infection (aOR 0.98, 95%CI 0.96–0.99; aOR 0.59, 95%CI 0.36–0.97). Compared with PLWH receiving one/two doses of COVID-19 vaccines, no significant differences in the risk of SARS-CoV-2 infection were observed among PLWH receiving three doses of inactivated vaccines and four doses of vaccines (three doses of inactivated vaccines plus one dose of inhaled recombinant adenovirus type 5 (AD5)-vectored vaccine). Among HIV-negative people, those receiving four doses of COVID-19 vaccines had a lower risk of SARS-CoV-2 infection than those receiving one/two doses (aOR 0.14, 95%CI 0.08–0.25).ConclusionsOur study proves that PLWH have a lower risk of Omicron variant infection than HIV-negative people. However, even PLWH with younger age and virological suppression should strengthen the prevention against SARS-CoV-2 infection. Three doses of inactivated vaccines plus one dose of inhaled recombinant AD5-vectored COVID-19 vaccine may provide better protection for HIV-negative people.

Case reports of diagnosis and treatment of adrenal tumors complicated by rupture and formation of retroperitoneal hematoma

This article presents different variants of the clinical course of complications of adrenal tumors with rupture and formation of retroperitoneal hematomas, depending on the morphological characteristics of the neoplasms. The first clinical case described a 38-year-old patient with adrenocortical carcinoma of the left adrenal gland up to 8 cm in size, complicated by rupture with the formation of a retroperitoneal hematoma with a volume of 2800 cm3 , simulating a giant extraorgan retroperitoneal tumor with anemia and cachexia. After surgical treatment and stabilization of the condition, the patient is referred for chemotherapy with a positive outcome. The second case is about a 21-year-old patient with undiagnosed pheochromocytoma, who had a tumor rupture with hemorrhage and the development of acute symptoms against the background of the start of antihypertensive therapy. After the retroperitoneoscopic adrenalectomy, the condition stabilized. The third case is about the experience of observing a 45-year-old patient with myelolipoma up to 6.4 cm, complicated by a previously suffered retroperitoneal hematoma, in whom surgical treatment was not performed due to the presence of end-stage chronic kidney disease and stable tumor condition.

KSHV vIL-6 enhances inflammatory responses by epigenetic reprogramming.

Kaposi sarcoma-associated herpesvirus (KSHV) inflammatory cytokine syndrome (KICS) is a newly described chronic inflammatory disease condition caused by KSHV infection and is characterized by high KSHV viral load and sustained elevations of serum KSHV-encoded IL-6 (vIL-6) and human IL-6 (hIL-6). KICS has significant immortality and greater risks of other complications, including malignancies. Although prolonged inflammatory vIL-6 exposure by persistent KSHV infection is expected to have key roles in subsequent disease development, the biological effects of prolonged vIL-6 exposure remain elusive. Using thiol(SH)-linked alkylation for the metabolic (SLAM) sequencing and Cleavage Under Target & Release Using Nuclease analysis (CUT&RUN), we studied the effect of prolonged vIL-6 exposure in chromatin landscape and resulting cytokine production. The studies showed that prolonged vIL-6 exposure increased Bromodomain containing 4 (BRD4) and histone H3 lysine 27 acetylation co-occupancies on chromatin, and the recruitment sites were frequently co-localized with poised RNA polymerase II with associated enzymes. Increased BRD4 recruitment on promoters was associated with increased and prolonged NF-κB p65 binding after the lipopolysaccharide stimulation. The p65 binding resulted in quicker and sustained transcription bursts from the promoters; this mechanism increased total amounts of hIL-6 and IL-10 in tissue culture. Pretreatment with the BRD4 inhibitors, OTX015 and MZ1, eliminated the enhanced inflammatory cytokine production. These findings suggest that persistent vIL-6 exposure may establish a chromatin landscape favorable for the reactivation of inflammatory responses in monocytes. This epigenetic memory may explain the greater risk of chronic inflammatory disease development in KSHV-infected individuals.

Sociodemographic characteristics and longitudinal progression of multimorbidity: A multistate modelling analysis of a large primary care records dataset in England.

Multimorbidity, characterised by the coexistence of multiple chronic conditions in an individual, is a rising public health concern. While much of the existing research has focused on cross-sectional patterns of multimorbidity, there remains a need to better understand the longitudinal accumulation of diseases. This includes examining the associations between important sociodemographic characteristics and the rate of progression of chronic conditions. We utilised electronic primary care records from 13.48 million participants in England, drawn from the Clinical Practice Research Datalink (CPRD Aurum), spanning from 2005 to 2020 with a median follow-up of 4.71 years (IQR: 1.78, 11.28). The study focused on 5 important chronic conditions: cardiovascular disease (CVD), type 2 diabetes (T2D), chronic kidney disease (CKD), heart failure (HF), and mental health (MH) conditions. Key sociodemographic characteristics considered include ethnicity, social and material deprivation, gender, and age. We employed a flexible spline-based parametric multistate model to investigate the associations between these sociodemographic characteristics and the rate of different disease transitions throughout multimorbidity development. Our findings reveal distinct association patterns across different disease transition types. Deprivation, gender, and age generally demonstrated stronger associations with disease diagnosis compared to ethnic group differences. Notably, the impact of these factors tended to attenuate with an increase in the number of preexisting conditions, especially for deprivation, gender, and age. For example, the hazard ratio (HR) (95% CI; p-value) for the association of deprivation with T2D diagnosis (comparing the most deprived quintile to the least deprived) is 1.76 ([1.74, 1.78]; p < 0.001) for those with no preexisting conditions and decreases to 0.95 ([0.75, 1.21]; p = 0.69) with 4 preexisting conditions. Furthermore, the impact of deprivation, gender, and age was typically more pronounced when transitioning from an MH condition. For instance, the HR (95% CI; p-value) for the association of deprivation with T2D diagnosis when transitioning from MH is 2.03 ([1.95, 2.12], p < 0.001), compared to transitions from CVD 1.50 ([1.43, 1.58], p < 0.001), CKD 1.37 ([1.30, 1.44], p < 0.001), and HF 1.55 ([1.34, 1.79], p < 0.001). A primary limitation of our study is that potential diagnostic inaccuracies in primary care records, such as underdiagnosis, overdiagnosis, or ascertainment bias of chronic conditions, could influence our results. Our results indicate that early phases of multimorbidity development could warrant increased attention. The potential importance of earlier detection and intervention of chronic conditions is underscored, particularly for MH conditions and higher-risk populations. These insights may have important implications for the management of multimorbidity.

Changes in femoral neck bone mineral density and structural strength during a 12-month multicomponent exercise intervention among older adults – Does accelerometer-measured physical activity matter?

Age-related bone loss is to some extent unavoidable, but it may be decelerated with regular exercise continued into older age. Daily physical activity alongside structured exercise may be an important stimulus for maintaining bone strength, but the relationships of habitual physical activity with bone strength are sparsely investigated in older adults. Therefore, the main aim was to investigate if accelerometer-derived impact-based and intensity-minute-based measures of physical activity were associated with changes in femoral neck bone traits during a 12-month exercise intervention among community-dwelling older men and women.Data comes from the PASSWORD study (ISRCTN52388040), a year-long multicomponent exercise intervention. Participants were 299 older adults (mean age 74 ± 4 years, 58 % women), who self-reported not to meet the physical activity guidelines for older adults but did not have any contraindications for exercising. The multicomponent training program included both supervised and self-administered exercises aimed at improving muscle strength, postural balance, and aerobic endurance. Physical activity was assessed at baseline and at six months into the intervention, and femoral neck bone properties at baseline and at twelve months. Physical activity measures were accelerometer-measured mean daily osteogenic index score, low, medium, and high intensity impact counts, and sedentary, light, and moderate-to-vigorous intensity activity minutes. Femoral neck bone mineral density (BMD) was measured with DXA and structural strength indicators (cross-sectional area [CSA] and section modulus) were subsequently derived from hip structural analysis. Longitudinal associations of physical activity and bone outcomes were analyzed with generalized estimating equation linear models. Sex was included as a moderating factor, and models were further adjusted by potentially confounding factors (age, height, weight, smoking status, medications, chronic disease conditions, and strength training adherence).Participants increased their physical activity by all measures and decreased their sedentary time from baseline to six months. BMD decreased from baseline to post-intervention, while CSA maintained stable and section modulus slightly increased. Osteogenic index, high impacts, and moderate-to-vigorous intensity physical activity, measured across the first half of the study, were positively associated with changes in BMD over 12 months (time х physical activity interaction effect: ß = 0.065, 95 % CI [0.004, 0.126]; ß = 0.169, 95 % CI [0.048, 0.289]; and ß = 0.151, 95 % CI [0.016, 0.286], respectively). That is, the higher the physical activity was, the smaller was the decline in BMD. Any physical activity measure was not associated with changes in CSA or section modulus in the full study sample. Sex did not significantly moderate the longitudinal associations, except the association between sedentary time and CSA (sex х time х PA interaction effect: ß = −0.017, 95 % CI [−0.033, −0.002]). An inverse association was found between sedentary time and changes in CSA in women, but not in men.In conclusion, BMD decline was less pronounced in individuals who accumulated more accelerometer-measured daily physical activity at the intensity of very brisk walking or light lateral jumping or higher intensities in a sample of relatively healthy, previously physically inactive older adults. Our findings support that accumulating the recommended amount of 150 or more weekly minutes of moderate-to-vigorous physical activity is also beneficial for older adults' bone health when incorporated into a multicomponent exercise program.

Molecular epidemiology

Abstract Environmental exposures increase risk for multiple diseases, including dementia. The modern expansion of industrialization and the combustion of fossil fuels, coupled with extensive application of chemical fertilizers in farming, have led to an increase in the levels of toxic elements in the air, water and food. A key part of this work is to identify biological signatures associated with toxic element exposure, such as arsenic, and its effects on chronic disease conditions. This presentation will showcase a worked example illustrating how arsenic exposure will be assessed in urine samples. iAs, MMA, DMA and AsB will be analysed in urine by ion chromatography interfaced with inductively coupled plasma-mass spectrometry detection (ICP-MS) in Prof. Andy Meharg's lab, Queens's University, Belfast. DNAm data will be processed through Rnbeads 2.0. A principal-component analysis (PCA) was then used to identify technical variability (batch effect) in DNAm data. After removing batch effect, Clean DNAm data will be used in linear regression models to determine CpG loci associated with arsenic exposure.