Subgroup Differences Research Articles

Situational and Dispositional Achievement Goals and Measures of Sport Performance: A Systematic Review with a Meta-Analysis

The purposes of this systematic review (PROSPERO ID: CRD42024510614, no funding source) were to quantify relationships between situational and dispositional dichotomous achievement goals and sport performance and explore potential relationship moderators. Published studies that reported at least one situational or dispositional achievement goal and a performance score were included. Studies without performance scores or based in a non-sport context were excluded. Information sources consisted of studies found in relevant published meta-analyses and EBSCOhost databases (finalized September 2024). The following statistics were conducted to assess the risk of bias: class-fail-safe n, Orwin’s fail-safe n, and funnel plots with trim and fill estimates. The summary statistics were r and d. Thirty studies from 1994 to 2024 met all inclusion criteria with 8708 participants from Europe, Asia, North America, and Oceania. The majority of samples were non-elite male youths and adolescents. The random-effects relationships (r) between task climate, 0.20 [0.14, 0.25], task orientation, 0.17 [0.12, 0.23], ego orientation, 0.09 [0.03, 0.16], and sport performance were small and significantly different (p < 0.05) from zero, while the ego motivational climate relationship was not, −0.00 [−0.48, 0.05]. The random-effects standard differences in means (d) for both the task orientation, 0.08 [0.02, 0.14], and ego orientation, 0.11 [−0.05, 0.26] were minimal in meaningfulness. Mixed-effects moderator analyses resulted in the following significant (p < 0.05) sub-group differences: subjective compared to objective performance measures (task orientation), elite compared to non-elite samples (task climate), and athlete-completed compared to coach-completed performance measures and performance records (task orientation). Finding only 30 studies meeting the inclusion criteria, which limited sub-group samples for moderation analyses, was the main limitation. Despite this limitation, AGT provides athletes and practitioners performance enhancement strategies. However, caution is warranted regarding relationship expectations given the small mean effect size values and the true prediction interval ranging from negative to positive, perhaps as a result of the heterogeneous samples and performance measures. A clear line of future research, considering the reviewed studies, with elite athletes is needed to verify the performance benefits of the task climate and ego orientation as well as the use of the ego goal orientation in selection decisions.

Remnant cholesterol and cognitive function: Evidence from the China health and retirement longitudinal study.

Evidence on associations of remnant cholesterol (RC) and its variability with cognitive function is still lacking. To explore the association of RC and its variability with cognitive function. Participants were recruited from a population-based cohort, the China Health and Retirement Longitudinal Study (CHARLS). Cognitive function was assessed by a standardized questionnaire from CHARLS, with domains of episodic memory and mental intactness. A linear mixed effects model was used to analyze the association of RC with cognitive function, along with its variability (calculated as standard deviation [SD], coefficient of variation [CV], variability independent of the mean [VIM]), with results expressed as β (95%CI). Potential subgroup differences in the association of RC and its variability with cognitive function were also explored. 4234 participants were eventually included, with mean (SD) age of 57.4 (8.0) years. Each 10 mg/dL increase in RC was associated with 0.053 (95%CI: 0.096, 0.009) points, 0.021 (95%CI: 0.042, 0.000) points, 0.032 (95%CI: 0.064, 0.001) points decrease in global cognitive function, episodic memory, and mental intactness scores, respectively. Compared with the first tertile (T1) group of RC variability (calculated as SD, VIM), T3 showed a lower level in global cognition and episodic memory after multivariate adjustment. The potential modification effects of educational level on RC and its variability in relation to cognitive function were also identified. Among Chinese middle-aged and older adults, higher RC level were associated with worse cognitive function. Greater RC variability was also associated with worse cognitive performance, especially in memory function.

Automated speech recognition bias in personnel selection: The case of automatically scored job interviews.

Organizations, researchers, and software increasingly use automatic speech recognition (ASR) to transcribe speech to text. However, ASR can be less accurate for (i.e., biased against) certain demographic subgroups. This is concerning, given that the machine-learning (ML) models used to automatically score video interviews use ASR transcriptions of interviewee responses as inputs. To address these concerns, we investigate the extent of ASR bias and its effects in automatically scored interviews. Specifically, we compare the accuracy of ASR transcription for English as a second language (ESL) versus non-ESL interviewees, people of color (and Black interviewees separately) versus White interviewees, and male versus female interviewees. Then, we test whether ASR bias causes bias in ML model scores-both in terms of differential convergent correlations (i.e., subgroup differences in correlations between observed and ML scores) and differential means (i.e., shifts in subgroup differences from observed to ML scores). To do so, we apply one human and four ASR transcription methods to two samples of mock video interviews (Ns = 1,014 and 414), and then we train and test models using these different transcripts to score multiple constructs. We observed significant bias in the commercial ASR services across nearly all comparisons, with the magnitude of bias differing across the ASR services. However, the transcription bias did not translate into meaningful measurement bias for the ML interview scores-whether in terms of differential convergent correlations or means. We discuss what these results mean for the nature of bias, fairness, and validity of ML models for scoring verbal open-ended responses. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Continental differences in the association between excess body weight and prognosis in triple-negative breast cancer: a meta-analysis.

The association between obesity and triple-negative breast cancer (TNBC) prognosis has been equivocal, with considerable heterogeneity between and within studies. Recent meta-analyses report adverse associations with overall survival (OS) and disease-free survival (DFS) in TNBC. We update this evidence and examine study- and disease-specific sources of heterogeneity. A systematic search of four databases was conducted until February 22, 2023. Random-effects meta-analyses were used to pool hazard ratios (HR) for OS, DFS, and breast cancer-specific mortality (BCSM). Subgroup analyses examined sources of study heterogeneity. In meta-analyses of included studies (n = 33), significant associations were observed between excess body weight and worse OS (n = 24; HR = 1.20; 95%CI 1.20-1.34), DFS (n = 26; HR = 1.15; 1.05-1.27), and BCSM (n = 9; HR = 1.13; 1.00-1.27). In subgroup meta-analyses, significant inter-study survival differences were observed for study location (OS, DFS), time period of diagnoses (DFS), menopausal status (OS), and body mass index cut points examined (OS). Asian and European studies reported significant associations with OS (HR = 1.31; 1.11-1.54 and HR = 1.38; 1.00-1.89, respectively) and DFS (HR = 1.28; 1.07-1.54 and HR = 1.44; 1.13-1.84, respectively); however, no association was observed between obesity and TNBC prognosis in North American studies (OS: HR = 1.03; 0.89-1.19; DFS: HR = 1.05; 0.95-1.15). Location subgroup differences remained robust after excluding poor-quality studies. Post hoc analysis in the subset of studies reporting predominantly (≥ 70%) White sample showed no statistically significant associations for OS (HR = 1.13; 95%CI 0.96, 1.34), DFS (HR = 1.03; 95%CI 0.86, 1.23), or BCSM (HR = 1.08; 95%CI 0.91, 1.27). This study further confirms that obesity is associated with poor prognosis in TNBC and identified subgroups at higher risk. Ethnic differences in the association between excess body weight and TNBC are reported. Further exploration of study and patient characteristics is needed to properly understand the populations most at risk.

Sodium-glucose cotransporter-2 inhibitors in acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials.

We aimed to assess the efficacy and safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus placebo, initiated within the hospitalization period, in addition to habitual treatment, for treating adult patients with confirmed acute myocardial infarction (AMI). We also conducted subgroup analysis by diabetes mellitus (DM) status and type of AMI. We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs). The primary outcome was hospitalization for heart failure (HF). The secondary outcomes were all-cause death, cardiovascular death, and serious adverse events (AEs). We pooled risk ratios (RR) with a 95% confidence interval (CI) for binary outcomes. The between-study variance was assessed using tau2 statistics. We included five RCTs, encompassing 11,211 patients. SGLT2i significantly reduced the risk of hospitalization for HF compared to placebo (RR 0.73; 95% CI [0.61, 0.88]). However, the risk of all-cause death (RR 1.05; 95% CI [0.78, 1.41]) and cardiovascular death (RR 1.04; 95% CI [0.84, 1.29]) was similar between the groups, as well as the risk of serious AEs (RR 1.01; 95% CI [0.90, 1.14]). In the subgroup analysis by DM status and type of AMI, there were no significant subgroup differences for the outcomes of hospitalization for HF and all-cause death. In patients with AMI, treatment with SGLT2i is safe and significantly reduces the risk of hospitalization for HF, but it has no impact on all-cause death and cardiovascular death compared to placebo.

Results of bracing adolescent idiopathic scoliosis in the context of clinical practice and the Scoliosis Research Society’s criteria: 5-year observational study from a German orthopaedic university hospital

BackgroundBrace therapy’s influence on adolescent idiopathic scoliosis’s (AIS) natural course is inconclusive.MethodsBrace-treated AIS patients from 2016 to 2020 were examined regarding four endpoints at brace weaning: surgery need, curve progress ≥ 6° and > 45°, and curve improvement ≥ 6°. Prediction variables’ influence was computed for the all-patients group and three subgroups (Subgroup 1: fulfilling the Scoliosis Research Society’s [SRS] criteria, Subgroup 2: initial Cobb angle < 25°, Subgroup 3: initial Cobb angle > 40°). According to the data characteristics, parametric and non-parametric tests and binary logistic regression were performed.ResultsThe research included 69 patients. Overall, after brace weaning surgery was recommended for 20.3% of them, curve progression was ≥ 6° in 23.2%, the Cobb angle was beyond 45° in 11.6%, and the Cobb angle improved by ≥ 6° in 20.3%. Patients needing surgery had a significantly higher initial Cobb angle (38.8° ± 9.8° vs 27.8° ± 7.6°, p < 0.001), lower Risser stages (p = 0.010), and higher Nash and Moe degrees (p = 0.030). Patients with curve progress ≥ 6° were younger at first curve notification (12.4 ± 1.5 vs 13.7 ± 1.7 years, p = 0.011) and older at menarche (13.4 ± 1.1 vs 12.6 ± 1.2 years, p = 0.037). Furthermore, 21.6% of all Risser 3 and 4 patients had still curve progress ≥ 6°. In-brace correction was significantly higher in patients with curve improvement ≥ 6° vs < 6° (54.0% ± 31.2% vs 31.9% ± 30.7%; p = 0.019). Nine patients fulfilled the SRS criteria, 22 had initial Cobb angles < 25°, and 11 had > 40°. Real brace wear (RBW) in all groups had no significant effect on outcome. Two significant subgroup differences were found: Surgery recommendation and curve progression beyond 45° were significantly more frequent in the initial Cobb angle > 40° subgroup.ConclusionsBrace effectiveness can be assumed because curve improvement was achieved in nearly one-fifth with sufficient in-brace correction. However, no significant influence of RBW on the outcome endpoints was demonstrated. To clarify conflicting results, big data management, including untreated patients, must be employed to further research AIS’s multifactorial influenced aetiology and course. Meanwhile, it is worth starting bracing in AIS in practice also beyond the SRS’s criteria.

Acculturation and self-management abilities of well-being among older Moroccans in the Netherlands

Abstract Background Migration involves a variety of stressors. Their accumulation over time may negatively impact migrants’ well-being. The extent that older migrants can integrate into a host society may determine their readiness to adopt behaviors such as self-management of well-being. Research regarding this relation among older Moroccans, one of the largest migrant groups in the Netherlands, has not been examined. This study aimed to investigate the relationship between acculturation and self-management abilities of well-being among older Moroccans and to examine differences in subgroups. Methods This cross-sectional study included 290 older Moroccans (≥ 65) living in Rotterdam, the Netherlands. Linear regression was applied to explore associations between acculturation (attachment to Moroccan and Dutch cultures) and self-management abilities of well-being. Independent samples t-tests were used to test differences between subgroups. Results Older Moroccans who received low education were found to be less attached to the Dutch culture [3.24 (0.72) vs. 3.54 (0.73); p = 0.016]. They were also poorer self-managers of their well-being [2.60 (0.59) vs. 2.86 (0.58); p = 0.012], along with those with multi-morbidity [2.55 (0.60) vs. 2.77 (0.54); p = 0.006] and those lacking comprehension of Dutch [2.46 (0.56) vs. 2.69 (0.59); p = 0.011]. Self-management abilities of well-being had a negative association with multi-morbidity (β = −0.18, p = 0.007) and lack of Dutch comprehension (β = −0.16, p = 0.031), and a positive association with attachment to Moroccan (β = 0.17, p = 0.012) and Dutch (β = 0.18, p = 0.010) cultures. Conclusions Findings indicate that attachment to Moroccan and Dutch cultures is beneficial for older Moroccans’ self-management of well-being. Efforts need to support older migrants’ integration for them to adequately function and feel at home. Interventions promoting integration and self-management need to consider the characteristics of older migrant populations Key messages • Attachment to origin and host cultures benefits older migrants’ self-management of well-being. The cultural context of older migrants needs to be considered when promoting values of self-management. • Differences in acculturation and self-management of well-being existed between older migrant subgroups. Interventions promoting these values should account for the diversity that exists among migrants.

Ethnic variations in post ST elevation myocardial infarction inflammatory kinetics

Abstract Introduction Sterile inflammation post myocardial infarction (MI) is essential to activation reparative mechanisms. However, excessive inflammation contributes to detrimental recovery and adverse outcomes(1). Several studies have reported an association between elevated leucocyte subpopulations and neutrophil-lymphocyte ratio (NLR) with poor prognosis after MI(2). In healthy volunteers, it is known that black individuals have a lower diurnal neutrophil, basophil, and monocyte count and the term ‘benign ethnic neutropenia’ has been used(3). However, the effect of ethnicity on leucocyte counts after MI is not known. Purpose We aimed to assess the interaction between ethnicity and leucocyte subpopulations and NLR. Understanding post-MI inflammation and its interaction with ethnicity is essential in providing personalised patient management and prognostication. Methods We conducted a single centre retrospective observational study of consecutive patients presenting with ST-segment elevation MI (STEMI) between 2016 and 2022. Patients were divided into white and other ethnic groups combined (‘ethnic minorities’) based on self-reported ethnicity. Leucocyte subpopulations, neutrophil and monocyte lymphocyte ratios (NLR and MLR, respectively) at baseline and for 4 days post admission were compared. Baseline variables were analysed with Shapiro-Wilk testing and presented as median (IQR). Area under the curve (AUC) was used to analyse magnitude of change in longitudinal analysis with smoothed conditional means (LOESS) to display trends in the data. Univariate and multivariate linear regression analyses were used to investigate for an association between ethnicity and baseline clinical variables. Results We included 1933 STEMI patients, of whom 1477 (76%) were white and 456 (24%) were from ethnic minority groups. Baseline neutrophils (7.73 [5.9-10] vs 9.04 [6.7-11.9] x109/L), monocytes (0.52 [0.38-0.69] vs 0.6 [0.44-0.82] x109/L), basophils (0.03 [0.02-0.04] vs 0.04 [0.02-0.06] x109/L), NLR (4.47 [2.93-7.19] vs 5.61 [3.64-8.89]) and MLR (0.3 [0.21-0.43] vs 0.36 [0.26-0.53]) were significantly lower (all p&amp;lt;0.001) in ethnic minority vs white patients. There were no differences in peak troponin T or CRP. Longitudinal assessment of leucocyte subgroups and NLR showed that white patients had a significantly higher AUC and difference between minimum and maximum values (delta) for neutrophils, monocytes, basophils and NLR (Panel 1). After correction, we observed a negative association between being in the ethnic minority group and baseline NLR (p=0.005) and basophil count (p&amp;lt;0.001). Conclusions Despite baseline differences in leucocyte subgroups and NLR according to ethnicity, there is a distinct interaction among patients with STEMI suggesting an ethnicity-specific inflammatory profile. Blunting of the magnitude and duration of leucocyte response is novel, and future work will focus on the implications for prognosis and tailored therapy.

Percutaneous mechanical circulatory support versus intraaortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock

Abstract Background Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is a disease process associated with significantly poor clinical prognosis, placing patients at increased risk for morbidity and mortality. Currently, the optimal choice for temporary mechanical circulatory support remains unclear, with studies evaluating use of percutaneous ventricular assist devices (pVAD) yielding conflicting results. Purpose The goal of this meta-analysis is to evaluate the efficacy of pVAD compared to intra-aortic balloon counterpulsation (IABP) in patients presenting with AMI-CS. Methods A database search was performed for studies reporting on the association of pVAD compared to IABP with clinical outcomes in patients with AMI-CS. The primary endpoint of interest was 30-day all-cause mortality. Secondary endpoints included cardiovascular (CV) mortality, and recurrence of AMI. The databases searched included Pubmed, Web of Science, and Embase. The search was not restricted by time or publication status. Registry studies were excluded from this analysis. Subgroup analysis was performed separating randomized controlled trials from retrospective cohort studies. Results A total of 8 studies with 651 participants (322 treated with pVAD, 329 treated with IABP) met inclusion criteria. Mean age was 65 years old, 73.9% were men, mean left ventricular ejection fraction was 28%, mean follow-up was 9.8 months (ranging 1-66 months). Treatment of AMI-CS patients with pVAD was not associated with lower risk of 30-day all-cause mortality compared to IABP (OR 0.90, 95% CI 0.63-1.27; p=0.55). Heterogeneity was low for the RCT subgroup and moderate for the cohort study subgroup (I2=0%; I2=48%). Use of pVAD in patients with AMI-CS was associated with a non-statistically significant trend toward lower CV mortality compared to IABP (OR 0.53, 95% CI 0.29-0.99; p=0.05). The heterogeneity was low (I2=0%). Use of pVAD was not associated with significantly lower risk of recurrent AMI (OR 0.62, 95% CI 0.22-1.74; p=0.37). Heterogeneity was low for this analysis (I2=0%). Test for subgroup differences was not statistically significant for any of the above analyses. Conclusion In patients presenting with AMI-CS, use of pVAD compared to IABP is not associated with lower risk of all-cause mortality or recurrent AMI. However given the apparent trend toward lower risk of CV mortality in patients treated with pVAD, additional high-quality prospective studies are required.Figure 1

Incidence of aortic valve reintervention in patients with aortic stenosis undergoing TAVI vs SAVR: A systematic review and meta-analysis of randomised controlled trials

Abstract Introduction Transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) are two established treatments for severe aortic stenosis (AS). The relative comparison between TAVI and SAVR for recurrent aortic valve interventions is not well defined. Purpose We aimed to perform a systematic review and meta-analysis comparing the incidence of aortic valve reintervention in patients undergoing TAVI versus SAVR. Methods MEDLINE, Embase and Cochrane databases were searched for randomised controlled trials (RCT) that compared TAVI with SAVR for the treatment of AS reporting the occurrence of aortic valve reinterventions. We also performed a subgroup analysis of different types of TAVI prosthesis. We performed a meta-regression to evaluate the effect of age and Society of Thoracic Surgeons (STS) risk score in the outcome of interest. Statistical analysis was performed using RevMan 5.4.1 and RStudio 2023.12.1. Heterogeneity was assessed with I2 statistics. Results We included 8 RCTs with 8,698 patients, of whom 4,443 (51%) underwent TAVI. Mean follow-up ranged from 1 to 10 years. Aortic valve reintervention was significantly more common in patients treated with TAVI compared with SAVR (RR 1.89; 95%CI 1.24-2.88; p = 0.003). In a subgroup analysis stratified by balloon-expandable or self-expandable valves, there were no significant subgroup differences in their respective comparisons with TAVR (p = 0.20). In meta-regression analysis, older age (p = 0.008) and higher STS score (p = 0.009) were significantly associated with a higher incidence of aortic valve reinterventions with TAVI relative to SAVR. Conclusion In patients who undergo aortic valve replacement, TAVI is associated with a significantly higher incidence of aortic valve reinterventions relative to SAVR, particularly in populations with older age or higher STS score.

Utility of venoarterial extracorporeal membrane oxygenation in patients with acute myocardial infarction complicated by cardiogenic shock

Abstract Background Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) continues to portend poor clinical prognosis and remains a major cause of morbidity and mortality. Although venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is frequently used in the treatment of AMI-CS, studies evaluating its benefit compared to percutaneous ventricular assist devices (pVAD) or standard medical therapy in this patient population have yielded conflicting results. Purpose The goal of this meta-analysis is to evaluate the use of ECMO compared to either pVAD or medical therapy with or without intra-aortic balloon counterpulsation (IABP) in patients presenting with AMI-CS. Methods A database search was performed for studies reporting on the association of ECMO compared to pVAD or medical therapy with or without IABP with clinical outcomes in patients with AMI-CS. The endpoints of interest were 30-day all-cause mortality and long term all-cause mortality. The databases searched included Pubmed, Web of Science, and Embase. The search was not restricted by time or publication status. Registry studies were excluded from this analysis. Results A total of 8 studies with 937 participants (447 treated with ECMO, 243 treated with pVAD, 247 treated with medical therapy with or without IABP) met inclusion criteria. Mean age was 63 years old, 80.5% were men, mean left ventricular ejection fraction was 26%, mean follow-up was 6.3 months (ranging 1-12 months). Treatment of AMI-CS patients with ECMO was not associated with lower risk of 30-day all-cause mortality compared to pVAD or standard medical therapy with or without IABP placement (OR 1.29, 95% CI 0.87-1.90; p=0.21; OR 0.58, 95% CI 0.25-1.35; p=0.13). Heterogenetic was low to moderate for each subgroup. Test for subgroup differences did not demonstrate statistically significant differences in the results for pVAD and for standard medical therapy with or without IABP (p=0.10, I2=64.1%). Compared to pVAD, ECMO was not associated lower risk of long-term mortality (OR 1.27, 95% CI 0.85-1.90; p=0.24). The heterogeneity for this analysis was low (I2=0%). Conclusion In patients presenting with AMI-CS, use of VA-ECMO is not associated with lower risk of mortality compared to pVAD or standard medical therapy with or without IABP placement. The risks and benefits of ECMO should be carefully considered compared to other forms of temporary mechanical circulatory support.Figure 1

Sex-related outcomes in patients receiving shortened or longer dual antiplatelet treatment after percutaneous coronary intervention: a systematic review and meta-analysis

Abstract Background There are known gender disparities in the pathophysiology, clinical presentation, and prognosis of coronary artery disease between male and female patients. Although antiplatelet therapy cessation is more frequent among women, female gender is an independent factor for major bleeding after percutaneous coronary interventions. Considering that the ischemic and bleeding risk of women undergoing PCI differ from men, it follows that the safety and efficacy of shortened, one or 3 months, DAPT (S-DAPT) compared to longer DAPT (L-DAPT) after PCI might differ between the sexes. Purpose Our systematic review and meta-analysis aims to explore the safety and efficacy of S-DAPT versus L-DAPT in men and women having undergone PCI. Methods Three major databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus) were screened for eligible randomized – controlled trials, or subgroup or post – hoc analyses of them. The studies should compare S-DAPT with L-DAPT in male and female patients undergoing PCI, providing separate data. The endpoints were Net Adverse Clinical Events (NACE), Major Adverse Cardiac Events (MACE), all-cause mortality, myocardial infarction and major bleeding. All endpoints were used as per trial defined and should be evaluated in 12-months. The effect of different DAPT regimens was assessed by calculating the risk ratio (RR) with 95% confidence intervals (CIs), using a random-effects model (Mantel-Haenzel). Results A total of eight studies and 46,476 patients were included; women were underrepresented being only the 26% (N=12,063) of the total participants. MACE did not differ significantly in the two arms in the total sample (RR: 0.94, 95%CI: 0.86-1.04); however, they were significantly reduced in women treated with S-DAPT (RR: 0.82, 95%CI: 0.70-0.97) (p-interaction: 0.049). (Figure 1) S-DAPT was associated with a significant reduction in both NACE (RR: 0.91, 95% CI: 0.85-0.99) (Figure 2A) and major bleeding (RR: 0.73, 95% CI: 0.57-0.95) (Figure 2C) in the total sample, without significant differences between male and female patients (p-interaction: 0.14 and 0.053, respectively). All-cause mortality (RR: 0.86, 95%CI: 0.73-1.01) (Figure 2B) and myocardial infarction rates (RR: 1.03, 95%CI: 0.86-1.24) (Figure 2D) were similar in both S-DAPT and L-DAPT in the total sample, without any significant subgroup differences (p-interaction: 0.13 and 0.051, respectively). Conclusions Shortened duration of DAPT significantly decreased MACE in women, in contrast with male patients, showing that women may benefit from abbreviated duration of DAPT. Further studies specifically investigating the optimal duration of DAPT in women are warranted and a sex-based approach could be considered in the management of antiplatelet treatment after PCI.A. NACE B. Mortality C. Bleedings D. MI

Cognitive emotional regulation in physiotherapy students in Croatia

ABSTRACT Background Cognitive emotional regulation refers to a conscious or unconscious process that affects an individual's emotions and the physical and mental health of the individual. The aim of this study was to detect strategies of cognitive emotional regulation used by physiotherapy students in stressful situations. Methods The study was conducted from January to March 2022 and enrolled 372 students. An announcement was posted electronically on the web page of each physiotherapy study in Croatia, inviting students to participate in the study. Each participant provided written informed consent. The Cognitive Emotion Regulation Questionnaire was used in the study for detecting cognitive emotional strategies that students use in stressful situations. Statistical analysis of data included descriptive statistics of data groups where values were expressed as mean and standard deviation. The Kolmogorov–Smirnov test was used to test the normality of the distribution. To test the differences between two independent groups, the Mann–Whitney U rank sum test was applied, while the non-parametric Kruskal–Wallis test was used to test the differences of several subgroups of variables. Categorical variables were tested with Fischer's exact test or chi-square test. Results The most frequently used emotional cognitive regulation strategies are acceptance and positive reappraisal. There is a statistically significant difference in the use of self-blame (p < .001), rumination (p < .001) and blaming others (p = 0.018) in relation to gender. Also, there is a statistically significant difference in the use of acceptance (p = 0.022), rumination (p < .001) and blaming others (p = 0.049) in relation to the year of study. Conclusion Education of physiotherapy students to the use of adaptive strategies could have a positive effect on the students’ learning quality, their decision–making abilities and the quality of physiotherapy provided to patients. Encouraging physiotherapy students to engage in cognitively adaptive ways of thinking can serve as a solid method to help students in an academic and professional environment.

Blood cadmium levels and overactive bladder in middle-aged and older adults in the United States: Insights from NHANES 2007–2020 data

Cadmium is a common environmental pollutant associated with various health risks. Its neurotoxic, muscle-damaging, and pro-inflammatory properties may be related to overactive bladder (OAB), though few studies have assessed its impact on urinary function. This study aimed to examine the potential link between cadmium exposure and OAB. Using data from the 2007–2020 National Health and Nutrition Examination Survey (NHANES), we analyzed adults aged 40 and older (n = 15,467) in a cross-sectional design. OAB was defined by the refined Overactive Bladder Symptom Score (OABSS). Weighted multivariate logistic regression examined the associations between blood cadmium levels and OAB and its components. Age and gender stratifications were performed, and restricted cubic splines (RCS) were used to explore non-linear associations between blood cadmium and OAB. Sensitivity analyses and co-exposure analyses with other pollutants were conducted to assess OAB definition stability, subgroup differences, and exposure collinearity. The prevalence of OAB was 26.2%. While blood cadmium showed a small, non-significant positive association with overall OAB, it was inversely associated with nocturia severity (OR = 0.85, 95% CI 0.74–0.98, p < 0.05). Blood cadmium was also linked to more severe urinary incontinence in the 50–59 age group and among non-Hispanic Black adults. A non-linear association between blood cadmium and OAB was observed (p for nonlinearity = 0.016, p < 0.05). In co-exposure analyses, cadmium remained a dominant and independent factor. These findings suggest that cadmium exposure may have a complex association with OAB and may relate differently to its various components. Further research is needed to explore these relationships.

Discrimination and health outcomes in England's black communities amid the cost-of-living crisis: evaluating the role of inflation and Bank Rates

ABSTRACT This study utilised longitudinal data from Black History Month events in London from 2021 to 2023. Novel findings revealed that increased inflation and Bank Rates, related to the cost-of-living crisis, were associated with greater discrimination and deteriorations in both general and mental health for Black individuals. Moreover, it was found that during the cost-of-living crisis period, i.e. 2022–2023, discrimination was more adversely related to general and mental health deterioration compared to the period before the cost-of-living crisis, i.e. 2021. In addition, women, non-native individuals, non-heterosexual individuals, the unemployed, economically inactive individuals, those with lower educational attainment, and older individuals experienced higher levels of discrimination and reduced general and mental health compared to reference groups. The findings of the study contribute to the literature by demonstrating the intertwined associations of macroeconomic deteriorations and discrimination with the health of the Black community, and its subgroup differences, providing a basis for targeted policies.

Treatment-free remission after discontinuation of tyrosine kinase inhibitors in patients with chronic myeloid leukemia in the chronic phase: a systematic review and meta-analysis

BackgroundTreatment-free remission (TFR) is a new long-term goal for treating selected patients with chronic myeloid leukemia in the chronic phase (CML-CP). Still, the appropriate group in which TFR can be attempted and the factors influencing it have not yet been identified. This meta-analysis aimed to explore TFR in CML-CP patients who achieved a deep molecular response (DMR) before Tyrosine kinase inhibitors (TKIs) discontinuation and to explore possible factors influencing TFR and the safety of discontinuation.MethodsWe performed a systematic review and single-arm meta-analysis with a systematic search of published literature up to September 2023 in PubMed, Embase, Web of Science, Cochrane Library, and CNKI databases. The assessment was performed using the MINORS scale. Random-effects models were used to calculate outcome metrics, including overall mean TFR rates at 12 and 24 months and subgroup differences. Data synthesis and analysis were done by Stata17.0 software.ResultsA total of 19 single-arm trials involving 2336 patients were included in this meta-analysis, with an overall mean TFR rate of 59% [95CI:0.56–0.63] at 12 months and 55% [95CI:0.52–0.59] at 24 months, and no CML-related deteriorations or deaths reported during the TFR period. Our subgroup analysis showed that better TFR was associated with prior interferon therapy (P = 0.003), and molecular response depth MR5.0 (P = 0.020).ConclusionOur study demonstrated that prior interferon therapy and attainment of a molecular response depth of MR5.0 or greater were associated with higher TFR rates, with patients who attained MR5.0 or greater achieving a TFR rate of up to 62% in the second year after TKI discontinuation. Considering the high heterogeneity of the included trials, the above influences still require further validation and more detailed subgroup analysis in future discontinuation trials.Systematic review registration:https://www.crd.york.ac.uk/prospero/ (Registration No. CRD42023471334).

Increasing loneliness among German children and adolescents from 2018 to 2022: A cross-sectional survey before and after the onset of the COVID-19 pandemic

Abstract Aim Loneliness is an increasingly present topic in scientific and public discourse, and has gained relevance due to the COVID-19 pandemic. Nevertheless, there is a lack of representative studies examining the prevalence of loneliness among children and adolescents before and after the pandemic. Accordingly, the present study aimed to determine the prevalence of loneliness among 11- to 15-year-old students before (2018) and after (2022) the onset of the COVID-19 pandemic and to investigate subgroup differences. Subject and methods In this cross-sectional Health Behaviour in School-aged Children (HBSC) study, the prevalence of loneliness was compared in two representative samples from the German federal state of Brandenburg from 2018 and 2022. In 2018, data were collected from 3,057 (51.8% girls, Mage = 13.1, SD = 1.7) and, in 2022, from 3,801 (52.6% girls, Mage = 13.5, SD = 1.6) students in general education schools. Loneliness was assessed using a single item from the Center for Epidemiologic Studies Depression Scale (CES-D). Chi-square test and logistic regressions were performed. Results In total, 11.8% of the students reported being lonely in 2018, and 19.3% reported being lonely in 2022. Loneliness was more prevalent among girls, nonbinary, older adolescents, and students with lower family affluence. The increase in loneliness did not differ depending on age, gender, or family affluence. Conclusion The findings highlight that loneliness among children and adolescents is a widespread phenomenon that has increased significantly from 2018 to 2022. There is a need for prevention measures and further research into health-related associations of loneliness.

Impact of chemotherapy on patients with mismatch repair deficient advanced endometrial carcinomas-a meta-analysis.

Chemo-immunotherapy is standard of care for women with recurrent or advanced mismatch repair deficient (dMMR) endometrial carcinomas (EC). However, it is uncertain whether patients with dMMR advanced or recurrent EC derive less benefit from chemotherapy than those with mismatch repair proficient (pMMR) EC. We performed a meta-analysis of randomized controlled trials (RCTs) in advanced/recurrent EC to determine the difference in the benefit of chemotherapy in dMMR vs pMMR EC. Data on chemotherapy outcomes including objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) were retrieved. We pooled these data using the inverse variance method and examined subgroup difference by MMR status. We also compared differences in PFS and OS outcomes by creating individual patient data from the Kaplan-Meier curves of trial publications for sensitivity analyses. A total of five RCTs with 1137 participants (dMMR, 26%; pMMR, 74%) were included. All participants were treated with carboplatin-based chemotherapy. There was no difference between the dMMR and pMMR subgroups for ORR (66.5% vs 64.0%, P = .20 for subgroup difference), PFS (HR 0.93, 95% CI 0.77-1.12, P = .44; median PFS 7.6 vs 9.5 months) or OS (HR 1.03, 95% CI 0.73-1.44, P = .88; median OS not reached vs 28.6 months). ORR, PFS and OS were similar among those with dMMR vs pMMR endometrial cancer treated with front-line, platinum-doublet chemotherapy in randomized clinical trials. These findings reinforce the importance of combining chemotherapy together with immune checkpoint inhibitors until the results of trials comparing immune checkpoint therapy alone with combination therapy are available.

MENINGIOMA OEDEMA AND SEIZURES – A META-ANALYSIS

Abstract AIMS Meningiomas are primary intracranial neoplasms. Oedema and seizures can occur in the pre and postoperative period and oedema is commonly cited as a risk factor for seizures. A meta-analysis of eight studies published in 2016 identified preoperative oedema as a risk factor for preoperative seizures. Our aim is to perform an updated review. The literature base has grown and there are studies presenting data on postoperative seizures. METHOD The meta-analysis protocol is uploaded to INPLASY (DOI: 10.37766/inplasy2023.7.0101). Existing literature from seven databases was collected and Cochrane guidance was followed. Data was analysed using packages within R programming software. Part of this work was presented in draft form at ILAE 2023 and here we present updated work. RESULTS Our search identified 44 unique studies for meta-analysis. Many studies were biased by subjective oedema measurement or lack of seizure definition. Preoperative oedema increased the odds of preoperative seizures; odds ratio (OR) 3.41, 95% confidence interval (CI) 3.00 to 3.87, p &amp;lt;.001, studies (k) 24, participants (n) 6,917, low heterogeneity (I2) 0%. There were no subgroup differences by oedema measurement or use of seizure definition. Preoperative oedema was associated with increased odds of early postoperative seizure (within one week of surgery) but the difference was not significant; OR 1.39, CI 0.97-1.99, p =.063, k = 6, n = 2,445, I2 = 0% (low). Preoperative oedema increased the odds of late postoperative seizures; OR 1.95, CI 1.55-2.45, p &amp;lt;.001, k = 7, n = 1,722, I2 = 0% (low). Oedema was associated with seizures following stereotactic radiosurgery in two studies. CONCLUSION Preoperative oedema is associated with seizures prior to and following treatment. While there is a positive association between preoperative oedema and early postoperative seizure it is not statistically significant.

Prediabetes increases the risk of pancreatic cancer: A meta-analysis of longitudinal observational studies.

Glycemic disorder is closely related to the risk of pancreatic cancer, but previous studies focused on the influence of diabetes. The aim of this meta-analysis was to investigate the influence of prediabetes, an intermediate state between normoglycemia and diabetes, on the risk of pancreatic cancer. Relevant longitudinal observational studies were identified through a search of Medline, Embase, and Web of Science databases. To minimize the influence of between-study heterogeneity, a randomized-effects model was used to pool the results. Nine cohort studies including 26,444,624 subjects were available for the meta-analysis. Among them, 2,052,986 (7.8%) had prediabetes at baseline, and the participants were followed for a mean duration of 5.9 years. It was found that, compared to people with normoglycemia, those with prediabetes had a higher incidence of pancreatic cancer (risk ratio [RR]: 1.42, 95% confidence interval: 1.36 to 1.49, p<0.001) with no statistical heterogeneity (I2 = 0%). Sensitivity analysis performed by excluding one dataset at a time did not significantly change the results (RR: 1.38 to 1.45, p all <0.05). Subgroup analyses indicated that the association between prediabetes and increased risk of pancreatic cancer was not significantly impacted by study characteristics such as study design, location, age, and sex of participants, definition of prediabetes, duration of follow-up, or adjustment for alcohol intake (p for subgroup difference all >0.05). Prediabetes may be associated with an increased risk of pancreatic cancer compared to normoglycemia.