Distinct Risk Factors Research Articles

The weight of office? A scoping review of mental health issues and risk factors in elected politicians across democratic societies.

The mental health and capacity to govern of democratically-elected politicians have become burgeoning topics of interest. Notably, in fulfilling demanding and high-stress roles, political officeholders could encounter distinctive risk factors, yet existing research literature about these subpopulations remains underexplored. This scoping review aimed to systematically examine the breadth of available evidence on mental health issues and risk factors affecting democratically-elected politicians internationally and to identify future research needs. Using pre-defined eligibility criteria based on JBI guidelines, a systematic keyword search was conducted in May 2024 of MEDLINE, Scopus, and APA PsycNet, supplemented by snowballing techniques. Only those studies reporting primary, empirical evidence on mental ill-health or risk factors with psychological correlates from serving politicians in "Full" or "Flawed" democracies (per Democracy Index) were included from 1999 to 2024. Titles and abstracts were screened and the full-texts of potentially eligible literature were assessed before extraction and synthesis. Eighteen sources met the eligibility criteria, cumulatively encompassing ~3,500 national, state, and municipal politicians across seven democracies (Australia, Canada, the Netherlands, Norway, New Zealand, the United Kingdom, and the United States). Cross-sectional surveys were predominantly utilized, with lesser use of mixed-methods approaches, qualitative interviews, and longitudinal cohorts. Violence emerged as a key concept, with twelve sources (66.7%) underlining its psychological toll and certain data indicating a disproportionate impact on female officeholders. Furthermore, four sources (22.2%) explored general psychopathology trends, revealing varying but sizeable mental ill-health and high-risk alcohol consumption rates, and two studies (11.1%) demonstrated adverse effects from specific occupational conditions. Current literature suggests that democratically-elected politicians can face complex mental health challenges. However, significant research gaps remain, including a paucity of prevalence estimates, longitudinal data, and intervention studies. Equally, the underrepresentation of most democratic countries accentuates the need for a more diverse evidence-base to better support the mental wellbeing of politicians worldwide.

Diabetes distress and depression in type 2 diabetes. A cross-sectional study in 18,000 individuals in the Central Denmark region.

Type 2 diabetes is linked to psychological distress and a doubled risk of depression. This study aims to characterize individuals with type 2 diabetes experiencing diabetes distress and/or depression in relation to lifestyle and metabolic outcomes. A population-based survey in 2020 targeted individuals with type 2 diabetes (aged 18-75 years) in the Central Denmark Region. This cross-sectional study assessed diabetes distress (using Problem-Area-in-Diabetes-scale) and depression (via hospital diagnosis and prescribed medication) as exposures. Logistic regression, adjusting for potential confounders, compared exposed and non-exposed groups on lifestyle habits, metabolic factors and medication usage related to cardio-metabolic risks. Of 18,222 respondents with type 2 diabetes (46% response rate), 11% had depression, 14% had diabetes distress and 4% had both. Compared to those with neither condition, those with depression were more often smokers (OR: 2.0, 95% CI: 1.8; 2.3) and sedentary in leisure time (OR: 2.0, 95% CI: 1.8; 2.2). Diabetes distress was associated with elevated HbA1c (OR: 1.8, 95% CI: 1.5; 2.0) and treatment with insulin (OR: 1.8, 95% CI: 1.6; 2.0). Half with diabetes distress displayed stable blood glucose levels. Those with both conditions had a higher risk of sedentary behaviour (OR: 2.7, 95% CI: 2.3; 3.2), clinical insomnia (OR: 6.5, 95% CI: 5.5; 7.7) and low self-rated health (OR: 7.5, 95% CI: 6.3; 9.0) than those with either psychological condition in isolation. This study emphasizes the importance of recognizing distinct features and risk factors associated with diabetes distress and depression in individuals with type 2 diabetes. Tailored care strategies for comorbid mental health issues are crucial for comprehensive management.

Distinct phenotype and risk factor analysis of persistent airflow limitation among asthmatic children: a case-control study.

Persistent airflow limitation (PAL) in childhood asthma is associated with a poor prognosis. The aim of this study was to categorize asthmatic children with PAL into distinct phenotypes and investigate the risk factors associated with each phenotype. We conducted a case-control study with a total of 119 PAL patients and 120 non-PAL (NPAL) individuals. To classify the patients into appropriate clusters, unsupervised cluster analysis using K-means clustering was employed. The clusters were then compared to explore different PAL phenotypes. Univariate and multivariate logistic regression analyses were performed to identify risk factors for PAL and calculate odds ratios (ORs) with 95% confidence intervals (95%CIs). K-means clustering divided patients into three clusters: Cluster 0 included 120 NPAL patients, Cluster 1 characterized by elevated blood neutrophils included 66 PAL patients, and Cluster 2 exhibited elevated blood eosinophils and FeNO levels, containing 53 PAL patients. Independent risk factors for PAL included older age in both Cluster 1 (9 11y: OR 12.67, 95%CI 3.30-55.74; 11y: OR 5.42, 95%CI 1.26-25.69) and Cluster 2 (9 11y: OR 7.25, 95%CI 1.70-33.35; 11y: OR 11.28, 95%CI 2.79-51.89), as well as pneumonia history, with an OR of 6.41(95%CI 1.34-33.41) in Cluster 1 and an OR of 7.92(95%CI 1.83-37.44) in Cluster 2. Furthermore, specific factors associated with Cluster 1 included BMI above 22 kg/ (OR 12.28, 95%CI 2.68-70.45), asthma duration exceeding three years (OR 4.77, 95%CI 1.60-15.94), and a blood neutrophil percentage between 0.4 and 0.5 (OR 4.13, 95%CI 1.17-16.6). In Cluster 2, independent risk factors included a blood eosinophil percentage greater than 0.07 (OR 4.36, 95%CI 1.16-19.73) and a high FeNO level (OR 3.94, 95%CI 1.35-11.97). Our study identified two phenotypes of PAL in asthmatic children: non-eosinophilic and eosinophilic inflammation. Older age and a history of pneumonia were independent risk factors for both phenotypes. For non-eosinophilic inflammation PAL, specific contributing factors included higher BMI, long duration of asthma, and a blood neutrophil percentage between 0.4 and 0.5. Elevated FeNO levels and blood eosinophilic percentage were independently associated with eosinophilic inflammation PAL.

Risk factors for shoulder pain and stiffness in adults aged 44 and older: an 11-year longitudinal population-based study

Objective We conducted a longitudinal observational study over 11 years to identify the risk factors for developing shoulder pain, stiffness, or both. Method The study population (n = 1645) was identified from Health 2000 Survey, a nationally representative sample of Finns aged ≥ 44 years, without shoulder pain and stiffness at the start of the study based on a questionnaire. The independent variables included age, sex, body mass index (BMI), education level, diabetes, physical work exposures, and Beck’s depression score. We used multinomial logistic regression models to estimate relative risk ratios and 95% confidence intervals for three outcomes: shoulder pain, shoulder stiffness, and both combined. Results We found that excess body mass and depressive symptoms were shared statistically significant risk factors for all three outcomes. However, we also observed distinct risk factor profiles: older age was associated with lower risk of shoulder pain but higher risk for shoulder stiffness with or without pain, while females had a lower risk of shoulder stiffness with or without pain. Participants with diabetes had higher risk of shoulder stiffness only. Physical workload factors predicted an increased risk of the combination of shoulder pain and stiffness. Conclusions Our study identified increased BMI and depressive symptoms as consistent risk factors for shoulder pain, stiffness, or both. Older age increased the risk of shoulder stiffness but lowered the risk of pain alone, while females had a lower risk of stiffness. Diabetes was specifically linked to shoulder stiffness, and physical workload increased the risk of combined pain and stiffness.

On the Links Between Exposure to Traumatic Events in Religious Contexts, Post-Traumatic Stress Symptoms, and a Positive Perception of God's Image Among Jewish Lesbians, Gays and Bisexuals in Israel.

This study constitutes one of the first investigations aiming to examine the association between traumatic experiences within religious settings and symptoms of post-traumatic stress among religious lesbians, gays, and bisexuals. Furthermore, the study tested whether the anticipated positive link between those traumatic experiences and post-traumtic stress is influenced by a positive perception of God's image. The sample consisted of 146 Israeli Jewish lesbians, gays, and bisexuals who professed a belief in God or demonstrated religious inclinations either presently or in the past. They completed self-report measures via an online questionnaire, assessing traumatic experiences within religious settings, post-traumtic stress symptoms, and positive perceptions of God's image. The findings revealed a significant and robust positive connection between traumatic experiences within religious settings and post-traumtic stress. A positive perception of God's image exhibited a negative correlation with post-traumtic stress but did not moderate the relationship traumatic experiences within religious settings and symptoms of post-traumatic stress. These findings highlight the significance of traumatic experiences within religious settings as a distinct potential risk factor of post-traumtic stress among lesbians, gays, and bisexuals and underscore the necessity of enhancing awareness among mental health professionals, religious leaders, and legal entities regarding the detrimental effects of those expereinces.

Focusing on women: dissecting sex-specific factors in cardiogenic shock through a large cohort and propensity score matching

Abstract Background Sex differences in cardiogenic shock (CS) are crucial for tailored interventions. We explored sex-based disparities a CS-registry encompassing both acute myocardial infarction (AMI) and non-AMI-CS. Purpose Investigate specific risk variables by type and sex of CS. Compare women-specific risk in CS types and through a propensity score matching (PSM). Methods 9430 patients in a CS registry, 4414 non-AMI-CS (2432 men, 1982 women) and 5016 AMI-CS (4025 men, 991 women). Utilized KM curves, Cox regression, and a multivariable model (for significant variables P<0.05) to identify sex-specific risk factors. Conducted PSM (K=1, 1:1 radius, caliper 0.2) for significant demographic and management variables, and incorporate age, DM2, MCS, PAC, mechanical ventilation (MV), hemodialysis, and exact for SCAI; and for AMI-CS, considered type of MI and primary reperfusion; to assess sex influence on CS mortality. Results Men with AMI an non-AMI-CS are younger, higher BMIs, and smoking history is more prevalent(P<0.05). Women with AMI had higher comorbidities, including HTN, HF, CKD, and AF(P<0.001). Conversely, men with non-AMI exhibit higher dyslipidemia, COPD, previous MI, PCI, and CABG(P<0.001). In terms of CS management, women with AMI are less likely to receive primary reperfusion(P<0.001), while women receive a higher number of vasoactive(P<0.001). Women receive less dobutamine and levosimendan in non-AMI-CS(P<0.001) but more norepinephrine in AMI & non-AMI(P<0.05), finally, more vasopressin in AMI-CS(P=0.006). The SCAI classification indicates that women with AMI tend to have a higher proportion of higher SCAI classes compared to men in AMI-CS (P<0.001) but comparable in non-AMI(P=0.296). Despite these differences, women experience higher mortality in both AMI & non-AMI(P<0.001 & 0.025).(Table 1) Also, different intensities in management strategies are seen by SCAI, and sex in general has been more intense in MCS(AMI) and vasoactive drugs(non-AMI) in men(data not shown). In multivariate analysis, we notice differences in the specific risk factors in men vs women.(Fig1). In mortality, had differences in both AMI and non-AMI-CS. In the case of AMI-CS Logrank(LR) P<0.001, 30 day-RMST of 2.11(1.12-3.08, P<0.001) days less, with a HR of 1.48(1.28-1.72, P<0.001) for women in AMI-CS. In non-AMI-CS LR P=0.006 in 30-days RSMT, a difference of diminished survival of 0.85(0.08-1.62, P=0.03) days, a HR of 1.18(1.05-1.32; P=0.007) for women in non-AMI-CS. (Fig1). When applying PSM, AMI-CS(931 vs 931) although differences arise in LR P=0.048, no differences are seen in 30-day RSMT 1.09(-0.17-2.35, P=0.09), HR 1.22(1.0-1.48, P=0.052). Non-AMI-CS(1406 vs 1406) no differences were appreciated(LR P=0.359), 30-day RSMT 0.4(-0.55-1.36, P=0.407), a HR 1.07(0.92-1.24, P=0.366). (Fig1). Conclusion Women's distinct risk factors may outweigh the impact of sex alone on outcomes. Sex-specific risk factors vary by CS type, underscoring the importance of tailored approaches.Table 1.Differences by CS type & sexFig 1.Forrest plot by CS type & sex

Trends in risk factor prevalence in young adults experiencing acute coronary syndrome

Abstract Introduction While for many decades the prevalence of coronary artery disease (CAD) and acute coronary syndrome (ACS) has been declining, it seems as this trend has reached a plateau, mostly in developing countries, but also in developed countries due to reasons such as immigration and unhealthy lifestyle concomitant to the pandemic of obesity and metabolic syndrome. Still, CAD remains the leading cause of death globally. Preventive cardiology guidelines addressed adequate control of traditional risk factors in order to reduce CAD burden, mortality and morbidity but to lesser extent fewer resources were invested for the younger population in their third or fourth decade for implementing this practical guideline. As global obesity pandemic emerged over the past decades, it emphasizes the need to re-evaluating risk factors, particularly the role of obesity and metabolic syndrome, in contributing to the rising incidence of ACS among the younger population. Purpose The study aims to analyze trends in risk factors among young adult which presented with ACS from 2005 to 2022. Results may inform targeted interventions and deepen understanding of ACS pathophysiology and severity. Methods The study encompassed 712 patients hospitalized between 2005 and 2022. Comparable groups were analyzed, including temporal changes, ST-elevation myocardial infarction (STEMI) vs. non-ST-elevation myocardial infarction (NSTEMI), different age groups, and various ethnicities. Categorical values were thoroughly examined, yielding insightful results. Results Temporal changes revealed that patients presenting with ACS before 2014 exhibited a higher incidence of Dyslipidemia and familial history (p=0.002 and p=0.005). Conversely, in the latter period, overweight and diabetes were more significant (p<0.001 and p=0.0176). In the STEMI vs. NSTEMI group, smoking was more prevalent in the STEMI group (p=0.0449), while diabetes, Dyslipidemia, and hypertension were more significant for the NSTEMI group (p=0.022, p=0.009, p<0.001). For the age group, the only observed difference was in hypertension for the 40-45 and 45-50 age group (p=0.0463). In the ethnicity group, individuals of Arab origin exhibited higher rates of smoking and familial cardiac background (p<0.001 and p=0.03), while in the non-Arab group, obesity was more significant (p<0.001). Conclusion The observed changes in the distribution of risk factors among patients with CAD align with global trends, indicating an increase in obesity. Belonging to the overweight population, prior to obesity, pose a prominent risk factor for ACS. Smoking remains a significant factor, with higher rates in patients presenting with STEMI, aligning previous research and re-emphasize the importance of prevention. Different demographic groups may exhibit distinct risk factors contributing to the common endpoint of CAD. Tailored intervention strategies considering diverse risk profiles are essential for effective coronary disease prevention.

Risk factors of all-cause mortality in heart failure with mildly reduced ejection fraction patients with different post-discharge left ventricular ejection fraction variation patterns

Abstract Background The identification of risk factors for all-cause mortality in patients diagnosed with heart failure with mildly reduced ejection fraction (HFmrEF) and exhibiting varying post-discharge left ventricular ejection fraction (LVEF) patterns remains incomplete. This study aimed to determine the independent risk factors of all-cause mortality among HFmrEF patients with different LVEF variation patterns post-discharge. Methods This retrospective study analyzed data from 807 HFmrEF patients admitted to our hospital between January 2015 and August 2020. Patients were categorized into three groups based on LVEF variation patterns within 6 months to one year post-discharge: Group A (transitioning to heart failure with reduced ejection fraction [HFrEF], n=225), Group B (remaining as HFmrEF, n=335), and Group C (reverting to heart failure with preserved ejection fraction [HFpEF], n=227). Patients were followed up for a mean of 33 months, with all-cause mortality as the primary endpoint. Multivariate Cox regression analysis was conducted to identify independent risk factors for all-cause mortality in each group. Results The mortality rates for Groups A, B, and C were 43.11%, 23.94%, and 24.67%, respectively (P<0.001). Independent risk factors for all-cause mortality in Group A included age (HR=1.04, P=0.007), obesity (HR=1.76, P=0.040), higher creatinine (>100 µmol/L, HR=1.83, P=0.029), higher E/e’ (HR=1.06, P=0.001), absence of PCI (HR=0.51, P=0.019), and non-use of ACEI/ARB (HR=0.039, P=0.006). In Group B, independent risk factors for all-cause mortality were age (HR=1.06, P<0.001), higher NT-proBNP (>2505 pg/ml, HR=2.50, P=0.002), and absence of PCI (HR=0.040, P=0.005). Group C exhibited age (HR=1.04, P=0.002), pleural effusion (HR=2.38, P=0.007), higher creatinine (>100 µmol/L, HR=2.84, P<0.001), and non-use of ACEI/ARB (HR=0.42, P=0.021) as significant independent risk factors associated with increased all-cause mortality risk. Conclusion This study highlights distinct risk factors associated with all-cause mortality in HFmrEF patients exhibiting different post-discharge LVEF variation patterns. Age emerged as a consistent risk factor across all groups, underscoring the importance of age-related considerations in managing HFmrEF patients. Additionally, factors such as obesity, renal function, echocardiographic parameters, and medication adherence played varying roles in influencing mortality risk depending on the evolution of LVEF following discharge. These findings emphasize the need for personalized risk stratification and tailored management strategies for HFmrEF patients to improve outcomes and reduce mortality rates.

A comparative retrospective longitudinal study of arthritis risk and cognitive decline in older adults

Arthritis often results in unmet healthcare needs for older adults with cognitive decline, who may struggle to communicate pain or recall symptoms. However, the risk factors for arthritis in this group remain underexplored. We addressed this gap by identifying and comparing arthritis risk factors among older adults with varying cognitive statuses. Data from 334 participants with cognitive decline and 808 participants with normal cognition were analysed using the Korean Longitudinal Study of Aging, tracking arthritis diagnoses over 12 years with Kaplan–Meier curves and Cox proportional hazards regression. Results showed 47.6% of older adults with cognitive decline developed arthritis, compared with 30.1% with normal cognition. Key risk factors for the cognitive decline group included depressive symptoms (hazard ratio [HR]: 1.87), living alone (HR: 1.66), infrequent social interactions (HR: 1.42), and greater dependency in daily activities (HR: 1.41). In the normal cognition group, additional chronic illnesses (HR: 1.41) and higher body mass index (HR: 1.09) were significant risk factors. Understanding these distinct risk factors is crucial for preventing and managing arthritis among at risk groups. Moreover, these findings can assist in developing comprehensive public health strategies integrating mental health and social support to improve health outcomes for older adults with cognitive decline.

The cardiovascular risks of sedentary behavior and the progress of physical activity interventions

Since the 1960s, sedentary behavior has been on the rise globally. Modern culture is characterized by sedentary behavior (SB), which has become a distinct risk factor for non-communicable illnesses. Cardiovascular diseases (CVD) are rapidly spreading around the world. A growing body of research has established the significance of SB as a risk factor for the onset of CVD. Additionally, blood lipoprotein (BL), blood pressure (BP), blood glucose (BG), and endothelial function (EF) are among the CVD risk variables that SB may significantly affect. Chinese scholars have not paid enough attention to the harm of SB to CVD, which needs urgent attention. Physical activity (PA) can improve the health of sedentary people. Increased PA may be able to counteract sedentary-induced CVD events, as analyzed by the study. In particular, a multi-component approach to exercise can significantly enhance cardio-metabolic health. Therefore, people may choose PA control as a means of reducing the incidence of CVD.

Long non-coding RNA AC010457.1 promotes the growth and EMT of gastric cancer via the PI3K/AKT axis

Gastric cancer (GC) is a malignancy with a relatively high mortality rate. This study aimed to ascertain the prognostic significance of long non-coding RNA (lncRNA) AC010457.1 in GC and elucidate its role in disease progression. The Cancer Genome Atlas (TCGA) database was used to screen the prognosis-associated differentially expressed lncRNAs in GC patients. Kaplan-Meier curves, univariate and multivariate Cox regression analyses were applied to assess the prognostic significance of AC010457.1. In vitro and in vivo functional assays were performed to evaluate the effects of AC010457.1 on cellular proliferation and metastasis. Mechanistic investigations, including Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, Western blotting (WB), Immunofluorescence (IF), and Immunohistochemistry (IHC), were used to explore the signaling pathways activated by AC010457.1. We demonstrated that AC010457.1 was abnormally upregulated in GC tissues, and that this aberrant upregulation was associated with a poor prognosis for GC patients. The functional experiments proved that the downregulated of AC010457.1 hindered GC cell proliferation, migration, and invasive potential. Furthermore, KEGG analysis revealed a significant association between AC010457.1 and the PI3K/AKT signaling pathway, which was further corroborated by WB analysis. Rescue experiments provided additional confirmation that AC010457.1 regulated PI3K/AKT promote GC proliferation, migration, and epithelial-mesenchymal transition (EMT). Collectively, our findings suggest that AC010457.1 overexpression serves as a distinct prognostic risk factor in GC and may represent a promising therapeutic target for the treatment of this malignancy.

Optimizing anesthesia management based on early identification of electroencephalogram burst suppression risk in non-cardiac surgery patients: a visualized dynamic nomogram

Background Burst suppression (BS) is a specific electroencephalogram (EEG) pattern that may contribute to postoperative delirium and negative outcomes. Few prediction models of BS are available and some factors such as frailty and intraoperative hypotension (IOH) which have been reported to promote the occurrence of BS were not included. Therefore, we look forward to creating a straightforward, precise, and clinically useful prediction model by incorporating new factors, such as frailty and IOH. Materials and methods We retrospectively collected 540 patients and analyzed the data from 418 patients. Univariate analysis and backward stepwise logistic regression were used to select risk factors to develop a dynamic nomogram model, and then we developed a web calculator to visualize the process of prediction. The performance of the nomogram was evaluated in terms of discrimination, calibration, and clinical utility. Results According to the receiver operating characteristic (ROC) analysis, the nomogram showed good discriminative ability (AUC = 0.933) and the Hosmer–Lemeshow goodness-of-fit test demonstrated the nomogram had good calibration (p = 0.0718). Age, Clinical Frailty Scale (CFS) score, midazolam dose, propofol induction dose, total area under the hypotensive threshold of mean arterial pressure (MAP_AUT), and cerebrovascular diseases were the independent risk predictors of BS and used to construct nomogram. The web-based dynamic nomogram calculator was accessible by clicking on the URL: https://eegbsnomogram.shinyapps.io/dynnomapp/ or scanning a converted Quick Response (QR) code. Conclusions Incorporating two distinctive new risk factors, frailty and IOH, we firstly developed a visualized nomogram for accurately predicting BS in non-cardiac surgery patients. The model is expected to guide clinical decision-making and optimize anesthesia management.

Differential Association of Preadolescent Risk Factors Across Developmental Patterns of Adolescent Concurrent Gambling Participation and Substance Use.

Early risk factors for gambling participation (GP) and substance use (SU) in adolescents have usually been studied separately, although these disorders were integrated into the same clinical category over a decade ago. This exploratory study aimed to investigate the early individual, parental, familial and social risk factors associated with developmental patterns of adolescent GP and SU in a population-representative cohort (N = 1594, 51.2% boys). Using a person-centered strategy and multiple assessments from age 12 to 17, six developmental patterns describing joint GP and SU courses were revealed. Non-substance users/non-gamblers served as the reference class in an integrated longitudinal-multivariate analysis framework examining 15 distinct risk factors. Results showed that a core of risk factors were common to all trajectory-classes of substance users with or without GP. For a similar level of SU, most of the risk factors associated with non-gambling users also affected their gambling peers. However, additional risk factors were specifically related to GP. Thus, substance users who also gamble were affected by a greater number of risk factors than non-gambling substance users. Findings are consistent with a developmental syndrome of addiction, which posits a shared etiology between different expressions of addiction as well as differences in risk factors that lead to distinct trajectories of addictive behaviors. They highlight the importance of considering both GP and SU for a comprehensive assessment of adolescents' level of risk with regard to addictive behaviors.

Factors Influencing Malnutrition Among Older Adult Residents in the Western Region of Saudi Arabia: Sex Differential Study.

The global population of older adults is on the rise. As people age, their physical functions gradually decline, leading to a decrease in the overall functioning of different organ systems. Due to these changes, older individuals are at a higher risk of encountering various adverse health outcomes and complications, such as malnutrition. This study aims to investigate the prevalence of malnutrition and its associated factors among older adults dwelling in the western region of Saudi Arabia. We have analyzed these factors separately for both men and women to understand any potential sex differences. A nonrandomized cross-sectional study was conducted for older adults aged ≥60 years in the western region of Saudi Arabia. Personal information was obtained through a closed questionnaire. The Mini Nutritional Assessment Short Form was used to determine the malnutrition status of older adults. Consequently, the individuals were divided into 2 groups: normal and malnourished. To assess the risk factors related to malnutrition, the odds ratio (OR) and 95% CI were determined using a binary logistic regression. The prevalence of malnutrition in men and women was around 7% and 5%, respectively. Potential risk factors related to malnutrition in men were higher age (OR 1.263, 95% CI 1.086-1.468; P=.002), being widowed (OR 8.392, 95% CI 1.002-70.258; P=.049), and having dental problems (OR 9.408, 95% CI 1.863-47.514; P=.007). On the other hand, risk factors associated with malnutrition in women were lower BMI (OR 0.843, 95% CI 0.747-0.952; P=.006) and being disabled (OR 18.089, 95% CI 0.747-0.952; P=.006). The findings of this study provide important insights into the risk factors for malnutrition among older adults in the western region of Saudi Arabia. While the overall prevalence of malnutrition was relatively low, the analysis revealed distinct risk factors for older men and women. Interventions developed based on the identified risk factors may prove effective in addressing the issue of malnutrition within this population.

Risk factors for Charcot foot development in individuals with diabetes mellitus.

Charcot foot is a complication of diabetes mellitus that has potentially disastrous consequences. Although it was first described in 1868 and found to be associated with diabetes in 1936, there is still uncertainty about the risk factors affecting the development of the condition. Here, we aim to identify risk factors for Charcot foot in a nationwide cohort study. A retrospective register-based cohort study was performed for the period 2001-2016, using nationwide registries. Individuals with diabetes and Charcot foot were identified and matched by diabetes type and with similar diabetes duration with individuals with diabetes but not Charcot foot. Logistic regression analyses were used to identify risk factors. A total of 3397 participants with diabetes mellitus and Charcot foot and 27,662 control participants with diabetes but without Charcot foot were included. HbA1c, duration of diabetes, micro- and macroalbuminuria, retinopathy and atherosclerosis (general and peripheral) were identified as risk factors for Charcot foot in participants with type 1 diabetes and participants with type 2 diabetes. In the most extensive study on Charcot foot to date, we identified distinctive and common risk factors associated with the development of Charcot foot in individuals with type 1 diabetes and type 2 diabetes.

Risk factors for persistent postoperative opioid use: an entity distinct from chronic postsurgical pain

Despite a decline in opioid prescriptions over the past decade, patients commonly receive opioid analgesics as a treatment for postoperative pain in the USA. One complication that patients may experience...

Machine learning analysis for detecting late recurrence and loss to follow‐up after renal cell carcinoma surgery

AbstractObjectivesRenal cell carcinoma (RCC) is shown to have a tendency for late recurrence, occurring 5 or more years after curative surgery. Imaging diagnosis is required for follow‐up, and there is no definitive answer as to how long this should continue. Some patients discontinue follow‐up visits at their own discretion. How best to predict late recurrence and loss to follow‐up (LF) remains unclear.Patients and methodsThis study targeted patients diagnosed with non‐metastatic RCC who underwent either radical or partial nephrectomy at Chiba University Hospital between 1988 and 2021. Follow‐up for patients with RCC is typically lifelong. We used random survival forests (RSFs), a machine learning‐based survival analysis method, to predict late recurrence and LF. For verification of prediction accuracy, we applied the time‐dependent area under the receiver operating characteristic curve (t‐AUC). To analyse the risks of late recurrence and LF, SurvSHAP(t) and partial dependence plots were used.ResultsWe analysed 1051 cases in this study. Median follow‐up was 58.5 (range: 0–376) months. The predictive accuracy of recurrence using RSF was t‐AUC 0.806, 0.761, 0.674 and 0.566 at 60, 120, 180 and 240 months postoperatively, respectively. The recurrence risk impact showed a time‐dependent increase up to approximately 50 months postoperatively. Beyond 50 months, there were no distinct risk factors characteristic of late recurrence. The predictive accuracy of LF using RSF was t‐AUC 0.542, 0.699, 0.685, 0.628 and 0.674 at 60, 120, 180, 240 and 300 months postoperatively, respectively. The risk of LF increased with advancing age beyond 70 years.ConclusionIt is difficult to identify factors that predict late recurrence. For long‐term follow‐up observation, it is essential to pay particular attention to patients with RCC aged 70 years and above. Establishing frameworks to facilitate collaboration with local hospitals near patients' residences and providing care within the community is necessary.

Clinical and molecular analysis of longitudinal rhinitis phenotypes in an urban birth cohort

BackgroundChronic rhinitis symptoms cause significant health burden among children and can have a heterogeneous presentation. Defining phenotypes of childhood chronic rhinitis and associated pathobiology may lead to prevention or improved treatments. ObjectivesTo identify longitudinal patterns of rhinitis symptoms in childhood and determine their associations with early life risk factors, allergic comorbidities, and nasal epithelial cell gene expression. MethodsChronic rhinitis symptoms were evaluated from ages 1 through 11 years in 485 urban children at high risk for allergic disease in the Urban Environment and Childhood Asthma (URECA) birth cohort. We identified longitudinal rhinitis phenotypes and their relationships to early life exposures, atopic comorbidities, and patterns of nasal epithelial gene expression at age 11 years. ResultsChronic rhinitis symptoms started early in many children and were a risk factor for developing aeroallergen sensitization. We identified four longitudinal rhinitis phenotypes: low/minimal disease, persistent, persistent decreasing, and late increasing. Persistent rhinitis was most closely linked to allergic sensitization and asthma. Risk factors for persistent rhinitis included frequent colds (p<0.001), antibiotic use (p<0.001), and reduced exposure to common indoor aeroallergens (p=0.003). Compared to low/minimal disease, rhinitis phenotypes were associated with increased expression of canonical Type 2 genes and decreased expression of immune response genes. ConclusionsIn urban children, rhinitis symptoms often precede aeroallergen sensitization. Rhinitis phenotypes based on symptoms had distinct risk factors and nasal transcriptome. These results suggest that focusing on early life risk factors and distinct immune mechanisms may be a target to preventing chronic rhinitis in childhood.

Distinctive characteristics, risk factors, and prevention of premature myocardial infarction: A narrative review.

The proportion of young individuals that present with acute myocardial infarction is a major problem that keeps increasing. The specific characteristics of premature coronary artery disease and its differences between young and older individuals need to be elucidated. Although risk factors are similar in different age categories, there is a great difference in their prevalence. The vast majority of young patients are males and there is a higher prevalence of cigarette smoking, family history of premature coronary artery disease, lipid disorders, and illicit drug use, while the prevalence of hypertension and diabetes mellitus is lower. Young individuals with acute coronary syndrome usually present either with ST-segment elevation or non-ST-segment elevation myocardial infarction. It is not unusual for young patients to present with atypical symptoms to the office of primary care physicians, leading occasionally to incorrect or delayed diagnosis. Therefore, prompt and correct diagnosis is necessary to implement the specific management as quickly as possible. A literature research of studies was conducted for the last 10 years, regarding the risk factors and prevention of premature myocardial infarction. As databases, we used PubMed and peer reviewed journals. The aim of this review is to raise awareness among family medicine and primary care physicians, regarding the clinical presentation of young patients with acute myocardial infarction, to provide optimal medical attention.

Valencene ameliorates ox-LDL induced foam cell formation by suppressing inflammation and modulating key proteins involved in the atherogenesis on THP-1 derived macrophages

Atherosclerosis is a distinct risk factor for cardiovascular and cerebrovascular disorders, which are significant contributors to global mortality. It is defined by macrophage-derived foam cell development followed by persistent inflammation, plaque formation, fibrosis and thrombosis. Studies have shown valencene, a sesquiterpene obtained from Valencia oranges, has several health-promoting properties. However, its protective effect against atherosclerosis and foam cell models remains unexplored. The present investigation revealed that valencene treatment suppresses foam cell generation and accumulation of lipids in THP-1-derived cells macrophage models activated with oxidized low-density lipoprotein (ox-LDL), maintained in vitro. The intracellular lipid content was qualitatively and semi-quantitatively analyzed by Oil Red O staining, and the compound's cytotoxicity was assessed through the MTT assay, considering both time-dependent and dose-dependent factors. The RT-qPCR results showed promising anti-inflammatory and anti-oxidant enzyme status upon valencene treatment. The H2DCFDA staining revealed valencene's ability to reduce the oxidative stress induced by ox-LDL. Further, high-throughput proteomic profiling was carried out to identify the target proteins affected by valencene treatment and thereby explore its mechanism of action on foam cell models. Proteomic studies revealed that valencene treatment regulates the expression of several proteins associated with ox-LDL-induced inflammation, defective cholesterol homeostasis and cholesterol efflux pathways.