Early Preventive Interventions Research Articles

Children’s Social, Emotional, and Behavioral Outcomes in Military Families: A Rapid Review

AbstractIn light of ongoing global military conflicts, including the Israel-Hamas war and the Russia-Ukraine war, it is imperative to study the effects of parental military service and deployment on the health and well-being of children within military families. Emerging evidence suggests that children with a parent in service appear to face unique developmental challenges associated with the military lifestyle, which differ from those experienced by civilian children. However, there is currently limited systematic research that compares the developmental outcomes of children with serving parents to their civilian peers. Therefore, the aim of this review is to synthesize existing literature on the behavioral, social, emotional, and educational functioning of children with currently serving parents in defense forces, in comparison to their civilian counterparts. This rapid systematic review was conducted in accordance with the Joanna Briggs Institute methodology framework, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and Cochrane Rapid Review methodological recommendations The following databases were searched: Medline, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials. Relevant online databases were searched from February 2012 to 2022 to examine the contemporary literature. Fourteen identified published quantitative studies were identified. No qualitative studies were found, and no study reported on academic outcomes. Despite considerable sample heterogeneity across studies, military children of all ages appear to be a particularly vulnerable population. Findings suggest that children in military families experience substantially higher risk for negative psychological, social, and behavioral health outcomes than their civilian counterparts, with parental deployment increasing risk across all developmental stages (i.e., early, middle, and late childhood). Among these age groups, adolescents of currently serving members showed highest risk, particularly concerning suicidal ideation and suicidal behaviors. Implications are discussed in terms of early detection, preventative interventions, and support services for families and children with a serving parent. PROSPERO registration: CRD42022313999.

A case-control study of the risk factors for fistula-in-ano in infants and toddlers

BackgroundLimited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives.ObjectivesThe purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies.Design and settingsA retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021.Independent variables(a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors.ResultsMothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089).ConclusionBased on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.

Metabolic syndrome and pharmacotherapy outcomes in patients with type 2 diabetes mellitus

BackgroundMetabolic syndrome is a group of metabolic abnormalities that increase predisposition to several diseases including ischemic heart disease and diabetes mellitus. The study aimed to investigate metabolic syndrome among patients with type-2 diabetes mellitus (DM), and its impact on pharmacotherapy outcomes.MethodsAn observational cross-sectional study was performed on 910 patients with type-2 DM between June and December 2023. Fasting blood sugar, triglycerides, high-density lipoproteins (HDL), blood pressure, and abdominal obesity were measured. Metabolic syndrome was identified according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Pharmacotherapy outcomes were assessed according to American Association of Clinical Endocrinologists and American Diabetes Association guidelines using the ability to achieve adequate glycemic control and normal levels of blood pressure and fasting plasma lipoproteins.ResultsIn total, 87.5% of type-2 DM patients had metabolic syndrome; the prevalence increased with age and was higher among females. Metabolic syndrome showed the following distribution of risk factors: insulin resistance (100%), low HDL (95.3%), elevated blood pressure (83%), triglycerides dyslipidemia (80.1%), and abdominal obesity (62.5%). Majority of the patients had either 5 or 4 risk factors of metabolic syndrome. The most common comorbidities were dyslipidemia (97.7%) and hypertension (83%). Treatment outcomes were insufficient where adequate glycemic control was only achieved in 12% of type-2 DM patients, and proper management of comorbid dyslipidemia and hypertension was achieved in 29% and 40.9% of patients, respectively. Adequate blood pressure control was less achieved in patients with metabolic syndrome (34.4%) than those without metabolic syndrome (77.2%). Similarly, dyslipidemia was less controlled in patients with metabolic syndrome (26.9%) than in those without metabolic syndrome (47.3%).ConclusionPharmacotherapy outcomes were inadequate for most patients with type-2 diabetes mellitus. Adopting early preventive and therapeutic interventions for metabolic syndrome is advised to improve treatment outcomes of the comorbid dyslipidemia and hypertension.

#1270 Exploring the shift in gut microbiota due to renal ischemia/reperfusion injury in rats

Abstract Background and Aims Acute kidney injury (AKI) due to renal ischemia/reperfusion (I/R) is a major clinical problem in renal transplantation and partial nephrectomy, which is associated with morbidity and mortality and substantial healthcare expenditures, but there is no effective and specific treatment. Recently, the clinical impact of the interaction between gut bacteria and the kidney function has become increasingly clear. Experimental evidence has highlighted a bidirectional relationship between gut microbiota and kidney disease. Therefore, we investigated the possibility that I/R can ameliorate AKI by studying gut-renal interactions and gut microbiota in AKI. Method We induced varying degrees of renal I/R injury in adult male Wistar rats by clamping the left renal pelvis for 30 and 45 minutes, simulating mild and severe conditions, respectively. These samples were subjected to extensive histologic examination using standard techniques such as hematoxylin and eosin (HE), Sirius Red, and F4/80 staining. In addition, we performed a quantitative analysis of the mRNA expression levels of fibrotic and inflammatory markers in both kidney and colon tissues using real-time PCR. Gut microbiota genomic DNA was extracted from rat feces and microbial 16S ribosomal RNA (rRNA) gene sequencing was performed. Results Renal function deteriorated with increasing ischemia time and fibrosis progressed, as confirmed by Sirius Red staining and qPCR of fibrosis genes such as TGFB. The expression of inflammatory genes such as IL-1B and IL-6 was also increased. The expression of inflammatory genes such as Toll-like receptor, C3, and IL-1B in the intestine also increased with ischemia time. In the fecal microbiota, the total read percentage of Bacteroides acidifaciens at the species level increased with increasing ischemia time. Conclusion The observed shifts in gut microbiota composition may serve as a critical indicator of chronic kidney disease (CKD)-induced gut dysbiosis secondary to AKI. This finding highlights the need for further research into the identification and migration patterns of the gut microbiota, which represents a promising avenue for early detection, prevention, and therapeutic intervention in AKI. Future investigations elucidating the mechanisms by which the microbiota influence IRI-induced AKI and the development of practical therapeutic strategies have the potential to significantly improve clinical outcomes in patients suffering from IRI-induced AKI.

Early pharmacological interventions for prevention of post-traumatic stress disorder (PTSD) in individuals experiencing acute traumatic stress symptoms.

Acute traumatic stress symptoms may develop in people who have been exposed to a traumatic event. Although they are usually self-limiting in time, some people develop post-traumatic stress disorder (PTSD), a severe and debilitating condition. Pharmacological interventions have been proposed for acute symptoms to act as an indicated prevention measure for PTSD development. As many individuals will spontaneously remit, these interventions should balance efficacy and tolerability. To assess the efficacy and acceptability of early pharmacological interventions for prevention of PTSD in adults experiencing acute traumatic stress symptoms. We searched the Cochrane Common Mental Disorders Controlled Trial Register (CCMDCTR), CENTRAL, MEDLINE, Embase and two other databases. We checked the reference lists of all included studies and relevant systematic reviews. The search was last updated on 23 January 2023. We included randomised controlled trials on adults exposed to any kind of traumatic event and presenting acute traumatic stress symptoms, without restriction on their severity. We considered comparisons of any medication with placebo, or with another medication. We excluded trials that investigated medications as an augmentation to psychotherapy. We used standard Cochrane methodological procedures. Using a random-effects model, we analysed dichotomous data as risk ratios (RR) and calculated the number needed to treat for an additional beneficial/harmful outcome (NNTB/NNTH). We analysed continuous data as mean differences (MD) or standardised mean differences (SMD). Our primary outcomes were PTSD severity and dropouts due to adverse events. Secondary outcomes included PTSD rate, functional disability and quality of life. We included eight studies that considered four interventions (escitalopram, hydrocortisone, intranasal oxytocin, temazepam) and involved a total of 779 participants. The largest trial contributed 353 participants and the next largest, 120 and 118 participants respectively. The trials enrolled participants admitted to trauma centres or emergency departments. The risk of bias in the included studies was generally low except for attrition rate, which we rated as high-risk. We could meta-analyse data for two comparisons: escitalopram versus placebo (but limited to secondary outcomes) and hydrocortisone versus placebo. One study compared escitalopram to placebo at our primary time point of three months after the traumatic event. There was inconclusive evidence of any difference in terms of PTSD severity (mean difference (MD) on the Clinician-Administered PTSD Scale (CAPS, score range 0 to 136) -11.35, 95% confidence interval (CI) -24.56 to 1.86; 1 study, 23 participants; very low-certainty evidence), dropouts due to adverse events (no participant left the study early due to adverse events; 1 study, 31 participants; very low-certainty evidence) and PTSD rates (RR 0.59, 95% CI 0.03 to 13.08; NNTB 37, 95% CI NNTB 15 to NNTH 1; 1 study, 23 participants; very low-certainty evidence). The study did not assess functional disability or quality of life. Three studies compared hydrocortisone to placebo at our primary time point of three months after the traumatic event. We found inconclusive evidence on whether hydrocortisone was more effective in reducing the severity of PTSD symptoms compared to placebo (MD on CAPS -7.53, 95% CI -25.20 to 10.13; I2 = 85%; 3 studies, 136 participants; very low-certainty evidence) and whether it reduced the risk of developing PTSD (RR 0.47, 95% CI 0.09 to 2.38; NNTB 14, 95% CI NNTB 8 to NNTH 5; I2 = 36%; 3 studies, 136 participants; very low-certainty evidence). Evidence on the risk of dropping out due to adverse events is inconclusive (RR 3.19, 95% CI 0.13 to 75.43; 2 studies, 182 participants; low-certainty evidence) and it is unclear whether hydrocortisone might improve quality of life (MD on the SF-36 (score range 0 to 136, higher is better) 19.70, 95% CI -1.10 to 40.50; 1 study, 43 participants; very low-certainty evidence). No study assessed functional disability. This review provides uncertain evidence regarding the use of escitalopram, hydrocortisone, intranasal oxytocin and temazepam for people with acute stress symptoms. It is therefore unclear whether these pharmacological interventions exert a positive or negative effect in this population. It is important to note that acute traumatic stress symptoms are often limited in time, and that the lack of data prevents the careful assessment of expected benefits against side effects that is therefore required. To yield stronger conclusions regarding both positive and negative outcomes, larger sample sizes are required. A common operational framework of criteria for inclusion and baseline assessment might help in better understanding who, if anyone, benefits from an intervention. As symptom severity alone does not provide the full picture of the impact of exposure to trauma, assessment of quality of life and functional impairment would provide a more comprehensive picture of the effects of the interventions. The assessment and reporting of side effects may facilitate a more comprehensive understanding of tolerability.

Modifiable protective factors for mental health resilience in the offspring of depressed parents: A high‐risk longitudinal cohort spanning adolescence and adulthood

AbstractBackgroundSeveral protective factors have been identified for mental health (MH) resilience in adolescent offspring of depressed parents. However, it is unclear if these effects persist into adulthood.MethodsDepressed parents and their offspring (N = 188) from the Early Prediction of Adolescent Depression study were assessed four times (mean offspring ages 12.39, 13.77, 14.82, and 23.41). Mental health resilience was examined using residual scores (better‐than‐expected mood‐, behaviour‐, or anxiety‐related MH at mean age 23 given risk exposure), and categorically as sustained good MH across adolescence and young adulthood.ResultsOnly 9.2% of young adults demonstrated sustained good MH. Parents of resilient individuals showed lower comorbidity (anxiety, antisocial behaviour and harmful drinking) and higher depression remission. Considering adolescent protective factors, weak evidence was observed of associations of mood‐resilience with adolescent peer‐relationship quality (β = −0.20, 95%CI:−0.36, −0.04); friendship quality (β = −0.14, 95%CI:−0.31, 0.02); risk adjustment (β = −0.16, 95%CI:‐0.34, 0.03) and dysfunctional attitudes (β = 0.18, 95%CI:0.01, 0.35). There was weak evidence of behavioural‐resilience association with parent positive expressed emotion (β = −0.15, 95%CI:−0.31, 0.02) and offspring exercise (β = −0.37, 95%CI:−0.77, 0.03). No adolescent protective factors showed an association with anxiety‐resilience. For sustained good MH, there was weak evidence of an association with inhibitory control (OR = 0.39, 95%CI:0.14, 1.07). Strong evidence was observed for associations between young adult‐reported peer relationship quality and mood‐resilience (β = −0.35, 95%CI:−0.53, −0.17), behavioural‐resilience (β = −0.33, 95%CI:−0.51, −0.14) and anxiety‐resilience (β = −0.34, 95%CI:−0.53, −0.14), while weak evidence was observed of an association of social activities with anxiety‐resilience (β = −0.51, 95%CI:−0.97, −0.06).ConclusionsWe found limited evidence for the long‐lasting effects of adolescent protective factors on adult MH resilience. Social factors remained protective into young adulthood, while family factors did not. Early preventative intervention might not be sufficient to maintain good long‐term MH, and young people will likely require more prolonged support.

Perioperative Acute Renal Injury: Revisiting Pathophysiology.

Acute renal dysfunction and subsequent acute renal failure after cardiac surgery are associated with high mortality and morbidity. Early therapeutic or preventive intervention is hampered by the lack of an early biomarker for acute renal injury. Recent studies showed that urinary neutrophil gelatinase-associated lipocalin (NGAL or lipocalin 2) is upregulated early (within 1 to 3 h) after murine renal injury and in pediatric acute renal dysfunction after cardiac surgery. The authors hypothesized that postoperative urinary NGAL concentrations are increased in adult patients developing acute renal dysfunction after cardiac surgery compared with patients without acute renal dysfunction. After institutional review board approval, 81 cardiac surgical patients were prospectively studied. Urine samples were collected immediately before incision and at various time intervals after surgery for NGAL analysis by quantitative immunoblotting. Acute renal dysfunction was defined as peak postoperative serum creatinine increase by 50% or greater compared with preoperative serum creatinine. Sixteen of 81 patients (20%) developed postoperative acute renal dysfunction, and the mean urinary NGAL concentrations in patients who developed acute renal dysfunction were significantly higher early after surgery (after 1 h, mean ± SD, 4,195±6,520 vs. 1,068±2,129ng/ml; P < 0.01) compared with patients who did not develop acute renal dysfunction. Mean urinary NGAL concentrations continued to increase and remained significantly higher at 3 and 18 h after cardiac surgery in patients with acute renal dysfunction. In contrast, urinary NGAL in patients without acute renal dysfunction decreased rapidly after cardiac surgery. Patients developing postoperative acute renal dysfunction had significantly higher urinary NGAL concentrations early after cardiac surgery. Urinary NGAL may therefore be a useful early biomarker of acute renal dysfunction after cardiac surgery. These findings may facilitate the early detection of acute renal injury and potentially prevent progression to acute renal failure.

Development, evaluation and validation of machine learning models to predict hospitalizations of patients with coronary artery disease within the next 12 months

BackgroundImproved survival of patients after acute coronary syndromes, population growth, and overall life expectancy rise have led to a significant increase in the proportion of patients with stable coronary artery disease (CAD), creating a significant load on the entire healthcare system. The disease often progresses with the development of many complications while significantly increasing the likelihood of hospitalization. Developing and applying a machine learning model for predicting hospitalizations of patients with CAD to an inpatient medical facility will allow for close monitoring of high-risk patients, early preventive interventions, and optimized medical care. AimsDevelopment and external validation of personalized models for predicting the preventable hospitalizations of patients with stable CAD and its complications using ML algorithms and data of real-world clinical practice. Methods135,873 depersonalized electronic health records of 49,103 patients with stable CAD were included in the study. Anthropometric measurements, physical examination results, laboratory, instrumental, anamnestic, and socio-demographic data, widely used in routine medical practice, were considered as potential predictors, a total of 73 features. Logistic regression, decision tree-based methods including gradient boosting (AdaBoost, LightGBM, XGBoost, CatBoost) and bagging (RandomForest and ExtraTrees), discriminant analysis (LinearDiscriminant, QuadraticDiscriminant), and naive Bayes classifier were compared. External validation was performed on the data of a separate region. ResultsThe best results and stability to external validation data were shown by the CatBoost model with an AUC of 0.875 (95% CI 0.865–0.885) for the internal testing and 0.872 (95% CI 0.856–0.886) for the external validation. The best model showed good performance evaluated through AUROC, Brier score and standardized net benefit (for the target NPV threshold) for the validation dataset that was only slightly similar to the train data. ConclusionThe metrics of the best model were superior to previously published studies. The results of external validation demonstrated the relative stability of the model to new data from another region that confirms the possibility of the model’s application in real clinical practice.

“Unravelling Colorectal Cancer: From Origin to Treatment”

The colon and rectum are the primary organs affected by colorectal cancer (CRC), which is the primary cause of cancer-related morbidity and mortality. Inflammation, particularly in disorders like inflammatory bowel diseases, increases the risk of colorectal cancer, with environmental factors playing a crucial role. The majority of adenocarcinomas typically develop from the epithelial cells that line the colon and rectum as a result of a complex series of genetic and epigenetic modifications. Benign precursor lesions such as adenomatous polyps trigger the slow progression of CRC over a period of ten years or longer. Its etiology is influenced by sporadic, familial, and hereditary forms; prominent hereditary syndromes include Lynch syndrome and familial adenomatous polyposis. Chromosome instability and microsatellite instability are the two main tumorigenic pathways that underpin the pathophysiology of CRC, exhibiting regional differences in the global epidemiology. Approaches: TNM classification is the basis for diagnosis, and various treatment modalities, such as surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy, and gene therapy, are employed during treatment. Surgical treatments, from minimally invasive procedures to colectomy, are essential and highlight the importance of total excision of the mesocolic region. The standard therapeutic approach consists of chemotherapy and targeted agents; however, newer like gene therapy and immunotherapy show promise. In order to improve outcomes and lessen the burden of the disease, combating CRC requires comprehensive strategies that include early detection, prevention, and innovative therapeutic interventions.

Construction of novel multi-epitope-based diagnostic biomarker HP16118P and its application in the differential diagnosis of Mycobacterium tuberculosis latent infection

Tuberculosis (TB) is an infectious disease that significantly threatens human health. However, the differential diagnosis of latent tuberculosis infection (LTBI) and active tuberculosis (ATB) remains a challenge for clinicians in early detection and preventive intervention. In this study, we developed a novel biomarker named HP16118P, utilizing 16 helper T lymphocyte (HTL) epitopes, 11 cytotoxic T lymphocyte (CTL) epitopes, and 8 B cell epitopes identified from 15 antigens associated with LTBI-RD using the IEDB database. We analyzed the physicochemical properties, spatial structure, and immunological characteristics of HP16118P using various tools, which indicated that it is a hydrophilic and relatively stable alkaline protein. Furthermore, HP16118P exhibited good antigenicity and immunogenicity, while being non-toxic and non-allergenic, with the potential to induce immune responses. We observed that HP16118P can stimulate the production of high levels of IFN-γ+ T lymphocytes in individuals with ATB, LTBI, and health controls. IL-5 induced by HP16118P demonstrated potential in distinguishing LTBI individuals and ATB patients (p=0.0372, AUC=0.8214, 95% CI [0.5843 to 1.000]) with a sensitivity of 100% and specificity of 71.43%. Furthermore, we incorporated the GM-CSF, IL-23, IL-5, and MCP-3 induced by HP16118P into 15 machine learning algorithms to construct a model. It was found that the Quadratic discriminant analysis model exhibited the best diagnostic performance for discriminating between LTBI and ATB, with a sensitivity of 1.00, specificity of 0.86, and accuracy of 0.93. In summary, HP16118P has demonstrated strong antigenicity and immunogenicity, with the induction of GM-CSF, IL-23, IL-5, and MCP-3, suggesting their potential for the differential diagnosis of LTBI and ATB.

The Current Strategy in Managing Congenital and Structural Heart Disease: Find and Treat Them Appropriately

Significant progress has been made in diagnosing and treating congenital heart defects (CHDs) over the past five decades. Notable advancements include pulse oximetry screening for critical CHDs in newborns and percutaneous, catheter-based procedures, improving outcomes even in developing nations. Recent studies demonstrate favorable outcomes with device closure of acyanotic CHDs, with non-fluoroscopy techniques adopted to minimize radiation risks. Positive results are observed with right ventricular outflow tract (RVOT) stent palliation for late-presenting cyanotic congenital heart diseases such as tetralogy of Fallot (TOF). Novel interventions like reverse Potts shunt anastomosis show promise in managing pediatric pulmonary arterial hypertension (PAH), while prophylactic treatments effectively reduce postoperative arrhythmias. Fontan procedure significantly enhances survival rates for individuals with single functional ventricles, although challenges arise with aging populations. In developed countries, fetal cardiac interventions utilizing advanced imaging techniques allow for early detection and preventive interventions, reducing secondary complications. Keyword: Fetal Intervention, Fontan, Non-Fluoroscopy, Percutaneous, Reverse Potts, Rheumatic Heart Disease, RVOT Stenting.

Performance of home-based and ambulatory blood pressure monitoring in obese children and their correlation with end organ damage.

The increasing prevalence of childhood obesity has led to a corresponding increase in hypertension among children, necessitating early identification of subclinical target organ damage for accurate cardiovascular risk assessment. However, in the pediatric population, there is a paucity of literature comparing ambulatory and home blood pressure monitoring, and this knowledge gap is exacerbated by limited access to ambulatory blood pressure monitoring (ABPM) facilities, particularly in developing countries, where pediatricians often resort to home blood BP monitoring as the preferred option. In this cross-sectional study with 60 obese children (aged 5-18 years) at a tertiary health care in central India, we aimed to comprehensively characterize blood pressure profiles, including office, ambulatory and home and investigated their correlations with indicators of end-organ damage. Among 60 children, 26 (43.3%) participants were found to be hypertensive based on 24 Hr ABPM evaluation. Masked hypertension and white coat hypertension (WCH) were observed in 21.6% and 13.3% respectively. Surprisingly, 20% of participants were identified as hypertensive through 7-day home BP monitoring (HBPM). A notable discordance of 36.6% was between HBPM and ABPM results. Moreover, 26.7% of the children had end-organ damage, with higher odds associated with night-time systolic ambulatory hypertension in the adjusted regression model (OR = 1.06, 95% CI: 1.03-1.10, p < 0.001). The study highlights 24-hour ABPM's vital role in classifying hypertensive status, especially in high-risk children. The diagnostic performance of HBPM shows poor sensitivity in detecting MH and lower specificity in identifying WCH compared to ABPM. This limitation translates to missed opportunities for early preventive interventions.

The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report

BackgroundTotal pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear.Case presentationA 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis.ConclusionStandardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.

Childhood Violence, High School Academic Environment, and Adult Alcohol Use Among Latinas and Black Women: A Structural Equation Modeling Study.

Young Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population. Data were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables. Childhood physical and sexual abuse was positively associated with depressive mood, anxiety disorders, and somatic complaints when participants were in the 20s. Depressive mood mediated childhood abuse and AUD when women were in the 30s. The high school academic environment attenuated the effect of physical, but not sexual abuse, on depressive mood (β = -0.59, B = -9.38, 95% CI [-14.00, -4.76]), anxiety symptoms (β = -0.61, B = -14.19, 95% CI [-21.76, -6.61]), appetite loss (β = -0.41, B = -10.52, 95% CI [-15.61, -5.42]), and sleeplessness (β = -0.50, B = -9.56, 95% CI [-13.95, -5.17]) in the early 20s. Our findings underscore the need to invest in early violence prevention interventions and in education to ensure equitable access to quality, academically oriented, and safe schools.

Adapting transformer-based language models for heart disease detection and risk factors extraction

Efficiently treating cardiac patients before the onset of a heart attack relies on the precise prediction of heart disease. Identifying and detecting the risk factors for heart disease such as diabetes mellitus, Coronary Artery Disease (CAD), hyperlipidemia, hypertension, smoking, familial CAD history, obesity, and medications is critical for developing effective preventative and management measures. Although Electronic Health Records (EHRs) have emerged as valuable resources for identifying these risk factors, their unstructured format poses challenges for cardiologists in retrieving relevant information. This research proposed employing transfer learning techniques to automatically extract heart disease risk factors from EHRs. Leveraging transfer learning, a deep learning technique has demonstrated a significant performance in various clinical natural language processing (NLP) applications, particularly in heart disease risk prediction. This study explored the application of transformer-based language models, specifically utilizing pre-trained architectures like BERT (Bidirectional Encoder Representations from Transformers), RoBERTa, BioClinicalBERT, XLNet, and BioBERT for heart disease detection and extraction of related risk factors from clinical notes, using the i2b2 dataset. These transformer models are pre-trained on an extensive corpus of medical literature and clinical records to gain a deep understanding of contextualized language representations. Adapted models are then fine-tuned using annotated datasets specific to heart disease, such as the i2b2 dataset, enabling them to learn patterns and relationships within the domain. These models have demonstrated superior performance in extracting semantic information from EHRs, automating high-performance heart disease risk factor identification, and performing downstream NLP tasks within the clinical domain. This study proposed fine-tuned five widely used transformer-based models, namely BERT, RoBERTa, BioClinicalBERT, XLNet, and BioBERT, using the 2014 i2b2 clinical NLP challenge dataset. The fine-tuned models surpass conventional approaches in predicting the presence of heart disease risk factors with impressive accuracy. The RoBERTa model has achieved the highest performance, with micro F1-scores of 94.27%, while the BERT, BioClinicalBERT, XLNet, and BioBERT models have provided competitive performances with micro F1-scores of 93.73%, 94.03%, 93.97%, and 93.99%, respectively. Finally, a simple ensemble of the five transformer-based models has been proposed, which outperformed the most existing methods in heart disease risk fan, achieving a micro F1-Score of 94.26%. This study demonstrated the efficacy of transfer learning using transformer-based models in enhancing risk prediction and facilitating early intervention for heart disease prevention.

Target product profiles: leprosy diagnostics.

The World Health Organization (WHO) aims to reduce new leprosy cases by 70% by 2030, necessitating advancements in leprosy diagnostics. Here we discuss the development of two WHO's target product profiles for such diagnostics. These profiles define criteria for product use, design, performance, configuration and distribution, with a focus on accessibility and affordability. The first target product profile outlines requirements for tests to confirm diagnosis of leprosy in individuals with clinical signs and symptoms, to guide multidrug treatment initiation. The second target product profile outlines requirements for tests to detect Mycobacterium leprae or M. lepromatosis infection among asymptomatic contacts of leprosy patients, aiding prophylactic interventions and prevention. Statistical modelling was used to assess sensitivity and specificity requirements for these diagnostic tests. The paper highlights challenges in achieving high specificity, given the varying endemicity of M. leprae, and identifying target analytes with robust performance across leprosy phenotypes. We conclude that diagnostics with appropriate product design and performance characteristics are crucial for early detection and preventive intervention, advocating for the transition from leprosy management to prevention.

PRESERVING THE HEALTH OF THE ORGAN OF VISION IN CHILDREN: ORGANIZATIONAL PRINCIPLES

Background. The relevance of the study is due to the growing prevalence of ophthalmic pathology among children, in particular, the growing prevalence of refractive errors in early and older adolescence. The results of scientific research prove the presence of a direct correlation between the growth of the prevalence of ophthalmic pathology and the growth of the child's age and the amount of visual stress, which is primarily related to the educational process during school education. The effective organization of medical care should take into account modern medical and preventive technologies of early preventive intervention, as well as be comprehensive with the involvement of medical specialists (pediatric ophthalmologists, family doctors) and educators, family members, parents of the child for effective support and leveling of managed risk factors for the development of ophthalmic pathology.&#x0D; Aim: to study the modern organizational principles of preserving the health of eye care of children, to clarify the medical and social aspects of the formation of the burden of ophthalmic pathology from childhood in different countries of the world.&#x0D; Materials and methods. The materials for the research were publications of the results of modern scientific research on the study of medical and social aspects of preserving the ophthalmic health of children, the peculiarities of the organization of providing medical and preventive care to children with visual impairments. The methods for carrying out scientific research were: system approach and system analysis, as well as content analysis.&#x0D; Results of the study prove the prospects for the implementation of medical and preventive strategies in the provision of primary and specialized ophthalmic medical care, in view of the significant medical and social burden of ophthalmopathology, the distribution of nosologies by class of diseases of the eye and its accessory apparatus, which are most often found in certain age groups of the children's population, is presented. It has been proven that compliance with the optimal periodicity of medical and preventive examinations is necessary for the majority of ophthalmological nosologies diagnosed since childhood and involves long-term supervision. In children of preschool, preschool and early school age, efforts at early prevention and diagnosis of such ophthalmological nosologies as: refraction anomalies (astigmatism, hypermetropia, myopia) are justified. strabismus and amblyopia; accommodation disorders; lack of convergence. Untreated or untimely detected refraction anomaly, strabismus, amblyopia can lead to the development of irreversible loss of visual functions, blindness and even inhibition of the formation of the visual system with distorted perception of visual information, which without timely correction lead to the appearance of complications, progression of strabismus, decrease in visual acuity, amblyopia , asthenopia, headache and deterioration of general well-being.&#x0D; Conclusion. The important medico-social importance of disorders of visual functions in childhood is a serious problem for the health care system, public health and ophthalmology service, in particular. Reasoned expediency of applying measures to level the managed risk factors against the background of intersectoral interaction of doctors, educators, the child himself and his family. This approach allows you to prevent the negative impact of ophthalmic pathology on academic performance, activate physical development, and promote harmonious personality development.

Epidemiology and risk factors of oral frailty among older people: an observational study from China

ObjectivesThis study aimed to compare the prevalence of oral frailty among community-dwelling older people in Nanjing, China with the usage of different measurements, and to investigate the potential risk factors of oral frailty.DesignCross-sectional study.Setting and participantsA total of 338 community-dwelling older people in Nanjing, China were recruited.MethodsOral frailty was measured based on the Oral Frailty Index-8 (OFI-8) scale and other measurement methods including the number of natural teeth (TN), repetitive saliva-swallowing test (RSST), and oral diadochokinesis (ODK). The chi-square test and the binary logistic regression analysis were performed to identify potential risk factors for oral frailty.ResultsThere were 310 participants included in the analysis. Prevalence of oral frailty by using the OFI-8, OFI-8 + TN, OFI-8 + ODK, OFI-8 + TN + ODK and RSST measurement methods were 69.0%, 27.4%, 51.9%, 21.0% and 2.9%, respectively. Passive smoking (OR = 2.04; 95%CI 1.03–4.03), being widowed/unmarried (OR1 = 2.53; 95%CI 1.25–5.10; OR2 = 2.94; 95%CI 1.12–7.77), pre-frailty (OR = 1.76; 95%CI 1.03–3.01), frailty (OR = 3.01; 95%CI 1.39–6.54), and aged 80 years and above (OR = 3.99; 95%CI 1.35–11.81) were found to be risk factors of oral frailty by the usage of the four kinds of measurement methods.Conclusions and implicationsThe definition and diagnostic criteria of oral frailty are strongly needed to be unified in future research. Only subjective assessment is not enough for assessing oral frailty. Among objective indicators, RSST is not suitable as a screening method for oral frailty. In addition, objective indicators including TN and ODK should be valued for early screening and preventive interventions. The risk factors of oral frailty include physical frailty, passive smoking, and being widowed.

DETECTION OF MEDICAL NEGLECT AND PREVENTION

Neglect is defined as the chronic failure of parents (guardians) to provide the child with the basic conditions necessary for its growth and development: food, clothing, housing, medical care and protection, encouraging the child's development. Diagnosing neglect requires teamwork, knowledge of symptoms and signs, as well as family characteristics. Types of neglect: physical, emotional, educational, lack of medical care. In case of suspected neglect, the competent professional team should be notified. The goal is early prevention and early intervention in case of neglect.

Abstract P274: Beyond MVPA: Machine Learning Insights Into Activity Patterns and Cardiometabolic Health in the National Health and Nutrition Examination Survey (NHANES) 2003-2004

Physical activity (PA) and sedentary behavior (SB) volumes and patterns may be useful in identifying individuals who are at elevated cardiometabolic risk. Identifying individuals at risk will facilitate early interventions for prevention of cardiovascular diseases. The objective of this project is to identify important free-living physical activity patterns to classify cardiometabolic markers including insulin, plasma glucose, and triglyceride. Methods: We used cross-sectional NHANES 2003-2004 accelerometer, blood exam and demographic data. We included adults age ≥18 years who wore a hip-worn ActiGraph 7164 during waking hours for at least 4 days of 10 hours/day of wear time. We included PA and SB predictors including minutes per day (min/d) in sedentary time (0-99 counts per minute, cpm), light intensity PA (100-759 cpm), Lifestyle PA (760-2019 cpm), moderate to vigorous PA (MVPA, ≥2019 cpm), number of breaks in SB, and number of 30-min and 60-min SB, 10-min MVPA bouts etc. The cut points for cardiovascular disease risk were defined based on literature as: fasting serum insulin ≤ 5 μU/mL, plasma glucose ≤ 100 mg/dL and triglyceride &lt; 150 mg/dL. Three random forest (RF) classification models were developed for each cardiometabolic marker using age, body-mass-index, general health, and PA variables as predictors. Models were trained and tested using a 60% training - 40% testing split. We tuned the hyperparameters (final selection: number of trees = 500 and variables = 3) to find the model with the highest testing accuracy based on the out-of-bag error. The importance of each predictor was measured and ranked by the mean decrease in GINI index. Results: The three datasets include insulin (n = 2810, age=34 ±23, 50% females), glucose (n = 1852, age = 49±20, 51% females) and triglyceride (n = 3180, age=36 ±24, 50% females). For insulin model, the PA variables with largest mean decrease in GINI index were SB time, light intensity PA, MVPA, and SB bouts of 30-min. Similarly, time spent in Lifestyle PA, light intensity PA, number of SB breaks and SB bouts of 30-min were the most important variables for abnormal fasting glucose prediction. The number of sedentary breaks, light intensity PA, SB time and SB bouts of 30-min were the most important PA predictors for risk of high triglyceride. Both BMI and age were important demographic variables for prediction of increased risk in each model. The prediction accuracy and precision are as following: Insulin(73%; 76%), Plasma Glucose(68%; 58%), and Triglyceride(64%; 46%). Conclusion: Cardiometabolic markers using free-living PA has the potential to provide insights for classifying the risk for cardiovascular disease based on given physiological marker cut-off points. The time spent lower intensity PA patterns and the number of sedentary breaks, and 30-minutes bouts are important predictors for identifying individuals who may have increased cardiometabolic risk.