Age Of Participants Research Articles

Improving cardiovascular risk stratification with ECG-predicted risk factors in primary prevention

Abstract Background Cardiovascular risk- and screening scores guide clinical practice. Built upon simple risk factors, they could benefit from information on actual, subclinical cardiac changes. The ECG provides proxies for various cardiac states, which can be detected using machine learning. We systematically assess the added value of ECG-based cardiovascular risk factor estimates for six outcomes in two population-based cohorts: Study of Health in Pomerania (SHIP-Start) and UK Biobank (UKB). Methods We employed convolutional neural networks to analyze ECGs from the Hamburg City Health Study (HCHS) for the assessment of multiple risk factors, including age, weight, diabetes, atrial fibrillation (AF) and heart failure. Cox models were fitted on UKB and SHIP to predict 5 and 15 year time-to-event. Endpoints were death, cardiovascular death, AF, stroke, heart failure and myocardial infarction. Covariates were sex, age, body mass index, diabetes, hypertension and smoking (Cox-RF), ECG-predicted risk factors (Cox-AI), and a combination (Cox-RF/AI). Stratified Monte Carlo cross-validation was used as validation and groups of C-indices were compared using Mann-Whitney U tests. Results The study included 9103 HCHS participants (mean age 62.0±8.4 years, 51% women), 3546 SHIP participants (age 49.7±16.4, 51% women), and 32828 UKB participants (age 64±7.6 years, 52% women). Cox-AI performed comparable or better than Cox-RF for AF (SHIP: 0.88 vs. 0.84, UKB: 0.71 vs. 0.72) and heart failure (SHIP: 0.8 vs. 0.79, UKB: 0.76 vs. 0.75), but was less strong for the other outcomes. The combination of information on cardiovascular risk factors and ECG information (Cox-RF/AI) significantly improved the predictive ability compared to risk factors alone (Cox-RF) for AF (SHIP: 0.89 vs. 0.84, UKB: 0.76 vs. 0.72), cardiovascular death (SHIP: 0.90 vs. 0.89, UKB: 0.75 vs. 0.74) and heart failure (SHIP: 0.81 vs. 0.79, UKB: 0.80 vs. 0.75). Discussion ECG-based risk factors complement risk stratification by incorporating nuanced information on cardiac function and structure, improving risk prediction and thus possibly clinical decision making and patient outcomes.

The Effect of the COVID-19 Pandemic on the Working Conditions and Efficiency of Radiographers at Ahvaz Jundishapur University of Medical Sciences' Radiology and CT Scan Imaging Centers

Background: Radiographers are highly skilled imaging technology users who work directly with COVID-19 cases. Objectives: This study aims to assess the impact of COVID-19 on the working conditions and efficiency of radiographers and their level of satisfaction with personal protective equipment (PPE), cleaning supplies, and facilities during the COVID-19 epidemic. Methods: A prospective observational study was conducted among radiographers registered in the radiology and CT scan imaging centers of Ahvaz Jundishapur University of Medical Sciences and some private centers between June and October 2022. A questionnaire with 28 multiple-choice questions was used to collect information. The questionnaire consisted of two sections; the first part contained demographic information. In the second part, participants answered questions about changes in working conditions, such as changes in stress level, work efficiency, the need for more rest, imaging time, use of equipment, and personal protective equipment at work, based on their experiences and observations during the COVID-19 pandemic. The data analysis was performed using Statistical Product Service Solutions (SPSS) software, version 26.0, with statistical significance assumed at a P-value < 0.05. Results: One hundred and fifty radiographers completed the questionnaire. The mean age and mean work experience of participants were 33.2 ± 8.3 years and 9 ± 7.2 years, respectively. The results showed that most participants of both sexes agreed that they needed more rest (P-value < 0.05); their work efficiency had not decreased significantly during the COVID-19 epidemic. The stress level of participants had significantly increased compared to before the epidemic. There were significant differences between government-owned hospitals and private radiology centers regarding the presence of a COVID-19-related protocol, the compulsory use of masks, the existence of decontamination instructions, the type of air decontamination, the contact with imaging equipment manufacturers, the timing of decontamination, and the type of decontamination applied to the imaging equipment (P-value < 0.05). Conclusions: This study demonstrated that the reduction in work efficiency among radiographers was not significant compared to before the COVID-19 pandemic. According to the study's results, radiographers' working conditions underwent numerous adjustments over the course of the COVID-19 epidemic.

Burnout and perceived stress among health visitors in Hungary

Abstract Background In Hungary, the health visitors are responsible for the health promotion of families and communities. However, as a consequence of the structural reorganization of the health visitors service and the emotionally situations (e.g. the war in a neighboring country, the economic crisis) that have arisen, there has been an increased prevalence of chronic stress, burnout and career abandonment among health visitors. The objective of the cross-sectional study was to ascertain the prevalence of burnout among health visitors and to examine the relationship between burnout and job stress. Methods The data was collected via an online questionnaire tool. In addition to questions pertaining to sociodemographic data, the questionnaire employed the Maslach Burnout Inventory (MBI Human Services Survey) and the Perceived Stress Scale (PSS). Hypotheses were tested using analysis of variance (ANOVA), Kruskal-Wallis test, Dunett test. The source population of the study was health visitors. A total of 178 health visitors constituted the target population. Results The average age of the study participants was 45.2 years. It can be observed that health visitors who perceive less appreciation from their colleagues, employers and caregivers are more likely to experience higher levels of burnout and stress (p < 0.05). The lowest levels of stress were observed in school health visitors, while the highest levels were seen in health visitors covering villages (p < 0.05). Those who remained in the field due to a passion for working with families and children, a sense of vocation, and a desire to help others exhibited lower levels of burnout (p < 0.05). The high number of clients served by health visitors was found to increase burnout and stress levels (p < 0.05). Conclusions The findings of this research will assist in the comprehension of the phenomenon of burnout among health visitors, thereby enabling the development of more efficacious methods for the treatment and prevention. Key messages • Preventing burnout among health visitors is a priority, as it affects their work and their relationship with the families they care for in the short and long term. • Health visitors frequently encounter families in crisis during the course of their work, necessitating regular supervision to maintain their mental health.

Application of resistance exercise training combined with CT image evaluation in postoperative functional rehabilitation and fracture risk prediction of elderly femurs

ObjectiveTo evaluate the overall functional recovery of femoral patients, improve recovery ability, and prevent fractures in the elderly. MethodsA group of elderly femoral postoperative participants were selected and randomly divided into resistance exercise training and routine rehabilitation training. Simultaneously, a control group (without a history of fractures) and a fracture group (with a history of fractures) were designed to predict fracture risk. Finally, computerized tomography was used to evaluate the functional rehabilitation status. ResultsThe resistance exercise training group showed significantly better performance in functional rehabilitation and fracture risk prediction than the control group, and the decrease in Barthel index at 12 weeks after surgery in this group was 6.25 (P > 0.001). The age, gender, and volumetric bone density between the control group and the fracture group showed P > 0.001, and the differences were statistically significant. The average age of the control group was significantly higher than that of the fracture group, and the proportion of males in the fracture group was significantly higher than that of the control group. The intramuscular fat content of the iliopsoas muscle in the fracture group was significantly lower than that in the control group, P = 0.004. This indicated that lower intramuscular fat content of the iliopsoas muscle was associated with higher fracture risk, as participants with lower intramuscular fat content of the iliopsoas muscle had less bone protection, resulting in an increased risk of fracture. The difference in body mass index between the two groups was not statistically significant, P = 0.737, indicating that the impact of this parameter on fracture risk was not significant in this study. ConclusionResistance exercise training combined with CT image evaluation is an effective rehabilitation strategy with high clinical application value. This study provides reliable empirical evidence for the application of resistance exercise training and the combination of CT image evaluation, and provides guidance for the optimization of clinical rehabilitation strategies.

Low income, being without employment, and living alone: How they are associated with cognitive functioning - Results from the German National Cohort (NAKO)

Abstract Background While people with low socioeconomic status tend to have worse cognitive functioning, little is known about the impact of specific socioeconomic conditions. Aim of the present analysis was to investigate to what extent cognitive functioning differs by three socioeconomic conditions: low income, being without employment, and living alone. Methods A total of N = 158,144 participants (age 19-75 years) of the population-based German National Cohort (NAKO) provided data on socioeconomic conditions and completed cognitive testing. Multivariable regression model including the three socioeconomic conditions, age, sex, education, occupational status, having diabetes, hypertension, myocardial infarction, stroke, and depressive symptoms was used for analysis. Results Results from fully adjusted analysis indicated that cognitive functioning (z-score) was lower among those with low income (b=-0.53, CI95%=-0.57; -0.49) compared to not having low income, living alone (b=-0.10, CI95%=-0.14; -0.07) compared to not living alone, and being without employment (b=-0.22, CI95%=-0.27; -0.17) compared to being employed. The difference in cognitive functioning between those exposed compared to not exposed to the condition was changing slightly with older age among those with low income (interaction with age b=-2.39, CI95%=-3.24; -1.55) and, to a smaller extent, among those living alone (interaction with age b=-0.76, CI95%=-1.34; -0.19). Conclusions Low income, being without employment, and living alone were independently associated with poorer cognitive functioning after adjusting for confounders. As those with low income had the poorest cognitive functioning in old age, it is important to explore pathways of how cognitive health in this population group can be improved.

The association between left ventricular mass index and all-cause mortality

Abstract Background Left ventricular hypertrophy (LVH) has been associated with a higher risk of all-cause mortality. However, there is a lack of optimal cut-off values for grading the severity of LVH in the general population. Purpose We aim to investigate the association between the left ventricular mass index (LVMi) estimated by echocardiography and all-cause mortality and determine the optimal cut-off values of LVMi for the general population to predict outcomes. Methods Consecutive participants undergoing echocardiography in a tertiary medical center in Taiwan during 2005-2021 were enrolled. LVMi was calculated using the cube formula from the linear method. The primary outcome was all-cause mortality by linking to the National Death Registry. The association between LVMi and all-cause mortality was assessed using the joinpoint linear regression analysis to derive the optimal cut-off values for LVMi. Using the Kaplan-Meier methods, we validated our results with a community-based cohort with a long-term follow-up period. Results 85,503 participants (age 64.3 ± 16.9 years, 53.7% men) were enrolled. During a mean follow-up of 67.6 ± 48.5 months, there were 14,565 deaths (17%). A U-shaped relationship between LVMi and the risk of all-cause mortality could be observed. The joinpoint linear regression analysis revealed that LVMi could be categorized into the following groups (less than 66 gm/m2, 66-87 gm/m2, 88-132 gm/m2, 133-170 gm/m2, and more than 171 gm/m2), with each group representing a different risk for all-cause mortality. (Figure 1) In the validated cohort categorized by the cut-off values of LVMi, the Kaplan-Meier analysis showed divergent risks for all-cause mortality between different groups in the community-indwelled populations (Figure 2, log-rank P-value< 0.001). Conclusion There was a U-shaped relationship between LVMi and the risk of all-cause mortality. Grading for the severity of LVH using the LVMi is warranted for the risk assessment in the general population.Figure 1Figure 2

Central Pulse Wave Velocity and Augmentation Index Are Repeatable and Reproducible Measures of Arterial Function.

Arterial function (specifically arterial stiffness) is an important cardiovascular risk factor. Pulse wave velocity (PWV) and augmentation index (Al ) are established indicators of arterial function. The present study aimed to evaluate the repeatability and reproducibility of PWV and Al in healthy individuals. Forty healthy participants (age 33 ± 11 years, 17 females) underwent resting supine PWV and Al assessments. Measurements were made in triplicate and repeated 1 week apart. Al was measured by brachial occlusion and PWV was measured from the carotid artery to the femoral artery via the tonometer-oscillometric method. Repeatability and reproducibility were assessed using the intraclass correlation coefficient (ICC). Interoperator reproducibility was performed on 10 participants. The average values for week-to-week visits for PWV and Al were 6.20 ± 0.91 versus 6.13 ± 0.91 ms-1 and 14.0 ± 11.8 versus 16.3 ± 12.2% respectively. For same-day measurements, both PWV and Al showed excellent repeatability (PWV: ICC = 0.96, 95% CI: 0.92-0.98, p < 0.01; Al : ICC = 0.90, 95% CI: 0.84-0.94, p < 0.01) and interoperator reproducibility (PWV: ICC = 0.98, 95% CI: 0.93-1.00, p < 0.01; Al : ICC = 0.93, 95% CI: 0.69-0.98, p < 0.01). Measurements were repeated 1 week apart and showed good reproducibility (PWV: ICC = 0.77, 95% CI: 0.61-0.87, p ≤ 0.01; Al : ICC = 0.73, 95% CI: 0.73-0.86, p < 0.01). PWV and Al demonstrate excellent repeatability and good reproducibility. Considering these variables are noninvasive and easy-to-measure, arterial function assessment may have a role in routine clinical practice to facilitate risk stratification in cardiovascular diseases.

Low HIV Viral Load Suppression and Its Implications for Controlling HIV among Refugee Adolescents and Youth Living in Refugee Settlements in Uganda: A Cross-sectional Analysis.

Viral load suppression (VLS) is considered crucial in the global efforts to end the HIV/AIDS pandemic and young people lag behind adults in this important indicator. However, little is known about VLS among refugee adolescents and youth (RAY), a vulnerable group, often ignored by research, with multiple intersecting risk factors and unique challenges. The goal of this study was to determine the prevalence of VLS and examine associated risk and protective factors among RAY in refugee settlements in Uganda, a country severely affected by the HIV/AIDS pandemic and currently hosting the most refugees in sub-Saharan Africa (SSA). We analyzed cross-sectional data from a pilot cluster randomized trial with 180 participants (ages 13-30) recruited from 20 health centers in three refugee settlements between July and December 2023. We employed a hierarchical (mixed-effects) logistic regression model to examine the association between selected demographic, psychosocial, and economic factors and VLS. The prevalence of VLS among RAY was very low at just 52%. Factors associated with VLS included financial stability, adherence self-efficacy, and HIV status disclosure. Having financial savings was associated with VLS (adjusted odds ratio:2.68; 95% CI: 1.48-5.11; p = 0.003). Treatment support from others including teachers and health care providers had five-fold odds of VLS (5.0, 1.64-15.24; p = 0.005). Conversely, older age and interactions between stigma/self-efficacy and stigma/HIV status disclosure were associated with viral load non-suppression. This study highlights the urgent need for tailored interventions targeting economic and psychosocial hardships like poverty, stigma, and food insecurity to enhance HIV VLS and other treatment outcomes among RAY.

Exaggerated blood pressure response to submaximal exercise must be considered relative to fitness: strong associations with hypertensive target organ damage

Abstract Exaggerated systolic blood pressure (SBP) during submaximal exercise is associated with increased cardiovascular (CV) risk. However, findings are mixed and new evidence indicates that cardiorespiratory fitness should be considered for proper clinical interpretation of exercise SBP responses. This study aimed to determine the relationship between SBP response to submaximal effort corrected for fitness and abnormalities of cardiac structure and function. Methods Each of 231 participants (age 54±12 years; 53% females) with controlled clinic BP, no evidence for ischemic heart disease, valvular heart disease or heart failure underwent cardiopulmonary exercise testing (Bruce protocol), resting and exercise echocardiography and 24h ABPM. Submaximal exercise SBP (measured at the 2nd stage of Bruce protocol) was corrected for two fitness variables: 1) peak VO2 and 2) maximal workload in METs (SBP/peakVO2 and SBP/METs). Results There were no, or weak, associations with exercise SBP and target organ damage. However, there was a progressive deterioration of cardiac function and structure parameters across the exercise SBP tertiles corrected for fitness (Table 1). Both SBP/peakVO2 and SBP/METs significantly correlated with left ventricular (LV) mass, LV diastolic and systolic, and left atrial parameters (Table 2). ROC analysis revealed good performance of corrected SBP response to submaximal exercise in detection of LV hypertrophy and diastolic dysfunction (AUC 0.792 and 0.808, and 0.771 and 0.802 for SBP/peakVO2 and SBP/METs, respectively; Figure). Conclusions Fitness-corrected SBP responses to submaximal exercise can identify more profound target organ damage with respect to cardiac function and structure even among patients with controlled clinic BP. Exaggerated BP response to exercise must be considered relative to fitness for proper clinical interpretation of BP responses to exercise testing.Figure

A U-shaped relationship between LVEF and the risk of heart failure hospitalization: a large hospital-based cohort study

Abstract Background Left ventricular ejection fraction (LVEF) is a frequently used metric for quantifying left ventricular function. Previous studies found a U-shaped relationship between LVEF and long-term survival. However, the association between the spectrum of LVEF and heart failure (HF) hospitalization remains unclear. Purpose We aim to investigate the distribution of HF hospitalizations across the spectrum of LVEF using a large hospital-based cohort. Methods Consecutive participants who underwent echocardiography (2002-2021) in a tertiary medical center in Taiwan were included. LVEF was measured by echocardiography using biplane Simpson’s method and was categorized into intervals of 5% from &amp;lt;20% to ≥70%. The study outcome was HF hospitalization by linking to the National Health Insurance Registry Database. Cox proportional hazards regression was used for analyses with adjustment for age, sex, hypertension, diabetes, hyperlipidemia, coronary artery disease, and history of HF. We used restricted cubic splines to demonstrate the distribution of HF hospitalizations across the spectrum of LVEF. Results 94,762 participants (age 59.7 ± 18.1, men 51.4%) were included. Adjusted hazard ratios (HR) for HF hospitalizations showed a U-shaped relationship between LVEF and the risk of incident HF hospitalization with a nadir of risk at LVEF of 60-70%. (Figure) Compared with the reference group (LVEF: 60-65%), subjects with LVEF&amp;gt; 70% had an HR of 1.49 (95% confidence interval [CI]: 1.21-1.84), and those with LVEF of 50-55% had an HR of 1.93 (95% CI: 1.68-2.22). Similar results with a nadir at 60-70% could be observed irrespective of different age groups defined by the World Health Organization (WHO), sex, with or without hypertension or diabetes. Conclusions A U-shaped relationship between LVEF and the risk of incident HF hospitalization can be observed, with a nadir at LVEF of 60-70%. LVEF ≥ 70% may be defined as supranormal LVEF that necessitates further HF treatment.Figure

Does perceived usability of a multi-component mobile device intervention improve health-related quality of life?

Abstract Background Good health-related quality of life (HRQL) is essential to healthy aging. Prior studies have demonstrated that mobile device technologies can promote HRQL in older adults. However, evidence of technology acceptance in older adults is often inconsistent and poorly understood. Purpose This study aims to 1) describe technology acceptance using efficiency, learnability, user experience (i.e., acceptability), and perceived control from the USABILITY survey of a multi-component mobile device intervention consisting of a wearable activity tracker (Fitbit Versa), access to Lose It app, and text messages (for experimental group only) in older adults at risk for cardiovascular disease, and 2) examine the correlation between technology acceptance and changes in HRQL before and after using each component of the digital intervention. Methods Data were collected using a purpose-built technology usability survey, and HRQL was assessed using the 12-Item Short Form Survey (SF-12), which measured perceived physical and mental health. Correlations were used to identify associations between technology acceptance and HRQL. Results The mean age of participants (n=54) was 65.4 ± 6.0 years; a majority were females (60%), married (53%), Hispanic (66%), and had a high school education or higher (76%). Table 1 shows that the experimental group had considerably higher HRQL at three months, but no differences in technology acceptance were noted. Fitbit technology adoption was found to be correlated with physical HRQL (r=304, p=0.027). The Lose It app showed no correlation with HRQL. Despite receiving higher usability ratings, SMS messages were not correlated with physical or mental HRQL. Conclusion Our findings demonstrate that older persons at risk for cardiovascular disease find mobile device intervention components acceptable. However, each component affected physical and mental health differently. These findings inform more complete technology acceptance models for older individuals' technology design, education, and deployment. Older persons prefer personalized communication, such as customized text messages, as the most favored aspect of the multi-component mobile device intervention. It warrants a larger clinical trial to determine its efficacy on HRQL.

Diabetes and the risk of cardiovascular events and all-cause mortality among older adults: an individual participant data analysis of five prospective studies.

Guidelines and studies provide conflicting information on whether type 2 diabetes (T2D) should be considered a coronary heart disease risk (CHD) equivalent in older adults. We synthesized participant-level data on 82,723 individuals aged ≥65 years from five prospective studies in two-stage meta-analyses. We estimated multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D (presence versus absence) on a primary composite outcome defined as cardiovascular events or all-cause mortality. Secondary outcomes were the components of the composite. We evaluated CHD risk equivalence by comparing outcomes between individuals with T2D but no CHD versus CHD but no T2D. The median age of participants was 71 years, 20% had T2D and 17% had CHD at baseline. A total of 29,474 participants (36%) experienced the composite outcome. Baseline T2D was associated with higher risk of cardiovascular events or all-cause mortality versus no T2D (HR 1.44, 95% CI [1.40-1.49]). The association was weaker in individuals aged ≥75 years versus 65-74 years (HR 1.32 [1.19-1.46] vs. 1.56 [1.50-1.62]; p-value for interaction = .032). Compared to individuals with CHD but no T2D, individuals with T2D but no CHD had a similar risk of the composite outcome (HR 0.95 [0.85-1.07]), but a lower risk of cardiovascular events (HR 0.76 [0.59-0.98]). T2D was associated with increased risk of cardiovascular events and all-cause mortality in older adults, but T2D without CHD conferred lower risk of cardiovascular events compared to CHD without T2D. Our results suggest that T2D should not be considered a CHD risk equivalent in older adults.

The Relationship between Fatalism and Hope Level in Surgical Cancer Patients: A Cross-Sectional Study

Aim: This study was conducted to determine the relationship between fatalism and level of hope in surgical cancer patients. Material and Methods: This descriptive study was conducted with the participation of 314 patients from the surgical clinics and oncology department of the Ondokuz Mayıs University Health Practice and Research Hospital between October 2021 and March 2023 in Turkey. All patients aged 18 and over who did not have communication problems, had cancer surgery, spread or radiation therapy, and did not agree to participate in the study were included in the study. Personal Information Form, Fatalism Tendency Scale, and Dispositional Hope Scale were used to collect data. Results: The mean age of participants was 59.45±10.16 (min-max:27-80). The mean Fatalism Tendency total score of patients was 82.8 ± 12.2, and the mean Dispositional Hope total score was 52.3 ± 7.2. It was determined that there was a significant difference between the Fatalism Tendency total score average, and the marital status, education level, place of residence, person living with, and seeing spirituality as important (p

Unlocking equity: assessing for gaps in cardiovascular guidelines for pregnant women

Abstract Introduction Cardiovascular disease is the primary contributor to pregnancy-related fatalities in the United States, displaying a gradual rise over the years. Pregnancy introduces unique physiological changes that can impact pre-existing cardiovascular conditions and trigger new complications. Considerable inequalities in pregnancy-related mortality built on race and ethnicity are unmistakable, with the highest rates observed in black non-Hispanic women. Purpose This study aims to evaluate current gaps in racial/ethnic minority participation in randomized control trials (RCTs) cited in major cardiology guidelines. Methods Citations in the 2018 ESC Guidelines for the Management of Cardiovascular Diseases During Pregnancy were evaluated for RCTs. The American Heart Association and American College of Cardiology guidelines were also examined. Manuscripts and supplementary data were examined for participant-level racial or ethnic data, including age, race, and ethnicity. Results Thirteen RCTs, representing 20,665 participants, spanning the period from 2002 to 2017, were reviewed. European guidelines referenced thirteen of the RCTS, while American guidelines referenced two RCTs. The average age of participants was 31 years old. Most of the trials were conducted in Europe (46%). Forty-six percent of RCTs reported race/ethnicity breakdowns, with pooled participation showing a majority of non-Hispanic white participants (76.7%), with limited representation from other racial groups (table). Eight trials focused on hypertension, two on venous thromboembolism, and one on heart failure. Conclusion Pregnant women are frequently excluded from RCTs due to concerns about potential harm to the developing fetus. Consequently, current guidelines lack robust RCTs tailored to pregnant women with various cardiovascular diseases. The underrepresentation of ethnic minorities in cardiovascular disease trials contributes to a scarcity of evidence-based recommendations for managing these conditions during pregnancy and postpartum. Future clinical practice guidelines should advocate for a more personalized and evidence-based approach to managing cardiovascular diseases in pregnancy.

Self-puberty staging in endocrine encounters during the COVID pandemic

BackgroundEvaluation of pubertal development is crucial in Endocrinology. The rise in telemedicine during COVID-19 has made conduct of physical examinations more challenging, especially for pubertal assessment. Previous studies on validity of pubertal self-staging versus clinical examination have yielded mixed results. This study aimed to determine validity and reliability of self-staging of puberty, with potential application during telemedicine visits. The present study is the first to assess pediatric self-rated pubertal staging during the pandemic.MethodsThe study included patients aged 7-22 years referred to Pediatric Endocrinology for specialty care, including pubertal staging. At clinic check-in, patients received a packet with study description, an option to “opt in” or “opt out”, sex-specific self-staging instructions, and Tanner (T) stage illustrations. Males received materials for pubic hair (PH) stages T1-T5; females received materials for PH and breast (BR) stages T1-T5. Patients who opted in had 10 minutes to select the image(s) that best matched their bodies, which they sealed in an envelope. This was followed by a clinic visit, where a board-certified pediatric endocrinologist conducted a physical examination, including breast staging (females), testicular size measurement (males), and pubic hair staging (both sexes). Pubertal stage Kappa statistics with 95% CI were calculated for each body part by sex, with Kappa ≥ 0.60 indicating significant agreement between self-assessment and physician assessment (0.40-0.60 moderate; 0.20-0.40 fair).ResultsOf 516 distributed packets, 243 self-assessments (125 females) were returned, with 81% (94 females/102 males) being complete (including pediatric endocrinologist staging). Mean age of participants was 12.8 years. Mean BMI was 22.2 kg/m² (males) and 23.7 kg/m² (females). Hypothyroidism was the most common endocrine diagnosis. For females, kappa was highest for BR and PH in T1 (BR 0.65, PH 0.57) and T5 (BR 0.57, PH 0.65). For males, kappa was highest in T1 (0.73) and T2 (0.58). Grouping Tanner stages into prepuberty (T1), early to mid-puberty (T2-T3), and late puberty (T4-T5) showed greater agreement.ConclusionPatients can reliably distinguish between “puberty” and “no puberty” using self-staging, though differentiating between later pubertal stages is more challenging. These findings help define the utility and limitations of self-staging during telemedicine visits.

Cancer prevention in people experiencing homelessness: feasibility of the Health Navigator Model

Abstract Background The Health Navigator Model (HNM) is a newly developed skill-mixed model that may improve access to cancer prevention services for over 895,000 People who are currently Experiencing Homelessness (PEH) in Europe. The aim of this study was to assess the feasibility and implementation of the model in European settings. Methods A co-designed pilot implementation study was undertaken in Austria, Spain, Greece and the United Kingdom. A total of 20 trained health navigators were appointed at support centres for PEH and facilitated PEH’s access to cancer prevention activities based on a comprehensive and tailored needs assessment. The study duration was 19 months, with two follow-ups. Feasibility data (recruitment/retention/participation rates, barriers, facilitators) were monitored throughout the study. Results More than 1,981 PEH were informed about the study and 652 of them participated. Most participants were male (64%), with low or no income (42%) and had previously experienced homelessness (51.7%). The mean age of participants was 47.4 years old. Overall, 69% of participants completed the first, and 42.5% completed the second follow-up. Main dropout reasons were loss of contact, loss of interest or having other priorities. Participants undertook a range of cancer prevention activities, including education (n = 494), workshops (n = 280), health consultations (n = 251), referrals for specialist care (n = 212) and cancer screening tests (n = 169). Difficulties in accessing the healthcare system, de-prioritising cancer and PEH’s complex needs were identified as the main barriers. Building trusting relationships with PEH, increasing cancer awareness and coordinating social and health services were identified as the main facilitators. Conclusions Implementing the Health Navigator Model was a feasible and dynamic process leading to improved equity and inclusion of people experiencing homelessness in cancer preventive services. Key messages • The Health Navigator Model is a feasible model to enhance cancer prevention among people experiencing homelessness following a person-centred, destigmatising approach. • Effective liaison between health and social services under the Health Navigator Model plays a critical role in facilitating access to cancer preventive care among people experiencing homelessness.

Comparison of intensive treatment versus standard treatment in lowering blood pressure and its association with cognitive decline and dementia: a systematic review and meta-analysis

Abstract Background The ideal blood pressure target level for preventing cognitive decline or dementia in patients with systemic arterial hypertension (SAH) remains unclear. Purpose This study aims to investigate whether intensive blood pressure reduction compared to standard treatment is associated with a reduced risk of cognitive decline or dementia in adults with SAH. Methods PubMed, Scopus and Cochrane databases were searched for randomized clinical trials (RCTs) comparing intensive treatment versus standard treatment for blood pressure reduction in patients with SAH. A random-effects model was used for analyzing the results, which were presented as relative risk (RR) with a 95% confidence interval (CI). Heterogeneity was examined using the I² statistic. Statistical analysis was performed using R software version 4.2.3. Results A total of 5 RCTs and 46,658 patients were included, of whom 23,726 (50,85%) underwent intensive therapy for SAH treatment. The mean age of participants ranged from 62.8 to 80.9 years in the intensive treatment group while it ranged from 63.3 to 80.3 years in the standard treatment group. Occurrence of dementia or probable dementia was significantly lower in the intensive treatment group (3.8% vs. 4,3%; RR 0.88; 95% CI: 0.80 - 0.96; p= 0.0049; I²=0%). Dementia or Cognitive decline (16.4% vs. 18.8%; RR 0.87; 95% CI 0.83 - 0.90; p &amp;lt; 0.000001; I²=0%), and cognitive decline (13.2% vs. 15.2%; RR 0.88; 95% CI 0.80 - 0.98; p= 0.014; I²=53%) also tended towards the intensive treatment group. Additionally, no significant association was found in mortality (6.4% vs. 7.3%; RR 0.87; 95% CI 0.75 - 1.02; p= 0.09; I²=28%) and serious adverse effects (34.4% vs. 35.5%; RR 0.99; 95% CI 0.92 - 1.06; p=0.73; I²=63%). Conclusion Our study shows that intensive blood pressure treatment is associated with a fewer occurrence of dementia, probable dementia and cognitive decline in comparison to the standard blood pressure target.General Analysis

The determinants of oral health in Turkish elderly: an analysis of Turkey Health Survey (THS) 2022

Abstract Background Oral health is an integral part of health and wellbeing; however, the use of dental care by the elderly is lower compared to other services. Considering the relationship between oral health and chronic diseases, along with healthcare use patterns, evaluating oral health in the elderly is crucial. This study aims to assess the oral health status and individual, socioeconomic and healthcare related factors in people aged 65 and over in Turkey. Methods This cross-sectional study was based on THS 2022 micro dataset. Participants aged 65 and over constituted the population of this study, with 3144 participants included. Data analysis was performed using SPSS 28.0 and included descriptive statistics, Pearson’s chi-square and logistic regression. Results The mean age of participants was 72.57 with 54% being women.Self-reported poor oral health was noted in 25.8%, and 75.2% did not receive dental care in the past year. Individual factors such as older age, obesity, and multimorbidity, as well as social factors like female gender, being single, and language barrier, were associated with worse oral health. Education and social support were also associated with oral health. Among economic factors, employment showed a significant association. Concerning healthcare-related factors, not using oral care in the past year, unmet dental care needs due to financial constraints, appointments, and transportation were associated with worse oral health. Logistic regression revealed significant associations between oral health and age, multimorbidity, gender, language, education, social support, employment, dental care use, unmet dental care needs due to financial constraints and transportation. Conclusions Addressing barriers and risk factors is needed to improve oral health among Turkey’s elderly. Efforts should focus on enhancing access to dental care and addressing socioeconomic determinants of oral health. Key messages • Identifying and addressing barriers and individual, socioeconomic and health-care related risk factors associated with poor oral health among the elderly in Turkey is important. • It is needed to prioritize efforts aimed at enhancing access to oral care for the elderly in Turkey by both improving physical access and addressing social determinants to ensure better oral health.

Trajectories of weight and their impact on cardiac remodeling and function 16 years after bariatric surgery

Abstract Introduction Obesity is a major risk factor for heart failure, particularly heart failure with preserved left ventricular (LV) ejection fraction. Surgical treatment of obesity have significant beneficial short-term effects on weight loss and on cardiac function; its long-term impact on cardiac remodeling and function remains largely unknown. Purpose We examine the long-term effect of bariatric surgery on cardiac remodeling and function in adults with preserved LV ejection fraction. Methods Forty-four individuals with severe obesity [body mass index (BMI) ≥35kg/m2] and preserved LV ejection fraction (≥50%) who underwent bariatric surgery (biliopancreatic diversion with duodenal switch [BPD-DS]) were included. Anthropometric measurements and echocardiography were obtained at baseline, 12 months and 16 years follow-up. Results Mean age of participants (71% female) was 44 ± 8 years and body mass index (BMI) 49.6 ± 6.1 kg/m2. Bariatric surgery led to marked weight reduction and significant improvements in obesity-related metabolic conditions/comorbidities (hypertension, dyslipidemia, type 2 diabetes). Mean percentage of weight loss at 12 months was 37.1 ± 7.0 %. Percentage of weight regain at 16 years averaged 8.9 ± 35.0 %. Bariatric surgery was associated with a significant reduction in indexed LV mass and LV hypertrophy (p &amp;lt;0.01), and improvement in LV diastolic function parameters (p &amp;lt;0.01) at 12 months. In many participants, cardiac remodeling parameters deteriorated at 16 years follow-up compared to the echocardiographic measurements taken at 12 months post-surgery. Prevalence of LV diastolic dysfunction increased at 16 years (81 vs. 38%; p&amp;lt;0.001), even after adjusting for age. Weight regain at 16 years (regaining &amp;gt;10% of weight lost; n=25; 57%) was not found to be associated with a worsening in cardiac remodeling compared to those who maintained weight loss, except for indexed LV mass (-9.3 ± 10.6 vs. -5.5 ± 7.8 g/m2.7; p=0.04) and LV end-diastolic diameter (-5.4 ± 4.0 vs. -3.5 ± 3.3 cm; p=0.01). Conclusion Bariatric surgery (BPD-DS) leads to durable long-term weight loss. Weight regain following bariatric surgery does not appear to have adverse effect on cardiac remodeling and function. Surgical treatment of obesity may be an effective and safe way to prevent clinical cardiac dysfunction and heart failure related to obesity.

Systematic review and meta-analysis on the effects of physical activity-based interventions on frailty status and clinical outcomes in adults with long-term cardiac conditions

Abstract Introduction Frailty is common in patients with long-term cardiac conditions and is associated with poor clinical outcomes, but limited treatment options are available. Previous studies investigating interventions for frailty have shown positive results with physical activity interventions, however, these studies were largely based on general elderly populations. Aim To assess the impact of physical activity-based interventions on frailty and clinical outcomes in frail patients with long-term cardiac conditions. Methods A systematic review and meta-analysis was conducted based on the PRISMA guideline, using Medline, Embase, CENTRAL, PEDro, CINAHL electronic databases for articles published between 2000 and 2023. Studies which recruited adults &amp;gt;18 years with long-term cardiac conditions (including angina, acute coronary syndrome (ACS), valve disease, heart failure (HF), atrial fibrillation, cardiac surgery and congenital heart disease) who underwent physical activity-based interventions were included. The primary outcome was change in frailty (measured using a validated tool) post intervention. We also assessed the effect of interventions on mortality and hospitalisation. Results We screened 2697 records and reviewed 91 full-text articles; 12 studies (14 articles) were included, involving 1394 patients. Median age of participants ranged from 64 to 82 years. Five studies recruited participants with HF, 3 evaluated participants post transaortic valve implantation, 3 recruited cardiac surgical patients and 1 study evaluated participants post ACS. Physical activity-based interventions were multi-domain, including a mixture of aerobic, strength, balance, endurance and respiratory muscle training; the majority (N=10) had individualised exercise prescription. Meta-analysis of 8 randomised controlled trials (RCTs) showed statistically significant improvement in frailty associated with physical activity-based interventions compared to controls [pooled standardised mean difference (95% CI) = -0.34 (-0.59 to -0.08), p = 0.01, I2 = 48%]. Seven RCTs evaluated change in frailty by short physical performance battery (SPPB). Meta-analysis of these studies showed a statistically significant improvement in SPPB associated with physical activity-based interventions compared to controls [pooled mean difference (95% CI) = 0.83 (0.31-1.34), p = 0.002, I2 = 49%]. (Figure) The magnitude of improvement in SPPB exceeded the minimally clinically significant improvement of 0.5. Three studies evaluated the effect of physical activity-based intervention on clinical outcomes, all of which showed neutral effect on mortality and hospitalisation. Conclusion Physical activity-based interventions in patients with frailty and long-term cardiac conditions were associated with significant improvement in frailty status, with neutral effect on mortality and hospitalisation. Figure: Meta-analysis of 7 RCTs assessing effect of physical activity-based interventions on SPPB