Exposure Variables Research Articles

Association of Smoking with progression from low-risk to high-risk intraductal papillary mucinous neoplasms and pancreatic cancer

BackgroundFactors associated with the risk of pancreatic adenocarcinoma (PDAC) may play a role in the development and progression of Intraductal Papillary Mucinous Neoplasms (IPMNs). However, data are limited. AimTo compare exposome factors in three groups of patients with “high or low-risk” IPMNs, as assessed at diagnosis and during a 24-months follow-up, and with PDAC. MethodsPatients were matched (same sex, age ±5) 1:1. Exposure variables were compared across groups using Kruskal-Wallis, ANOVA, or Chi-square tests with Bonferroni correction. ResultsA total of 151 patients were enrolled in each of the three groups (453 overall). The proportion of current smokers was progressively higher in “low-risk”, “high-risk” IPMNs and PDAC patients (8.1 %, 11.2 %, 23.3 %; p = 0.0002). The three groups did not differ in terms of ever or heavy smoking, BMI, history of diabetes, cancer, cholecystectomy or chronic pancreatitis, use of statins or aspirin, and family history of cancer. A history of peptic ulcer was more common in PDAC (7.2 %) than in either “low-risk” (2.0 %) or “high-risk” (2.6%) IPMNs (p = 0.02, not significant after Bonferroni correction). ConclusionActive smoking seems associated with the progression of IPMNs to malignancy, and cessation of active smoking might be advised in patients with IPMN.

Unpacking Breastfeeding Disparities: Baby-Friendly Hospital Designation Associated with Reduced In-Hospital Exclusive Breastfeeding Disparity Attributed to Neighborhood Poverty.

To examine US in-hospital exclusive breastfeeding (EBF) and the associations with Baby-Friendly designation and neighborhood sociodemographic factors. Hospital data from the 2018 Maternity Practices in Infant Nutrition and Care survey were linked to hospital zip code tabulation area (ZCTA) sociodemographic data from the 2014-2018 American Community Survey (n = 2,024). The percentages of residents in the hospital ZCTA were dichotomized based on the relative mean percentage of the hospital's metropolitan area, which were exposure variables (high/low Black hospitals, high/low poverty hospitals, high/low educational attainment hospitals) along with Baby-Friendly designation. Using linear regression, we examined the associations and effect measure modification between Baby-Friendly designation and hospital sociodemographic factors with in-hospital EBF prevalence. US mean in-hospital EBF prevalence was 55.1%. Baby-Friendly designation was associated with 9.1% points higher in-hospital EBF prevalence compared to non-designated hospitals [95% confidence interval (CI): 7.0, 11.2]. High Black hospitals and high poverty hospitals were associated with lower EBF prevalence (difference= -3.3; 95% CI: -5.1, -1.4 and - 3.8; 95% CI: -5.7, -1.8). High educational attainment hospitals were associated with higher EBF prevalence (difference = 6.7; 95% CI: 4.1, 9.4). Baby-Friendly designation was associated with significant effect measure modification of the in-hospital EBF disparity attributed to neighborhood level poverty (4.0% points higher in high poverty/Baby-Friendly designated hospitals than high poverty/non-Baby-Friendly designated hospitals).

Can Verbal Interview Decrease Preoperative Anxiety and Postoperative Discomfort in Oral and Maxillofacial Surgery Patients?: A Randomized Clinical Trial

BackgroundPreoperative anxiety is a condition that can be seen frequently in oral and maxillofacial surgery patients and affects the recovery process. PurposeThe aim of this study was to determine the effect of preoperative educational/informative interviews on preoperative anxiety levels and postoperative discomfort in patients undergoing oral and maxillofacial surgery. Study design, setting, sampleThis prospective randomized clinical trial involved patients who underwent oral and maxillofacial surgery at Aydın-Adnan-Menderes University, Oral and Maxillofacial Surgery Hospital. Patients with neurological or psychological disorders, a history of previous psychiatric drug use, those who used anxiolytic or sedative drugs before surgery, those who required postoperative anxiolytic and opioid administration, or patients who underwent nonstandard surgical and anesthesia protocols were excluded. Exposure VariablePreoperative educational/informative interview is the exposure variable. Subjects were randomly assigned to the intervention and control groups. Main outcome variablesThe primary outcome variable was preoperative anxiety measured by the Spielberger State-Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information scale (APAIS). The secondary outcome variables were postoperative pain measured by Visual Analog Scale (VAS) at the first and sixth hours, postoperative nausea (repeated gagging or spitting), and postoperative vomiting (active vomiting)were observed within 6 hours following general anaesthesia. CovariatesThe study’s covariates were age, weight, sex, American Society of Anes-thesiologists Physical Status Classification System (ASA) score, marital status, edicational background, surgery procedure, anesthesia procedure, duration of surgery, recovery time. AnalysesThe chi-square and student t-tests were used to compare primary predictor and covariates against outcome variables. A p-value <.05 was considered significant. ResultsA total of 92 patients were included in this study, with 46 randomized to intervention group and 46 to control group. The mean age (37.78±13.94 years vs 33.34±15.17 years, p=0.16) and sex differences (female/male: 16/30(34.8/65.2) vs 26/20(56.5/43.5), p=0.06) were comparable between groups. While higher values were recorded in the average anxiety scores in the control group than in the study group, statistically significant differences were found [STAI-S (37.36±10.87 vs 52.39±12.13) (p<0.01), APAIS-T (15.82±5.35 vs 21.39±6.69) (p<0.01), APAIS-A (4.17±2.12 vs 6.47±2.15) (p<0.01), APAIS-B (5.76±2.03 vs 7.65±2.60) (p<0.01), and APAIS-C (6.04±2.47 vs 7.21±2.38), (p<0.05)]. At the same time, there was also a significant difference in terms of early postoperative pain [(2.08±2.77 vs 3.43±2.86), (p=0.02)] and postoperative nausea [12/34 (26.1/73.9) vs 25/21(54.3/45.7), (p=0.01)]. Conclusions and RelevanceOral and maxillofacial surgery causes significant situational anxiety. This study showed that preoperative educational/informative interviews reduced preoperative anxiety levels and postoperative discomfort such as early postoperative pain, nausea, and vomiting.

Pharmacogenetic Testing or Therapeutic Drug Monitoring: A Quantitative Framework.

Pharmacogenetic profiling and therapeutic drug monitoring (TDM) have both been proposed to manage inter-individual variability (IIV) in drug exposure. However, determining the most effective approach for estimating exposure for a particular drug remains a challenge. This study aimed to quantitatively assess the circumstances in which pharmacogenetic profiling may outperform TDM in estimating drug exposure, under three sources of variability (IIV, inter-occasion variability [IOV], and residual unexplained variability [RUV]). Pharmacokinetic models were selected from the literature corresponding to drugs for which pharmacogenetic profiling and TDM are both clinically considered approaches for dose individualization. The models were used to simulate relevant drug exposures (trough concentration or area under the curve [AUC]) under varying degrees of IIV, IOV, and RUV. Six drug cases were selected from the literature. Model-based simulations demonstrated that the percentage of patients for whom pharmacogenetic exposure prediction is superior to TDM differs for each drug case: tacrolimus (11.0%), tamoxifen (12.7%), efavirenz (49.2%), vincristine (49.6%), risperidone (48.1%), and 5-fluorouracil (5-FU) (100%). Generally, in the presence of higher unexplained IIV in combination with lower RUV and IOV, exposure was best estimated by TDM, whereas, under lower unexplained IIV in combination with higher IOV or RUV, pharmacogenetic profiling was preferred. For the drugs with relatively low RUV and IOV (e.g., tamoxifen and tacrolimus), TDM estimated true exposure the best. Conversely, for drugs with similar or lower unexplained IIV (e.g., efavirenz or 5-FU, respectively) combined with relatively high RUV, pharmacogenetic profiling provided the most accurate estimate for most patients. However, genotype prevalence and the relative influence of genotypes on the PK, as well as the ability of TDM to accurately estimate AUC with a limited number of samples, had an impact. The results could be used to support clinical decision making when considering other factors, such as the probability for severe side effects.

CVM-1118: A potent oral anti-vasculogenic mimicry (VM) agent in combination with nivolumab in patients with unresectable advanced hepatocellular carcinoma (HCC)—A phase IIa study.

e16150 Background: CVM-1118 is a potent anti-tumor new chemical entity with multiple mechanisms of action including induction of apoptosis, cell cycle arrest, and inhibition of VM network formation. This study evaluated the anti-tumor effect and safety profile of CVM-1118 plus nivolumab in patients with progressive unresectable advanced HCC following the first-line therapy with TKIs. Methods: Eligible pts had unresectable advanced HCC and were refractory to prior systemic therapy (e.g., sorafenib, lenvatinib, regorafenib, and/or ramucirumab), with the exception of prior immunotherapy. Patients received oral CVM-1118 at 200 mg BID (400 mg daily) in combination with intravenous nivolumab at 240 mg Q2W in 28-day cycles. The primary endpoint of objective response rate was evaluated using mRECIST. The secondary endpoints were overall response rate (ORR) (per RECIST 1.1), progression free survival (PFS), disease control rate (DCR), and duration of overall response (DoR). Results: A total of 31 evaluable pts were enrolled (25 M/6 F; median age 65 y, range 44–80 y). All patients were Child Pugh A, BCLC stage B (13%, n = 4) or C (87%, n = 27) at the start of treatment. The median number of prior lines of therapy was 1 (range 1–2). The duration of CVM-1118 and nivolumab treatment ranged from 1.5–15.0 mos (median 3.1 mos) with 5/31 (16%) pts remaining on treatment for ≥ 4.6 mos (range 4.67–15.0 mos). The best ORR was 19.4% (mRECIST) (2 CR (6%), 4 PR (13%)), with remaining responses including 11 SD (36%) and 14 PD (45%). The DCR was 54.8% (95% CI 37.3–72.3%), the median PFS was 3.53 mos (95% CI 1.9–5.4 mos) and the median DoR was 10.4 mos (95% CI 2.8–13.7 mos). The most common treatment-related AEs ³ grade 3 included AST increased (12.9%), neutrophil count decreased (9.7%), anemia (6.5%), and WBC decreased (6.5%). As opposed to therapy with atezolizumab plus bevacizumab, gastrointestinal hemorrhage and hypertension were not observed in this study. Pharmacokinetics data demonstrated that CVM-1118 was rapidly metabolized to CVM-1125 in all pts following administration. On Day 1, the mean drug exposure of CVM-1125 was Cmax 564 ng/mL and the AUC0-24 was 2154 ng·hr/mL. Intersubject variability of drug exposure appeared to be high; the T1/2 of CVM-1125 was ~1.7 hr. Conclusions: CVM-1118 combined with nivolumab demonstrated clinical activity in advanced HCC pts with a safety profile that appears favorable compared to atezolizumab plus bevacizumab. These data support further development of the combination of CVM-1118 and nivolumab in pts with unresectable advanced HCC. Clinical trial information: NCT05257590 .

Factors associated with PrEP-era HIV seroconversion in a 4-year U.S. national cohort of n = 6059 sexual and gender minority individuals who have sex with men, 2017-2022.

Community-based cohort studies of HIV seroconversion can identify important avenues for enhancing HIV prevention efforts in the era of pre-exposure prophylaxis (PrEP). Within individuals, one can assess exposure and outcome variables repeatedly and with increased certainty regarding temporal ordering. This cohort study examined the association of several risk factors with subsequent HIV seroconversion. We report data from a 4-year study (2017-2022) of 6059 HIV seronegative sexual and gender minority individuals who have sex with men who had indications for-, but were not using-, PrEP at enrolment. Participants completed repeat exposure assessments and self-collection of biospecimens for HIV testing. We examined the roles of race and ethnicity, socio-economic status, methamphetamine use and PrEP uptake over the course of follow-up in relation to HIV seroconversion. Over 4 years, 303 of the participants seroconverted across 18,421 person-years (incidence rate = 1.64 [95% CI: 1.59-1.70] per 100 person-years). In multivariable discrete-time survival analysis, factors independently associated with elevated HIV seroconversion risk included being Black/African American (adjusted risk ratio [aRR]: 2.44, 1.79-3.28), Hispanic/Latinx (1.53, 1.19-1.96), housing instability (1.58, 1.22-2.05) and past year methamphetamine use (3.82, 2.74-5.33). Conversely, time since study enrolment (24 vs. 12 months, 0.67, 0.51-0.87; 36 months, 0.60, 0.45-0.80; 48 months, 0.48, 0.35-0.66) and higher education (master's degree or higher vs. less than or equal to high school, 0.36, 0.17-0.66) were associated with reduced seroconversion risk. Compared to non-PrEP users in the past 2 years without a current clinical indication, those who started PrEP but then discontinued had higher seroconversion risk, irrespective of clinical indication (3.23, 1.74-6.46) or lack thereof (4.30, 1.85-9.88). However, those who initiated PrEP in the past year (0.14, 0.04-0.39) or persistently used PrEP in the past 2 years (0.33, 0.14-0.74) had a lower risk of seroconversion. Of all HIV seroconversions observed during follow-up assessments (12, 24, 36 and 48 months), methamphetamine was reported in the 12 months prior 128 (42.2%) times (overall). Interventions that acknowledge race and ethnicity, economic variables such as education and housing instability, and methamphetamine use are critically needed. Not only are interventions to engage individuals in PrEP care needed, but those that retain them, and re-engage those who may fall out of care are essential, given the exceptionally high risk of seroconversion in these groups.

The factors associated with all-cause in-hospital mortality in patients with malignant well-differentiated gastroenteropancreatic neuroendocrine tumors: A retrospective analysis of National Inpatient Survey (NIS) 2020 dataset.

e16292 Background: Neuroendocrine tumors (NET) affect less than 200,000 (52 per 100,000) of the US population, with malignant well-differentiated gastroenteropancreatic (GEP) NETs accounting for about 65% of the cases. Owing to its rarity, the evidence on factors associated with all-cause mortality is limited. To address this gap, this study aims to identify socio-demographic and clinical factors associated with all-cause in-hospital mortality for patients with malignant well-differentiated GEP NET. Methods: We analyzed data from 2020 Nationwide Inpatient Sample survey on patients hospitalized with malignant well-differentiated GEP NET. Using ICD10 code, we identified patients hospitalized with any diagnosis of malignant well-differentiated GEP NET. In-hospital mortality was assessed based on the patient final disposition on discharge and dichotomized. Exposure variables analyzed included age, sex, tumor site, history of essential hypertension, COVID-19, hyperlipidemia, insurance status, length of hospital stay, and number of comorbidities present on the patients record. Multivariable logistic regression was used to assess for factors associated with mortality. Results: Of the 956 patients in this study, most were white (73.43%), male (48.28%) and mean age was 65 years (SD 13.59). Affected sites include small intestine (57.25%), pancreas (13.56%), colon (8.47%), appendix (8.26%), stomach (8.68%) and rectum (3.51%). Our results revealed that females were less likely to die in the hospital compared to their male counterpart hospitalized with malignant well-differentiated GEP NET (aOR = 0.42; 95% CI: 0.19 - 0.95). The presence of hyperlipidemia was significantly associated with in-hospital mortality (aOR = 0.24; 95% CI: 0.08 - 0.75). For every unit increase in the number of comorbidities, there is 12% increased risk of mortality (aOR = 1.12; 95% CI: 1.05 -1.19). The associations of age, race, tumor site, history of hypertension, insurance status or length of stay with in-hospital mortality were not statistically significant. Conclusions: Our study found significant associations of sex, hyperlipidemia, number of comorbidities and in-hospital mortality among patients with malignant well-differentiated GEP NET. Findings from this study highlight that factors such as sex, hyperlipidemia and number of comorbidities may be critical when developing prognostic tools that can be used to determine the risk of mortality among hospitalized patients hospitalized with these tumors.

Methods for structural sexism and population health research: Introducing a novel analytic framework to capture life-course and intersectional effects

Accumulating evidence links structural sexism to gendered health inequities, yet methodological challenges have precluded comprehensive examinations into life-course and/or intersectional effects. To help address this gap, we introduce an analytic framework that uses sequential conditional mean models (SCMMs) to jointly account for longitudinal exposure trajectories and moderation by multiple dimensions of social identity/position, which we then apply to study how early life-course exposure to U.S. state-level structural sexism shapes mental health outcomes within and between gender groups. Data came from the Growing Up Today Study, a cohort of 16,875 children aged 9–14 years in 1996 who we followed through 2016. Using a composite index of relevant public policies and societal conditions (e.g., abortion bans, wage gaps), we assigned each U.S. state a year-specific structural sexism score and calculated participants’ cumulative exposure by averaging the scores associated with states they had lived in during the study period, weighted according to duration of time spent in each. We then fit a series of SCMMs to estimate overall and group-specific associations between cumulative exposure from baseline through a given study wave and subsequent depressive symptomology; we also fit models using simplified (i.e., non-cumulative) exposure variables for comparison purposes. Analyses revealed that cumulative exposure to structural sexism: (1) was associated with significantly increased odds of experiencing depressive symptoms by the subsequent wave; (2) disproportionately impacted multiply marginalized groups (e.g., sexual minority girls/women); and (3) was more strongly associated with depressive symptomology compared to static or point-in-time exposure operationalizations (e.g., exposure in a single year). Substantively, these findings suggest that long-term exposure to structural sexism may contribute to the inequitable social patterning of mental distress among young people living in the U.S. More broadly, the proposed analytic framework represents a promising approach to examining the complex links between structural sexism and health across the life course and for diverse social groups.

Sex differences in the combined influence of inflammation and nutrition status on depressive symptoms: insights from NHANES.

Both nutrition and inflammation are associated with depression, but previous studies have focused on individual factors. Here, we assessed the association between composite indices of nutrition and inflammation and depression. Adult participants selected from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018 were chosen. The exposure variable was the Advanced Lung Cancer Inflammation Index (ALI) integrating nutrition and inflammation, categorized into low, medium, and high groups. The outcome variable was depression assessed using the Patient Health Questionnaire-9 (PHQ-9). A multivariable logistic regression model was employed to evaluate the relationship between ALI and the risk of depression. After extensive adjustment for covariates, in the overall population, participants with moderate and high levels of ALI had a decreased prevalence of depression compared to those with low ALI levels, with reductions of 17% (OR, 0.83; 95% CI: 0.72-0.97) and 23% (OR, 0.77; 95% CI: 0.66-0.91), respectively. Among females, participants with moderate and high ALI levels had a decreased prevalence of depression by 27% (OR, 0.73; 95% CI: 0.60-0.88) and 21% (OR, 0.79; 95% CI: 0.64-0.98), respectively, compared to those with low ALI levels, whereas no significant association was observed among males. Subgroup analyses based on females and males yielded consistent results. In this study, we observed a negative correlation between moderate to high levels of ALI and the prevalence of depression, along with gender differences. Specifically, in females, greater attention should be given to the nutritional and inflammatory status.

Emotional risk factors before in vitro fertilization among infertile couples in daily clinical practice in Sari in 2020–2022

Background and AimThe relationship between psychological factors and treatment outcomes with assisted reproductive technology has sparked considerable debate. This study aims to investigate the emotional risk factors in couples seeking infertility treatment using assisted reproductive technology in Sari, Iran, from 2020 to 2022.Materials and methodsThis research is a cross-sectional study and emotional risk factors and other related factors were examined using the Persian version of the SCREENIVF demographic, social, and clinical status questionnaire, social, and clinical status questionnaire before using Assisted reproductive technology in 460 infertile couples selected from infertility treatment centers in Sari City, Iran. The samples were randomly selected using a table of random numbers. Data analysis was performed using SPSS version 22 software.ResultsThe mean age of the male and female participants were 31.70 ± 5.71 and 35.22 ± 5.48, respectively. The results regarding emotional risk factors and other related factors revealed that the variables of remarriage (P = 0.048) and exposure of spouse to emotional risk factors (P = 0.001), history of depression disorder (P = 0.007), and history of anxiety disorder (P = 0.009) were significantly correlated with the exposure of women to emotional risk factors. Furthermore, men’s exposure to emotional risk factors was significantly correlated with primary education (P = 0.026) and diploma (P = 0.043) levels, age (P = 0.006), and wife’s exposure to emotional risk factors (P = 0.001).ConclusionBy identifying infertile couples who are at risk of emotional risk factors, healthcare professionals can provide appropriate support and interventions to mitigate the emotional challenges associated with infertility. This proactive approach can significantly enhance couples undergoing infertility treatment’s well-being and mental health.

Preventive dental care reduces risk of cardiovascular disease and pneumonia in hemodialysis population: a nationwide claims database analysis

This study aims to investigate the impact of dental care utilization status on the occurrence of fatal complications such as cerebral/cardiovascular disease (CVD) and infectious diseases in patients with end-stage renal disease (ESRD) undergoing hemodialysis. This retrospective cohort study was performed using the Japanese claims database and included patients who first underwent hemodialysis between April 2014 and September 2020. The exposure variable of interest was the pattern of dental utilization, which was categorized into three groups, “dental treatment group”, “preventive dental care group”, and “no-dental visit group”. The primary outcomes were the time interval until a composite end point of first major cardiovascular event (acute myocardial infarction, heart failure, or cerebral infarction) of infectious disease (pneumonia and sepsis). The secondary outcomes were the time interval until the incidence of each component of primary outcomes. Survival analyses, including log-rank tests and Cox proportional hazards regression analyses, were performed. Among the 10,873 patients who underwent the first dialysis treatment, 6152 were assigned to the no-dental visit group, 2221 to the dental treatment group, and 2500 to the preventive dental care group. The preventive dental care group had significantly lower hazard ratios (HRs) of the incidence of CVD (adjusted hazard ratio [aHR]: 0.86, 95% confidence interval [CI]: 0.77–0.96) and infectious diseases (aHR: 0.86, 95% CI: 0.76–0.97). As for pneumonia, preventive dental care and dental treatment groups had significantly lower HRs (aHR: 0.74 and 0.80, 95% CI: 0.61–0.88, 0.66–0.96) than the no-dental visit group. This study demonstrated that dental visits for preventive dental care were associated with a significant risk reduction in CVD and infectious complications in patients with ESRD undergoing hemodialysis.

Optimal reinsurance under a new design: two layers and multiple reinsurers

We investigate the optimal reinsurance problem considering a more realistic two-layer design involving excess-of-loss reinsurance and multiple reinsurers. Unlike the commonly assumed single-layer design in the existing literature, our approach involves a top layer consisting of excess-of-loss reinsurance and the involvement of multiple reinsurers. Our focus is on the insurer's management of risk exposure and costly capital reinvestment strategies to maximize the company value. We formulate this problem as an optimization problem with constrained multivariate reinsurance exposure variables, and capital injection control. Our findings show that, from a profitability standpoint, when the surplus is low and the excess-of-loss reinsurance is not too expensive, the insurer should obtain a two-layer reinsurance with an excess-of-loss reinsurance at the top layer and a combination of proportional reinsurance from multiple reinsurers at the bottom layer. In contrast, when the surplus is relatively large or the excess-of-loss reinsurance is too expensive, the insurer should purchase a single-layer proportional reinsurance from multiple reinsurers. When the surplus is large enough, the insurer should not acquire any reinsurance. Our results suggest that stand-alone excess-of-loss reinsurance is never optimal when there is also proportional reinsurance with a variance premium principle available for losses below the excess threshold, and we theoretically confirm that a multi-layer reinsurance design is preferable over a single-layer design. Furthermore, our results demonstrate that in order to maximize the company's value, dividends should be paid according to the lump-sum barrier strategy, and capital injections should be considered only if the surplus is null and the transaction costs on capital injections are not too high.

“The reasons you believe …”: An exploratory study of text driven evidence gathering and prediction from first responder records justifying state authorised intervention for mental health episodes

Objective First responders’ mandatory reports of mental health episodes requiring emergency hospital care contain rich information about patients and their needs. In Queensland (Australia) much of the information contained in Emergency Examination Authorities (EEAs) remains unused. We propose and demonstrate a methodology to extract and translate vital information embedded in reports like EEAs and to use it to investigate the extreme propensity of incidence of serious mental health episodes.Methods The proposed method integrates clinical, demographic, spatial and free text information into a single data collection. The data is subjected to exploratory analysis for spatial pattern recognition leading to an observational epidemiology model for the association of maximum spatial recurrence of EEA episodes.Results Sentiment analysis revealed that among EEA presentations hospital and health service (HHS) region #4 had the lowest proportion of positive sentiments (18 %) compared to 33 % for HHS region #1 pointing to spatial differentiation of sentiments immanent in mandated free text which required more detailed analysis.At the postcode geographical level, we found that variation in maximum spatial recurrence of EEAs was significantly positively associated with spatial range of sentiments (0.29, p < 0.001) and the postcode-referenced sex ratio (0.45, p = 0.01). The volatility of sentiments significantly correlated with extremes of recurrence of EEA episodes. The predicted (probabilistic) incidence rate when mapped reflected this correlation.Conclusions The paper demonstrates the efficacy of integrating, machine extracted, human sentiments (as potential surrogates) with conventional exposure variables for evidence-based methods for mental health spatial epidemiology.Such insights from informatics-driven epidemiological observations may inform the strategic allocation of health system resources to address the highest levels of need and to improve the standard of care for mental patients while also enhancing their safe and humane treatment and management.

Two-sample Mendelian randomization analysis of the causal relationship between blood eosinophils and allergic rhinitis.

Previous studies have revealed a correlation between eosinophils and allergic rhinitis, but the causal relationship has not been fully confirmed. This study aims to evaluate the causal link between blood eosinophils and allergic rhinitis using the Mendelian randomization (MR) method. Summary data from the Genome-Wide Association Study Catalog (GWAS) for eosinophil count (exposure variable) and allergic rhinitis (outcome variable) were collected. GWAS data for the exposure variable were obtained from the IEU Open GWAS Project developed by the Integrative Epidemiology Unit at the University of Bristol, while data for the outcome variable were sourced from the FinnGen Biobank (Finland) database. The causal relationship between eosinophils and allergic rhinitis was analyzed using the two-sample MR method with inverse variance weighted (IVW) analysis. Sensitivity analyses were conducted using the weighted median method, MR-Egger regression, leave-one-out analysis, and funnel plots. An increase in blood eosinophil count showed a potential causal relationship with an increased risk of allergic rhinitis (OR=1.187, 95% CI 1.051 to 1.341, P=0.006). This finding was consistent across the weighted median method and MR-Egger regression. Leave-one-out analysis indicated that no single nucleotide polymorphism significantly influenced the causal inference. There is a causal association between increased eosinophil count and a higher risk or worsening of allergic rhinitis.

Mandibular asymmetries in brazilian adolescents: prevalence and associated factors

Objectives : Estimate the prevalence of mandibular asymmetries in Brazilian adolescents and investigate the demographic and skeletal factors associated to the asymmetries. Methods : Cone beam computed tomography (CBCT) images from 376 individuals aged from 10 to 19 were analysed to investigate mandibular asymmetry categorized as relative mandibular symmetry, moderate asymmetry, and severe asymmetry. Exposure variables included sex, age, side of mandibular deviation, sagittal and vertical skeletal pattern of the individuals, and cranial base angulation. The chi-square test was used to evaluate the association among asymmetry and the exposure variables. Gross prevalence rations were estimated and adjusted by Poisson regression with robust variance. Significance level was established at 5%.

The impact of depression-mediated gut microbiota composition on Irritable Bowel Syndrome: A Mendelian study

ObjectiveThis study uses a two-sample Mendelian randomization (MR) analysis to delineate the causal influence of gut microbiota on the occurrence of irritable bowel syndrome (IBS), concurrently assessing the potential mediating function of depression within this framework. MethodsSeveral two-sample MR methods were used to assess the causal repercussions of gut microbiota on the onset of both IBS and depression. Following this, gut microbiota and depression, which demonstrated notable causal associations, were integrated as exposure variables in a multivariable Mendelian randomization (MVMR) framework to construct a model encompassing gut microbiota, depression, and IBS. Mediation effects were assessed by examining the indirect pathway of gut microbiota → depression → IBS. ResultsTwo-sample MR analysis unveiled a statistically significant causal association (P < 0.05) between specific bacterial group within the gut microbiota, notably p_Actinobacteria(OR = 0.829225), c_Clostridia(OR = 0.798897), s_Desulfovibrio_piger(OR = 1.163912), g_Streptococcus(OR = 1.132735), c_Actinobacteria(OR = 0.829224), and the onset of IBS. In the MVMR analysis, the relationship between depression and IBS was significant across Model 3, Model 7, Model 8, and Model 13 (P < 0.05). Assessment of mediation effects revealed that c_Clostridia and o_Clostridiales indirectly impacted IBS through depression, with masking effect ratios of 168.46 % and 168.44 %, respectively. ConclusionThese findings underscore a resilient causal association between the composition of gut microbiota and the initiation of IBS. Furthermore, depression serves as a mediator for particular groups of gut bacteria, thereby contributing to the development of IBS. These observations imply that interventions targeting mental health may potentially alleviate the risk of IBS onset attributable to adverse configurations of gut microbiota.

Prevalence and determinants of massage therapy use in the U.S.: Findings from the 2022 National Health Interview Survey

BackgroundThis study presents findings on the prevalence and determinants of past-year massage therapy use among U.S. adults from the 2022 round of the National Health Interview Survey (NHIS) (total available N = 27,651), an annual national population survey. MethodsThe NHIS uses face-to-face interviews on a representative sample of the civilian, noninstitutionalized U.S. population drawn using a systematic, stratified, single-stage probability design. The analyses consist of logistically modeling the determinants of three outcome (dependent) measures: past year utilization of a practitioner of massage, past year utilization of massage for pain, and past-year utilization of massage to restore overall health. Exposure (independent) variables include numerous sociodemographic, health services, health-related, mental health and well-being, and behavioral indicators. ResultsThe past-year prevalence rate for visiting a massage therapist in the U.S. is 11.1 %. The past-year rate for massage visits for pain is 6.0 %, and for restoring overall health is 8.5 %. Significantly higher rates are found among females and socioeconomically advantaged individuals, among other categories, and the strongest net determinant of massage therapy utilization is use of complementary or integrative practitioners. ConclusionIt is apparent that massage therapy is a commonly utilized therapeutic modality in the U.S. While use of complementary or integrative therapies is a significant determinant of massage utilization, it may not be fitting to consider massage therapy itself as an “alternative” therapy, but rather a widely used and increasingly mainstream therapeutic modality meriting wider integration into the community of healthcare professions.

Grandparents' and domestic helpers' childcare support: Implications for well‐being in Asian families

AbstractObjectiveTo investigate whether childcare support from grandparents and domestic helpers is associated with family well‐being in Singapore, with a focus on parent and child psychological well‐being as well as the quality of interactions and relationships within the family.BackgroundResearch on the implications of childcare support from maternal grandparents, paternal grandparents, and domestic helpers for family well‐being remains a gap in the literature. This involvement could enhance family well‐being through instrumental assistance and emotional encouragement in childcare. However, it could also create a negative emotional climate for families if the relationship of the mother with the grandparents or domestic helper is marked by conflict.MethodThis study used questionnaire data from 615 mother–child dyads from the birth cohort, Growing Up in Singapore Towards healthy Outcomes. The exposure variable was children's caregiving arrangements assessed at child ages 4.5 and 6 years, and the outcome variables were maternal well‐being, maternal parenting, and family functioning measured at concurrent assessments, and child well‐being assessed at age 10 years.ResultsChildcare support from maternal grandparents, but not from paternal grandparents or domestic helpers, showed concurrent associations with warmer parenting by mothers at child ages 4.5 and 6 years. Early childcare support from domestic helpers at child age 6 years predicted higher depressive symptoms in children at age 10 years.ConclusionOur findings suggest that childcare support from maternal grandparents, who are most likely to share a close bond and value system with mothers, could be most beneficial for families in Singapore.

Sociodemographic Heterogeneity in the Associations of Social Isolation With Mortality

There are limited data on whether the vulnerabilities and impacts of social isolation vary across populations. To explore the association between social isolation and mortality due to all causes, cardiovascular diseases (CVD), and malignant neoplasms focusing on heterogeneity by sociodemographic factors. This cohort study used a moderator-wide approach to examine the heterogeneity in the association of social isolation with all-cause, CVD, and malignant neoplasm mortality using baseline data from the Japan Gerontological Evaluation Study in 2010 and 2011. Eligible participants were adults aged 65 years or older without heart disease, stroke, cancer, or impaired activity of daily living across 12 Japanese municipalities. Follow-up continued until December 31, 2017, identifying 6-year all-cause, cardiovascular disease (CVD), and malignant neoplasm mortality. Logistic regression assessed effect modification by age, gender, education, income, population density, marital status, and employment on mortality associations. Data analysis was performed from September 13, 2023, to March 17, 2024. Social isolation, determined by a 3-item scale (scores of 2 or 3 indicating isolation) was the primary exposure variable. Six-year all-cause, CVD, and malignant neoplasms mortality. This study included 37 604 older adults, with a mean (SD) age of 73.5 (5.9) years (21 073 women [56.0%]). A total of 10 094 participants (26.8%) were classified as experiencing social isolation. Social isolation was associated with increased all-cause (odds ratio [OR], 1.20 [95% CI, 1.09-1.32]), CVD (OR, 1.22 [95% CI, 0.98-1.52]), and malignant neoplasm mortality (OR, 1.14 [95% CI, 1.01-1.28]). Stratified analysis showed associations of social isolation with all-cause and malignant neoplasm mortality among people with high income (highest tertile all cause: OR, 1.27 [95% CI, 1.06-1.53]; malignant neoplasm: OR, 1.27 [95% CI, 1.02-1.60]), living in areas with high population density (highest tertile all cause: OR, 1.47 [95% CI, 1.26-1.72]; malignant neoplasm: OR, 1.38 [95% CI, 1.11-1.70]), not married (all cause: OR, 1.33 [95% CI, 1.15-1.53]; malignant neoplasm: OR, 1.25 [95% CI, 1.02-1.52]), and retirees (all cause: OR, 1.27 [95% CI, 1.14-1.43]; malignant neoplasm: OR, 1.27 [95% CI, 1.10-1.48]). Formal testing for effect modification indicated modification by population density and employment for all-cause mortality and by household income and employment for neoplasm mortality. Social isolation was associated with increased risks of all-cause, CVD, and malignant neoplasm mortality, with associations varying across populations. This study fills an important gap in research on social isolation, emphasizing its varied associations across demographic and socioeconomic groups.

#908 The effect of obesity and fat distribution on estimated glomerular filtration rate (eGFR): A Mendelian randomization and image data analysis study

Abstract Background and Aims Obesity is intimately linked to the initiation and progression of chronic kidney disease, but questions on causality still remain. The diagnosis of chronic kidney disease is often based solely on creatinine- and/or cystatin C-based estimated glomerular filtration rate (eGFR), but both these endogenous biomarkers are also known to be related to body composition. This study aims to further investigate how obesity causally affects eGFR, derived from both biomarkers. Method Methods used were: Traditional cross-sectional analyses and magnetic resonance imaging data analyses performed in the POEM study (502 subjects, all aged 50 years), and two-sample Mendelian randomization using already published summary data. Outcome variables for all analyses were eGFR indexed to body surface area, based on creatinine and cystatin C, respectively. In both the traditional cross-sectional and the Mendelian randomization analyses body mass index and waist circumference were used as exposure variables. In the image data analyses, eGFR was regressed nonparametically on fat content and tissue volume for each 3D voxel. Results were visualized as a correlation “imiomics” map. Results Results from the POEM study showed in an adjusted model a negative correlation between cystatin C calculated eGFR and both body mass index [beta = −0.190 (95% CI: −0.280 to −0.100)] and waist circumference [beta = −0.160 (95% CI: −0.250 to −0.060)]. In contrast, a positive association was found for eGFR when using creatinine levels [beta = 0.120 (95% CI: 0.030 to 0.210) for body mass index; beta = 0.160 (95% CI: 0.070 to 0.260) for waist circumference]. This pattern was repeated in the image data analysis, which was visualized in the imiomics map: both visceral and subcutaneous adipose tissue were negatively correlated to eGFR based on cystatin C but positively correlated to eGFR based on creatinine (Fig. 1). Mendelian randomization implied a negative causal effect of obesity-related measures on cystatin C-based eGFR, with statistically significant estimates for both body mass index [beta = −0.031 (95% CI: −0.037 to −0.026)] and waist circumference [beta = −0.038 (95% CI: −0.045 to −0.031)]. No statistically significant effects was found on creatinine-based eGFR (Fig. 2). Conclusion This study indicates a causal negative effect of obesity on cystatin C-based eGFR, but not on eGFR calculated from creatinine. This discrepancy is further highlighted by analyses of adipose tissue from magnetic resonance imaging. These findings thus warrant further research on the impact of using the endogenous biomarkers creatinine and cystatin C to estimate renal function when assessing the link between obesity and chronic kidney disease.