Greater Proportion Of Individuals Research Articles

Diurnal patterns of salivary cytokines differentially correlate with greater fluctuations in cortisol and diet composition: A pilot study

Chronic stress and elevated cortisol are associated with adverse metabolic profiles and lifestyle patterns, systemic low-grade inflammation, and increased chronic disease risk; however, it is less clear how the degree of cortisol fluctuations impacts these parameters. Adult men and women (18-70y) were recruited to participate in a 5-day observational study, in which they underwent a baseline health and body composition assessment, completed 5-day diet, exercise, and stress records, and provided saliva samples in the morning, afternoon, and evening to measure fluctuations in cortisol, interleukin-1β (IL-1β), and IL-6. Degree of cortisol variability over the 5-day period (highest cortisol measure - lowest cortisol measure) was used to classify subjects into high (n = 9) and low (n = 9) cortisol fluctuation groups. Participants with greater fluctuations in salivary cortisol had higher salivary cortisol concentrations on average, which was attributed to higher maximal and morning cortisol. A greater proportion of individuals with higher cortisol flux worked in first responder/emergency professions, and exhibited minimal dietary pattern differences compared to those with low cortisol flux. While body fat percentage and mass positively correlated with minimum salivary cortisol measures, body composition and blood pressure did not differ between low vs. high salivary cortisol flux groups. Interestingly, we observed diurnal patterns of salivary IL-1β concentrations, with higher IL-1β in the morning, and greater afternoon IL-1β in the high cortisol flux group compared to the low cortisol flux group. Independent of cortisol flux, waking satiety and intake patterns of dietary nutrients and food groups/type differentially correlated with salivary cytokine concentrations in a time of day-dependent manner. Our findings suggest that greater fluctuations in cortisol are associated with distinct diurnal salivary cortisol and IL-1β concentrations but minimal lifestyle and dietary factors, whereas dietary patterns are strongly and differentially associated with salivary cytokine profiles.

Using Computational Phenotyping to Identify Divergent Strategies for Effort Allocation Across the Psychosis Spectrum.

Disturbances in effort-cost decision-making have been highlighted as a potential transdiagnostic process underpinning negative symptoms in individuals with schizophrenia. However, recent studies using computational phenotyping show that individuals employ a range of strategies to allocate effort, and use of different strategies is associated with unique clinical and cognitive characteristics. Building on prior work in schizophrenia, this study evaluated whether effort allocation strategies differed in individuals with distinct psychotic disorders. We applied computational modeling to effort-cost decision-making data obtained from individuals with psychotic disorders (n = 190) who performed the Effort Expenditure for Rewards Task. The sample included 91 individuals with schizophrenia/schizoaffective disorder, 90 individuals with psychotic bipolar disorder, and 52 controls. Different effort allocation strategies were observed both across and within different disorders. Relative to individuals with psychotic bipolar disorder, a greater proportion of individuals with schizophrenia/schizoaffective disorder did not use reward value or probability information to guide effort allocation. Furthermore, across disorders, different effort allocation strategies were associated with specific clinical and cognitive features. Those who did not use reward value or probability information to guide effort allocation had more severe positive and negative symptoms, and poorer cognitive and community functioning. In contrast, those who only used reward value information showed a trend toward more severe positive symptoms. These findings indicate that similar deficits in effort-cost decision-making may arise from different computational mechanisms across the psychosis spectrum.

Gender-Diverse Patients' Awareness and Utilization of Gender-Affirming Laryngological Services.

Despite gender-affirming laryngological services (GALS; eg, voice therapy or surgery) being available nationwide, there is a discrepancy between the number of transgender and gender diverse (TGD) people with vocal incongruence and those who pursue services. Primary care is an important setting for accessing gender-affirming care, including learning about GALS. The purpose of this study was to understand the relationship between access to primary care and utilization of GALS. An anonymous cross-sectional online survey was developed in REDCap. Between June-November 2022, 187 TGD respondents answered all questions related to this analysis. We assessed the relationship between having a primary care provider (PCP) and use of GALS via logistic regression. Of the 167 individuals who reported having a PCP, 54% reported familiarity with GALS, compared to 45% of individuals without a PCP. Compared to the group without a PCP, a greater proportion of individuals with a PCP had received professional voice therapy (21% vs 5%) and voice surgery (3% vs 0%). Logistic regression models did not demonstrate a significant effect of primary care access on either familiarity with, or use of, GALS. Most respondents (89%) were linked to the medical community through a PCP. A greater proportion of respondents with a PCP had accessed professional voice therapy and voice surgery compared with respondents without a PCP, though this difference was not statistically significant. Increased communication between GALS providers and PCPs would raise awareness of available services and may strengthen the referral pipeline to increase access to vocal care. Level III.

Reproductive cycle of the mangrove oyster Crassostrea rhizophorae (Guilding, 1828) in Delta do Parnaíba, Brazil

This study describes some aspects of the reproductive biology of the native oyster Crassostrea rhizophorae in the Delta do Parnaíba estuary, located between the states of Maranhão and Piauí, Brazil. The oysters were acquired from landings at Porto dos Tatus (Ilha Grande - PI) between June 2017 and May 2018. Approximately 50 individuals per month (n=611) with an average total shell length of 74.44 mm (±14.31 SD) were collected for analysis of gonadal development and condition index and correlated with temporal variations in local rainfall. The C. rhizophorae population in the Parnaíba Delta estuary showed a sex ratio of 2.18 females to 1 male and continuous reproduction. The condition index (CI) values in the dry period were higher, coinciding with a greater proportion of individuals in the gametogenesis and pre-spawning stages. In the rainy season, there was a reduction in the CI as a result of animals in the gamete release stage.

Carbon monoxide and carboxyhemoglobin contents in exhaled air and blood pressure levels with diff erent nicotine delivery pathways

Aim. To assess the content of CO and COHb in exhaled air and the level of blood pressure (BP) in the working-age population of Yuzhno-Sakhalinsk when using various means of nicotine delivery.Materials and methods. The study participants (n = 503) were surveyed using a questionnaire. The BP and oxygen saturation parameters were assessed. The content of CO and COHb content in exhaled air was measured using a smokerlyzer. Statistical processing was performed using nonparametric methods.Results. The study group was dominated by males (58.3%). A high incidence of smoking was observed among females, with up to 42% in the general group and 48.8% in the group of consumers of alternative nicotine delivery systems (ANDS). A correlation between the content of CO and COHb and the smoking experience of more than 10 years was established, regardless of the means of nicotine delivery. Arterial hypertension was registered among 39.8% of the surveyed participants, with a higher frequency in cigarette smokers (28.8%, p = 0.02). This was associated with a greater proportion of individuals (62%) with a long smoking experience of more than 10 years (p = 0.003). A weak direct correlation was established between an increase in blood pressure and the content of CO and COHb (p < 0.001).Conclusion. The share of females as active consumers of tobacco products has grown, particularly in the form of ANDS. Among smokers, the average high level of CO and COHb prevails, which correlates with the smoking experience of more than 10 years and does not depend on the means of nicotine delivery. A direct relationship between the intensity of smoking and the risk of hypertension was established.

Social determinants of health disparities in Staten Island compared with Manhattan, Queens, Brooklyn, and the Bronx: Contribution to COVID-19 outcomes.

Social determinants of health (SDH) negatively affectedCoronavirus disease-2019 (COVID-19) outcomes within the five boroughs of New York City. The goal of this study was to determine whether differences in social demographics within the borough of Staten Island, compared with the other four boroughs, may have contributed to poor COVID-19 outcomes in Staten Island. Data were obtained from public data sources. Social demographics obtained included age, household income, poverty status, and education level. COVID-19 infection, hospitalization, and death rates reported from Staten Island were compared with rates from Manhattan, Queens, Brooklyn, and the Bronx (February 29, 2020-October 31, 2022). Mean differences in case rates of COVID-19 were higher in Staten Island compared to all four boroughs. Mean differences in hospitalization and death rates were higher than Manhattan but similar to the other four boroughs. Within Staten Island, case rates were highest in zip codes 10306 and 10309. Hospitalization and death rates were highest in Staten Island zip code 10304. We found that the zip codes of Staten Island with poorer COVID-19 outcomes had more individuals with less than a high school degree, lower mean household income, higher proportion of households earning less than $25,000 a year, and a greater proportion of individuals using public transportation. Differences in COVID-19 infection, hospitalization, and death rates exist between the five boroughs and between the 12 zip codes within Staten Island. These differences in COVID-19 outcomes can be attributed to different SDH.

Higher prevalence of coronary microvascular dysfunction in asymptomatic individuals with high levels of lipoprotein(a) with and without heterozygous familial hypercholesterolaemia

Background and aimsMicrovascular dysfunction underlies many cardiovascular disease conditions; little is known regarding its presence in individuals with high levels of lipoprotein(a) [Lp(a)]. The aim of the present study was to determine the frequency of microvascular dysfunction among such subjects with and without concomitant familial hypercholesterolemia (FH). MethodsFour groups of asymptomatic individuals aged 30–59 years, without manifest cardiovascular disease, were recruited (n = 30 per group): controls with Lp(a) < 30 nmol/L, mutation-confirmed FH with Lp(a) < 30 nmol/L, or >125 nmol/L, and individuals with isolated Lp(a) > 125 nmol/L. Participants underwent evaluation of myocardial microvascular function by measuring coronary flow reserve (CFR) using transthoracic Doppler echocardiography, and of peripheral microvascular endothelial function by peripheral arterial tonometry. ResultsThe groups were balanced in age, sex, and body mass index. Each of the three dyslipoproteinaemic groups had a greater proportion of individuals with impaired coronary flow reserve, 30%, compared to 6.7% of controls (p = 0.014). The median CFR levels did not differ significantly between the four groups, however. Cholesterol-lowering treatment time was longer in the individuals with normal than in those with impaired CFR in the FH + Lp(a) > 125 group (p = 0.023), but not in the group with FH + Lp(a) < 30 (p = 0.468). There was no difference in peripheral endothelial function between the groups. ConclusionsCoronary microvascular dysfunction is more prevalent in asymptomatic individuals with isolated Lp(a) elevation and in heterozygous FH both with and without high Lp(a) compared to healthy controls. Cholesterol-lowering treatment could potentially prevent the development of microvascular dysfunction.

44 Can Clinical Trial data Inform our Understanding of the role of Depressive Symptoms in Alzheimer's Disease?

Objective:Neuropsychiatric symptoms concerning mood are common in Alzheimer's disease (AD), but it is unclear if they are etiologically related to AD pathophysiology or due to factors considered to be non-pathogenic, such as small vessel cerebrovascular disease. New generation clinical trials for AD often enroll participants with evidence of AD pathophysiology, indexed by amyloid PET scanning, but who are cognitively asymptomatic. We used screening data from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's (A4) study to examine the extent to which depressive symptoms are associated with amyloid pathophysiology and small vessel cerebrovascular disease, in the form of white matter hyperintensities (WMH).Participants and Methods:The A4 study randomizes cognitively healthy older adults with evidence of amyloid pathophysiology on PET scanning. We used screening data, which included amyloid status (positive, negative) by visual read, amyloid PET standard uptake value ratio (SUVR) in cortical regions, and MRI data acquired in a subset (n=1,197, mean age 71.6 +/- 4.8 years, 57% women) to quantitate total WMH volume. Depressive symptoms were evaluated with the 15-item Geriatric Depression Scale, which we used both as a continuous variable and to define 'depressed' and 'non-depressed' groups, based on a cut score of &gt; 5. We examined whether 1) depressive symptoms and proportion of depressed individuals differed between amyloid positive and negative groups, 2) there is a relationship between amyloid SUVR and depressive symptoms that differs as a function of amyloid positivity status, and 3) there is a relationship between WMH volume and depressive symptoms that differs as a function of amyloid positivity status.Results:Although depressive symptom severity did not differ between groups (t=0.14, p=0.88), a greater proportion of individuals were classified as depressed in the amyloid negative group than the amyloid positive group (3.5% vs. 1.9%, X2=4.60, p=0.032). Increased amyloid SUVR was associated with increased GDS scores among amyloid positive individuals (r=0.117, p=0.002) but not among amyloid negative individuals (r=0.006, p=0.68, Positivity Status x SUVR interaction on GDS: ß=0.817, p=0.029). Increased WMH was associated with higher GDS scores (ß=0.105, p=0.017) but not differentially in amyloid positive and negative participants (Positivity Status x WMH interaction on GDS: ß=-0.010, p=0.243).Conclusions:These analyses have several implications. First, individuals who are screened to participate in a clinical trial but do not have evidence of amyloidosis may be misattributing concerns about underlying AD pathophysiology to depressive symptoms. Second, the severity of AD pathophysiology, indexed by amyloid PET SUVR, may drive a small increase in depressive symptomatology among individuals over visual diagnostic thresholds. Third, small vessel cerebrovascular changes are additionally associated with depressive symptoms but in a manner that is independent of AD pathophysiology. Overall, depressive symptoms and depression are likely multiply determined among prospective clinical trial participants for preclinical AD.

Energetics and fuel use vary with migration strategy across populations of Common Blackbirds

Abstract Seasonal migration is a physiologically demanding endeavour that animals prepare for by finding and storing energy. Species and populations vary in their tendencies to migrate and the energetic demands of migration likely determine the degree and type of preparation that different animals undergo. Birds fuel their migratory flight using stored fat. Previous work has suggested that in addition to being energetically dense, certain lipids like polyunsaturated fatty acids (PUFAs) may be particularly efficient fuels that are preferentially mobilized for flight or serve may additional functions, such as modulating membrane fluidity or stimulating gene expression as ligands, during long‐distance migratory flight. Using a series of behavioural and metabolic experiments in a partial transplant aviary setting of Common Blackbirds (Turdus merula) populations that range from being fully migratory to partially migratory to sedentary, we asked how migratory restlessness (Zugunruhe), weight gain and oxidation of stearic acid (18:0), oleic acid (18:1n‐9), linoleic acid (18:2n‐6) and alpha linolenic acid (18:3n‐3; ALA) varied with migratory mode and season. We found no population‐level differences in the timing of Zugunruhe. However, before migration, a greater proportion of individuals from fully migratory populations exhibited weight gain and migratory restlessness, as well as increased oxidation of PUFAs. After Zugunruhe, only individuals from migratory populations showed reduced PUFA oxidation. All populations showed increased oxidation of saturated fat after Zugunruhe. Our results demonstrate that certain migratory traits, like the timing of Zugunruhe are expressed similarly across populations in response to local environmental conditions, while other traits, like lipid oxidation, can vary among populations. Read the free Plain Language Summary for this article on the Journal blog.

Variant RHD alleles and Rh immunization in patients with sickle cell disease.

RH diversity among patients and donors contributes to Rh immunization despite serologic Rh-matched red cell transfusions. Anti-D can occur in D+ patients with RHD variants that encode partial D antigens. Anti-D has also been reported in patients with conventional RHD transfused primarily with units from Black donors who frequently have variant RHD. We report 48 anti-D in 690 D+ transfused individuals with sickle cell disease, categorized here as expressing conventional D, partial D or D antigen encoded by RHD*DAU0. Anti-D formed in a greater proportion of individuals with partial D, occurred after fewer D+ unit exposures, and remained detectable for longer than for those in the other categories. Among all anti-D, 13 had clinical or laboratory evidence of poor transfused red cell survival. Most individuals with anti-D were chronically transfused, including 32 with conventional RHD who required an average of 62 D- units/year following anti-D. Our findings suggest that patients with partial D may benefit from prophylactic D- or RH genotype-matched transfusions to prevent anti-D. Future studies should investigate whether RH genotype-matched transfusions can improve use of valuable donations from Black donors, reduce D immunization and minimize transfusion of D- units to D+ individuals with conventional RHD or DAU0 alleles.

The truth about gluten!

AbstractWheat was first cultivated in the Fertile Crescent (South Western Asia) with a farming expansion that lasted from around 9000 BC to 4000 BC. Whilst humans have been exposed to wheat for around the last 10 000 years, humans have existed for greater than 2·5 million years. Therefore, wheat (and thereby gluten) are relatively new introductions to our diet! By the end of the 20th century, global wheat output had expanded by 5-fold, with a corresponding increase in the prevalence of gluten-related disorders. Coeliac disease (CD) is a state of heightened immunological responsiveness to ingested gluten in genetically susceptible individuals. CD now affects 1 % or more of all adults, for which the management is a strict lifelong gluten-free diet (GFD). However, there is a growing body of evidence to show that a far greater proportion of individuals without CD are self-initiating a GFD. This includes individuals initiating a GFD as a lifestyle choice, people with irritable bowel-type symptoms and those diagnosed with non-coeliac gluten (or wheat) sensitivity. Despite a greater recognition of gluten-related disorders, gaps still remain in our understanding of both their aetiology and management. This article explores the role of the gluten-free diet in gluten-related disorders, along with current uncertainties.

PS-BPC03-8: MORNING BLOOD PRESSURE SURGE AND THE VASCULATURE: A COMPARISON BETWEEN YOUNG DIPPERS AND NON-DIPPERS FROM THE AFRICAN-PREDICT STUDY

Background and aim: Adverse changes in large arteries and retinal microvascular calibres are predictors for hypertension and stroke. These adverse changes were reported in response to the suppressed night-time dipping as well as in hypertensive individuals with exaggerated morning surge. However, it is unknown whether young healthy individuals with normal morning surge, but with non-dipping night-time blood pressure profile, will already present with early onset of micro and macrovascular changes. We investigated the relationship of morning surge with retinal vessel calibres and large artery stiffness in healthy young dippers and non-dippers. Methods: We included black and white participants (N = 323), aged 20–30 years, determined sleep-trough surge. We determined central retinal artery and vein equivalents from fundus images, as well as carotid-femoral pulse wave velocity. Results: Dippers had a greater morning surge (within normal range) (p &lt; 0.001) and a greater proportion of individuals with exaggerated morning surge (p &lt; 0.001). In dippers only, we found a positive relationship between central retinal artery equivalent and morning surge (p = 0.040). In sensitivity analysis, the association between central retinal artery equivalent and morning surge in dippers lost significance (p = 0.09) when 24-hour diastolic blood pressure was replaced with night-time diastolic blood pressure. However, an independent negative association between central retinal artery equivalent and night-time diastolic blood pressure (p &lt; 0.001) emerged. Normal morning surge of dippers was positively associated with central retinal artery equivalent (dependent on night-time dipping). Conclusion: Normal night-time dipping may therefore be involved in preserving retinal arteriolar diameter of dippers, which may reflect a lower vascular resistance.

Transforming the invisible into the visible: disparities in the access to health in LGBT+ older people

ObjectivesTo compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+. MethodsA cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models. Results6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. ConclusionHealthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all.

Assessment of changes in immune status linked to COVID-19 convalescent and its clinical severity in patients and uninfected exposed relatives

IntroductionThe immune response during and after SARS-CoV-2 infection can be complex and heterogeneous, and it can be affected by the severity of the disease. It can also contribute to an unfavorable evolution and bring about short and long term effects. The aim of this study was to characterize the lymphocyte composition according to the severity of COVID-19, as well as its degree of relationship to the specific humoral response to SARS-CoV-2 in convalescents up to 106 days after the infection and in their exposed relatives. MethodsAn applied research was carried out with a cross-section analytical design, from March 11 to June 11, 2020 in Cuba. The sample consisted of 251 convalescents from COVID-19 over 18 years of age and 88 exposed controls who did not become ill. The B and T cell subpopulations, including memory T cells, as well as the relationship with the humoral immune response against SARS-CoV-2, were identified by flow cytometry and enzyme immunoassay. ResultsConvalescent patients, who evolved with severe forms, showed a decrease in frequency and a greater proportion of individuals with values ​​lower than the minimum normal range of B cells, CD3 + CD4 + cells and the CD4 + / CD8 + ratio, as well as a higher frequency and a greater proportion of individuals with values ​​above the normal maximum range of CD3 + CD8 + and NK cells. Convalescent patients with severe forms of COVID-19 that exhibited IgG / RBD titers ≥ 1/200 had a lower frequency of TEMRA CD8 + cells (p = 0.0128) and TEMRA CD4 + (p = 0.0068). IgG / RBD titers were positively correlated with the relative frequency of CD4 + CM T memory cells (r = 0.4352, p = 0.0018). ConclusionsThe identified alterations of B and T lymphocytes suggest that convalescent patients with the severe disease could be vulnerable to infectious, autoimmune or autotinflammatory processes; therefore, these individuals need medical follow-up after recovering from the acute disease. Furthermore, the role of T cells CD4 + CM in the production of antibodies against SARS-CoV-2 is confirmed, and it is noted that the defect of memory T cells CD8 + TEMRA could contribute to the development of severe forms of COVID-19.

Lost employment potential and supporting people with Parkinson’s to stay in work: insights from a Pan European cross-sectional survey

Purpose To explore, in a European cohort of people living with Parkinson’s (PD), issues affecting employment and economic consequences, considering age at diagnosis. Materials and methods A cross-sectional survey (European convenience sample). Inclusion criteria were ≥18 years, a PD diagnosis and in work when diagnosed. Data were collected online on demographics, employment status, occupation, and perceived health. For those no longer in paid work, time from diagnosis until loss of employment, reasons for leaving and enablers to stay in work were ascertained. Results Between April and November 2019, n = 692 enrolled and n = 560 were eligible. Those who had lost paid work (n = 190, 34%) reported worse fatigue, sleep, and general health than those still in work (p < 0.05). Average annual income reduced from €26973.48 ± 12013.22 (year-1) to €14843.85 ± 16969.84 (year-10). Post-diagnosis lost employment potential was 20.1 (95% confidence interval (CI): 16.6–23.6) years at career establishment, 9.8 (95%CI: 8.9–10.7) years at mid working and 1.2 (95%CI: 0.6–1.6) years for those nearing retirement age. A greater proportion of individuals at career establishment age reported dexterity, eating, sleep, fatigue, and anxiety as factors for leaving work (p < 0.05). Conclusions This study confirms lost productivity after a PD diagnosis, especially in those with many years of potential employment ahead. The study also identified potential targets for interventions. Clinical trial registration: Clincaltrials.gov (NCT03905954). Implications for rehabilitation People with Parkinson’s diagnosed at career establishment or at mid working age risk losing many years of potential employment. Most people with Parkinson’s do not receive early intervention to support self-management of problems identified with leaving work early, such as fatigue. Adaptations to the work environment and more flexible working patterns were identified factors that may help people remain in work.

Eating disorders in the U.S. Medicare population.

The social and economic burden of eating disorders is significant and often financially devastating. Medicare is the largest public insurer in the United States and provides coverage for older adults and some disabled individuals. This study explores prevalence, sociodemographic and clinical characteristics, and health care spending for Medicare enrollees with eating disorders. A cross-sectional study was conducted with the nationally representative 20% sample of 2016 Medicare inpatient, outpatient, carrier, and home health fee-for-service claims and Medicare Advantage encounter records. Sociodemographic characteristics and comorbid somatic conditions were compared between individuals with versus without an eating disorder diagnosis. Mean spending was compared overall and separately for inpatient, outpatient, home health, and pharmacy claims. The sample included 11,962,287 Medicare enrollees of whom 0.15% had an eating disorder diagnosis. Compared to those without a 2016 eating disorder diagnosis, a greater proportion of individuals with an eating disorder were female (73.8% vs. 54.3%), under age 65 (41.6% vs. 15.5%), and dually eligible for Medicaid due to disability or low-income qualification (48.0% vs. 19.6%). Individuals with eating disorders had higher rates of comorbid conditions, with the greatest differences in cardiac arrythmias (35.3% vs. 19.9%), arthritis (40.1% vs. 26.6%), and thyroid conditions (32.2% vs. 19.4%). Spending was higher for enrollees with eating disorders compared to those without overall ($29,456 vs. $7,418) and across settings. The findings establish that eating disorders occur in the Medicare population, and that enrollees with these illnesses have risk factors associated with significant healthcare spending and adverse health outcomes.

FRAGILITY FRACTURES IN BRAZIL: CROSS-SECTION STUDY.

ABSTRACTObjective: To evaluate the involvement of orthopedists and orthopedic residents with fragility fractures, in its clinical, therapeutic, and social aspects.Methods: Cross-sectional observational and prospective study that took place in the period from June to August 2020.Results: 540 participants were analyzed. The population consisted of orthopedists (85.56%; N = 462) and residents (14.44%; N = 78), with a greater proportion of individuals from 41 to 50 years of age (36.67%; N = 198) and from the Southeast region (57.22%; N = 309). For 47.04% (N = 254) of the participants, the profile of the patient at risk for fragility fracture corresponds to: woman, sedentary, smoker and over 60 years of age. The consensus among the participants (97.96%; N = 529) is that fragility fractures occur in or near home environments. Moreover, 47.59% (N = 257) believe that the first fragility fracture is the most important predictive risk factor for subsequent occurrences and 63.89% (N = 345) of the participants claim to attend more than 15 cases per year. Regarding treatment, 74.44% (N = 402) are dedicated exclusively to orthopedic aspects (68.33%; N = 369). However, 62.41% (N = 337) of the participants believe that patients with fragility fractures should receive medication and supplements. Likewise, 70.74% (N = 382) of the participants consider that home security measures and training of family members are important, and they attribute the role to the multidisciplinary team.Conclusions: Fragility fractures are frequent in the routine of Brazilian orthopedists. However, they are not familiar with adjuvant treatments for fragility fractures, acting almost exclusively in the orthopedics aspects of these injuries. Level of Evidence II, Prospective Study.

Investigating the risk of cardiovascular risk factor subgroups in cognitively normal elderly on progression to AD: A latent class approach

Individual cardiovascular risk factors (CVRFs) have been associated with neurodegenerative processes. However, CVRFs often co-occur with one another and little is known regarding the extent of their clustering, and effect on progression to Alzheimer's disease (AD). We identify classes of CVRFs in cognitively normal (CN) individuals, and investigate their risk on progression to AD.CN individuals were recruited from the National Alzheimer's Coordinator Center dataset, with follow-up. To identify CVRF classes at baseline, a latent class analysis (LCA) was conducted with five vascular (hypertension, hypercholesterolemia, heart condition, stroke, and smoking history), and two metabolic (diabetes, and high body mass index (BMI)) indicators. Separate cox regressions were conducted to investigate the risk of CVRF class on progression to clinically-diagnosed and neuropathology-confirmed AD (clinically-diagnosed AD with intermediate/high AD Neuropathologic Change). Post-hoc analyses investigated differences in non-AD related neuropathologies between CVRF classes.This study included 12,412 CN individuals (age:70.9±10.5, male:35% (N=4312), MMSE:28.9±1.4, 6% (N=788) of whom progressed to AD). The LCA identified three phenotypes of baseline CVRF classes (Figure 1). One group had low probabilities of CVRFs (N=5398 (43%)) (reference group). The second group had higher probabilities of hypertension and hypercholesterolemia (vascular-dominant class) (N=5721 (46%)). The third group had higher probabilities of hypertension, hypercholesterolemia, diabetes, and high BMI (vascular/metabolic class) (N=1293 (10%)). Compared to the reference group, the vascular-dominant class (HR:1.14, 95%CI:1.02-1.27, p=.02), and vascular/metabolic class (HR:1.33, 95%CI:1.11-1.59, p=.002) were associated with an increased risk of progression to clinically-diagnosed AD. Compared to the reference group, only the vascular dominant class was associated with an increased risk of progression to neuropathology-confirmed AD (HR:1.40, 95%CI:1.00-1.96, p=.05). Post-hoc analyses determined that compared to other classes, the vascular/metabolic class had the greatest proportion of individuals with underlying cerebrovascular disease (CVD) (46% vs. ≤28%)(X2 (2)=5.76, p=.05).Presence of vascular-dominant, or a combination of vascular/metabolic CVRFs were associated with an increased risk of progression to clinically-diagnosed AD. The fact that vascular/metabolic class was not associated with an increased risk of progression to neuropathology-confirmed AD, suggests that the development of cognitive impairment in this group is due to underlying neurobiological processes such as CVD that are not related to AD.

Determining the Agreement Between Common Measures Of VOR Function After A Mild Traumatic Brain Injury in Children and Adolescents

<h3>Research Objectives</h3> Alterations to vestibulo-ocular reflex (VOR) function (1-3) and cervical spine injury (4-6) may contribute to dizziness reported following pediatric mild traumatic brain injury (mTBI). Moreover, dizziness has been correlated with a more negative prognosis. While various measures are used to assess VOR function, there is no consensus on what the optimal battery of tests may be. The influence of cervical injury on findings from these tests remains unclear. Objectives: i) to determine the level of agreement between symptom- and performance-based tests of VOR function in a pediatric mTBI sample; ii) to characterize the level of symptom provocation induced by VOR tests in individuals with and without cervical findings. <h3>Design</h3> Cross-sectional study. <h3>Setting</h3> Tertiary care pediatric hospital. <h3>Participants</h3> 101 participants (54.5% female), mean age 13.92 years (SD 2.63), completed a VOR assessment (mean time since injury 18.26 days (SD 6.16)). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Symptom provocation was measured by the Vestibular/ocular motor screening tool (VOMS). Performance was measured by VOMS VOR performance, the head thrust test (HTT), the computerized dynamic visual acuity test, and the video head impulse test. Cervical impairment was measured by the cervical flexion rotation test, range of motion test and self-reported neck pain. <h3>Results</h3> No outcomes demonstrated agreement with VOR symptom provocation (k=-0.15-0.14). Among performance-based measures, fair agreement was demonstrated between VOMS VOR performance and the clinical HTT (k=0.32), while little to no agreement was demonstrated between the remaining measures. VOR dizziness symptoms were reported in a greater proportion of individuals with cervical findings (41.1-41.8%) than without (2.3-6.8%). <h3>Conclusions</h3> The findings indicate i) that symptom-based VOR tests measure a different construct than performance-based tests, ii) the distinct role of each measure when assessing VOR function should be further understood, and iii) cervical injury may contribute to symptoms induced by tests of VOR function. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose. This study was funded by an ERA-Net NEURON JTC Cofund Program.

Clinical Characterization of Epilepsy in Children With Angelman Syndrome

BackgroundEpilepsy is highly prevalent in children with Angelman syndrome (AS), and its detailed characterization and relationship to the genotype (deletion vs nondeletion) is important both for medical practice and for clinical trial design. Methods and MaterialsWe retrospectively analyzed the main clinical features of epilepsy in 265 children with AS who were enrolled in the AS Natural History Study, a multicenter, observational study conducted at six centers in the United States. Participants were prospectively followed up and classified by genotype. ResultsEpilepsy was reported in a greater proportion of individuals with a deletion than a nondeletion genotype (171 of 187 [91%] vs. 48 of 78 [61%], P < 0.001). Compared with participants with a nondeletion genotype, those with deletions were younger at the time of the first seizure (age: median [95% confidence interval]: 24 [21-24] months vs. 57 [36-85] months, P < 0.001) and had a higher prevalence of generalized motor seizures. Hospitalization following a seizure was reported in more children with a deletion than a nondeletion genotype (92 of 171 [54%] vs. 17 of 48 [36%], P = 0.04). The overall prevalence of absence seizures was not significantly different between genotype groups. Forty-six percent (102/219) of the individuals reporting epilepsy were diagnosed with AS concurrently or after their first seizure. ConclusionsSignificant differences exist in the clinical expression of epilepsy in AS according to the underlying genotype, with earlier age of onset and more severe epilepsy in individuals with AS due to a chromosome 15 deletion.