Higher MCS Research Articles

Flight-related determinants of health-related quality of life of asylum seekers and refugees in Germany: a longitudinal study based on the German Socio-Economic Panel (SOEP)

BackgroundGermany played a key role as receiving country during the so-called refugee and displacement crisis with about 5 million asylum seekers arriving in the EU between 2014 and 2020. It is well known that asylum seekers and refugees (ASRs) have a high burden of disease and are particularly prone to mental disorders such as trauma, stress-related and affective disorders. Not much is known about the determinants of health-related quality of life (HrQoL) among ASRs, especially in the context of the flight. Therefore, the aim of this study was to analyze the associations between flight-related characteristics and HrQoL of ASRs in Germany.MethodsThe sample of this study was based on five consecutive waves of the Survey of Refugees samples of the German Socio-Economic Panel (n = 8015; 14,314 observations). Mental and physical HrQoL was measured using the mental (MCS) and physical (PCS) component summary scores of the SF-12v2. Associations between flight-related characteristics and HrQoL were examined using multilevel mixed-effects linear regressions.ResultsThe different countries of birth were associated with varying MCS and PCS scores. The MCS and PCS scores were lower among ASRs with an economic situation below average in their countries of origin. Persecution, discrimination, and poor living conditions as reasons for leaving the county were associated with lower MCS scores. ASRs who were dissatisfied with their own living situation and who were discriminated often due to their origin had both lower MCS and PCS scores. Not feeling welcome in Germany and missing people from one’s country of origin were both associated with lower MCS scores. No worries about not being able to stay in Germany or not being able to return to one’s country of origin were both associated with higher MCS scores.ConclusionsThe economic situation in the country of origin and the presence of persecution, discrimination, and/or poor living conditions as reason for flight may be pre-flight-related determinants of HrQoL of ASRs in Germany. Possible post-flight-related determinants can be the residence status, the satisfaction with one’s living situation, discrimination due to one’s origin and a feeling of missing people from one’s country of origin. With regard to those determinants, the clarity about the residence status, reducing racial discrimination and the mourning of flight-related circumstances must be ensured.

Molecular docking combined with in vitro validation study to explore the effect of lupenone on alleviating renal fibrosis based on TGF-β/Smad/CTGF signaling pathway

Hyperglycemia and renal fibrosis play critical roles in the occurrence and development of diabetic complications such as diabetic nephropathy (DN). Lupenone, a stable pentacyclic triterpenoid compound, has anti-hyperglycemic and anti-renal fibrosis activities. Previous research has confirmed that lupenone can improve renal fibrosis in type 2 diabetic nephropathy by regulating TGF-β/Smad/CTGF signaling pathway. However, the binding power of lupenone with its related targets has not been confirmed, and it is unclear whether it exerts anti-renal fibrosis effects as a prototype component. Therefore, the aim of this study was to identify the underlying mechanism of lupenone on anti-renal fibrosis based on the TGF-β/Smad/CTGF signaling pathway and elucidate their binding ability using molecular docking and in vitro cell experiments. Molecular docking results suggested that lupenone combined well with fibronectin, TGF-β1, TβRI, TβRII, Smad2, Smad3, Smad4, Smad7 and Smurf2, respectively. And lupenone could significantly reduce high glucose-induced MCs cytotoxicity. Furthermore, lupenone significantly downregulated the mRNA and protein expression of collagen-I, collagen-IV, fibronectin, TGF-β1, p-TβRI/TβRI, TβRII, p-Smad2/Smad2, p-Smad/Smad3, Smad4, Smurf2, and CTGF in high glucose-induced MCs, with the best effect observed in the high-dose lupenone group. These results concluded that lupenone could inhibit the generation of fibrosis factors collagen-I, collagen-IV, and fibronectin and delay the process of fibrosis by regulating the TGF-β/Smad/CTGF signaling pathway in MCs.

Internet of Vehicles Based On Cellular-Vehicle-To-Everything (C-V2X)

In line with the development of automotive and traffic systems, high mobility and density in different road topologies cause scalability and delay issues due to frequent disconnection between communication nodes. From a safety aspect, Cellular-V2X (C-V2X) wireless technology was introduced by the Third Generation Partnership Project Organization (3GPP) to realise the transmission of emergency messages at critical times, anywhere. Specifically, Mode 4 C-V2X supports side-link communication without relying on a base station to provide network coverage. However, Mode 4 is susceptible to several limitations, which include half-duplex transmission, packet collision, and propagation errors that will cause intermittent connectivity issues. It is also difficult to determine appropriate parameter configurations that can increase the spectrum efficiency of dense networks to facilitate reliable and low-latency networks. The objective of this paper is to investigate the effectiveness of a Mode 4 C-V2X system under different road topologies and traffic scenarios. The study adopts a Krauss vehicular mobility model based on SUMO software to model normal and dense networks in a highway and a road intersection scenario, then perform simulation using OMNET++ software to analyse the impact of different physical layer (PHY) configurations such as modulation and coding scheme, packet size, number of resource block allocation, as well as the probability of resource reservation. The results show that the optimal configuration of parameters depends on the scenario. For highway scenarios, a lower MCS and a higher number of RBs are recommended. For road intersection scenarios, a higher MCS and a lower number of RBs are recommended. The packet size should also be in accordance with the requirements of the application used. The findings of this study can be used to assist in the design of an optimal intelligent transportation system using adaptive C-V2X parameters that can be automatically adjusted under different scenarios and network conditions.

PATIENT-RELATED OUTCOMES AND BIOLOGIC MEDIATORS OF SARCOIDOSIS

PATIENT-RELATED OUTCOMES AND BIOLOGIC MEDIATORS OF SARCOIDOSIS

50. High surgical invasiveness combined with frailty is associated with greater improvement throughout long-term recovery after ASD surgery with minimum five-year follow-up

<h3>BACKGROUND CONTEXT</h3> Evidence on long-term surgical recovery in adult spinal deformity (ASD) patients who are both frail and have an invasive procedure is limited. <h3>PURPOSE</h3> This study aims to evaluate frail and invasive patients with 5-year recovery kinetics. We hypothesize that patients who are both frail and have invasive surgeries will have adverse postoperative recovery kinetics <h3>STUDY DESIGN/SETTING</h3> Retrospective review. <h3>PATIENT SAMPLE</h3> A total of 133 ASD patients with complete HRQOL data at preoperative, 1-year, 2-year, 5-year follow-up were included. <h3>OUTCOME MEASURES</h3> Integrated Health State Scores (IHS) in Oswestry Disability Index (ODI), Short-form 36 (SF-36) physical (PCS) and mental (MCS) component score, and Scoliosis Research Society (SRS)-22r measures <h3>METHODS</h3> ASD-FI scores were used to stratify non-frail (0.3) patients. ASD-SR scores were used to stratify low invasive (90) surgeries. Using ASD-FI and ASD-SR, patients were separated into four cohorts: non-frail low invasive (NFLI), frail low invasive (FLI), non-frail high invasive (NFHI), and frail high invasive (FHI). HRQOLs at 1 year, 2 years, and 5 years were normalized against preoperative values. AUC was calculated across time points to generate an integrated health state score (IHS). Multivariable linear regression was used to compare IHS scores of FLI, NFHI, and FHI to NFLI while controlling for age, gender, comorbidity, and radiographic alignment. <h3>RESULTS</h3> Of 633 eligible ASD patients, 339 had 5-year follow-up. Of those, 125 patients with complete HRQOL data at preoperative, 1-year, 2-year, and 5-year visits were included; 27.2% (34) were NFLI, 20.0% (25) were FLI, 26.4% (33) were NFHI, and 26.4% (33) were FHI. Using NFLI as the referent, FLI and NFHI did not have differences in ODI, MCS, PCS or SRS-22r IHS scores (P >0.05). On multivariable analysis of integrated health scores, FHI had higher MCS (7.6 vs 5.47; P=0.0188), SRS activity (6.97 vs 5.67; P=0.0004), SRS pain (8.49 vs 6.4; P=0.001), SRS appearance (8.97 vs 6.81; P=0.0014), SRS satisfaction (11.71 vs 7.97; P=0.0033), and SRS total (7.49 vs. 6.09; P=0.0002), indicating more improved recovery over a 5-year period. Patients who were FHI had higher rates of complications (P <0.05). <h3>CONCLUSIONS</h3> Despite having more complications, patients who were frail and underwent more invasive surgeries were more likely to have greater overall improvement in activity, pain, and satisfaction over a 5-year period relative to preoperative baseline. Our results suggest that frailty in combination with invasiveness do not hinder long-term postoperative recovery kinetics, in comparison to frailty or invasiveness alone. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Long-term air pollution exposure, greenspace and health-related quality of life in the ECRHS study

BackgroundAssociations of long-term exposure to air pollution and greenspace with health-related quality of life (HRQOL) are poorly studied and few studies have accounted for asthma-rhinitis status. ObjectiveTo assess the associations of air pollution and greenspace with HRQOL and whether asthma and/or rhinitis modify these associations. MethodsThe study was based on the participants in the second (2000–2002, n = 6542) and third (2011–2013, n = 3686) waves of the European Community Respiratory Health Survey (ECRHS) including 19 centres. The mean follow-up time was 11.3 years. HRQOL was assessed by the SF-36 Physical and Mental Component Summary scores (PCS and MCS). NO2, PM2.5 and PM10 annual concentrations were estimated at the residential address from existing land-use regression models. Greenspace around the residential address was estimated by the (i) mean of the Normalized Difference Vegetation Index (NDVI) and by the (ii) presence of green spaces within a 300 m buffer. Associations of each exposure variable with PCS and MCS were assessed by mixed linear regression models, accounting for the multicentre design and repeated data, and adjusting for potential confounders. Analyses were stratified by asthma-rhinitis status. ResultsThe mean (SD) age of the ECRHS-II and III participants was 43 (7.1) and 54 (7.2) years, respectively, and 48 % were men. Higher NO2, PM2.5 and PM10 concentrations were associated with lower MCS (regression coefficients [95%CI] for one unit increase in the inter-quartile range of exposures were −0.69 [−1.23; −0.15], −1.79 [−2.88; −0.70], −1.80 [−2.98; −0.62] respectively). Higher NDVI and presence of forests were associated with higher MCS. No consistent associations were observed for PCS. Similar association patterns were observed regardless of asthma-rhinitis status. ConclusionEuropean adults who resided at places with higher air pollution and lower greenspace were more likely to have lower mental component of HRQOL. Asthma or rhinitis status did not modify these associations.

Health-related quality of life, health literacy and COVID-19-related worries of 16- to 17-year-old adolescents and parents one year into the pandemic: a cross-sectional study

BackgroundThe uncertain and challenging situation caused by the COVID-19 pandemic affects adolescents and their parents in an exceptional way. More knowledge of health-related quality of life (HRQoL), health literacy (HL) and COVID-19-related worries in adolescents and parents 1 year into the pandemic is needed. The present study aimed to describe HRQoL, HL and COVID-19-related worries of 16- to 17-year-old adolescents and parents of adolescents. Further, to assess the strength of associations between gender, HL, COVID-19-related worries and HRQoL.MethodsA cross-sectional study involving 215 adolescents and 320 parents was conducted, exploring HRQoL, HL, COVID-19-related worries and sociodemographic variables. KIDSCREEN-10 and RAND-36 were used to measure HRQoL. Data were analyzed using bivariate methods, multiple linear regression and robust regression.ResultsAdolescents’ HRQoL was notably lower compared to previous Norwegian studies and European norms. Parents’ HRQoL was comparable to Norwegian norms. Adolescents and parents reported moderate-to-high HL and high degrees of COVID-19-related worries. Females reported significantly lower HRQoL and more worries compared to males. In adolescents, higher HL was significantly associated with higher HRQoL. COVID-19-related worries were not significantly associated with HRQoL. In parents, higher HL in the “understand health information” domain was significantly associated with higher HRQoL for mental well-being (mental component sum scores [MCS]) and with lower HRQoL for physical well-being (physical component sum scores [PCS]). Being worried a lot about infecting others and about family/friends becoming sick was significantly associated with higher MCS and lower MCS, respectively. COVID-19-related worries were not significantly associated with PCS.ConclusionsOur results indicate that the pandemic has a major negative impact on adolescents’ HRQoL. Parents’ HRQoL remained unchanged and comparable to previous studies. Our study demonstrates that HL, gender and COVID-19-related worries are significantly associated with adolescents’ and parents’ HRQoL, indicating that efforts aimed at increasing their HL might indirectly affect their HRQoL as well and that gender-specific interventions or strategies could be beneficial.

Establishment of a finite element model and stress analysis of intra-articular impacted fragments in posterior malleolar fractures

BackgroundIntra-articular impacted fragments (IAIFs) are considered articular surface fragments resulting from impact and compressive forces. The malreduction of IAIFs in posterior malleolar fractures has been associated with talar subluxation and long-term post-traumatic arthritis. In this study, we establish IAIF defect finite element models of different sizes in posterior malleolar fractures and explored how IAIF defects predict the onset of post-traumatic arthritis.MethodsA reliable three-dimensional finite element model of the normal ankle was established. Finite element models with different sizes of IAIF defects were created to calculate ankle joint contact stress. The finite element data were recorded and analyzed.ResultsThere was a linear relationship between the size of the IAIF defect and MCS with IAIF defects in the posterolateral region. The result of Pearson linear correlation analysis was r = 0.963, P = 0.009. The regression equation was MCS = 0.087*AI + 2.951 (AI, area of IAIF) by simple linear regression analysis. When the IAIF defect was in the posteromedial region, there was also a linear relationship between the size of the IAIF defect and MCS. The result of Pearson linear correlation analysis was r = 908, P = 0.033. The regression equation was MCS = 0.065*AI + 1.841. The MCS was increased mainly in the border of the IAIF defect.ConclusionsA small IAIF defect in the posterior malleolus will result in a high MCS, and the MCS in the posterolateral region is larger than the MCS in the posteromedial region when the size of the IAIF defect is the same. We obtain the regression equation of MCS and area of IAIF defect. This indicates that patients are more prone to post-trauma arthritis when the size of IAIF defects is more than 17.8 mm2 in the posterolateral region and more than 40.9 mm2 in the posteromedial region.Trial registration Retrospectively registered.

TLR9 regulates NLRP3 inflammasome activation via the NF-kB signaling pathway in diabetic nephropathy

BackgroundToll-like receptors (TLRs) are critical sensors for the conservation of bacterial molecules and play a key role in host defense against pathogens. The effect of TLRs on the maintenance of diabetic nephropathy (DN) and resistance to infection has been investigated; however, the detailed effects of TLR9 on DN development remain elusive.MethodsWe performed quantitative reverse transcription-polymerase chain reaction and western blotting to detect TLR9 expression levels in the kidneys of experimental mice (db/db) and high-glucose-treated mouse mesangial cell strains (MCs).ResultsTLR9 expression was found to be remarkably upregulated in the kidneys of experimental mice (db/db) and MCs cultivated under hyperglycemic conditions. Moreover, knockdown of TLR9 could restrain NF-kB viability and downregulate the NLRP3 inflammasome in high glucose-treated MCs. TLR9 inhibition also alleviated inflammation and apoptosis, which was reversed by the addition of the NF-κB activator, betulinic acid. Furthermore, depleted TLR9 levels restrained NF-κB viability and NLRP3 expression and reduced kidney inflammation, microalbuminuria discharge, blood sugar level, and glomerular damage in experimental mice (db/db) kidneys. ConclusionsThese findings offer novel insights into the regulation of TLR9 via the nuclear factor-kB/NOD-, LRR-, and pyrin domain-containing protein 3 inflammasome inflammation pathways in DN progression.

Evaluating the Impact of Social and Built Environments on Health-Related Quality of Life among Cancer Survivors.

With almost 17 million U.S. cancer survivors, understanding multilevel factors impacting health-related quality of life (HRQOL) is critical to improving survivorship outcomes. Few studies have evaluated neighborhood impact on HRQOL among cancer survivors. We combined sociodemographic, clinical, and behavioral data from three registry-based studies in California. Using a three-level mixed linear regression model (participants nested within block groups and study/regions), we examined associations of both independent neighborhood attributes and neighborhood archetypes, which capture interactions inherent among neighborhood attributes, with two HRQOL outcomes, physical (PCS) and mental (MCS) composite scores. For the 2,477 survivors, 46% were 70+ years, 52% were non-Hispanic White, and 53% had localized disease. In models minimally adjusted for age, stage, and cancer recurrence, HRQOL was associated with neighborhood socioeconomic status (nSES), racial/ethnic composition, population density, street connectivity, restaurant environment index, traffic density, urbanicity, crowding, rental properties, and non-single family units. In fully adjusted models, higher nSES remained associated with better PCS, and restaurant environment index, specifically more unhealthy restaurants, associated with worse MCS. In multivariable-adjusted models of neighborhood archetype, compared with upper middle-class suburb, Hispanic small town and inner city had lower PCS, and high status had higher MCS. Among survivors, higher nSES was associated with better HRQOL; more unhealthy restaurants were associated with worse HQROL. As some neighborhood archetypes were associated with HRQOL, they provide an approach to capture how neighborhood attributes interact to impact HRQOL. Elucidating the pathways through which neighborhood attributes influence HRQOL is important in improving survivorship outcomes.

PMH41 Health-Related Quality of Life of Type-2 Diabetic Patients with Diagnosed Depression, Undiagnosed Depression and No Depression in the United States: Medical Expenditure Panel Survey, 2016-2018

The coexistence of diabetes and depression is associated with impairment of Health-Related Quality of Life (HRQoL). Many diabetic patients have undiagnosed depression, leaving the patient untreated and worsening the condition. Given the growing humanistic burden of depression, this study's objective was to examine the differences in the HRQoL of Type-2 diabetic patients with diagnosed, undiagnosed, and no depression. A retrospective, cross-sectional study design was implemented using Medical Expenditure Panel Survey data (2016-2018). Type-2 diabetic patients were stratified using the ICD-10-CM depression code and PHQ-2 screener: (1) Diagnosed (2) Undiagnosed (PHQ-2 ≥ 3 and no depression diagnosis) (3) No depression. HRQoL was measured using the Physical and Mental Component Summary(PCS and MCS) scores obtained from the SF-12v2/VR-12. Regression analysis was used to examine the impact of depression status on the HRQoL using the diagnosed depression group as the reference. We identified 7191(unweighted) adults with diabetes, 8.84% had undiagnosed depression, and 16.19% had diagnosed depression. A significantly higher proportion of patients under 125% of the poverty line were found in the undiagnosed group (47.01%) than the diagnosed (36.00%) and no depression group(23.67%). The mean and standard deviation of the HRQoL (MCS; PCS) scores were significantly lower in the diagnosed (41.4±11.41; 36.05±11.85) and undiagnosed ( 36.69±9.97; 31.63±10.73) group than no depression(52.9±8.52; 42.40±11.87). Results from regression analysis indicated that patients with undiagnosed depression had lower MCS (4.46 points; p<0.001) and PCS( 3.50 points; p<0.001) than those with diagnosed depression. Conversely, patients with no depression had higher MCS (10.24 points; p<0.001) and PCS( 3.74 points; p<0.001) than the diagnosed depression group. Timely diagnosis and treatment of undiagnosed depression in diabetic individuals are necessary to improve health outcomes. Optimal treatment of patients with diagnosed depression and access to appropriate mental healthcare services irrespective of income level is essential to achieve better HRQoL.

Adult Children’s Migration and Health-Related Quality of Life Among Older Nepalese Adults

Traditionally, adult children have served as primary caretakers and providers for older Nepalese adults. However, out-migration of adult children for employment and other opportunities is increasing. Health-related quality of life (HRQOL) in older Nepalese adults in general and in the context of adult children’s migration is poorly understood. This study aims to assess HRQOL of older Nepali adults and its relationship with adult children’s migration. We used existing cross-sectional survey data on 260 older adults from the Krishnapur municipality, which has witnessed a high rate of adult migration. HRQOL was assessed using the SF-12, which provides a physical (PCS) and mental (MCS) health component. Scores for PCS and MCS range from 0-100; a higher score indicates better HRQOL. Simple and multiple linear regression were used to assess correlates of HRQOL. Participants had suboptimal HRQOL [mean (±SD): PCS =40.4±9.2 and MCS=45.2±7.7]. After adjusting for covariates, adult children’s migration was associated with lower MCS scores (β: -2.33, 95%CI: -4.21, -0.44). Individuals with more than one child had higher MCS scores (β: 2.14, 95%CI: 0.19, 4.09). Females (β: -3.64, 95%CI: -7.21, -0.06) and those with a history of unemployment (β: -6.36, 95%CI: -10.57, -2.15) had lower PCS scores than their respective counterparts. The presence of one or more chronic conditions was associated with significantly lower PCS and MCS. Our findings suggest that out-migration of adult children may negatively effect HRQOL among older Nepali adults, specifically their psychological well-being. Additional research is needed to investigate potential moderating factors that may serve as important buffers.

"Moving Away From Cancer" Prospective Exercise Trial for Female Rural Cancer Survivors: How Can We Step It Up?

This prospective trial's objective was to determine feasibility and outcomes of an exercise-based intervention for rural overweight/obese female cancer survivors. Survivors of endometrial, breast, or ovarian cancer enrolled in a 6-month program of increased aerobic activity (30 minutes daily walking) and strength-training exercises using exercise bands (THERABAND; Akron, OH) with personalized telephone motivational coaching. Baseline demographics, anthropomorphic measurements, quality of life (QOL), fitness, and readiness to adopt exercise changes were assessed; daily steps, band use, and follow-up measurements were assessed at 3 and 6 months. Study completion was modeled using logistic regression. The mean age of the 99 women was 59.9 years, the mean body mass index (BMI) was 35.9 kg/m2, 88.9% were white, and 41.4% reported current exercise. Fifty-five women (55.6%) completed the 6-month program, and 36 (36.4%) completed exercise interventions. Using logistic regression to model study completion, only baseline QOL scores (physical component summary) and mental component summary) remained significant predictors. The mean weight change was a gain (0.88 kg). Higher MCS baseline scores and prior regular exercise predicted continued exercise and increased step counts, whereas higher BMI and baseline sleep predicted decreased QOL. Top walking barriers were feeling unwell and weather; barriers to strength exercises were band dislike and pain. The most significant predictor of trial completion and improved exercise outcomes was a higher baseline mental QOL. Motivation, belief in the importance of exercise, and prescribed/monitored exercise regimens were not sufficient; supportive and cognitive behavioral therapy interventions for survivors are needed to sustain uptake.

FMS-AMS: Secure proximity-based authentication for wireless access in Internet of Things

Proximity-based authentication enables wireless access points (AP) to allow connection only to devices within a certain authentication range. This would be very convenient for allowing network access only to those within a physical boundary. However, an attacker not within the authentication range may deceive the AP into authenticating its proximity by eavesdropping with higher receiver gain and increasing its transmit power. This can be done easily using an amplifier or a directional antenna. To address this challenge, we propose `Fixed MCS SNR (FMS)' filtering scheme based on the intuition that high MCS requires high SNR, and amplifying the received signal strength does not necessarily improve SNR. We experimentally show that this is true in reality, and our real-world evaluation in various environments (14 locations) shows that FMS scheme prevents `amplifier attacks' in all cases. To further counter the false positives of FMS against `directional antenna attacks' (avg. 35.7%), we also propose `Authentication Motion with Signal strength gap (AMS)' filtering scheme which defends against both attacks in all cases at the cost of requiring the user to make a simple motion. FMS or AMS scheme can be selected according to the application requirement to enhance the security of proximity-based authentication in upcoming IoT.

Indoor air quality and self-reported multiple chemical sensitivity in newly constructed apartments in Indonesia

There is a possibility that sick building syndrome has already spread widely among newly constructed residential buildings in developing countries. This study investigates the current conditions of IAQ and their effects on health among occupants in two representative types of residential buildings in Jakarta and Surabaya: high-rise apartments and traditional landed houses. A total of 707 respondents were interviewed and 125 rooms were measured during 2017–2018. The results indicated that approximately 40–50% of the respondents in the newly constructed apartments showed some degrees of MCS risk. Formaldehyde and TVOC concentrations in apartments were especially critical. Furthermore, the respondents with a higher MCS risk were found to be exposed to increased TVOC concentrations in the apartments. Other than the IAQ, higher levels of stress are probably one of the most influential factors, followed by gender (females), occupation, window-opening, frequency of cleaning, the prevalence of allergic diseases and possession of AC.

Response of hormone in rice seedlings to irrigation contaminated with cyanobacterial extract containing microcystins

Microcystins released by cyanobacteria affect crop growth and productivity, and even food safety. Plant hormones play a vital role in regulating growth, development and stress response in plants. Therefore, we studied the response of hormones including abscisic acid (ABA), indole-3-acetic acid (IAA), Zeatin (ZT) and gibberellin (GA3) as well as hormone balances (IAA/ABA, ZT/ABA and GA/ABA) to cyanobacterial extract containing microcystins (1, 10, 100 and 1000 μg/L) during stress and recovery periods. Low concentration microcystins (1 μg/L) promoted growth of rice seedlings by increasing levels of IAA, ZT and GA3 and maintaining hormone balances. In addition, the up-regulation of OsYUCCA1 increased IAA level in rice roots by promoting IAA biosynthesis. High concentrations microcystins (10, 100 or1000 μg/L) inhibited growth of rice seedlings by reducing levels of IAA, ZT and GA3 and ratios of IAA/ABA, ZT/ABA and GA/ABA due to increased ABA level. The increase in ABA in rice seedlings induced by high concentrations MCs was resulted from up-regulation of OsNCED1, OsNCED3, OsNCED4 and OsZEP to enhance ABA biosynthesis, and was controlled by up-regulating expression levels of OsABAox1-3 for enhancing ABA catabolism as negative feedback. The highest concentration of MCs (1000 μg/L) caused irreversible damage to metabolisms of IAA and ABA, partly resulting in unrecoverable inhibition on rice growth. All results demonstrate that “low-concentration promotion and high-concentration inhibition” of microcystins was associated with changes in hormone levels and balances by affecting their metabolisms, and could be helpful for guiding agricultural irrigation with microcystin contaminated water.

Joint trajectories of disease activity, and physical and mental health-related quality of life in an inception lupus cohort.

To examine for latent patterns of SLE disease activity trajectories that associate with specific latent patterns of health-related quality of life (HRQoL; Medical Outcomes Study Short Form-36), and to determine baseline predictors of class membership. In this retrospective longitudinal inception cohort of 222 SLE adults over 10 years, trajectories of three outcomes were studied jointly: Short Form-36 physical (PCS) and mental (MCS) component summaries and adjusted mean SLEDAI-2000 (AMS). Group-based joint trajectory modelling was used to model latent classes; univariable and multivariable analyses were used to identify predictors of class membership. Four latent classes were identified: Class 1 (C1) (24%) had moderate AMS, and persistently low PCS and MCS; C2 (26%) had low AMS, moderate PCS and improved then worsened MCS; C3 (38%) had moderate AMS, and persistently high PCS and MCS; and C4 (11%) had high AMS, moderate-low PCS and improving MCS. Baseline older age was associated with lower HRQoL trajectories. Higher AMS trajectories did not associate with a particular pattern of HRQoL trajectory. A higher prevalence of fibromyalgia (44% in C1) was associated with worse HRQoL trajectories. Disease manifestations, organ damage and cumulative glucocorticoid were not differentially distributed across the latent classes. High disease activity did not necessarily associate with low HRQoL. More patients with worse HRQoL trajectories had fibromyalgia. Older age at diagnosis increased the probability of belonging to a class with low HRQoL trajectories. The care of SLE patients may be improved through addressing fibromyalgia in addition to disease activity.

Practice variation in the use of tests in UK primary care: a retrospective analysis of 16 million tests performed over 3.3 million patient years in 2015/16

BackgroundThe UK’s National Health Service (NHS) is currently subject to unprecedented financial strain. The identification of unnecessary healthcare resource use has been suggested to reduce spending. However, there is little very research quantifying wasteful test use, despite the £3 billion annual expenditure. Geographical variation has been suggested as one metric in which to quantify inappropriate use. We set out to identify tests ordered from UK primary care that are subject to the greatest between-practice variation in their use.MethodsWe used data from 444 general practices within the Clinical Practice Research Datalink to calculate a coefficient of variation (CoV) for the ordering of 44 specific tests from UK general practices. The coefficient of variation was calculated after adjusting for differences between practice populations. We also determined the tests that had both a higher-than-average CoV and a higher-than-average rate of use.ResultsIn total, 16,496,218 tests were ordered for 4,078,091 patients over 3,311,050 person-years from April 1, 2015, to March 31, 2016. The tests subject to the greatest variation were drug monitoring 158% (95%CI 153 to 163%), urine microalbumin (52% (95%CI 49.9 to 53.2%)), pelvic CT (51% (95%CI 50 to 53%)) and Pap smear (49% (95%CI 48 to 51%). Seven tests were classified as high variability and high rate (clotting, vitamin D, urine albumin, prostate-specific antigen (PSA), bone profile, urine MCS and C-reactive protein (CRP)).ConclusionsThere are wide variations in the use of common tests, which is unlikely to be explained by clinical indications. Since £3 billion annually are spent on tests, this represents considerable variation in the use of resources and inefficient management in the NHS. Our results can be of value to policy makers, researchers, patients and clinicians as the NHS strives towards identifying overuse and underuse of tests.

Individual, Social, and Societal Correlates of Health-Related Quality of Life Among African American Survivors of Ovarian Cancer: Results from the African American Cancer Epidemiology Study.

While the incidence of epithelial ovarian cancer (EOC) is lower among African American (AA) women compared with European American (EA) women, AA women have markedly worse outcomes. In this study, we describe individual, social, and societal factors in health-related quality of life (HRQL) in AA women diagnosed with EOC in the African American Cancer Epidemiology Study (AACES) that we hypothesize may influence a patient's capacity to psychosocially adjust to a diagnosis of cancer. There were 215 invasive EOC cases included in the analysis. HRQL was measured using the SF-8 component scores for physical (PCS) and mental (MCS) health. We used least squares regression to test the effects of individual dispositional factors (optimism and trait anxiety); social level (perceived social support); and societal-level factors (SES defined as low family income and low educational attainment, and perceived discrimination) on HRQL, while adjusting for patient age, tumor stage, body mass index, and comorbidity. Mediation analysis was applied to test whether social support and physical activity buffer impacts of EOC on HRQL. Optimism, trait anxiety, social support, poverty, and past perceived discrimination were significantly associated with HRQL following diagnosis of EOC. Specifically, higher family income, lower phobic anxiety, and higher social support were associated with better wellbeing on the MCS and PCS (p < 0.01). Higher perceived discrimination was associated with both lower MCS and PCS, whereas higher optimism was associated with higher MCS. Physical activity (MET-min/week) and social support displayed significant overall mediation for effects of SES on MCS and PCS, but not for trait anxiety. Both pre- and postdiagnosis characteristics of AA women with EOC are important predictors of HRQL after cancer diagnosis. Individual, social, and societal-level factors each contribute to HRQL status with EOC and should be assessed.

PMH71 - AN ASSESSMENT OF HEALTH OUTCOMES BY PATIENT ACTIVATION LEVEL IN THE EU5

The aim was to examine the relationship between levels of patient activation (knowledge, skill, and confidence in health management) and health outcomes across multiple conditions. Data from the 2017 EU5 (n=62,000; France, Germany, Italy, Spain, and UK) Kantar Health PaCeR (patient-centered research) platform was used. Adults were surveyed using stratified random sampling based on gender and age to ensure representativeness to the general population. Patients self-reported a physician diagnosis of depression, type 2 diabetes (T2D), chronic pain, or psoriasis. The Patient Activation Measure®1,2 or PAM® consists of four levels. Level 1 or “disengaged and overwhelmed” indicates lowest patient activation while level 4 or “maintaining behaviors and pushing further” indicates highest activation. Outcomes included healthcare provider (HCP) visits, health-related quality of life (HRQoL; SF-12v23 mental component summary [MCS] and physical component summary [PCS] scores), and work and activity impairment4. Across all conditions, higher patient activation was associated with a greater percentage of patients with HCP visits, improved HRQoL, and less activity impairment. The percent of patients with HCP visits increased as patient activation increased ranging from 90.3% to 99.3%. Higher levels of patient activation corresponded to better health. Across all conditions, there was a clinically meaningful difference in MCS which ranged from 4.27 (level 1) to 8.04 (level 4). T2D patients at the highest activation level had the highest MCS (50.27), whereas patients with depression had the lowest MCS (38.09). PCS scores across all conditions and activation levels were lower than the general population. Higher patient activation scores were associated with less activity impairment and this was most pronounced for patients with depression (54.6% vs. 45.7%, p < 0.05) or T2D (45.3% vs. 31.0%, p < 0.05). Understanding where patients fall on the activation continuum can inform communications to increase patients’ activation and improve health outcomes.