High Risk Research Articles

Clinical diagnosis of cerebral amyloid angiopathy related hemorrhage in China: Simplified Edinburgh criteria and Boston criteria version 2.0

Background: Accurate diagnosis of cerebral amyloid angiopathy (CAA) in surviving patients is indispensable for making treatment decisions and conducting clinical trials. We aimed to evaluate the diagnostic value and clinical utility of the simplified Edinburgh computed tomography (CT) criteria for CAA-related hemorrhage in Chinese patients. Methods: We analyzed 212 patients with lobar hemorrhage who underwent brain CT and magnetic resonance imaging (MRI) from a multicentre cohort. Using the Boston criteria version 2.0 (v2.0) as the gold standard, we assessed the application value of the simplified Edinburgh CT criteria, and investigated whether the Edinburgh CT criteria predict patient outcomes. Results: Patients with probable CAA accounted for 36.6% according to the Boston criteria v2.0. The Edinburgh CT criteria indicated an area under the receiver operating characteristic curves (AUC) of 0.735 for the diagnosis of probable CAA, and it performed better when there was a high-risk threshold of CAA in the decision curve analysis. Patients with a high risk of CAA based on the Edinburgh CT criteria had poorer outcomes at 90-day after adjusting for confounding factors ( p = 0.034). Finger-like projections in the Edinburgh CT criteria were associated with lobar microbleeds, cortical superficial siderosis, and multispot white matter hyperintensity according to the Boston criteria. Conclusions: Taking the Boston criteria v2.0 as the gold standard, the Edinburgh CT criteria demonstrated good diagnostic value and predicted outcomes well at 90-day in Chinese patients with lobar hemorrhage. Further studies with larger sample sizes are required to confirm these findings.

Near-infrared brain functional characteristics of mild cognitive impairment with sleep disorders

BACKGROUND Mild cognitive impairment (MCI) has a high risk of progression to Alzheimer’s disease. The disease is often accompanied by sleep disorders, and whether sleep disorders have an effect on brain function in patients with MCI is unclear. AIM To explore the near-infrared brain function characteristics of MCI with sleep disorders. METHODS A total of 120 patients with MCI (MCI group) and 50 healthy subjects (control group) were selected. All subjects underwent the functional near-infrared spectroscopy test. Collect baseline data, Mini-Mental State Examination, Montreal Cognitive Assessment scale, fatigue severity scale (FSS) score, sleep parameter, and oxyhemoglobin (Oxy-Hb) concentration and peak time of functional near-infrared spectroscopy test during the task period. The relationship between Oxy-Hb concentration and related indexes was analyzed by Pearson or Spearmen correlation. RESULTS Compared with the control group, the FSS score of the MCI group was higher (t = 11.310), and the scores of Pittsburgh sleep quality index, sleep time, sleep efficiency, nocturnal sleep disturbance, and daytime dysfunction were higher (Z = -10.518, -10.368, -9.035, -10.661, -10.088). Subjective sleep quality and total sleep time scores were lower (Z = -11.592, -9.924). The sleep efficiency of the MCI group was lower, and the awakening frequency, rem sleep latency period, total sleep time, and oxygen desaturation index were higher (t = 5.969, 5.829, 2.887, 3.003, 5.937). The Oxy-Hb concentration at T0, T1, and T2 in the MCI group was lower (t = 14.940, 11.280, 5.721), and the peak time was higher (t = 18.800, 13.350, 9.827). In MCI patients, the concentration of Oxy-Hb during T0 was negatively correlated with the scores of Pittsburgh sleep quality index, sleep time, total sleep time, and sleep efficiency (r = -0.611, -0.388, -0.563, -0.356). It was positively correlated with sleep efficiency and total sleep time (r = 0.754, 0.650), and negatively correlated with oxygen desaturation index (r = -0.561) and FSS score (r = -0.526). All comparisons were P < 0.05. CONCLUSION Patients with MCI and sleep disorders have lower near-infrared brain function than normal people, which is related to sleep quality. Clinically, a comprehensive assessment of the near-infrared brain function of patients should be carried out to guide targeted treatment and improve curative effect.

Posttraumatic stress symptoms among Chinese university students during the COVID-19 pandemic: Prevalence, correlates, and mental health help-seeking

BACKGROUND Revisiting the epidemiology of posttraumatic stress symptoms (PTSSs) among university students during the coronavirus disease 2019 (COVID-19) pandemic as well as understanding the mental health help-seeking behavior of individuals with PTSSs has critical implications for public mental health strategies in future medical pandemics. AIM To investigate the prevalence and correlates of PTSSs among university students during the first wave of the COVID-19 pandemic in China and to examine mental health help-seeking behaviors among these students. METHODS A total of 2507 Chinese university students were recruited via snowball sampling. The students completed the Seven-item Screening Scale for Post-traumatic Stress Disorder during the first wave of the COVID-19 pandemic in China. Sociodemographic characteristics, pandemic-related characteristics, and mental health help-seeking behaviors of students with PTSSs were also collected. RESULTS The prevalence of PTSSs among the participants was 28.0%. Seven significant correlates of PTSSs were identified (odds ratio = 1.23-3.65, P ≤ 0.024): Female sex, being 19 years old or older, living with others or alone, a low level of family economic status, fair or poor interpersonal relationships, severe or very severe local pandemic, and having family members diagnosed with COVID-19. However, only 3.28% of the students with PTSSs reported seeking help from mental health specialists. Among the 23 students who sought help from mental health specialists, 13 opted for online or telephone-based psychological consultation. CONCLUSION Our data suggest that there was a high risk of PTSSs among university students and a high level of unmet mental health needs during the COVID-19 pandemic. The delivery of mental health services online or via telephone is a promising approach to address these unmet needs.

Metabolic pathway modulation by olanzapine: Multitarget approach for treating violent aggression in patients with schizophrenia

BACKGROUND The use of network pharmacology and blood metabolomics to study the pathogenesis of violent aggression in patients with schizophrenia and the related drug mechanisms of action provides new directions for reducing the risk of violent aggression and optimizing treatment plans. AIM To explore the metabolic regulatory mechanism of olanzapine in treating patients with schizophrenia with a moderate to high risk of violent aggression. METHODS Metabolomic technology was used to screen differentially abundant metabolites in patients with schizophrenia with a moderate to high risk of violent aggression before and after olanzapine treatment, and the related metabolic pathways were identified. Network pharmacology was used to establish protein-protein interaction networks of the core targets of olanzapine. Gene Ontology functional analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were subsequently performed. RESULTS Compared with the healthy group, the patients with schizophrenia group presented significant changes in the levels of 24 metabolites related to the disruption of 9 metabolic pathways, among which the key pathways were the alanine, aspartate and glutamate metabolism and arginine biosynthesis pathways. After treatment with olanzapine, the levels of 10 differentially abundant metabolites were significantly reversed in patients with schizophrenia. Olanzapine effectively regulated six metabolic pathways, among which the key pathways were alanine, aspartate and glutamate metabolism and arginine biosynthesis pathways. Ten core targets of olanzapine were involved in several key pathways. CONCLUSION The metabolic pathways of alanine, aspartate, and glutamate metabolism and arginine biosynthesis are the key pathways involved in olanzapine treatment for aggressive schizophrenia.

Factors associated with renal involvement in adult immunoglobulin a vasculitis: what is it?

ABSTRACT Objective The objective of this study is to examine the potential of specific parameters in determining renal involvement in adult patients diagnosed with Immunoglobulin A vasculitis (IgAV). Methods The patients’ records with IgAV meeting the EULAR/PRINTO/PRES classification criteria who were diagnosed between January 2017 and January 2022 were retrospectively reviewed. The Birmingham Vasculitis Activity Score (BVAS) version 3 was used to assess initial disease activity. A comparison was conducted between the data of patients with and without renal involvement. To investigate factors associated with renal involvement, the significant parameters were used to develop a forward stepwise multivariate regression model. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the predictive ability of significant parameters for renal involvement. Results The study included 85 patients, of whom 22 (25.9%) had renal involvement. Patients with renal involvement had a median age of 60.5 years and a median follow-up of 56.3 months. The median BVAS and ferritin/albumin ratio (FAR) values were significantly higher in patients with renal involvement (p < 0.001). Multivariate regression analysis identified initial BVAS and FAR values as factors associated with renal involvement. ROC analysis demonstrated that the initial BVAS and FAR values were associated with renal involvement, with AUCs of 0.882 and 0.817, respectively (p < 0.001). Conclusions The initial BVAS above 7.5, and baseline FAR above 24.97 are factors associated with renal involvement. The results of this study may provide the basis for identifying individuals at high risk for renal involvement and, consequently, for more rigorous monitoring.

Prediction of pre-eclampsia using maternal hemodynamic parameters at 12 + 0 to 15 + 6 weeks.

To compare the maternal hemodynamic profile at 12 + 0 to 15 + 6 weeks' gestation in women who subsequently developed pre-eclampsia (PE) and those who did not, and to assess the screening performance of maternal hemodynamic parameters for PE in combination with the Fetal Medicine Foundation (FMF) triple test, including maternal factors (MF), mean arterial pressure (MAP), uterine artery pulsatility index and placental growth factor. This was a prospective case-control study involving Chinese women with a singleton pregnancy who underwent preterm PE screening at 11 + 0 to 13 + 6 weeks' gestation using the FMF triple test, between February 2020 and February 2023. Women identified as being at high risk (≥ 1:100) for preterm PE by the FMF triple test were matched 1:1 with women identified as low risk (< 1:100) for maternal age ± 3 years, maternal weight ± 5 kg and date of screening ± 14 days. Two-dimensional transthoracic echocardiography was performed at 12 + 0 to 15 + 6 weeks to evaluate maternal hemodynamic parameters (heart rate (HR), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR)). Maternal hemodynamic parameters were expressed as multiples of the median (MoM) values, determined by linear regression models to adjust for gestational age (GA) and MF. The distribution of log10 MoM values of maternal hemodynamic parameters in cases of PE and unaffected pregnancies, and the association between these hemodynamic parameters and GA at delivery, were assessed. The risks of preterm PE (delivery before 37 weeks) and any-onset PE (delivery at any time) were reassessed using Bayes' theorem after maternal hemodynamic parameters were added to the FMF triple test. The screening performance for preterm PE and any-onset PE was determined by the area under the receiver-operating-characteristics curve (AUC) and detection rate at a 10% fixed false-positive rate (FPR). Differences in AUC (ΔAUC) were assessed using DeLong's test. A total of 743 cases were analyzed, of whom 39 (5.2%) subsequently developed PE, including 29 (3.9%) cases of preterm PE and 10 (1.3%) cases of term PE. Mean log10 SVR MoM was significantly higher in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log10 SV MoM and log10 CO MoM were significantly lower in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log10 HR MoM was not significantly different between the study groups. Mean log10 CO MoM and log10 SVR MoM were not significantly correlated with GA at delivery in preterm PE and any-onset PE. For the prediction of preterm PE and any-onset PE, adding CO or SVR or replacing MAP with CO and SVR in the FMF triple test achieved an identical or greater AUC compared with the FMF triple test, but ΔAUC was not significantly different. In addition, adding CO or SVR or replacing MAP by CO and SVR in the FMF triple test did not improve the detection rate for preterm PE and any-onset PE at a fixed FPR of 10%. Women with preterm PE or any-onset PE exhibited increased SVR and decreased CO before the clinical manifestations of PE became apparent. These changes may serve as early indicators of cardiovascular maladaptation. However, assessment of maternal hemodynamics at 12 + 0 to 15 + 6 weeks does not enhance the screening performance for preterm PE and any-onset PE of these parameters. The FMF triple test remains superior to other biomarker combinations for predicting PE. © 2025 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Combined first-trimester screening for preterm small-for-gestational-age infants: Australian multicenter clinical feasibility study.

To assess the performance of the Fetal Medicine Foundation (FMF) first-trimester competing-risks screening model for small-for-gestational-age (SGA) fetuses requiring delivery at < 37 weeks' gestation, in a large cohort of women receiving maternity care in Australia. This was a retrospective analysis of prospectively collected data from a cohort of women attending one of two private multicenter fetal medicine practices for first-trimester screening for preterm pre-eclampsia (PE), defined as PE requiring delivery before 37 weeks' gestation. Risk for preterm SGA, defined as SGA requiring delivery before 37 weeks, was calculated but was not disclosed to the patient or referring physician. Screening data were matched to obstetric outcomes. The primary outcome was the efficacy of the FMF screening model in assessing the risk of preterm SGA. The potential effect on identifying other adverse pregnancy outcomes was also assessed. During the study period, 22841 women with a singleton pregnancy underwent combined first-trimester screening for preterm PE. These data were compared with those of 301721 women in the state of Victoria with a singleton pregnancy who did not undergo screening during the study period. Calculation of the risk for preterm SGA identified 3030 (13.3%) pregnancies as high risk. The sensitivity of the model was 48.6% (95% CI, 41.0-56.2%), specificity was 87.0% (95% CI, 86.6-87.5%) and positive and negative predictive values were 2.9% (95% CI, 2.7-3.1%) and 99.5% (95% CI, 99.4-99.6%) respectively. Pregnancies at high risk for preterm SGA were also more likely to have preterm PE (risk ratio (RR), 2.28 (95% CI, 1.72-3.03)) and preterm birth (RR, 1.46 (95% CI, 1.32-1.63)), compared with unscreened pregnancies. Pregnancies at low risk for preterm SGA were less likely to result in a stillbirth (RR, 0.64 (95% CI, 0.47-0.86)) compared with unscreened pregnancies. Combined first-trimester screening for preterm SGA shows moderate screening efficacy and therefore could help to inform pregnancy management and improve antenatal resource allocation. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Spatiotemporal evolution of landscape ecological risk and its driving factors of the Beijing–Tianjin–Hebei major mineral belt, 1985–2022

The Beijing-Tianjin-Hebei major mineral belt represents a significant economic development area in China. Effective monitoring and assessment of the regional landscape ecological risk can provide a scientific basis for an ecological protection strategy for the environmental protection of the Beijing-Tianjin-Hebei major mineral belt. In this study, a landscape ecological risk index was constructed based on land use/land cover, and the spatial and temporal variations of landscape ecological risk were subsequently analyzed. Furthermore, the contribution of the main driving factors of landscape ecological risk was quantified in the Beijing-Tianjin-Hebei major mineral belt. The results demonstrate that: (1) The land use types within the study area underwent significant changes from 1985 to 2022. The predominant type of transfer was cropland, which was primarily converted to construction land, grassland, and woodland. (2) The landscape ecological risk in central-northern and western parts of the Beijing-Tianjin-Hebei major mineral belt is higher, while the landscape ecological risk in the southwest parts is lower. Using 2015 as the time point, the landscape ecological risk in the study area was found to change, with the average value of landscape ecological risk for all classes of landscape ecological risk within 2015–2022 being lower than that of 1985–2015, with the exception of the high-risk area. The mean annual landscape ecological risk is obviously higher during the 1985–2015 period in comparison to the 2015–2022 period, with the exception of regions exhibiting high risk. (3) There is a significant positive spatial correlation between landscape ecological risks in different periods. The pattern of landscape ecological risk exhibits both ‘high-high’ aggregation and ‘low-low’ aggregation. The ‘high-high’ aggregations are primarily located in the northern, central and western parts of the study area, while the ‘low-low’ aggregation zones are mainly located in the southeastern study region. (4) The spatial distribution of landscape ecological risk is predominantly shaped by population density and slope. In the context of interactive factor detection, the positive interaction between slope and average annual temperature, night-time illumination and slope, population density and annual precipitation were identified as exerting a more significant influence on the observed spatial differentiation of landscape ecological risk. It was found that the interaction of multiple drivers had a more pronounced impact on landscape ecological risk than any single factor. The findings of the research project provide a scientific rationale and reference for future land use, resource optimization, landscape ecological risk differential management and ecological restoration. Furthermore, the findings are of considerable importance in terms of maintaining ecological security patterns.

Implications of a new clinical classification of acute myocardial infarction.

The diagnostic criteria for type 2 myocardial infarction identify a heterogenous group of patients with variable outcomes and no clear treatment implications. We aimed to determine the implications of a new clinical classification for myocardial infarction with more objective diagnostic criteria using cardiac imaging. In a prospective cohort study, patients with type 2 myocardial infarction underwent coronary angiography and cardiac magnetic resonance imaging or echocardiography. The new classification was applied to identify (a) spontaneous myocardial infarction due to acute coronary pathology, (b) secondary myocardial infarction precipitated by acute illness in the presence of obstructive coronary artery disease, a new regional wall motion abnormality or infarct pattern scarring, and (c) no myocardial infarction in the absence of obstructive disease or new myocardial abnormality. In 100 patients (65 years, 43% women) with type 2 myocardial infarction, the new classification identified 25 and 31 patients with spontaneous and secondary myocardial infarction, respectively, and 44 without myocardial infarction. Compared to patients without myocardial infarction, those with secondary myocardial infarction were older, had more risk factors, and higher troponin concentrations (P<0.05 for all). During a median follow up of 4.4 years, death, myocardial infarction or heart failure hospitalization was more common in secondary myocardial infarction compared to those without myocardial infarction (55% [17/31] versus 16% [7/44], P<0.001). A new clinical classification of myocardial infarction informed by cardiac imaging would reduce the diagnosis of myocardial infarction in acute illness and identify those patients at highest risk who are most likely to benefit from treatment. https://clinicaltrials.gov/ct2/show/NCT03338504.

Does remission of type 2 diabetes matter? A qualitative study of healthcare professionals' perspectives and views about supporting remission in primary care.

Trials conducted in highly selected populations have shown that type 2 diabetes (T2D) remission is possible, but the feasibility and acceptability of supporting remission in routine clinical practice remain uncertain. We explored primary care professionals' perceptions and understandings of T2D remission and their views about supporting remission within routine clinical care. Semi-structured interviews were conducted with 14 GPs and nine nurses working in Scottish general practices. Data were analysed thematically. Most participants considered remission to be a motivational tool but were unsure that it actually altered clinical management, due to patients still requiring follow-up and their expectations that remission is often temporary because of the constant effort required to sustain remission in an obesogenic environment. These perceptions, together with participants' concerns about loss to follow-up of patients who were likely to relapse and/or were still at high cardiovascular risk, appeared to underpin a reluctance to code remission in medical records. Most participants did not consider remission support to be a clinical priority. Moreover, they described being sensitive to the pitfalls of only encouraging some patients to pursue remission, because if resources were directed towards apparently more motivated, affluent individuals, there was a risk that this could widen health inequalities. For integration of remission support into mainstream T2D care to be successful, primary care professionals may need to be persuaded that remission matters more than encouraging well-managed T2D. They would also benefit from clear guidance on follow-up and optimal support for people in remission.

The brain structure underlying the nonlinear association between early-life tobacco smoke exposure and the risk for cognitive decline and dementia in adulthood: a large prospective cohort study

BackgroundThe impacts of early-life tobacco smoke exposure, including exposure during pregnancy and the initiation of smoking during childhood and adolescence, on cognitive decline and the risk of dementia in later life have not been investigated.MethodsWe used data from the UK Biobank (UKB) to assess early-life tobacco exposure, including in utero exposure and the age at which smoking was initiated. Cox proportional-hazards regression models were employed to gauge the relationships between early-life tobacco smoke exposure and both the risk of cognitive decline and dementia in adulthood. We adjusted for potential confounding factors, including age, gender, race, household income, alcohol consumption status, physical activity, family history of dementia, education level, and other relevant variables.ResultsThis study of 291,113 UKB participants and 4,836 new dementia cases over a median 13.26-year follow-up found that in utero tobacco exposure led to significant cognitive decline in adulthood, but not a higher dementia risk. Those who began smoking in childhood or adolescence had significant cognitive decline and increased dementia risk. Early smoking was linked to various brain structure changes, including volumes of the hippocampus, lateral ventricles, white and gray matter.ConclusionsEarly exposure to tobacco is associated with cognitive decline and an increased risk of dementia in adulthood. This underscores the significance of educational campaigns targeting the reduction of smoking among children, adolescents, and pregnant women as an effective strategy to mitigate cognitive decline and dementia in adulthood.

Impact of severe intra-abdominal adhesions on early maternal complications following cesarean delivery.

The rising rates of cesarean delivery (CD), which are a leading cause of intra-abdominal adhesions, represent a major concern for maternal health. We aimed to describe early maternal complications following CD in women with severe intra-abdominal adhesions. A prospective observational study was conducted at a university-affiliated tertiary medical center (January 2021 and March 2023) in Israel. Women who underwent CD were assessed for intra-abdominal adhesions by questionnaires completed by the surgeons. Adhesions were evaluated at four anatomical sites: abdomen-to-uterus, uterus-to-bladder, skin-to-fascia, and other intra-abdominal sites. Each site was scored on a scale of 0-2, with a total score ranging from 0 to 8. Severe adhesions were defined as a total score ≥5. The primary outcome measures were a composite complication which included at least one or more of postoperative need for blood or iron products, fever, prolonged hospitalization, re-hospitalization, and emergency room visits. Overall, 2797 women were included in the study, of whom 295 (10.6%) exhibited severe adhesions. Women with severe adhesions had a higher composite risk for maternal complications following CD (RR = 1.28, 95% confidence interval [CI]: 1.12-1.45, P < 0.001), specifically, postoperative need for blood or iron products (RR = 1.71, 95% CI: 1.15-2.55, P = 0.007) and prolonged hospitalization (RR = 1.49, 95% CI: 1.10-2.03, P = 0.009). There were no significant group differences in the rates of postoperative fever, re-hospitalization or emergency room visits. In multivariate analysis, severe adhesions had an independent impact on maternal complications (CI: 1.06-1.95, P value 0.017). Severe intra-abdominal adhesions diagnosed in CD had an impact on early maternal complications.

Association between atherogenic index of plasma and future risk of cardiovascular disease in individuals with cardiovascular-kidney-metabolic syndrome stages 0–3: a nationwide prospective cohort study

BackgroundAs an emerging concept, Cardiovascular-kidney-metabolic syndrome (CKM) elucidates the intricate interconnection between metabolic disorders(Mets), cardiovascular disease(CVD), and chronic kidney disease(CKD). Within this context, while numerous studies have demonstrated a correlation between the Atherogenic Index of Plasma (AIP) and CVD, the precise relationship between long-term fluctuations in the AIP and the incidence of CVD in patients with CKM syndrome remains unclear.MethodThe CKM stages 0–3 population was obtained from the China Health and Retirement Longitudinal Study (CHARLS). The outcome CVD was defined as self-reported heart disease and/or stroke. AIP control level was classified using k-mean cluster analysis. Logistic regression was used to analyse the effect of cumulative AIP (cumAIP) on the incidence of CVD. Restricted cubic spline models (RCS) were used to explore the potential non-linear relationship between cumulative AIP and CVD risk at different CKM syndrome stages.ResultsOf the 3429 CKM stages 0–3 participants, 620 patients developed CVD during the 3-year follow-up period. After adjusting for various confounders, the odds ratio (OR) for the well-controlled class 2 compared with the best AIP control class 1 were 1.37 (1.04, 1.81), the OR for the moderately-controlled class 3 were 1.54 (95% CI, 1.04–2.26), the poorly-controlled class 4 were 1.65 (95% CI, 1.13–2.41), and the worst-controlled class 5 were 2.14 (95% CI, 1.15–3.97). In restricted cubic spline regression analyses, changes in AIP were linearly associated with the occurrence of CVD events. Further weighted quartiles and regression analyses indicated that triglyceride(TG) was a key variable for AIP in predicting CVD events in the CKM stages 0–3 population.ConclusionsPoor control level of AIP are associated with an increased risk of CVD events in the population of CKM stages 0–3. Long-term dynamic monitoring of changes in AIP may help in the early identification of patients at high risk of developing CVD in the individuals with CKM stages 0–3.

Barriers facilitators and needs of female sex workers in Arak to access sexual health services a qualitative study

The sexual health of female sex workers is of particular concern due to severe complications arising from multiple and unprotected sexual relationships. This qualitative study, the initial study conducted in Iran, explored the sexual health needs, barriers, and facilitators to accessing sexual health services among women at high risk of STIs in Arak. In this qualitative research study, we used a content analysis design. Fourteen female sex workers who attended the specialized HIV center in Arak participated in the study. Data were collected and analyzed using qualitative content analysis. Data were classified into three main themes: (1) barriers and facilitators in accessing sexual health services; (2) educational needs for sexual health; and (3) peer education from the perspectives of sex workers. Three categories of barriers emerged: “personal”, “environmental and structural”, and “psychological and social” ones. Personal barriers included a lack of information, privacy concerns, fear of untreatable or complex diagnoses, and cultural beliefs and shame. Environmental and structural barriers included financial barriers, inadequate emphasis on sexual health, mistreatment by healthcare staff, poor quality of distributed condoms, and insufficient preventive education. Psychological and social barriers included partner rejection following infection. Facilitators for accessing sexual health services included respectful care, effective counseling for anxiety and stress. Access to preventive healthcare included the availability of screenings and vaccinations, and condom distribution at the center. Educational needs encompassed skills in negotiation and communication, understanding sexual health, positive body image and accepting sexual orientation, and preventing and managing STIs. The participants believed that peer education offers several benefits, including building credibility and trust among peers, fostering positive interactions within peer groups, enhancing support through shared experiences, improving access to educational resources and empowerment through peer education. However, it also presented drawbacks, such as a lack of trust in peers and deficiencies in specialized resources. To improve access to sexual health services for female sex workers, it is essential for services to be transparently and comprehensively introduced; and for cultural and social barriers to be reduced. Additionally, it is recommended that services be provided either free of charge or at reduced costs to enable this vulnerable group to utilize the services effectively. Future studies should focus on investigating strategies to gather data and improve sexual health of female sex workers at community level.

A cross-sectional study of the association between dietary inflammatory index and glaucoma prevalence in a US population

AIM: To assess the relationship between dietary inflammatory index (DII) and prevalence of glaucoma among individuals aged 40y and above in the United States. METHODS: Participants were drawn from 2 cycles of the National Health and Nutrition Examination Survey (NHANES, 2005-2008) for a cross-sectional study. DII was calculated from 24-hour dietary recall questionnaire conducted by experienced researchers and data analyzed in R according to the NHANES user guide, “Stratified Multi-stage Probability Sampling”. The relationship between DII and glaucoma was evaluated by multi-factor logistic regression analysis and the existence of a non-linear association examined by restricted cubic spline (RCS) analysis. RESULTS: A total of 5359 subjects were included and the cross-sectional analysis weighted to represent the US population of 109 million. DII was elevated in glaucoma patients (P&lt;0.001) and smoking and alcohol use contributed to significant differences (P&lt;0.001). DII correlated negatively with Healthy Eating Index (HEI)-2015 (Spearman rank correlation coefficient, r=-0.49). RCS analysis showed a linear relationship between DII and glaucoma risk (P of non-linear relationship =0.575). CONCLUSION: An increased DII is strongly associated with high risk of glaucoma and diet-induced inflammation should be controlled to delay glaucoma progression.

An Intersectional Perspective on Cyberbullying: Victimization Experiences Among Marginalized Youth

ABSTRACTIntroductionThe impact of cyberbullying victimization on youth development, encompassing mental health, academic performance, and socioemotional well‐being, has been widely documented. Research highlights the heightened vulnerability of sexual and gender minoritized youth, along with other youth from marginalized groups, to cybervictimization. However, there is a gap in understanding how intersecting marginalized social identities affect experiences of cyberbullying.MethodsThis study employs an intersectionality framework to examine cybervictimization among youth. The sample consists of 444,224 students in grades 9–12 from the 2017–2019 California Healthy Kids Survey. Using exhaustive chi‐square automatic interaction detection (ECHAID), the analysis identifies the prevalence of cybervictimization across multiple intersecting social identities, including sex assigned at birth, gender modality (cisgender 97.6%), sexual orientation, race/ethnicity, grade level, and socioeconomic status.ResultsCybervictimization was reported by 22.7% of youth in the sample. Rates were two to three times higher among youth with multiple marginalized identities. Youth at the intersection of bisexual sexual orientation, transgender gender modality, and racial/ethnic minoritized identities faced a particularly high risk of cybervictimization.ConclusionsThere is an urgent need for future research in cyberbullying and youth development. Such research should focus on identifying and understanding the intersectional nature of discrimination and victimization, both in‐person and online, to develop evidence‐based prevention programs that effectively address the complexities of minoritized identities and discrimination in the digital world.

ANALYSIS OF HEMODIALYSIS SERVICE UTILIZATION BY JKN PARTICIPANTS IN THE SPECIAL REGION OF YOGYAKARTA: AN ANALYSIS OF BPJS KESEHATAN CLAIM DATA IN 2023

Chronic kidney disease (CKD) has become a serious global health problem with significant socio-economic implications. This study aims to analyze the determinants of the utilization of hemodialysis services for National Health Insurance (JKN) participants in the Special Region of Yogyakarta (DIY) in 2023. The study employs a cross-sectional design to analyze secondary data from the BPJS Kesehatan claim database in 2020, focusing on JKN participants receiving dialysis services at Advanced Referral Health Facilities (FKRTL). Data extraction is followed by analysis using STATA software, which includes univariate and bivariate analyses, multicollinearity and overdispersion tests, model comparison via Akaike Information Criterion (AIC), and multivariate analysis through Poisson regression and Binomial Negative methods. A total of 3,220 participants (0.089%) were enrolled in the study. The highest distribution of participants was in Sleman Regency (36.49%), followed by Bantul (29.53%), and Yogya City (25.96%). From the results of the binomial regression analysis, it was found that the age factor had a significant negative influence (p=0.000) with a coefficient of -0.0046 and an IRR of 0.9954, which means that every increase in age by one year will decrease the frequency of visits by 0.46%. The prevalence of diabetes (3.1%) and hypertension (10.2%) which exceed the national average indicates a high risk factor for CKD in this region is high. The age factor and location of health facilities in SLEMAN Regency significantly affected the frequency, while the segment group, gender, and nursing class rights did not show significant influence.

Laryngeal Abscess: A 34-Year Review

Abstract This study aimed to investigate the frequency, clinical-epidemiological characteristics, and management of laryngeal abscesses in our hospital setting. We included all patients treated for primary laryngeal abscesses in the Otorhinolaryngology Department of a tertiary hospital over a 34-year period. Patients with abscesses believed to have originated from adjacent regions were excluded. Thirteen patients with laryngeal abscesses were identified, with epiglottitis being the most common etiology (61%). Three patients were immunosuppressed. Four patients required urgent tracheotomy, and one underwent cricothyrotomy due to upper airway obstruction. All cases were drained under general anesthesia via a transoral route. Five patients required admission to the intensive care unit, and two experienced severe complications. There were no fatalities. Laryngeal abscesses are rare, with epiglottitis being the predominant cause. These cases pose a high risk of upper airway obstruction, highlighting the importance of early diagnosis and prompt treatment by a multidisciplinary team to prevent complications.

The Influence of Demographic and Economic Factors on the Widow’s Reverse Annuity Benefits in Coronavirus Pandemic

Abstract The COVID-19 pandemic has affected many areas of society and the economy. In the epidemiological field, it has significantly increased mortality, especially in the elderly population. It has greatly affected the real estate and financial market. The price of housing, inflation, and interest rates rose. Therefore, housing is currently unaffordable. The analysis of the Life Expectancy Tables jumped to a higher risk of death for men than for women. The pandemic has made women more likely to be widowed than men, and more often, while their economic and social status has worsened. Higher mortality rates have an impact on the cash flow associated with insurance and reverse annuity contracts. Reverse annuity benefits also depend on the value of property and the interest rate. This article analyses the impact of higher mortality rates, property values, and interest rates on annuity benefits for widows. The actuarial value of the life annuity is used on the calculation of benefits. The interest rate is modelled using the Svensson model of spot interest and the 3m WIBOR. Financial mathematics for life insurance and demographic methods are used.

Trends and Prevalence of Low Birth Weight in India: What Does data suggest?

Introduction: “Low birth weight” (LBW) is defined as birth weight &lt; 2.5 kg (2500 grams). LBW infants remain at a relatively higher risk of mortality than those with normal birth weight. This is still a major public health problem in developing countries like India. This study examines the trend and prevalence of LBW in India and its data characteristics. Methods: National Family Health Survey (N.F.H.S.) data rounds were collected from 1992-2021. The study sample included women aged 15-49 years. The logistic regression model was fitted to assess the maternal determinants affecting the birth weight among newborns. Also, the heaping pattern of the data for each round of N.F.H.S. data was analyzed. Results: The trend and prevalence of low birth weight were reported 1884 (25.2%) in the first round of the National Family Health Survey, 1859 (22.7 %) in the second, 4146 (21.5%) in the third, 35476 (18.2%) in fourth, and 38167 (18.2%) in fifth, which remains constant in comparison to the previous round. Conclusion: The prevalence of LBW in India has declined over the past decades as reported in data like NFHS-I, II &amp; III, but NFHS-IV and V are constant. Sociodemographic factors are shown as a risk factor for LBW. Data heaping is a key challenge to give the correct estimate of LBW and it is found in each round of the data set. Maternal health services are required during the gestation period to reduce LBW