Incidence Of Chronic Disease Research Articles

Elevated TyG-BMI index predicts incidence of chronic kidney disease

Chronic kidney disease (CKD) represents a significant global public health issue, with its incidence and prevalence escalating annually. Metabolic disorders are one of the major etiological factors of CKD. This study investigates the relationship between the emerging metabolic index triglyceride-glucose body mass index (TyG-BMI) and the onset of CKD. Our study enrolled 3,485 healthy participants (1,576 men and 1,909 women), with a follow-up period of 3 years. The primary outcome was the emergence of CKD, defined by an eGFR less than 60 mL/(min × 1.73 m2) or the onset of proteinuria. To examine the TyG-BMI and CKD onset relationship, we used univariate and multivariate logistic regression analyses, stratified analyses, and receiver operating characteristic (ROC) curves. After a three-year follow-up, CKD developed in 2% (n = 70) of the participants. Subjects were divided into three equal groups based on their TyG-BMI values, from lowest to highest. After adjusting for potential confounders, the highest TyG-BMI group exhibited a multifactor-adjusted odds ratio (OR) of 4.24 (95% CI 1.30–13.78, P = 0.016) compared to the lowest group. Stratified analyses revealed that the association between TyG-BMI and CKD onset was stronger among females, individuals younger than 60 years, and those with a BMI ≥ 24 kg/m2. Furthermore, TYG-BMI was effective in predicting the incidence of CKD. Our findings indicate that TyG-BMI is an independent risk factor for the onset of CKD and that assessment of TyG-BMI may be useful for the early identification of individuals at high risk for CKD.

The impact of chronic diseases on the health-related quality of life of middle-aged and older adults: the role of physical activity and degree of digitization

BackgroundThe incidence of chronic diseases is on the rise worldwide, with a high mortality rate in China, posing a serious threat to the health-related quality of life (HRQoL) of middle-aged and older adults. This study explores the association between chronic diseases and the HRQoL of middle-aged and older adults, as well as the role of physical activity (PA) and degree of digitization in this relationship.MethodsThe data used in this study was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which included 13,620 middle-aged and older Chinese adults (≥ 45 years). The study utilized correlation analysis, and bootstrapping to investigate the mediating role of PA and the moderating influence of the degree of digitization. Data analysis was conducted using SPSS 26.0.ResultsThe study findings indicate that the severity of chronic disease has a significant negative predictive effect on HRQoL (PCS, physical component summary; MCS, mental component summary) (PCS: β = -2.515, p < 0.01, MCS: β = -0.735, p < 0.01). Further analysis revealed that PA plays a mediating and masking role in the impact of chronic disease on PCS and MCS. Additionally, the degree of digitization moderates the relationship between chronic disease and PA, chronic disease and PCS, and PA and PCS.ConclusionFor middle-aged and older persons, chronic diseases have a detrimental effect on their HRQoL; nevertheless, PA can help. Furthermore, proper internet usage can help older individuals to some extent in mitigating the negative impact of chronic diseases. Therefore, it is encouraged to promote PA among the elderly with chronic diseases to improve their physical health, as well as to guide them in the proper use of the Internet to establish healthy behaviors.

Effects of a 4-week free-sugar avoidance during periodontal therapy: An explorative randomized controlled clinical trial.

This study investigated the effect of a 4-week free-sugar avoidance on periodontal parameters during periodontal therapy. Twenty-one patients with untreated periodontitis and daily free-sugar intake were allocated to a sugar avoidance group (SAG) and a control group (CG). The SAG received a 45-min dietary consultation and was instructed to avoid free sugars during the following 4 weeks after subgingival instrumentation, while the CG continued with their regular diet. Bleeding on probing (BOP), plaque control record, body weight (BW), visceral fat (FATv), and a food frequency questionnaire (FFQ) were collected at baseline (T1), 4 weeks (T2), and 8 weeks (T3) after subgingival instrumentation. The main outcome parameter BOP was significantly reduced at T2 by 40.3% ± 15.54 in the SAG and 34% ± 12.47 in the CG (intra-p value both <0.001, inter-p value 0.361). A linear regression analysis of changes at patient level adjusted for age and FATv revealed a significant group difference for BOP (regression coefficient = -6.8; p = 0.019). Significant reductions were observed in BW, FATv and mean daily intake of free sugars (-14.4g/day), and a significant increase of vitamin C derived from fruits (75.89mg/day) at T2 in the SAG only. This study may indicate additional beneficial effects of a sugar avoidance on periodontal and metabolic parameters, and nutritional intake during periodontal therapy. German Clinical Trials Register (DRKS00026699). The current widespread free-sugar consumption is linked to an increasing incidence of chronic non-communicable diseases. Data indicate a relationship between sugar intake and a higher prevalence of periodontitis and increased gingival inflammation. This study showed that free-sugar avoidance after periodontal therapy had additional beneficial effects on periodontal and metabolic parameters in 10 test and 11 control patients. After 4 weeks of avoiding free sugars like sweets, processed white flour, juice, and so forth, periodontal bleeding was significantly reduced in both groups (-40.3% test group, -34% control group). Further regression analysis revealed a significant difference between groups favoring the intervention. Additionally, body weight and visceral fat were significantly reduced in the intervention group, only. To avoid sugar, patients were allowed to replace it with whole fruit, which led to increased levels of micronutrients such as vitamin C. Therefore, free-sugar avoidance may be of therapeutic benefit in addition to periodontal therapy. Further research is needed to investigate this effect in larger cohorts.

Chronic disease incidence explained by stepwise models and co-occurrence among them

Multimorbidity (MM) is the co-occurrence of two or more chronic diseases. We provided a dynamic approach revealing the MM complexity constructing a multistep incidence-age model for all patients with MM between 2014 and 2021 in the Basque Health System, Spain. The multistep model, with eight steps for males and nine for females, is a very well-fitting representation of MM. To gain insight into the MM components, we modeled the 19 diseases used to calculate the Charlson Comorbidity Index (CCI). We observed that the CCI diseases formed a complex interaction network. Hierarchical clustering of the incidence-age profiles clustered the CCI diseases into low- and high-risk of dying pathologies. Diseases with a higher number of steps are better represented by a multistep model. Anatomically, diseases associated with the central nervous system have the highest number of steps, followed by those associated with the kidney, heart, peripheral vasulature, pancreas, joints, cerebral vasculature, lung, stomach, and liver.

Correlation Between RET-He and Quality of Life in Chronic Kidney Disease Patients with Routine Hemodialysis: A Study at Ulin General Hospital Banjarmasin

Background: The 2018 Riskesdas report revealed that the incidence of chronic kidney disease (CKD) affects 0.38% of Indonesia’s population. Anemia frequently complicates CKD, especially in patients undergoing regular hemodialysis. Reticulocyte hemoglobin equivalent (RET-He) assesses hemoglobin content in reticulocytes, indicating iron availability for erythropoiesis in the bone marrow. CKD significantly impacts patients' socio-economic status, heightening morbidity and mortality while diminishing quality of life. The relationship between RET-He and the quality of life in CKD patients on routine hemodialysis remains unclear. Objective: To investigate the correlation between RET-He and quality of life in CKD patients undergoing routine hemodialysis. Methods: A cross-sectional observational analytical study with data from medical records of CKD patients receiving routine hemodialysis between October 1st and October 30th, 2021. The Spearman correlation test was used for analysis. Results: This study included 92 patients, consisting of 40 males and 52 females, with a median age of 50 years and RET-He values at 31. Quality of life metrics included physical function (800, range: 0-1000), physical limitations (300, range: 0-400), body pain (175, range: 75-255), general health (475, range: 225-600), vitality (320, range: 200-400), social function (175, range: 75-200), emotional limitations (300, range: 100-300), and mental health (380, range: 160-500). The correlation analysis revealed no significant relationships: physical function (p=0.359), physical limitations (p=0.813), body pain (p=0.373), general health (p=0.547), vitality (p=0.616), social function (p=0.828), emotional limitations (p=0.482), and mental health (p=0.136). Conclusion: There is no significant correlation between RET-He levels and the quality of life in CKD patients undergoing regular hemodialysis.

Prospective study on the joint effect of persistent organic pollutants and glucose metabolism on chronic kidney disease: Modifying effects of lifestyle interventions

There is no evidence on the associations between persistent organic pollutants (POPs) and the incidence of chronic kidney disease (CKD) in the Chinese rural population. We aimed to investigate the individual and mixed effects of 22 POPs on the prevalence and incidence of CKD, and the joint effects of POPs and abnormal glucose metabolism as well as the modification effects of healthy lifestyle on these associations. A total of 2775 subjects, including 925 subjects with normal plasma glucose (NPG) and 925 subjects with prediabetes (PDM) and type 2 diabetes mellitus (T2DM), were enrolled from the Henan Rural Cohort Study. Logistic regression and quantile g-computation were performed to assess the individual and mixed effects of POPs on the risk of CKD. Joint effects of POPs and abnormal glucose metabolism status, as well as the modification effects of lifestyle on CKD were assessed. After 3-year follow-up, an increment of ln-o,p’-DDT was related to an elevated risk of CKD prevalence. Positive associations of p,p’-DDE and β-BHC with CKD incidence were observed (P < 0.05). In addition, participants with high levels of ∑POPs were associated elevated incidence risk of CKD (OR: 1.217, 95%CI: 1.008–1.469). One quartile increase in POPs mixture was associated with the increased incidence of CKD among T2DM patients (P < 0.05). Further, a higher risk of CKD was observed among PDM and T2DM patients with high levels of o,p’-DDT, p,p’-DDE, β-BHC, and ∑POPs than NPG subjects with low levels of pollutants. In addition, interactive effects of ∑POPs and lifestyle score on CKD incidence were found. Individual and mixed exposure to POPs increased the prevalence and incidence of CKD, and glucose metabolic status exacerbated the risk of CKD resulting from such exposures. Further, the modifying effects of lifestyle were observed, highlighting the importance of precision prevention for high-risk CKD population and healthy lifestyle intervention measures.

Proton pump inhibitors may increase the risk of cisplatin-induced acute kidney injury in patients with nasopharyngeal carcinoma: a prospective cohort study

Cisplatin is the most commonly used platinum-based treatment for nasopharyngeal carcinoma (NPC). However, its clinical application is limited owing to its nephrotoxicity and gastrointestinal reactions. Proton pump inhibitors (PPIs) have been reported to increase nephrotoxicity risk in previous studies. We aimed to evaluate whether PPIs increase cisplatin-induced nephrotoxicity in patients with NPC. In total, 295 patients were included in this prospective cohort study: 145 in the PPIs group and 150 in the non-PPIs group. All patients underwent cisplatin-based induction chemotherapy, followed by cisplatin-based concurrent chemoradiotherapy. The PPIs group received 40 mg of intravenous esomeprazole sodium for 7 days in each chemotherapy cycle. Chi-squared test and logistic regression analyses with odds ratios and 95% confidence intervals were applied to assess the association between PPIs and the risk of acute kidney injury (AKI). AKI incidence in the PPIs group was significantly higher than that in the non-PPIs group (P = 0.005). After adjusting for various confounders including demographic features, clinical features, and renal function indices, PPIs use was significantly associated with a higher AKI risk (odds ratio: 2.775; 95% confidence interval 1.280–6.020; P = 0.010). The incidences of acute and chronic kidney diseases were similar between both groups (P > 0.05), whereas the incidence of nausea was lower in the PPIs group than in the non-PPIs group (P = 0.029). This study has shown that PPIs use may increase the risk of cisplatin-induced acute nephrotoxicity in patients with NPC.

Circulating metabolomics revealed novel associations between multiple ambient air pollutants exposure and chronic obstructive pulmonary disease incidence: Evidence from a prospective cohort study

The mechanisms underlying relationships between ambient air pollution and chronic obstructive pulmonary disease (COPD) risk remained largely uncertain. In this study, we aim to evaluate whether metabolic signature comprising multiple circulating metabolites can characterize metabolic response to the multiple air pollution; and to assess whether the identified metabolic signature contribute to COPD risk. A total of 227,962 participants with complete data were included from the UK biobank study. Concentrations of nitrogen dioxide (NO2), nitrogen oxides (NOx), and particulate matter (PM2.5 and PM10) were evaluated by land-use regression models. We newly computed an air pollution score to reflect joint exposure to multiple air pollutants. Circulating metabolome was quantified by nuclear magnetic resonance (NMR) spectroscopy. During a median of 12.78 years of follow-up, a total of 8685 incident COPD cases were documented. After multiple correction, the Cox regression models showed that 102 of 143 metabolites were significantly associated with COPD risk. Utilizing elastic net regularized regressions, we identified a metabolic signature comprising 106 metabolites (including lipid, fatty acids, glycolysis and amino acids et al.) were robustly related to air pollution score. In the multivariate-adjusted Cox regression models, the derived metabolic signature showed a positive correlation with incident COPD [HR per SD = 1.20 (95% CI: 1.17–1.22)]. Casual mediation analysis further noted that the constructed metabolic signature mediated 10.5 % (8.3%–13.1%) of the air pollution-COPD associations. Taken together, our findings identified a metabolic signature that captured metabolic response to various air pollutants exposure jointly, and predicted future COPD risk independent of known risk factors.

Positive Impact on Critical Care Knowledge Acquisition and Skills of VietnameseNurses through an Online Standardized Training Program

Background Improved access to healthcare, increasing elderly population, growing incidence of chronic diseases, combined with the high prevalence of accidents and infectious diseases are driving the demand for critical care services in acute hospitals. However, low and middle-income countries not only have a shortage of critical care nurses, but there are also gaps in their graduate, post-graduate, and specialized training as well as in their continuing education to support them in their role. Methods This quality improvement project aimed to assess the effect of a web-based group study program on knowledge acquisition and skills and competency development of critical care nurses at seven private,not-for-profit hospital sites within a hospital system in Vietnam. The Essentials of Critical Care Orientation 4.0 course from the American Association of Critical Care Nurses was delivered to two cohorts of ICU nurses who worked in critical care. Course content was translated in Vietnamese. The program leveraged a preceptor-facilitator-learner model that depended on group discussions and self-learning. Program effectiveness was evaluated using quantitative pre- and post-test design, combined with a post-program survey. ResultsAverage post-test scores of the first cohort increased by 34.0% over pre-test while those of the second cohort increased by an average 41.0%.Post-program survey revealed that all learners were satisfied with the quality of content, the web-based delivery system, content translation and the overall teaching methodology. Learners also demonstrated greater confidence in delivering safe, proactive patient care. Conclusion The utilization of an online, standardizedwestern education program, translated to Vietnamese,delivered through a facilitator-group learning model is successful in increasing the knowledge level of Vietnamize critical care nurses.

RIPK3 causes mitochondrial dysfunction and albuminuria in diabetic podocytopathy through PGAM5-Drp1 signaling

BackgroundReceptor-interacting protein kinase (RIPK)3 is an essential molecule for necroptosis and its role in kidney fibrosis has been investigated using various kidney injury models. However, the relevance and the underlying mechanisms of RIPK3 to podocyte injury in albuminuric diabetic kidney disease (DKD) remain unclear. Here, we investigated the role of RIPK3 in glomerular injury of DKD. MethodsWe analyzed RIPK3 expression levels in the kidneys of patients with biopsy-proven DKD and animal models of DKD. Additionally, to confirm the clinical significance of circulating RIPK3, RIPK3 was measured by ELISA in plasma obtained from a prospective observational cohort of patients with type 2 diabetes, and estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), which are indicators of renal function, were followed up during the observation period. To investigate the role of RIPK3 in glomerular damage in DKD, we induced a DKD model using a high-fat diet in Ripk3 knockout and wild-type mice. To assess whether mitochondrial dysfunction and albuminuria in DKD take a Ripk3-dependent pathway, we used single-cell RNA sequencing of kidney cortex and immortalized podocytes treated with high glucose or overexpressing RIPK3. ResultsRIPK3 expression was increased in podocytes of diabetic glomeruli with increased albuminuria and decreased podocyte numbers. Plasma RIPK3 levels were significantly elevated in albuminuric diabetic patients than in non-diabetic controls (p = 0.002) and non-albuminuric diabetic patients (p = 0.046). The participants in the highest tertile of plasma RIPK3 had a higher incidence of renal progression (hazard ratio [HR] 2.29 [1.05–4.98]) and incident chronic kidney disease (HR 4.08 [1.10–15.13]). Ripk3 knockout improved albuminuria, podocyte loss, and renal ultrastructure in DKD mice. Increased mitochondrial fragmentation, upregulated mitochondrial fission-related proteins such as phosphoglycerate mutase family member 5 (PGAM5) and dynamin-related protein 1 (Drp1), and mitochondrial ROS were decreased in podocytes of Ripk3 knockout DKD mice. In cultured podocytes, RIPK3 inhibition attenuated mitochondrial fission and mitochondrial dysfunction by decreasing p-mixed lineage kinase domain-like protein (MLKL), PGAM5, and p-Drp1 S616 and mitochondrial translocation of Drp1. ConclusionsThe study demonstrates that RIPK3 reflects deterioration of renal function of DKD. In addition, RIPK3 induces diabetic podocytopathy by regulating mitochondrial fission via PGAM5-Drp1 signaling through MLKL. Inhibition of RIPK3 might be a promising therapeutic option for treating DKD.

Systematic Review and Meta-Analysis of the Incidence of Chronic Kidney Disease After Pediatric Critical Illness.

Survivors of pediatric critical illnesses are at risk of significant long-term organ sequelae. Chronic kidney disease (CKD) is a complication of critical illness (and ICU interventions) associated with growth impairment, cardiovascular disease, and early death. Our objective was to synthesize the evidence on the incidence of CKD among survivors of pediatric critical illness. MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Register of Controlled Trials from inception to February 2024. Observational studies reporting the incidence of de novo CKD among survivors of pediatric critical illness. Two reviewers independently extracted data on study design, setting, population, demographics, diagnostic criteria, and outcome. Meta-analysis was used to describe the incidence of CKD among survivors, risk of bias (RoB) assessed using the Joanna Briggs Institute Tool, and strength and reliability of evidence assessed with GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). CKD was quantified as an estimated glomerular filtration rate (eGFR) less than 90 mL/min/1.73 m2 (outcome 1), eGFR less than 60 mL/min/1.73 m2 (outcome 2), and end-stage renal disease (ESRD) as eGFR less than 15 mL/min per 1.73 m2 (outcome 3). Twelve studies (3642 patients) met selection criteria and reported at least one measure of CKD. The median duration of follow-up was 2, 3.6, and 5 years, respectively, for outcomes 1, 2, and 3. For each threshold, the pooled estimate of CKD incidence was 24% (95% CI, 16-32%) for eGFR less than 90, 14% (95% CI, 6-23%) less than 60, and 4% (95% CI, 0-7%) for ESRD. The overall quality assessment indicated a moderate RoB. Among a heterogenous population of pediatric critical illness survivors, an important minority of survivors developed CKD or ESRD. This study highlights the importance of diagnostic criteria for reporting, a greater focus on postcritical care surveillance and follow-up to identify those with CKD. Further study would facilitate the delineation of high-risk groups and strategies for improved outcomes.

Health inequalities and their relationship with socioeconomic indicators in the Maresme region (Catalonia): A cross-sectional ecological study.

Health inequalities are universal, but their magnitude and determinants vary according to geographic areas, and understanding variations is essential to designing and implementing preventive and corrective policies. Our objective was to evaluate health inequalities in the Maresme region (Catalonia, Spain) and the relationship with socioeconomic indicators. Cross-sectional ecological study (2017). SITE: Maresme region. Population assigned to any of the Maresme's 21 basic health areas (BHAs). Sociodemographic, socioeconomic, health, and health resource use indicators published by the Catalan Health Service's Information and Knowledge Unit. Differences observed between BHAs were 49% in mortality, 266% in diabetes incidence, 348% in stroke incidence, and 89% in hospitalizations. In the most compared to the least disadvantaged BHAs, socioeconomic deprivation, as measured by the socioeconomic index (SEI), was 4.6 times greater and the percentage population with low educational attainment (EA) was 3.7 times higher. Greater deprivation was associated with greater prevalence of diabetes, chronic obstructive pulmonary disease, and high blood pressure, and greater incidence of diabetes, ischemic heart disease, and cancer. Likewise, a greater percentage population with low EA was associated with higher premature mortality and avoidable hospitalizations. Great variation exists in socioeconomic, health, and health resource use between the different Maresme BHAs. Socioeconomic deprivation is strongly correlated with the prevalence and incidence of certain chronic diseases, and low EA is correlated with premature mortality and avoidable hospitalizations. Our findings point to the urgency of taking health inequalities into account in designing and implementing healthcare strategies, programs, and policies.

Adverse Events Comparison of Double Beta-Lactam Combinations for Bloodstream Infections: Ampicillin plus Ceftriaxone and Ampicillin/Cloxacillin.

In Japan, only ampicillin/cloxacillin (ABPC/MCIPC) is available as an anti-staphylococcal penicillin-based treatment for Staphylococcus aureus bacteremia. However, the incidence of adverse events associated with double beta-lactam administration remains unknown. Therefore, we investigated the adverse events of double beta-lactam administration in patients with bacteremia. Adult patients (≥18 years) with bacteremia treated with ABPC, ABPC + ceftriaxone (CTRX), or ABPC/MCIPC were retrospectively analyzed. The primary outcome of this study was the incidence of adverse events such as acute kidney injury, liver dysfunction, and myelosuppression. Chi-square tests and t-tests were used for bivariate analysis. Propensity score (PS) matching was conducted to adjust for confounding factors. We included 277 ABPC-, 57 ABPC + CTRX-, and 43 ABPC/MCIPC-treated patients. Significant differences were noted in age, number of male patients, proportion of patients with qSOFA score ≥2, incidence of chronic kidney disease, treatment duration, mechanical ventilation use, vasopressor use, and proportion of patients with acute kidney injury (AKI) KDIGO grade ≥2. Further, a significant difference was observed between ABPC and ABPC/MCIPC, with a hazard ratio of 1.83 in AKI. In the PS-matched cohort, AKI incidence associated with ABPC/MCIPC was significantly higher than that associated with ABPC. ABPC + CTRX may be safe, whereas ABPC/MCIPC presents a higher risk of AKI and may not be suitable.

Development of an Intelligent Health Education System Based on Large Language Model for Elderly Pulmonary Aspiration Prevention.

As the aging process accelerates, the incidence of chronic diseases in the elderly is rising. As a result, it is crucial to optimize health education for the elderly. Pulmonary aspiration and aspiration pneumonia are significant concerns endangering the health of the elderly. The health education paradigm now in use to prevent pulmonary aspiration in the elderly has numerous flaws, including a lack of home-based health education and the digital divide. Large language model (LLM), an example of artificial intelligence technology, is anticipated to bring a chance to address these issues and offer easily comprehensible health information for the prevention of pulmonary aspiration in the elderly. Our multidisciplinary research team fully understood the needs from the perspective of physicians, nurses and patients, built a knowledge graph (KG), and developed an intelligent Health EducAtion system based on LLM for the prevention of elderly Pulmonary Aspiration (iHEAL-ePA system).

Sleep patterns and risk of chronic disease as measured by long-term monitoring with commercial wearable devices in the All of Us Research Program

Poor sleep health is associated with increased all-cause mortality and incidence of many chronic conditions. Previous studies have relied on cross-sectional and self-reported survey data or polysomnograms, which have limitations with respect to data granularity, sample size and longitudinal information. Here, using objectively measured, longitudinal sleep data from commercial wearable devices linked to electronic health record data from the All of Us Research Program, we show that sleep patterns, including sleep stages, duration and regularity, are associated with chronic disease incidence. Of the 6,785 participants included in this study, 71% were female, 84% self-identified as white and 71% had a college degree; the median age was 50.2 years (interquartile range = 35.7, 61.5) and the median sleep monitoring period was 4.5 years (2.5, 6.5). We found that rapid eye movement sleep and deep sleep were inversely associated with the odds of incident atrial fibrillation and that increased sleep irregularity was associated with increased odds of incident obesity, hyperlipidemia, hypertension, major depressive disorder and generalized anxiety disorder. Moreover, J-shaped associations were observed between average daily sleep duration and hypertension, major depressive disorder and generalized anxiety disorder. These findings show that sleep stages, duration and regularity are all important factors associated with chronic disease development and may inform evidence-based recommendations on healthy sleeping habits.

Reassessing urban park accessibility: an improved two-step floating catchment area method based on the physical activity services perspective

Urban parks, as important carrier of outdoor physical activity, can effectively reduce the incidence of chronic diseases and promote public health. The accessibility of parks directly affects residents’ levels of physical activity. However, current accessibility assessments do not consider physical activity needs into account and are unable to adapt to the current developmental needs of a healthy China. We propose a framework for evaluating park accessibility oriented towards a physical activity service perspective. First, we introduced a park attractiveness index based on physical activity preferences. The index encompasses not only objective park features but also subjective environmental perception features, which are evaluated using deep-learning techniques. Furthermore, the size of the park catchment area was correlated with the park attractiveness index, and the likelihood of park selection based on people's physical activity preferences was computed. Fuzhou City's Gulou District was selected for this case study. The results show the following: (1) Our proposed evaluation model can identify more underserved neighborhoods in scenarios geared toward physical activity requirements than traditional approaches. (2) The distribution of parks in the Gulou District was not sufficiently balanced, with the accessibility value at the 90th percentile only slightly higher than the average value of 6.35. There was obvious spatial differentiation, with a pattern of high values in the central area and low values in the surrounding areas. (3) Approximately 12.70 % of the population is located within service-blind zones and the overall level of accessibility is poor. This study offers novel ideas and approaches for optimizing the spatial layout of urban parks within a health-oriented framework. This aids planners and policymakers in enhancing the spatial layout of parks and ensuring equitable access to urban parks that foster physical activity.

Mendelian randomization analysis revealed that albuminuria is the key factor affecting socioeconomic status in CKD patients

Previous studies indicate a strong correlation between the incidence of chronic kidney disease (CKD) and lower economic status. However, these studies often struggle to delineate a clear cause–effect relationship, leaving healthcare providers uncertain about how to manage kidney disease in a way that improves patients’ financial outcomes. Our study aimed to explore and establish a causal relationship between CKD and socioeconomic status, identifying critical influencing factors. We utilized summary meta-analysis data from the CKDGen Consortium and UK Biobank. Genetic variants identified from these sources served as instrumental variables (IVs) to estimate the association between CKD and socioeconomic status. The presence or absence of CKD, estimated glomerular filtration rate (eGFR), and albuminuria were used as exposures, while income and regional deprivation were analyzed as outcomes. We employed the R packages ‘TwoSampleMR’ and ‘Mendelianrandomization’ to conduct both univariable and multivariable Mendelian randomization (MR) analyses, assessing for potential pleiotropy and heterogeneity. Our univariable MR analysis revealed a significant causal relationship between high levels of albuminuria and lower income (OR = 0.84, 95% CI: 0.73–0.96, p = 0.013), with no significant pleiotropy detected. In the multivariable MR analysis, both CKD (OR = 0.867, 95% CI: 0.786–0.957, p = 0.0045) and eGFR (OR = 0.065, 95% CI: 0.010–0.437, p = 0.0049) exhibited significant effects on income. This study underscores that higher albuminuria levels in CKD patients are associated with decreased income and emphasizes the importance of effective management and treatment of albuminuria in CKD patients to mitigate both social and personal economic burdens.

Pomalidomide Use and Kidney Outcomes in Patients With Relapsed/Refractory Multiple Myeloma and Chronic Kidney Disease: A Real-World, Population-Based Cohort Study

BackgroundPomalidomide-based regimens are the cornerstone of treatment for relapsed/refractory MM (RRMM). Despite the high incidence of chronic kidney disease (CKD) in RRMM, individuals with advanced CKD have been excluded from phase II/III RCTs, creating a gap in our understanding of the effects of pomalidomide use in patients with RRMM complicated with advanced CKD. We undertook a cohort to study to understand the efficacy safety of pomalidomide-based regimens among patients with CKD using real-world data. MethodsPopulation-based, cohort study of patients ≥ 18 years with RRMM treated with pomalidomide in Ontario, Canada. Primary outcome was all-cause mortality. Secondary outcomes were time-to-major adverse kidney events (MAKE), time-to-next treatment, kidney response and safety. ResultsTotal 748 patients with RRMM utilizing pomalidomide were included; 440 had preserved kidney function, 210 had moderate CKD (eGFR 30-59 mL/min/1.73m2), and 98 had advanced CKD (eGFR < 30 mL/min/1.73m2). Mean age was 70.2 years, 43.3% were women. Patients with advanced CKD had a higher risk of all-cause mortality compared to the preserved kidney function group (aHR 1.37, 95% CI 1.06, 1.78). MAKE was higher in advanced CKD (aHR 1.70, 95% CI 1.03, 2.35). Kidney response was similar between moderate and severe CKD groups (aOR 1.04, 95%, CI 0.56-1.90). Safety outcomes were similar between groups. ConclusionsPatients with advanced CKD and RRMM on pomalidomide-based regimens exhibited reduced survival and a higher risk for MAKE. However, the probability of experiencing some degree of kidney recovery is 50% in both moderate and severe CKD, with comparable safety outcomes.

Olive Oil Consumption, Risk Factors, and Diseases: An Umbrella Review.

Olive oil is a vegetable oil that provides health benefits, including a reduction in free radicals and total cholesterol and prevention of chronic diseases. The escalating incidence of chronic diseases presents a substantial challenge to public health, prompting numerous studies to assess these health-related effects. Despite several systematic reviews and meta-analyses summarizing the association between olive oil consumption and specific health outcomes, there is no summary of the accumulated evidence from these reviews. This umbrella review summarizes the evidence on olive oil consumption or intervention in adults and its association with multiple risk factors and diseases. We retrieved systematic reviews of randomized trials or observational studies on oral interventions or the consumption of olive oil. The systematic search encompassed databases including MEDLINE, Embase, Scopus, Web of Science, LILACS, and CENTRAL from inception to February 6, 2023. Two independent reviewers conducted data extraction and assessed methodological quality using the Joanna Briggs Institute tool. Overall, 17 systematic reviews of randomized trials and observational studies, covering outcomes such as cardiovascular diseases, cancer, type 2 diabetes, glucose metabolism, inflammatory and oxidative markers, and all-cause mortality, were included. The evidence suggests a beneficial association between olive oil consumption and cardiovascular diseases, cancer, type 2 diabetes, and all-cause mortality. However, the evidence was less definitive for inflammatory markers, oxidative stress, glucose metabolism, and blood lipid outcomes. Several meta-analyses revealed high heterogeneity and wide confidence intervals, along with a limited number of randomized clinical trials. Given the high heterogeneity and low quality of evidence, further studies involving randomized trials are imperative. Prioritizing an in-depth analysis of specific olive oil components and using a control group with distinct characteristics and different effects is strongly recommended. PROSPERO registration no. CRD42022357290.

Somatic and psychiatric comorbidity in people with diagnosed gambling disorder: A Finnish nation-wide register study.

This is the first nation-wide register study based on a total population sample measuring the gender-specific incidences of chronic diseases and conditions among adults diagnosed with gambling disorder (GD). The study used aggregated data for 2011-22 retrieved from the Register of Primary Health Care visits, Care Register for Health Care and Care Register for Social Welfare, including specialized outpatient and inpatient health care, inpatient social care and institutional care and housing services with 24-hour or part-time assistance, set in mainland Finland. Participants comprised people aged 18-90+ years with GD diagnosis [corresponding to pathological gambling, International Classification of Diseases 10th revision (ICD-10) code F63.0, n = 3605; men n = 2574, women n = 1031]and the general population (n = 4 374 192). Incidences of somatic diseases and psychiatric disorders were calculated for the people with diagnosed GD and for the general population, separately for women and men. After standardizing for age, the incidence of each diagnostic group was systematically higher for people with GD compared with the general population, except for cancer. The highest standardized incidence ratio (SIR) values were for psychiatric disorders [SIR = 234.2; 95% confidence interval (CI) = 226.1-242.4], memory disorders (SIR = 172.1; 95% CI = 119.1-234.8), nervous system diseases (SIR = 162.8; 95% CI = 152.8-173.1), chronic respiratory diseases (SIR = 150.6; 95% CI = 137.6-164.2), diabetes (SIR = 141.4; 95% CI = 127.9-155.5) and digestive diseases (SIR = 134.5; 95% CI = 127.1-142.2). In Finland, the incidence of chronic diseases and conditions among people with gambling disorder is higher compared with the general population, apart from cancer.