Large Population Sample Research Articles

Predicting the Need for Phototherapy After Discharge: Update for 2022 Phototherapy Guidelines.

In 2021, Kuzniewicz et al1 reported that the difference (Δ-total serum bilirubin [TSB]) between last TSB before discharge and the 2004 American Academy of Pediatrics (AAP) phototherapy threshold was an excellent predictor of a postdischarge TSB above the 2004 AAP phototherapy threshold (area under the receiver operating characteristic curve = 0.93). The 2004 AAP hyperbilirubinemia guidelines have since been updated with thresholds for phototherapy that now increase with each week of gestation and are about 1 to 3 mg/dL higher than those from 2004. We sought to quantify how well the predischarge Δ-TSB predicts a postdischarge TSB exceeding the new 2022 AAP phototherapy thresholds.2This retrospective cohort study used the same cohort as our 2021 publication: 163 930 infants born at ≥35 weeks’ gestation July 1, 2012, to December 31, 2017, at 11 Kaiser Permanente Northern California hospitals employing universal TSB screening with at least 1 predischarge TSB. We excluded 9800 for prolonged hospitalization, 4 for direct hyperbilirubinemia, 476 with a predischarge TSB before 12 hours of age, and 2425 who received phototherapy or had a TSB above the 2022 AAP threshold before discharge from all analyses.For all analyses except those used to calculate inverse-probability of censoring weights, we also excluded 4546 infants who, after discharge, received phototherapy before having a TSB above the 2022 AAP threshold. Thus, the final cohort included 146 679 infants. The Kaiser Permanente Northern California institutional review board approved the study (CN-17-3051 01).Our primary predictor was Δ-TSB, defined as the difference between the 2022 AAP phototherapy threshold (for infants of the same age, gestational age and direct antiglobulin test result) and the last inpatient TSB level. (Note in our previous article, our definition was the negative of the above: the TSB minus the threshold.) We created a 5-category Δ-TSB variable to match the AAP 2022 follow-up guideline, as well as an 8-category Δ-TSB variable. We did not have data on transcutaneous bilirubin levels.Our outcomes were a TSB level above the 2022 AAP phototherapy threshold at <24 hours, <48 hours or <30 days from the predischarge TSB. We used linear interpolation to estimate the time that the TSB crossed the phototherapy thresholds.To avoid bias from censoring those who received phototherapy before exceeding the threshold (“subthreshold phototherapy”), we used inverse probability of (non)censoring weights.3 We created models for the probability P of receiving subthreshold phototherapy, based on data available at the time of discharge. We then excluded those infants who had received subthreshold phototherapy and weighted the remaining observations by 1/(1-P) after replacing weights above the 99th percentile with 99th percentile weights.Results by either in 1-mg/dL categories of Δ-TSB or in the 5 categories used in the 2022 guideline (0–<2; 2–<3.5; 3.5–<7; or ≥7 mg/dL) were consistent with those previously reported,1 showing excellent prediction and discrimination (Table 1). Eighty-four percent of the infants had Δ-TSB ≥5.5 mg/dL, with a risk of crossing the phototherapy threshold ≤0.3% (Table 1).We have documented that a single number available at the time of hospital discharge, the Δ-TSB, was a strong predictor of the probability of exceeding the AAP's 2022 phototherapy threshold. The maintenance of discrimination with the higher thresholds is not surprising: Although the slightly raised phototherapy thresholds reduced the risk of the outcome, for an infant with the same TSB level, the Δ-TSB would also be slightly increased, thereby reflecting that lower risk.The excellent discrimination we observed (area under the receiver operating characteristic curve ≥0.93) is largely a result of 84% of the infants having a Δ-TSB that correctly identified them as being at very low risk.Strengths of this study include the large sample size and population with near universal TSB screening. As previously described,1 prediction could be improved by including additional variables, including the most recent rate of rise, formula feeding, age, and gestational age. Nonetheless, our results suggest that a single number, the Δ-TSB divided into 5 categories, provides considerable prognostic information. This supports its use in the 2022 AAP guideline, which provides explicit follow-up recommendations based upon the Δ-TSB in 5 categories.

Age-specific random day serum antimüllerian hormone reference values for women of reproductive age in the general population: a large Chinese nationwide population-based survey

Antimüllerian hormone, the most reliable biomarker of ovarian reserve, is widely used in various clinical situations. Antimüllerian hormone levels consistently decrease with age. However, there is no standard, age-specific reference values for antimüllerian hormone in women of reproductive age, which limits its application. This study aimed to establish age-specific antimüllerian hormone percentile reference values for women of reproductive age. A nationwide, population-based cross-sectional survey was conducted between May 2019 and April 2021 in 15 provinces and municipalities in mainland China. A total of 10,053 eligible women aged 20 to 49 years were selected using a multistage stratified sampling procedure. Women who were pregnant, had undergone ovarian surgery, took hormone drugs in the past 3 months, or had an antimüllerian hormone outlier value were excluded from establishing antimüllerian hormone percentile reference values. Serum antimüllerian hormone concentrations were measured using ultrasensitive, 2-site enzyme-linked immunosorbent assays (Ansh Lab, Webster, TX) in the Reproductive Endocrinology Laboratory of Peking University Third Hospital. Generalized additive models for location scale and shape with the Box-Cox t original distribution were used to estimate the fitted antimüllerian hormone percentile reference values. A total of 9112 eligible women aged 21 to 49 years were included in the fitting model. The fitted 50th (2.5th-97.5th) percentiles of antimüllerian hormone values for women aged 21, 25, 30, 35, 40, 45, and 49 years were 4.83 (0.79-18.41), 4.47 (0.72-16.58), 3.67 (0.50-13.82), 2.59 (0.24-10.35), 1.35 (0.05-6.68), 0.33 (<0.01 to 3.40), and 0.04 (<0.01 to 1.77) ng/mL, respectively. The population-based decline rate of antimüllerian hormone accelerated with increasing age, especially age >35 years. The magnitude of the decline of the 25th antimüllerian hormone percentile curve was greater than that of the 75th percentile curve. This study established age-specific antimüllerian hormone percentile reference values for women of reproductive age based on a large representative sample of the general population and described antimüllerian hormone changes. These findings may facilitate antimüllerian hormone application in clinical practices.

Efficacy of attention bias modification via smartphones in a large population sample.

Negative affective biases are a key feature of anxiety and depression that uphold and promote negative mood. Bias modification aims to reduce these biases using computerized training, but shows mixed success and has not been tested at scale. The aim was to determine whether bias modification delivered via smartphones can improve mood in a large sample. In total, 153 385 self-referring participants were randomly assigned to modification or sham bias training on a dot-probe or visual-search task. The primary outcome of interest was balance of mood, assessed on the Positive and Negative Affect Schedule. In total, 22 933 participants who provided at least two mood ratings were included in analyses. There was a large amount of participant attrition. In the remaining smaller sample, results supported the prediction that visual-search modification would result in improved mood (95%CI [0.10, 0.82]; p = 0.01, d = 0.05, N = 2588 after two ratings; 95%CI [1.75,6.54]; p = 0.001, d = 0.32, N = 118 after six ratings), which was not seen for the sham version (N = 4818 after two ratings; N = 138 after six ratings). Dot-probe modification was not associated with mood improvements (p = 0.52). Visual-search, but not dot-probe, bias modification slightly but significantly improved mood. Although this effect size is very small and subject to large participant drop-off, it might be worth considering an adjunct to current treatments.

Analysis of Non-Invasive Fingerprint Thickness Based Authentication Method Utilizing Near Infrared Spectroscopy

Fingerprints are a popular method of biometric based authentication. However, methods currently in use are susceptible to being bypass through the use of forgeries of the fingerprint pattern. Measuring the epidermal thickness of the fingerprint is a solution to the issue, as there are no current ways for a third-party to precisely replicate the thickness measurements. Near-Infrared Diffused Reflectance (NIR-DR) spectroscopy is the proposed method of measuring fingerprint thickness. Reflectance reading is taken at 5 specific wavelength points to generate a simplified plot for comparison. Thickness measurement is gauged by calculationg change in reflectance percentage between the 800-900nm range. Data gathered showed variation in the reflectance spectra that was unique to each subject. Application for a fingerprint thickness-based authentication method is plausible but require additional research with a larger population sample and looking into the effects of age and skin colour for their effect on epidermal thickness.

Epigenetics as a Biomarker for Early-Life Environmental Exposure.

There is interest in evaluating the developmental origins of health and disease (DOHaD) which emphasizes the role of prenatal and early-life environments on non-communicable health outcomes throughout the life course. The ability to rigorously assess and identify early-life risk factors for later health outcomes, including those with childhood onset, in large population samples is often limited due to measurement challenges such as impractical costs associated with prospective studies with a long follow-up duration, short half-lives for some environmental toxicants, and lack of biomarkers that capture inter-individual differences in biologic response to external environments. Epigenomic patterns, and DNA methylation in particular, have emerged as a potential objective biomarker to address some of these study design and exposure measurement challenges. In this article, we summarize the literature to date on epigenetic changes associated with specific prenatal and early-life exposure domains as well as exposure mixtures in human observational studies and their biomarker potential. Additionally, we highlight evidence for other types of epigenetic patterns to serve as exposure biomarkers. Evidence strongly supports epigenomic biomarkers of exposure that are detectable across the lifespan and across a range of exposure domains. Current and future areas of research in this field seek to expand these lines of evidence to other environmental exposures, to determine their specificity, and to develop predictive algorithms and methylation scores that can be used to evaluate early-life risk factors for health outcomes across the life span.

Parallel exploratory and confirmatory factor analysis of the Hungarian Fear of COVID-19 Scale in a large general population sample: a psychometric and dimensionality evaluation

BackgroundThis study aims to confirm validity and reliability of the Hungarian version of Fear of COVID-19 Scale (FCV-19S) and evaluate its dimensional structure.MethodsCross-sectional survey was carried out in 2021 among Hungarian general population. In addition to classical test theory methods, construct dimensionality of FCV-19S was assessed using EFA with principal axis factoring method and CFA with diagonally-weighted least squares estimation. Fear score was compared in age, gender, educational level, vaccination and infection subgroups.ResultsSignificant differences in FCV-19S mean scores were observed between three subgroups (age, gender, vaccination). Items showed good internal consistency (Cronbach α = 0.88). EFA identified two latent factors (eig = 4.2 and 1.02), though parallel analysis supports the one-factor model. The two-dimensional structure was confirmed by CFA, items 3,4,6,7 correlated with Factor 1 (physiological fear), items 1,2,5 with Factor 2 (emotional fear).ConclusionThe Hungarian version of FCV-19S seems valid and reliable. The EFA identified two-latent factors (emotional and physiological fear), that was confirmed by CFA. The two-factor structure had better model fit, though its’ acceptance is limited.

Antipsychotics for schizophrenia spectrum disorders with catatonic symptoms.

Antipsychotics for schizophrenia spectrum disorders with catatonic symptoms.

Social norms, sanctions, and conditional entry in markets with externalities: Evidence from an artefactual field experiment

In an artefactual field experiment with a large and heterogeneous population sample, we test the implications of social norms for market interactions associated with negative real-world externalities. We run large stylized markets in which sellers and buyers decide whether to enter the market and how much to bid for experimental coupons. Trading leads to profits for sellers and buyers but at the same time destroys donations for a good cause.Calculated over all our treatments, we observe that two-thirds of the participants refuse to trade. Eliciting a controlled measure for conditional moral behavior in one treatment, we find that roughly a quarter of potential traders make their decisions contingent on the decisions of others, indicating that the desire to conform to social norms affects trading decisions in markets with negative externalities. If observers can sanction traders, we find that more than 80% of them are willing to incur personal costs to sanction trading, thus enforcing a social norm for moral behavior.

Maltese Allelic Variants in Corneal Dystrophy Genes in a Worldwide Setting.

This study aimed to establish which worldwide population cohorts have a genetic make-up closest to that of a large sample of the Maltese population with regard to corneal dystrophy (CD) genes. Single nucleotide polymorphisms (SNPs) in the Maltese cohort were compared with worldwide cohorts. Fixation index(FST) values were calculated to evaluate population differentiation. The genetic prevalence of CD subtypes in worldwide and Maltese cohorts were calculated, and single nucleotide missense mutations present in the Maltese cohort were evaluated for potential pathogenicity. FST values showed that CD-related genes differ substantially among the studied cohorts. FST values for each SNP showed greatest differentiation between the Maltese and African cohorts and least differentiation with the Puerto Rican, Mexican, and Colombian cohorts. One TGFBI casual CD mutation, 502V, which causes a Bowman's layer CD/atypical Thiel-Behnke CD was identified in the Maltese cohort. The KRT3 NC_000012.11:g.53186088G>C mutation was potentially deleterious. Identifying populations with least genetic differentiation can facilitate and help guide future diagnostic and treatment strategies for Maltese individuals with CDs in the absence of comparable Maltese data. Analysing the previously unknown CD genetic pool present in a large Maltese cohort adds to the global genetic bank that researchers rely on for medical progress.

The short term safety of COVID-19 vaccines in Australia: AusVaxSafety active surveillance, February - August 2021.

Objective:To assess the short term safety of the COVID‐19 vaccines Comirnaty (Pfizer–BioNTech BNT162b2) and Vaxzevria (AstraZeneca ChAdOx1) in Australia.Design:Prospective observational cohort study; online surveys by AusVaxSafety, a national active vaccine safety surveillance system, three and eight days after vaccination.Setting, participants:People aged 16 years or more who received COVID‐19 vaccines at sentinel vaccination hubs, general practices, or Aboriginal Community Controlled Health Organisation clinics, 22 February – 30 August 2021.Main outcome measures:Primary outcome: proportion of respondents who reported any adverse event following immunisation (AEFI) 0–3 days after vaccination. Secondary outcomes: proportions of respondents who reported specific adverse events or medical review for AEFI within seven days of vaccination; impact on usual daily activities; recovery.Results:4 851 480 people received COVID‐19 vaccines at participating sentinel sites during the study period (25% of all COVID‐19 vaccine doses administered in Australia to 30 August 2021). 3 035 983 people responded to both surveys (response rate, 62.6%); 35.9% of respondents reported one or more AEFI 0–3 days after Comirnaty dose 1, 54.7% after Comirnaty dose 2, 52.8% after Vaxzevria dose 1, and 22.0% after Vaxzevria dose 2. Local pain, fatigue, headache, and myalgia were the most frequently reported symptoms. After adjusting for demographic characteristics, vaccination site type, jurisdiction, and self‐reported medical conditions, the odds of reporting any AEFI were higher for women than men (range of adjusted odd ratios [aORs], by vaccine and dose, 1.53–1.84), for people with a history of anaphylaxis (aOR range, 1.28–1.45), and for people reporting certain underlying conditions, including obesity (aOR range, 1.15–1.75), immunodeficiency (aOR range, 1.04–2.24), or chronic inflammatory disease (aOR range, 1.05–1.75). 0.9% of respondents sought medical advice in the three days following vaccination, most frequently after Comirnaty dose 2 (1.4%) and Vaxzevria dose 1 (1.2%).Conclusion:AusVaxSafety active surveillance affirms the short term safety profile of Comirnaty and Vaxzevria vaccines in a large population sample during the first six months of the Australian COVID‐19 vaccination program.

Changes in Expression of DNA-Methyltransferase and Cannabinoid Receptor mRNAs in Blood Lymphocytes After Acute Cannabis Smoking.

BackgroundCannabis use is a component risk factor for the manifestation of schizophrenia. The biological effects of cannabis include effects on epigenetic systems, immunological parameters, in addition to changes in cannabinoid receptors 1 and 2, that may be associated with this risk. However, there has been limited study of the effects of smoked cannabis on these biological effects in human peripheral blood cells. We analyzed the effects of two concentrations of tetrahydrocannabinol (THC) vs. placebo in lymphocytes of a subset of participants who enrolled in a double-blind study of the effects of cannabis on driving performance (outcome not the focus of this study).MethodsTwenty four participants who regularly use cannabis participated in an experiment in which they smoked cannabis cigarettes (5.9 or 13.4% THC) or placebo (0.02%) ad libitum. Blood samples were drawn at baseline and several times after smoking. Lymphocytes were separated and stored at –80°C for further analysis. Samples were analyzed for mRNA content for cannabinoid receptors 1 (CB1) and 2 (CB2), methylation and demethylating enzymes (DNMT, TET), glucocorticoid receptor (NRC3) and immunological markers (IL1B, TNFα) by qPCR using TaqMan probes. The results were correlated with THC whole blood levels during the course of the day, as well as THCCOOH baseline levels. Statistical analyses used analysis of variance and covariance and t-tests, or non-parametric equivalents for those values which were not normally distributed.ResultsThere were no differences in background baseline characteristics of the participants except that the higher concentration THC group was older than the low concentration and placebo groups, and the low concentration THC group had higher baseline CB2 mRNA levels. Both the 5.9 and 13.4% THC groups showed increased THC blood levels that then decreased toward baseline within the first hour. However, there were no significant differences between THC blood levels between the 5.9 and 13.4% groups at any time point. At the 4-h time point after drug administration the 13.4% THC group had higher CB2 (P = 0.021) and DNMT3A (P = 0.027) mRNA levels than the placebo group. DNMT1 mRNA levels showed a trend in the same direction (P = 0.056). The higher 13.4% THC group had significantly increased CB2 mRNA levels than the 5.9% concentration group at several post drug administration time points and showed trends for difference in effects for between 5.9 and 13.4% THC groups for other mRNAs. TET3 mRNA levels were higher in the 13.4% THC group at 55 min post-cannabis ingestion. When the high and lower concentration THC groups were combined, none of the differences in mRNA levels from placebo remained statistically significant. Changes in THC blood levels were not related to changes in mRNA levels.ConclusionOver the time course of this study, CB2 mRNA increased in blood lymphocytes in the high concentration THC group but were not accompanied by changes in immunological markers. The changes in DNMT and TET mRNAs suggest potential epigenetic effects of THC in human lymphocytes. Increases in DNMT methylating enzymes have been linked to some of the pathophysiological processes in schizophrenia and, therefore, should be further explored in a larger sample population, as one of the potential mechanisms linking cannabis use as a trigger for schizophrenia in vulnerable individuals. Since the two THC groups did not differ in post-smoking blood THC concentrations, the relationship between lymphocytic changes and the THC content of the cigarettes remains to be determined.

Study of the helminth fauna in eagle owl (Bubo bubo) in the south of Spain.

In this study we show the results of the eagle owls’ (Bubo bubo) helminthfauna found in Andalusia. A total number of 50 specimens have been analysed in a period of 10 years (from 2011 to 2020). Prevalence (), mean intensity (IM) and mean abundance (AM) of parasitation have been obtained. The percentage of parasitation in the total sample was 80% (40 out of 50 eagle owls): 78% nematodes, 8% trematodes, 6% cestodes and 4% acantocephalans. 7 species of helminths were identified: 6 nematodes, and 1 trematode. In the case of cestodes and acantocephalans it was not possible to determine species and only the genus was identified.The intestinal nematode Capillaria tenuissima ( = 58% (44–71.2); IM = 11,52 (5.83–28.9)) was the core species whereas Synhimantus laticeps (P% = 16 (7.5–28.8); IM = 4 (1.75–7.25)) and Hartertia hispanica (P% = 16 (7.5–28.8); IM = 1,5 (1–2)) were the secondary species. The remainder species were considered satellite species, with low prevalence and average abundance. Likewise, descriptive parameters of the helminth community were determined: species richness, 1.56 (1.29–1.94), total abundance, 12 (7.24–26.40), Brillouin's diversity index, 0.18 (0.10–0.29) and Berger-Parker dominance index, 0.88 (0.81–0.93).The data from this study show a non-diverse helminthic community, without species dominance with C. tenuissima as the central species, followed by S. laticeps and H. hispanica as secondary species. Worth mentioning is the presence of H. hispanica, which is considered an endemic species in Spain and specifically in Andalusia.To the authors’ knowledge, this is the largest population sample taken in parasitological studies about helminths of this raptor in Europe and the first one carried out in the south of Spain (Andalusia).

Differentiating Fissure‐Fed Lava Flow Types and Facies Using RADAR and LiDAR: An Example From the 2014–2015 Holuhraun Lava Flow‐Field

Distinguishing between lava types and facies using remote sensing data is important for interpreting the emplacement history of lava flow-fields on Earth and other planetary bodies. Lava facies typically include a mixture of lava types and record the collective emplacement history of material preserved at a particular location. We seek to determine if lava facies in the 2014–2015 Holuhraun lava flow-field are discernable using radar roughness analysis. Furthermore, we also seek to distinguish between lava types using high resolution Light Detection and Ranging (LiDAR) data. We extracted circular polarization ratios (CPR) from the Uninhabited Aerial Vehicle Synthetic Aperture Radar and cross-polarization (VH/VV) data from the Sentinel-1 satellite to analyze the surface roughness of three previously mapped lava facies: rubbly, spiny, and undifferentiated rubbly–spiny. Using the Kruskal-Wallis test, we reveal that all but one pair of the facies are statistically separable. However, the populations overlap by 88–89% for CPR and 64–67% for VH/VV. Therefore, owing to large sample populations (n > 2 × 105), slight differences in radar data may be used to probabilistically infer the presence of a particular facies, but not directly map them. We also calculated the root-mean-square slope and Hurst exponents of five different lava types using LiDAR topography (5 cm/pixel). Our results show minute differences between most of the lava types, with the exception of the rubbly pāhoehoe, which is discernable at 1σ. In brief, the presence of “transitional” lava types (e.g., rubbly pāhoehoe) within fissure-fed lava flow-fields complicates remote sensing-based mapping.

Physiological and Immunological Assessment in Infertile Women Undergoing In-vitro Fertilization

All the available reports on the issue of infertility confirmed the increase in this population problem worldwide. Although the accurate estimate of the number of infertile people is due to several reasons, including the discrepancy in the true definition of infertility (whether it extends for one, two or five years of failed pregnancy attempts), as well as the great discrepancy in the size of the selected population groups (large population sample size versus epidemiological studies) and defining the category that diagnosed included (individuals, women, or couples). The goal of today’s IVF program is to obtain high-quality embryos with high efficiency in development, which leads to an increase in live birth rates.

Repeated neurofilament light chain measurements did not capture Riluzole therapeutic effect in amyotrophic lateral sclerosis patients.

BackgroundLittle is known about the influence of Riluzole on serum neurofilament light chain (sNfL) levels, a biomarker of prognosis in amyotrophic lateral sclerosis (ALS), and variations with time of sNfL concentrations are controversial.MethodsSera from ALS patients (n = 141) and controls (n = 33) were collected at inclusion (sNfL1) and second visit (sNfL2, mean delay 10.4 ± 8.7 months). sNfL levels, determined by single‐molecule array, were compared between ALS and controls at both time points. sNfL concentration changes were compared between patients with Riluzole (w/Ril) at inclusion in the study and those who were treated by Riluzole following inclusion (w/o Ril). The factors influencing sNfL concentrations and changes were studied using linear regression and multivariate analysis.ResultssNfL levels were higher in ALS patients than in controls at the two time points (p < 0.00001). In ALS patients, sNfL concentrations were higher in females for both sNfL1 (p = 0.014) and sNfL2 (p < 0.001). In the whole ALS group, sNfL levels were higher at sNfL2 than at sNfL1 (p < 0.001). sNfL1 and sNfL2 concentrations were similar between the two ALS subgroups (w/ and w/o Ril). ALS functional rating scale‐revised rate of decline and gender were the two main factors significantly influencing both sNfL1 and sNfL2 levels (p < 0.01). However, only gender was shown to significantly influence sNfL changes with time (p = 0.003).ConclusionsIn this study, sNfL levels increased with time in ALS patients and there was no difference between subjects already treated by Riluzole and those treated after sNfL1. Further studies with larger population samples and different sampling intervals are warranted to better determine the real potential of sNfL measurement as a tool to monitor treatment response in ALS.

Predictors of Crosscutting Patterns of Psychological Health and Family Maltreatment.

Psychological problems and family maltreatment are significant public health problems. Although research focuses almost exclusively on either individual psychological problems or family maltreatment, there is substantial co-occurrence of these problems. Similarly, intervention services are often "siloed": individuals with mental health needs are referred for mental health services, individuals with family conflict are referred for family-based treatment, etc. These treatment "silos" may miss the larger picture of the co-occurrence of risk, promotion, and the problems themselves. In a previous paper, we used latent class analysis to identify subgroups of individuals with crosscutting patterns (i.e., classes) of psychological and family maltreatment problems. In this study, we explored the predictors of these latent classes. Participants consisted of two large population samples of U.S. Air Force active duty members (ns = 27,895 and 30,841) who were married or cohabiting and had one or more children living in their household. Participants completed an anonymous community assessment survey, which included questionnaire items tapping personal, family, and community problems and well-being. Assessments were conducted in 2008 and 2011. All study procedures were approved by the authors' Institutional Review Board. We used exploratory factor analysis and latent class analysis to (1) identify higher-order factors of risk and promotive variables and (2) examine them as predictors of our previously identified latent classes. Findings indicated that individuals who reported better physical well-being as well as personal and family coping, relationship satisfaction, and support were more likely to be in the lowest-risk subgroup. Notably, individuals in the subgroup most at risk for serious violence and suicide, evidencing disinhibitory psychopathology, endorsed lower risk and higher promotive factors than those individuals in other high-risk subgroups who fell along the internalizing/externalizing continuum. These findings reinforce the need for integrated prevention and treatment of psychological and family maltreatment problems. Not only do these problems often co-occur, but their risk and promotive factors also tend to be intertwined. The unique (i.e., not on the continuum of the other five classes) problem profile of participants evidencing disinhibitory psychopathology is matched by a unique risk/promotive factor profile, and they will thus likely require a unique intervention approach.

Adjustable-loop implants are non-inferior to fixed-loop implants for femoral fixation in anterior cruciate ligament reconstruction.

Button implants with an adjustable-loop device (ALD) are often used in anterior cruciate ligament reconstruction (ACLR). Clinical research comparing ALDs with fixed-loop devices (FLD) has mainly been conducted in small patient populations with short follow-up times. To determine whether ALDs are safe to use in ACLR, a non-inferiority study with a large sample population and a long follow-up period would be beneficial. This study compared ALDs with FLDs to determine non-inferior revision surgery rates, knee stability, and patient-reported outcomes (PROM) in ACLRs. This non-inferiority register-based cohort study was conducted using data from the Danish Knee Ligament Reconstruction Registry (DKRR). A total of 12,723 patients > 15years of age with primary ACLR using hamstring tendon autografts and either an FLD or ALD for femoral fixation were included: 9719 patients were in the FLD group, and 3014 patients were in the ALD group. The primary outcome was revision ACLR with a non-inferiority margin for ALDs at 4% at the 2-year follow-up. The secondary outcomes were anterior and rotatory knee stability and PROMs based on the Knee Injury and Osteoarthritis Outcome Score (KOOS) at the 1-year follow-up. The crude cumulative revision rates in ALD implants at 2 and 5 years were 2.1% (95% CI 1.62-2.68) and 5.0% (95% CI 4.22-5.96), respectively. In the FLD group, the rates were 2.2% (95% CI 1.89-2.48) at 2 years and 4.7% (95% CI 4.31-5.20) at 5 years. The 1-year side-to-side differences were 0.97mm (95% CI 0.90-1.03) in the ALD group and 1.45mm (95% CI 1.41-1.49) in the FLD group. In the FLD group, 13% had a positive pivot shift, and in the ALD group, 6% had a positive pivot shift. There were no differences in KOOS. ALDs were non-inferior to FLDs regarding revision rates, knee stability, and patient-reported outcomes. Based on this conclusion, ALDs are safe to use for femoral fixation in ACLR. III.

P1181: REAL-WORLD CHARACTERISTICS AND CLINICAL OUTCOMES IN RELAPSE/REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA POST CAR-T FAILURE

Background: Progressive disease following chimeric antigen receptor T-cell (CAR-T) therapy for diffuse large B-cell lymphomas (DLBCL) is a common scenario. There are limited treatment options after CAR-T failure with a poor prognosis for patients at this stage in their disease. The effectiveness of existing treatment options following CAR-T failure is still being investigated in the real-world setting. Aims: To further understand the clinical outcomes of CAR-T failure in relapse/refractory (RR) DLBCL patients in the real-world setting. Methods: This retrospective analysis identified adult patients diagnosed with RR-DLBCL [01/01/2014 – 03/31/2021] who received CAR-T therapy and experienced a subsequent disease progression or death. COTA’s Real World Evidence (RWE) database is comprised of longitudinal, HIPAA-compliant data abstracted from electronic health records (EHR) from over 200 sites of care in US (60% academic, 40% community). The first post CAR-T therapy was categorized as checkpoint inhibitor +/- other therapies (CPI), investigational therapies, tafasitamab +/- lenalidomide, polatuzumab-containing regimen (pola-containing), lenalidomide +/- anti-CD20, BTK inhibitors (BTKi), chemotherapy/chemoimmunotherapy (CT/CIT), allogenic stem-cell transplant (allo-SCT), or anti-CD20 monoclonal antibody. Overall response rate (ORR), complete response (CR), and overall survival (OS) were reported for treatment groups with at least 5 patients. Results: Of the 97 CAR-T patients identified, 57 (59%) patients failed CAR-T therapy due to receiving subsequent line of therapy, having documented progression event, or death. Patients who failed CAR-T were 67% male and on average 59 years old. Within a median follow-up of 12.4mo, 44 (77%) initiated further therapy whereby 7 (16%) initiated investigational therapies, 9 (20%) CPI, 7 (16%) tafasitamab +/- lenalidomide, 6 (14%) pola-containing, 5 (11%) lenalidomide +/- anti-CD20, 3 (7%) CT/CIT, 3 (7%) anti-CD20 monoclonal antibody, 2 (5%) BTKi, and 2 (5%) allo-SCT as their first post CAR-T therapy. Of these patients, 48% received more than two lines of therapies after CAR-T. Response rates of select first therapies received after CAR-T are detailed in Table 1. Outside clinical trials, ORR and CRs were highest for lenalidomide +/- anti CD20 (60% & 20%), followed by CPI (33% & 0%), pola-containing (33% & 0%) and tafasitamab +/- lenalidomide (14% & 0%). OS of first post CAR-T therapy was highest for lenalidomide+/- anti CD20 (12.5 mo), then CPI (11 mo), pola-containing therapy (6.37 mo), and tafasitamab +/- lenalidomide (2.7 mo). Image:Summary/Conclusion: There is no existing standard of care after patients fail CAR-T therapy. Although further research is warranted in a larger sample population, poor clinical outcomes in treatment response and longevity were observed with existing treatment options. There is still a high unmet need for more effective therapies after CAR T-cell therapy has failed.

ISU DAN TANTANGAN DALAM PENGIMPLEMENTASIAN PROGRAM JAMINAN KESEHATAN DI INDONESIA

There is evidence that the existence of Universal Health Insurance Coverage could increase household welfare, particularly, in their consumption. However, there is disagreement in the discussion of this topic. This study examines whether the Universal Health Insurance program in Indonesia could increase household consumption among self-employed citizens. Using household panel datasets about household consumption, household characteristics, and community characteristics for a large sample of Indonesian population over period 1995-2015, we find that the participation in this program has positive impact on household consumption. This paper divides the data into four waves, consisting of five consecutive years each. By using IV we found that the estimation is relatively stable in every wave, except in the periods between 2010-2015, when new participants in the programs suddenly jumped significantly.

Association between anemia and depression: The 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey

BackgroundSeveral studies have reported an association between anemia and depression. However, whether anemia is independently associated with depression remains controversial. The current study aimed to investigate the association between anemia and depression according to sex in a large national sample population. MethodsData from the 2014, 2016, and 2018 Korean National Health and Nutrition Examination Survey were analyzed, and 15,472 participants were included in this study. Anemia was defined as a hemoglobin level <13 g/dL in men and <12 g/dL in women. We defined a Patient Health Questionnaire-9 score ≥10 as depression and ≥5 as mild depressive symptoms. ResultsThe prevalence of depression was significantly higher in women with anemia than in women without anemia (8.9 % vs. 7.0 %, P = 0.036). In women, anemia was significantly associated with depression after adjusting all covariates in multilevel logistic regression analysis (odds ratio, 1.37; 95 % confidence interval, 1.08–1.75; P = 0.011). However, no significant association was observed in men. LimitationsThere is a limit to explaining the causal direction, and several factors may not have been considered as confounders. Also, patients with severe diseases were excluded from data acquisition. A structured diagnostic interview, other than the self-report method, was not conducted. ConclusionsThe findings of this study suggest that anemia is associated with depression in women but not in men. A decrease in tissue oxygenation, deterioration of physical performance due to anemia, and altered monoamine synthesis due to malnutrition may have an effect on depression.