Large Association Research Articles

Application of Regression model in Analyzing Carbon Emission Reduction Effect of Digital Economy Development: Evidence from China

This study examines how consumers' psychological requirements influence their purchase intention for new energy vehicles (NEVs). It seeks to determine how exogenous latent variables influence consumers' purchase intentions for NEVs in Guangzhou, China. Understanding these elements is important because they can help drive NEV manufacturers' marketing strategies and product development. To investigate the key factors influencing NEVs purchase intention, the study adopts the Stimulus-Organism-Response (SOR) model, which is combined with the Technology Acceptance Model (TAM) and Customer Perceived Value (CPV) theory. A questionnaire study was administered to Guangzhou residents to gather information about their perceptions of NEVs, such as perceived ease of use, perceived usefulness, perceived product quality, perceived service quality, and considered value of test drives. Structural Equation Modeling (SEM) was used to test the hypotheses and investigate the variables' direct and indirect impacts on purchase intention. The results show that the perceived ease of use had the greatest overall influence on NEVs purchase intentions, followed by perceived product quality, perceived usefulness, and perceived value of test drives. Perceived service quality, while significant, has a relatively little impact. Notably, women are more influenced by perceived ease of use and product quality perception, whereas men's purchase intention is primarily influenced by perceived service quality. Educational levels also have an impact, with highly educated people having a larger association between purchase intention and perceived ease of use. The direct effect of perceived usefulness on purchase intention has also been validated, emphasizing the importance of customers perceiving NEVs as valuable and useful. This study verifies the SOR model's usefulness in assessing purchase intentions for NEVs and demonstrates the important influence of customer psychological needs on purchasing decisions. The study makes specific strategic recommendations to NEV makers and marketers by identifying perceived ease of use, perceived product quality, and perceived usefulness as important factors of purchase intention. These include optimizing product design for ease of use, improving service quality, and promoting the value and use of NEVs through marketing initiatives. Overall, this study contributes to a better understanding of customer perceptions about NEVs and provides recommendations for increasing their acceptance in the Guangzhou market and elsewhere.

Utility of Parent and Teacher Behavior Ratings for Self-Regulatory Outcomes of Preschool Children: A Multi-Study Examination.

Despite frequent reliance on teacher and parent ratings of children's behavior for multi-informant assessment, agreement between teachers' and parents' ratings is low. This study examined the predictive utility of teacher and parent ratings for children's self-regulatory outcomes (i.e., executive function, continuous performance task) in four studies. Study 1 included 163 children ranging from 31 to 84 months of age (M = 55.58 months, SD = 8.43). Study 2 included 1,088 children ranging from 48 to 63 months of age (M = 55.15, SD = 3.65). Study 3 included 246 bilingual Spanish-speaking children ranging from 40 to 72 months of age (M = 56.66, SD = 6.06). Study 4 included 280 children ranging from 38 to 75 months of age (M = 55.92, SD = 4.16). Across studies, parents and teachers rated children's externalizing behaviors on the Conners' Rating Scale, the Strength and Weaknesses of ADHD-Symptoms and Normal Behavior Scale, or both; children completed a variety of performance-based self-regulation tasks. The strength of associations of parent and teacher ratings with self-regulatory outcomes was compared, and regression analyses determined the unique and overlapping variance accounted for by different raters. Teachers' ratings had larger associations with self-regulation than did parents' ratings across outcomes and studies-except for two instances in Study 4 where the associations for teachers' and parents' ratings were equal. These findings indicate that teachers supply more useful information than parents, possibly because teachers have better-informed expectations of children's behavior, and they raise questions about the utility of multi-informant assessment, at least with preschool children.

Massive Clusters and OB Associations as Output of Massive Star Formation in Gaia Era

Over the past two decades, our understanding of star formation has undergone a major shift, driven by a wealth of data from infrared, submillimeter and radio surveys. The emerging view depicts star formation as a hierarchical process, which predominantly occurs along filamentary structures in the interstellar medium. These structures span a wide range of spatial scales, ultimately leading to the birth of young stars, which distribute in small groups, clusters and OB associations. Given the inherently complex and dynamic nature of star formation, a comprehensive understanding of these processes can only be achieved by examining their end products—namely, the distribution and properties of young stellar populations. In the Gaia era, the nearby OB associations are now characterised with unprecedented detail, allowing for a robust understanding of their formation histories. Nevertheless, to fully grasp the mechanisms of star formation and its typical scale, it is essential to study the much larger associations, which constitute the backbones of spiral arms. The large catalogues of young open clusters that have emerged from Gaia DR3 offer a valuable resource for investigating star formation on larger spatial scales. While the cluster parameters listed in these catalogues are still subject to many uncertainties and systematic errors, ongoing improvements in data analysis and upcoming Gaia releases promise to enhance the accuracy and reliability of these measurements. This review aims to provide a comprehensive summary of recent advancements and a critical assessment of the datasets available.

Association between cardiovascular health and perceived quality of life in ethnically diverse adults: insights from the Community of Mine study using the American Heart Association's Life's Simple 7.

The association between cardiovascular health (CVH) with perceived quality of life (PQoL) and variations by sex and Hispanic ethnicity is not well understood. This study included 583 participants (42% Hispanic, 56% female, mean age 59years). Linear regression modeled the covariate-adjusted associations between CVH, using the combined 7 components of Life's Simple 7 (LS7; ideal and intermediate, compared to poor), and PQoL (total and physical, social, and cognitive health domains). For individual LS7 components, we assessed effect modification by sex and Hispanic ethnicity. Compared to individuals with poor CVH, those with intermediate (β [95% CI] = 0.22 [0.09, 0.35]) and ideal (β [95% CI] = 0.22 [0.08, 0.36]) CVH had higher overall PQoL. This effect was dominated by the physical PQoL domain. Of LS7 components, ideal body mass index (BMI) (β [95% CI] = 0.17 [0.03, 0.31]) and physical activity (β [95% CI] = 0.26 [0.12, 0.40]) were associated with overall PQoL. Ideal diet (β [95% CI] = 0.32 [0.08, 0.56]) and fasting plasma glucose (β [95% CI] = 0.32 [0.06, 0.58]) were associated with the physical PQoL domain. A higher PQoL score was associated with intermediate BMI in women, and physical PQoL was associated with smoking for women. A BMI*Hispanic interaction resulted in larger associations between intermediate/ideal BMI and physical PQoL in non-Hispanics. Ideal or intermediate CVH health factors and health behaviors were associated with higher PQoL. Sex and ethnicity differences suggest that perceived quality of life is associated with BMI for women and non-Hispanics.

Analyzing dropout intentions in vocational education and training: exploring the nexus between different dimensions of dropout reasons and the different directions of dropout intention

Extensive research has focused on various dimensions of dropout reasons, yet it often overlooks the importance of considering different dropout directions in the analysis. Our cross-sectional study examines the association of factors of six dimensions of dropout reasons (learner, professional, company, school, activity, and context) with four directions of dropout intention (upwards, downwards, horizontal: occupational change, and horizontal: company change). Stepwise regression analyses using dropout intention as a prior inner condition (before actual dropout behavior) with data from 559 industrial and office management trainees in Germany are conducted. Results indicate that the largest association across different directions of dropout intentions is exerted by the trainees’ occupational identity (professional dimension) and the year in training (context dimension). School factors like the use of outdated teaching equipment and learner factors like trainees’ high professional commitment predict upward dropouts, while a low level of trainees’ workplace social involvement (activity dimension) predicts downward dropouts. Company factors like unfavourable working regulations predict occupational change, and a low level of trainees’ functional involvement (activity dimension) predicts company change. Additionally, we confirm the previously found significant associations of activity and professional factors, particularly the cooperation between learning venues (school and training company) and the alignment between training and the desired occupation. The desired occupation predicts dropout intentions in the upward and horizontal direction (occupational change), and a low level of learning venue cooperation predicts the upward, horizontal (company change), and downward directions. To mitigate dropout rates, we recommend that vocational education and training stakeholders adopt preventive strategies by targeting specific directions of dropout intentions and the factors associated with the six dimensions of dropout reasons.

Abstract A048: Association between ambient particulate matter and colorectal cancer incidence: The Multiethnic Cohort Study

Abstract Background: Growing evidence suggests that air pollution may be a risk factor for colorectal cancer (CRC). We examined the association between ambient particulate matter (PM) exposure and CRC risk within the Multiethnic Cohort Study (MEC), representing the first study to include a large sample of racial and ethnic minoritized populations. Methods: The MEC is a prospective study that recruited, from 1993 through 1996, men and women ages 45-75 years largely from five racial and ethnic groups (African American, Japanese American, Latino, Native Hawaiian, and Non-Hispanic White) living in Hawai‘i and California. This study included 98,675 California MEC participants, residing predominately in Los Angeles County. Satellite-based PM2.5 (PM with an aerodynamic diameter <2.5μm) exposures were estimated from a published spatiotemporal model. Kriging interpolation was used to estimate PM10 (PM <10μm) exposures using routine air monitoring data from the US Environmental Protection Agency. Time-varying PM exposures were assessed from time of recruitment through 12/31/2018. Incident invasive CRC cases were identified via linkage with the California Cancer Registry (n=3,217). Cox proportional hazards models were used to examine the association between PM and CRC risk using age as the time metric, with strata defined by age at cohort entry and race and ethnicity, and adjusting for demographic and lifestyle factors. Heterogeneity of the PM-CRC association was assessed by sex, race and ethnicity, and CRC subsite (right colon, left colon, rectum). Results: Risk of CRC increased with PM2.5 (per 10μg/m3 hazard ratio [HR] 1.13, 95% confidence interval [CI] 0.96-1.33) with a larger HR observed among females (HR 1.29, 95% CI 1.03-1.62) than males (HR 0.96, 95% CI 0.76-1.22) (Pheterogeneity=0.24). CRC risk was positively associated with PM2.5 across race and ethnicity (except for African American participants) with the largest HR observed among Latino participants (HR 1.47, 95% CI 1.03-2.08) (Pheterogeneity=0.20). There was no statistically significant heterogeneity of PM2.5 effect by tumor subsite (Pheterogeneity=0.07); although larger HRs were seen for left colon (HR 1.52, 95% CI 1.08- 2.14) and rectal cancers (HR 1.54, 95% CI 1.05-2.25) than right colon cancers (HR 1.09, 95% CI 0.88-1.35). PM10 was not associated with CRC risk (per 10 μg/m3; HR 1.02, 95% CI 0.93-1.22) with no evidence of heterogeneity in associations by sex or race and ethnicity (respective Pheterogeneity 0.75, 0.44). Although HRs for PM10 appeared to differ by CRC subsite (Pheterogeneity=0.03), the 95% CI of these HRs included the null (right HR 0.95, 95% CI 0.84-1.06; left HR 1.13, 95% CI 0.95-1.35; rectal HR 1.18, 95% CI 0.97-1.43). Conclusions: Preliminary findings suggest that PM2.5 exposure is associated with CRC risk with larger associations in females and, possibly, for left colon and rectal cancer. Additional studies are needed to confirm these findings and evaluate the potential biological pathways underlying these associations. Citation Format: Ugonna Ihenacho, Chiuchen Tseng, Jun Wu, Scott Fruin, Timothy V. Larson, Salma Shariff-Marco, Loïc Le Marchand, Daniel O. Stram, Lynne R. Wilkens, Christopher A. Haiman, Beate Ritz, Iona Cheng, Anna H. Wu. Association between ambient particulate matter and colorectal cancer incidence: The Multiethnic Cohort Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A048.

A Census of the β Pic Moving Group and Other Nearby Associations with Gaia* * Based on observations made with the Gaia mission, the Two Micron All Sky Survey, the Wide-field Infrared Survey Explorer, the NASA Infrared Telescope Facility, Cerro Tololo Inter-American Observatory, the Southern Astrophysical Research Telescope, Gemini Observatory, the Spitzer Space Telescope, and the eROSITA instrument on the

I have used the third data release of the Gaia mission to improve the reliability and completeness of membership samples in the β Pic moving group (BPMG) and other nearby associations with ages of 20–50 Myr (Sco Body, Carina, Columba, χ 1 For, Tuc-Hor, IC 2602, IC 2391, NGC 2547). I find that Carina, Columba, and χ 1 For are physically related and coeval, and that Carina is the closest fringe of a much larger association. Similarly, Tuc-Hor and IC 2602 form a coeval population that is spatially and kinematically continuous. Both results agree with hypotheses from Gagné et al. I have used the new catalogs to study the associations in terms of their initial mass functions, X-ray emission, ages, and circumstellar disks. For instance, using the model for Li depletion from Jeffries et al., I have derived an age of 24.7−0.6+0.9 Myr for BPMG, which is similar to estimates from previous studies. In addition, I have used infrared photometry from the Wide-field Infrared Survey Explorer to check for excess emission from circumstellar disks among the members of the associations, which has resulted in a dramatic increase in the number of known disks around M stars at ages of 30–50 Myr and a significant improvement in measurements of excess fractions for those spectral types and ages. Most notably, I find that the W3 excess fraction for M0–M6 initially declines with age to a minimum in BPMG (<0.015), increases to a maximum in Carina/Columba/χ 1 For ( 0.041−0.007+0.009 , 34 Myr), and declines again in the oldest two associations (40–50 Myr). The origin of that peak and the nature of the M dwarf disks at >20 Myr are unclear.

Relationships between ankle blood pressure indices and major adverse cardiovascular events in people with and without type 2 diabetes

BackgroundThe relationship between ankle blood pressure (BP) and cardiovascular disease remains unclear. We examined the relationships between known and new ankle BP indices and major cardiovascular outcomes in people with and without type 2 diabetes.MethodsWe used data from 3 large trials with measurements of ankle systolic BP (SBP), ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). The primary outcome was a composite of cardiovascular mortality, myocardial infarction, hospitalization for heart failure, or stroke. Secondary outcomes included death from cardiovascular causes, total (fatal and non-fatal) myocardial infarction, hospitalization for heart failure, and total stroke.ResultsAmong 42,929 participants (age 65.6 years, females 31.3%, type 2 diabetes 50.1%, 53 countries), the primary outcome occurred in 7230 (16.8%) participants during 5 years of follow-up (19.4% in people with diabetes, 14.3% in those without diabetes). The incidence of the outcome increased with lower ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, multivariable-adjusted hazard ratios (HRs, 95% CI) of the outcome for each lower fourth were 1.05 (0.98–1.12), 1.17 (1.08–1.25), and 1.54 (1.54–1.65) for ankle SBP; HR 1.06 (0.99–1.14), 1.26 (1.17–1.35), and 1.48 (1.38–1.58) for ABI; and HR 1.02 (0.95–1.10), 1.15 (1.07–1.23), and 1.48 (1.38–1.58) for APPD. The largest effect size was noted for ankle SBP (HRs 1.05 [0.90–1.21], 1.21 [1.05–1.40], and 1.93 [1.68–2.22]), and APPD (HRs 1.08 [0.93–1.26], 1.30 [1.12–1.50], and 1.97 [1.72–2.25]) with respect to hospitalization for heart failure, while only a marginal association was observed for stroke. The relationships were similar in people with and without diabetes (all p for interaction > 0.05).ConclusionsInverse and independent associations were observed between ankle BP and cardiovascular events, similarly in people with and without type 2 diabetes. The largest associations were observed for heart failure and the smallest for stroke. Including ankle BP indices in routine clinical assessments may help to identify people at highest risk of cardiovascular outcomes.Graphical abstractAnkle blood pressure indices and incidence of major cardiovascular outcomes. Expanded MACE, a composite of death from cardiovascular causes, myocardial infarction,hospitalization for heart failure, or stroke. BP, blood pressure; CV, cardiovascular; HHF, hospitalization for heart failure; HR, Hazard ratio (for the lowest fourth of blood pressure indice compared to the highest); MACE, major adverse cardiovascular events; MI, myocardial infarction; Total, fatal and non-fatal MI or stroke.

Cutaneous Neurofibromas and Quality of Life in Adults With Neurofibromatosis Type 1

There is a burgeoning interest in therapeutic development for cutaneous neurofibromas (cNFs), a major cause of morbidity in persons with neurofibromatosis type 1 (NF1). To determine meaningful clinical trial outcomes, deeper understanding is needed regarding how cNFs are associated with quality of life (QoL). However, this understanding has been hampered by challenges in recruiting participants with this rare genetic disease. To develop a large, crowdsourced validated registry of persons with NF1 and determine the association of specific cNF features with QoL, pain, and itch. From May 2021 to December 2023, a decentralized platform was developed and recruited persons 40 years or older with NF1 and at least 1 cNF from 49 states and 12 countries, who provided clinical survey data, detailed photographs, and genetic sequencing data. Photographs from 583 participants were scored on 12 features of cNFs, including general severity, number, size, facial severity, color, and subtypes. cNF features derived from participant-supplied photographs. Total Skindex scores and subdomain scores (symptoms, emotion, function, pain, and itch). Of 583 participants, 384 (65.9%) were female, and the mean (range) age was 51.7 (40.0-83.0) years. Female sex, general severity, number, size, and facial severity of cNFs were negatively associated with QoL, as demonstrated by increased total Skindex scores. QoL had the largest association with the number of cNFs and presence of facial cNFs. Increasing number of cNFs was associated with worse QoL, and even individuals with a low cNF burden (<10 total cNFs) experienced a decrease in QoL. The results of this study suggest that reducing cNF number, particularly on the face, may be associated with improved QoL in individuals with NF1. In addition, early intervention before the development of numerous tumors may lead to the highest benefit in QoL. These data potentially provide insight into which individuals and cNF tumors may benefit most from therapy and highlights the utility of a completely decentralized, photograph-validated and age-controlled study for rare genetic disease. This cohort will allow analysis of disease and tumor heterogeneity after full phenotypic expression is achieved in NF1 and potentially serves as an example in its design for other rare diseases that struggle from poor recruitment.

Factores que afectan la tasa de gestación con embriones cebú producidos in vitro en trópico

Objective. To study the factors affecting the success of embryo transfers (ET). Materials and methods. 1087 ET in zebu cattle were analyzed. The considered extrinsic factors of the donor cows were the cattle production unit from which they were sourced (n=13), amount of transfers in the unit (1 time, &gt;1 time), geographical zone (n=4), period (dry or rainy) and year season; and the intrinsic factors were the breed of the bull and DC, semen, embryo quality and embryo developmental stage. Statistics were compiled with ci2 for the analysis of the main effects, and correlations were estimated through a multivariate clustering analysis. Results. The general pregnancy rate was 37.99±1.47, and there were differences (p&lt;0.05) observed among the CPU (2.78–75%). The PR was higher in the dry than in the rainy period (44.55 vs 31.28%), and in fall and winter (p&lt;0.05) than spring and summer (42.76, 43.98, 37.57 and 29.77%, respectively), and there were differences observed between the geographical zones as well (p&lt;0.05). The PR was higher with excellent-quality embryos (p&lt;0.05) than with good-quality embryos (38.9 vs. 26.3%). The period and year season had an effect over the RC (p&lt;0.05), and the grouping analysis showed a correlation (r&gt;0.90) between the period and year season during Oocyte pick-up (OPU) over the PR; moreover, semen, EQ and EDS had larger associations with the PR (r&gt;0.80). Conclusions. Environmental conditions at the moment of OPU and EQ are factors worth considering in embryo transfer programs with zebu cattle using in vitro produced embryos in tropical conditions.

Association of latent class analysis-derived multimorbidity clusters with adverse health outcomes in patients with multiple long-term conditions: comparative results across three UK cohorts

It remains unclear how to meaningfully classify people living with multimorbidity (multiple long-term conditions (MLTCs)), beyond counting the number of conditions. This paper aims to identify clusters of MLTCs in different age groups and associated risks of adverse health outcomes and service use. Latent class analysis was used to identify MLTCs clusters in different age groups in three cohorts: Secure Anonymised Information Linkage Databank (SAIL) (n=1,825,289), UK Biobank (n=502,363), and the UK Household Longitudinal Study (UKHLS) (n=49,186). Incidence rate ratios (IRR) for MLTC clusters were computed for: all-cause mortality, hospitalisations, and general practice (GP) use over 10 years, using <2 MLTCs as reference. Information on health outcomes and service use were extracted for a ten year follow up period (between 01st Jan 2010 and 31st Dec 2019 for UK Biobank and UKHLS, and between 01st Jan 2011 and 31st Dec 2020 for SAIL). Clustering MLTCs produced largely similar results across different age groups and cohorts. MLTC clusters had distinct associations with health outcomes and service use after accounting for LTC counts, in fully adjusted models. The largest associations with mortality, hospitalisations and GP use in SAIL were observed for the "Pain+" cluster in the age-group 18-36 years (mortality IRR=4.47, hospitalisation IRR=1.84; GP use IRR=2.87) and the "Hypertension, Diabetes & Heart disease" cluster in the age-group 37-54 years (mortality IRR=4.52, hospitalisation IRR=1.53, GP use IRR=2.36). In UK Biobank, the "Cancer, Thyroid disease & Rheumatoid arthritis" cluster in the age group 37-54 years had the largest association with mortality (IRR=2.47). Cardiometabolic clusters across all age groups, pain/mental health clusters in younger groups, and cancer and pulmonary related clusters in older age groups had higher risk for all outcomes. In UKHLS, MLTC clusters were not significantly associated with higher risk of adverse outcomes, except for the hospitalisation in the age-group 18-36 years. Personalising care around MLTC clusters that have higher risk of adverse outcomes may have important implications for practice (in relation to secondary prevention), policy (with allocation of health care resources), and research (intervention development and targeting), for people living with MLTCs. This study was funded by the National Institute for Health and Care Research (NIHR; Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity)-NIHR202020).

Adverse childhood experiences and cancer: A systematic review and meta-analysis.

10565 Background: Cancer is one of the leading causes of morbidity and mortality globally, with increasing incidence rates. The major governing cancer societies identify cancer risk factors into five broad groups (infectious disease, environmental/chemical pollutants, genetics, behavioral and ultraviolet radiation). However, little attention has been dedicated to understanding the potential primordial risk of the early psychosocial environment. Life course epidemiology is a framework that considers how the harmful effects of adverse childhood experiences (ACEs) contribute to the development of disease later in life. It is postulated that such stressful events that occur during a critical period of development likely trigger increased inflammatory responses, which could ultimately contribute to the manifestation of chronic diseases such as cancer. While there are studies that have reported an association between ACEs and cancer, this relationship has yet to be systematically analyzed. The objectives of this study are to a) meta-analyze the pooled association of the presence of at least one ACE, b) the burden of different ACEs, and c) specific ACE types, and their association with cancer in adulthood. Methods: This systematic review compiled studies from PubMed, EMBASE, Medline, Web of Science, Google Scholar, Biological Psychiatry, and grey literature up to Mar 16, 2023, and was registered on PROSPERO. Observational studies with a comparator group that assessed ACEs that occurred prior to age 18, and diagnosed cancer ≥21 years of age were included. Two review authors independently screened articles, extracted data, assessed risk of bias using QUIPS, and conducted GRADE assessment. Pooled odds ratios (ORs) were calculated using multilevel linear random-effects models. Results: Of the total 39,658 articles, our search identified 26 studies, of which 23 studies (356,519 participants, 9 countries) were eligible for meta-analysis. The occurrence of ≥1 ACE(s) was associated with cancer (OR=1.16, 95% CI: 1.08-1.24, I2 = 58.7%), compared to participants with no ACEs. As the number of ACEs increased, the odds of cancer increased (≥4 ACEs compared to no ACEs OR=1.30, 1.04-1.62, p-trend = 0.0003). Specific ACE types did explain a significant amount of heterogeneity (F = 2.02, p = 0.04). Parental or sibling death (OR=1.88, 1.29-2.73), household mental illness (OR=1.36, 1.14-1.61), sexual abuse (OR=1.20, 1.04-1.37), and physical abuse (OR=1.18, 1.05-1.34) had the largest associations with cancer. Conclusions: Our findings confirm ACEs as important risk factors for cancer in adulthood. These findings have important clinical and public health implications to develop primary and secondary prevention and treatment strategies. Also, further research is warranted to explore this relationship on the epigenetic level, and among specific cancers.

Medicaid expansion and cancer stage at diagnoses during the COVID-19 pandemic in the United States.

1526 Background: Substantial cancer underdiagnosis, especially for early-stage diseases, occurred during the COVID-19 pandemic in the US in 2020. The Affordable Care Act expanded Medicaid to nonelderly adults with income up to 138% Federal Poverty Level in states that opted in, potentially facilitating residents’ access to care during pandemic-related financial and employment instability, thus aiding in timely detection of cancer. This study examines the association of Medicaid expansion with changes in cancer stage at diagnosis during the COVID-19 pandemic. Methods: Adults aged 18-64 years newly diagnosed with cancer in 2019 and 2021 were identified from the National Cancer Database. Year 2020 was excluded to avoid confounding from distinct geographic patterns of COVID-19 infections. A difference-in-differences (DD) approach was used to compare the changes in proportions of patients diagnosed at stage I/II in 2021 vs 2019 between Medicaid expansion states and non-expansion states. Adjusted DD estimates were calculated with linear probability models and stratified by key sociodemographic factors and cancer type. Results: A total of 427,368 adults newly diagnosed with cancer in 2019 and 393,961 in 2021 were identified. Patients diagnosed with stage I/II decreased nationwide, however, decreases were larger in non-expansion states (from 58.3% in 2019 to 56.9% in 2021) compared to expansion states (61.4% in 2019 to 60.7% in 2021), leading to a DD of 0.92 percentage points in early-stage cancer diagnosis associated with Medicaid expansion (95% CI =0.46-1.38). The association was strongest among individuals aged 18-44 years (DD=1.46, 95% CI=0.42-2.49), men (DD=1.46, 95% CI=0.73-2.19), those living in most socioeconomically deprived areas (DD=1.40, 95% CI=0.41-2.40) and nonmetropolitan areas (DD=1.82, 95% CI=0.56-3.09). When stratified by cancer type, the largest associations were seen for esophageal cancer (DD=3.86, 95% CI=0.26-7.45) and prostate cancer (DD=2.81, 95% CI=1.43-4.18). Conclusions: Substantial cancer underdiagnosis and declines in proportion of early-stage diagnoses continued nationwide in 2021, the second year of the COVID-19 pandemic. However, the pattern was worse in non-expansion states, suggesting a protective effect of Medicaid expansion on cancer early diagnosis during the public health emergency. Findings may inform policy makers and the public in the 10 states that have yet to expand Medicaid eligibility.

Time-varying associations of patient and tumor characteristics with cancer survival: an analysis of SEER data across 14 cancer sites, 2004-2017.

Surveillance, Epidemiology, and End Results (SEER) cancer registries provides information about survival duration and cause of death for cancer patients. Baseline demographic and tumor characteristics such as age, sex, race, year of diagnosis, and tumor stage can inform the expected survival time of patients, but their associations with survival may not be constant over the post-diagnosis period. Using SEER data, we examined if there were time-varying associations of patient and tumor characteristics on survival, and we assessed how these relationships differed across 14 cancer sites. Standard Cox proportional hazards models were extended to allow for time-varying associations and incorporated into a competing-risks framework, separately modeling cancer-specific and other-cause deaths. For each cancer site and for each of the five factors, we estimated the relative hazard ratio and absolute hazard over time in the presence of competing risks. Our comprehensive consideration of patient and tumor characteristics when estimating time-varying hazards showed that the associations of age, tumor stage at diagnosis, and race/ethnicity with risk of death (cancer-specific and other-cause) change over time for many cancers; characteristics of sex and year of diagnosis exhibit some time-varying patterns as well. Stage at diagnosis had the largest associations with survival. These findings suggest that proportional hazards assumptions are often violated when examining patient characteristics on cancer survival post-diagnosis. We discuss several interesting results where the relative hazards are time-varying and suggest possible interpretations. Based on the time-varying associations of several important covariates on survival after cancer diagnosis using a pan-cancer approach, the likelihood of the proportional hazards assumption being met or corresponding interpretation should be considered in survival analyses, as flawed inference may have implications for cancer care and policy.

Reported Impact of COVID-19 Workload and Stressors on School Nurses' Provision of Care During the 2021-2022 School Year: A Secondary Analysis of U.S. School Nurse Survey Data.

Many school nurses experienced increased work burden and stress during the COVID-19 pandemic. This analysis examined data from a Centers for Disease Control and Prevention cross-sectional, nationwide survey of school nurses in March 2022 to examine associations between school nurses' ability to conduct their core responsibilities and selected nurse and school factors among school nurses during the 2021-2022 school year and COVID-19 pandemic. Perceived adequate staffing and financial compensation reduced the odds of reported difficulties across all core school nursing tasks. Nurses without a registered nurse license and with higher caseloads were more likely to report difficulty in implementing specific tasks. The impact of these factors varied, with inadequate financial compensation having the largest association with school nurses' difficulty implementing all the core responsibilities. The study results improve our understanding of school nurses' challenges in implementing core school nursing responsibilities during the COVID-19 pandemic in the 2021-2022 school year.

Are higher protein intake and distribution of protein intake related to higher appendicular muscle mass among an older Japanese population?: A cross-sectional analysis of the National Health and Nutrition Survey 2017.

Protein intake is an important component in retaining muscle mass, especially among older people. This study examined the relationship between total protein intake and/or the distribution of protein intake in each meal and appendicular muscle mass, using data from the National Health and Nutrition Survey (NHNS) in Japan. Data from the NHNS were re-analyzed in this study. We used data from a one-day dietary record, physical examination, and lifestyle questionnaire completed by 1766 participants aged over 60 years. Appendicular muscle mass was assessed by multiple-frequency bioimpedance measurement. Leucine intake was calculated by the weighted average amino acid content from all 98 food subcategories used in the NHNS, based on amino acid composition data in the 2020 Standard Tables of Food Composition. Participants with higher protein intake showed significantly higher appendicular muscle mass. This relationship was independent of physical activity, including steps taken per day, exercise habit, and physical labor. Frequent intake of ≥0.4 g protein/kg/meal was not related to appendicular muscle mass. The combination of higher total protein intake and higher physical activity seemed to have the largest association with appendicular muscle mass. Higher protein intake may be related to higher appendicular muscle mass, independent of higher physical activity, among older Japanese people. Geriatr Gerontol Int 2024; 24: 634-640.

Sociocultural pressures and engagement with cosmetic products and procedures in adult women

Previous studies have shown that cosmetic procedures and products that perpetuate Western hegemonic beauty standards among women have become increasingly popular, and pressures from sociocultural agents to utilize them are significant. However, little work has documented the relationship between perceived sociocultural pressures and use of cosmetic procedures and products among a larger age range of adult women. A community sample of 308 women aged 18–66, mean (SD) age of 35.7 (9.7), reported on the cosmetic procedures they had considered or used, as well as perceived pressures from the media, peers, romantic partners, and health and beauty professionals. Findings revealed that, among those investigated, the most frequently utilized products and procedures were supplements and hair removal. However, a significant minority reported considering more invasive procedures, including cosmetic surgery. Media was the predominant source of pressure, while partners were the least frequently endorsed. While pressure from professionals and peers had small-to-moderate associations with utilization of cosmetic products and procedures, pressure from partners had the largest association with their use. This work frames important future directions for examining the impact of sociocultural pressures on women’s willingness to utilize cosmetic products and procedures that are sometimes underregulated and risky for physical and mental health.

Metabolic Syndrome Traits Increase the Risk of Major Adverse Liver Outcomes in Type 2 Diabetes.

Type 2 diabetes (T2D) increases the risk for major adverse liver outcomes (MALOs), including cirrhosis and its complications. Patients with T2D frequently have other traits of the metabolic syndrome (MetS). It remains uncertain whether there is a synergistic effect of accumulating MetS traits on future MALO risk. Patients with T2D without a history of liver disease were identified from national registers in Sweden from 1998 to 2021. MetS traits included hypertension, low HDL level, hypertriglyceridemia, obesity, and albuminuria, in addition to T2D. MALO events were identified based on administrative coding from national registers until 31 October 2022. Data were analyzed using Cox regression models. In total, 230,992 patients were identified (median age 64 years; 58% male), of whom 3,215 (1.39%) developed MALOs over a median follow-up of 9.9 years. Compared with patients with one MetS trait (only T2D) at baseline, those with more than one MetS trait had a higher rate of MALOs (adjusted hazard ratio [aHR] 2.33, 95% CI 1.53-3.54). The rate of MALOs increased progressively with increasing numbers of MetS traits at baseline (aHR 1.28 per added trait, 95% CI 1.23-1.33). During follow-up, patients who acquired additional MetS traits had a progressively higher rate of MALOs. The MetS trait with the largest association with incident MALOs was hypertension (aHR 2.06, 95% CI 1.57-2.71). Having or acquiring additional traits of MetS increase the rate of progression to MALOs in patients with T2D. These results could be used to inform screening initiatives for liver disease.

Lymph Node Isolated Tumor Cells in Patients With Endometrial Cancer

Isolated tumor cells (ITCs) are the histopathological finding of small clusters of cancer cells no greater than 0.2 mm in diameter in the regional lymph nodes. For endometrial cancer, the prognostic significance of ITCs is uncertain. To assess clinico-pathological characteristics and oncologic outcomes associated with ITCs in endometrial cancer. This retrospective cohort study using the National Cancer Database included patients with endometrial cancer who had primary hysterectomy and nodal evaluation from 2018 to 2020. Patients with microscopic and macroscopic nodal metastases and distant metastases were excluded. Data were analyzed from June to September 2023. Regional nodal status with ITCs (N0[i+] classification) or no nodal metastasis (N0 classification). (1) Clinical and tumor characteristics associated with ITCs, assessed with multivariable binary logistic regression model, and (2) overall survival (OS) associated with ITCs, evaluated by nonproportional hazard analysis with restricted mean survival time at 36 months. A total of 56 527 patients were included, with a median (IQR) age of 64 (57-70) years. The majority had T1a lesion (37 836 [66.9%]) and grade 1 or 2 endometrioid tumors (40 589 [71.8%]). ITCs were seen in 1462 cases (2.6%). In a multivariable analysis, ITCs were associated with higher T classification, larger tumor size, lymphovascular space invasion (LVSI), and malignant peritoneal cytology. Of those tumor factors, LVSI had the largest association with ITCs (7.9% vs 1.4%; adjusted odds ratio [aOR], 4.37; 95% CI, 3.87-4.93), followed by T1b classification (5.3% vs 1.3%; aOR, 2.62; 95% CI, 2.30-2.99). At the cohort level, 24-month OS rates were 94.3% (95% CI, 92.4%-95.7%) for the ITC group and 96.1% (95% CI, 95.9%-96.3%) for the node-negative group, and the between-group difference in expected mean OS time at 36 months was 0.35 (SE, 0.19) months, but it was not statistically significant (P = .06). There was a statistically significant difference in OS when the low-risk group (stage IA, grade 1-2 endometrioid tumors with no LVSI) was assessed per nodal status and adjuvant therapy use (P < .001): (1) among the cases treated with surgical therapy alone, 24-month OS rates were 95.9% (95% CI, 89.5%-98.5%) for the ITC group and 98.8% (95% CI, 98.6%-99.0%) for the node-negative group, and the between-group mean OS time difference at 36 months was 0.61 (SE, 0.43) months (P = .16); and (2) among the cases with ITCs, adjuvant therapy (radiotherapy alone, systemic chemotherapy alone, or both) was associated with improved survival compared with no adjuvant therapy (24-month OS rates, 100% vs 95.9%; between-group mean OS time difference at 36 months, 0.95 [SE, 0.43] months; P = .03). In this cohort study of patients with surgically staged endometrial cancer, the results of exploratory analysis suggested that presence of ITCs in the regional lymph node may be associated with OS in the low-risk group. While adjuvant therapy was associated with improved OS in the low-risk group with ITCs, careful interpretation is necessary given the favorable outcomes regardless of adjuvant therapy use. This hypothesis-generating observation in patients with low-risk endometrial cancer warrants further investigation, especially with prospective setting.

Stressful life events and prenatal representations of the child

ABSTRACT Caregivers’ mental representations of their children can be assessed prenatally and are prospectively associated with later caregiving quality and caregiver–child attachment. Compared to balanced, distorted or disengaged representations are linked to insecure caregiver–child attachments. The present study explored factors (i.e. stressful life experiences and positive experiences) that may be linked to risk for distorted and disengaged representations. We used a brief version of the Prenatal Working Model of the Child Interview in a sample of 298 pregnant people (ages 19 to 45 years; M = 30.83, SD = 5.00) between gestational age 11–38 weeks (M = 23.49, SD = 5.70). A greater number of stressful events across three developmental periods (i.e., lifespan, childhood, and pregnancy) were related to increased odds of distorted, compared to balanced classification. Pregnancy stress had the largest association. Positive experiences from childhood did not buffer the association between stress and representations. Findings highlight the importance of stress on prenatal representations of one’s child.