Life Survey Research Articles

The physical and virtual presence of the local state and citizens’ life satisfaction in urbanising China

China’s rapid and ongoing urbanisation has led to the expansion of the local state. The state, traditionally exhibited as physical institutions of government, has emerged virtually in recent years based on intricate network infrastructure systems, such as social media platforms. Scholars contend that a strong physical state infrastructure enhances government function and can increase citizens’ life satisfaction; in contrast, the state’s virtual presence is unlikely to exert a substantial independent impact because of its reliance on the state’s physical infrastructure. In this research, we calibrated innovative measures of the state’s physical and virtual presence. Combined with data from the 2018 Urbanisation and Quality of Life Survey conducted in 40 sampling sites undergoing rural–urban transition, we further assessed how the local state’s physical and virtual presence is associated with citizens’ self-reported life satisfaction in the context of China’s national new-type urbanisation. Our results, based on three-level mixed-effects regressions, indicate that the local state’s bricks-and-mortar institutions do not correlate with citizens’ life satisfaction; rather, the establishment of a web-based, cost-effective, transparent, and coordinated virtual presence is associated with a higher level of life satisfaction among citizens. At a time when the Chinese central government emphasises its commitment to ‘people-centred’ urbanisation, the findings offer insight into the strategies that local governments could employ to improve governance quality and enhance citizens’ well-being.

Association between long-term PM2.5 exposure and mortality on Sumatra Island: Indonesian Family Life Survey (IFLS) 2000-2014.

The concentration of PM2.5 (particulate matter with a diameter < 2.5µm) on Sumatra Island has increased, mainly because of forest and peatland fires, transportation, and industry. Biomass burning releases partially burned carbon into the atmosphere, resulting in a smoky haze containing PM2.5. Air quality has deteriorated quickly, and PM2.5 has become a major health hazard in Indonesia. Studies on long-term exposure to PM2.5 have indicated its associations with both morbidity and mortality. Here, we measured long-term (2000-2014) exposure to PM2.5 on the basis of satellite-derived aerosol optical depth measurements (1 × 1 km2) used to predict ground-level PM2.5 concentrations. Additionally, population data on Sumatra Island residents from the fourth wave of the Indonesian Family Life Survey (IFLS) were obtained. We investigated the association between long-term PM2.5 exposure and mortality with a retrospective cohort study design. A total of 2409 subjects aged ≥ 40years participated in the IFLS-3 beginning in November 2000, and we examined mortality outcomes until the IFLS-5 in September 2014. We used Cox regression models to calculate hazard ratios (HRs) of mortality associated with PM2.5 exposure. According to the adjusted model, the mortality HRs per 10µg/m3 increase in PM2.5 concentration were 1.10 (95% CI 1.03, 1.17) for all natural causes, 1.17 (95% CI 1.05, 1.25) for cardiovascular causes, and 1.19 (95% CI 1.04, 1.36) for respiratory causes. Long-term exposure to PM2.5 was associated with all-natural, cardiovascular, and respiratory mortality on Sumatra Island, where PM2.5 levels exceed the WHO and US-EPA air quality standards.

The psychological empowerment and quality of work life among Jordanian primary care nurses and midwives

IntroductionThe healthcare industry, particularly in the context of primary care, presents various challenges to nurses and midwives, influencing their psychological empowerment (PE) and quality of work life (QWL).ObjectiveThis study’s objective is to assess the levels of PE and QWL among Jordanian primary care nurses and midwives and explore the relationship between PE and QWL.MethodsUtilizing a descriptive correlational design, the study included 273 Jordanian primary care nurses and midwives through convenience sampling. The Psychological Empowerment Instrument and Brook’s Quality of Nursing Work Life Survey were used to measure PE and QWL. Data was analyzed using descriptive statistics to describe the study participant’s characteristics and inferential analysis such as Pearson correlation, and multiple regression to examine relationships and identify predictors of study variables.ResultsThe study found that the QWL scale had high reliability (Cronbach’s alpha = 0.954), and similarly, the PE scale demonstrated strong reliability (Cronbach’s alpha = 0.948). Moving on to the core findings, significant positive correlations were identified between PE and QWL, with a correlation coefficient of r = 0.568 (p &amp;lt; 0.01), indicating that higher levels of psychological empowerment were associated with better quality of work life. Furthermore, the regression analysis revealed that PE accounted for approximately 32.3% of the variability in QWL scores. Interestingly, participants holding diplomas reported the highest QWL scores (mean = 136.14), while those contemplating leaving the nursing profession displayed significantly lower QWL scores (mean = 114.14). No significant correlations were found between PE and sociodemographic variables such as age, income, and years of experience.ConclusionThis study reveals a crucial need to enhance PE and QWL. Key findings show moderate PE and QWL levels, with variations based on educational background and workplace. The positive correlation between PE and QWL identifies the benefits of fostering empowerment through professional development, job autonomy, and decision-making. These insights are vital for improving nursing practice and policy and enhancing nurse satisfaction and patient care.

Sleep quality and cognitive function on self-rated health status among the elderly: Findings from the Indonesian family life survey (IFLS-5)

Sleep quality and cognitive function on self-rated health status among the elderly: Findings from the Indonesian family life survey (IFLS-5)

Field of study, political attitudes, and support for the radical right in Sweden and Europe

This study uses three different surveys to investigate the links between various educational fields, radical right support, and political opinions. Logit regressions and KHB mediation analysis of 41,770 observations from the Swedish SOM survey (2011–2019) reveal that graduates from technical and agricultural fields are approximately twice as likely to support the radical right as graduates from sociocultural fields. Fields such as natural sciences, business, and health demonstrate medium to medium-high support. These differences are partially mediated by horizontal, but not vertical, labor market allocation. Replication using the European Social Survey (ESS) indicates that these patterns are generalizable to Western, but not Eastern, Europe. Additional analyses show that radical right support and refugee intake skepticism decrease with years spent in sociocultural, but not technical, fields in upper-secondary school. Moreover, panel data from the Swedish Level of Living Survey (LNU) show that progressive attitude shifts occur predominantly following education in sociocultural fields.

Loneliness and Suicidality Among Older Korean Adults During the COVID‐19 Pandemic: The Mediating Role of Depressive Symptoms

ABSTRACTObjectivesDuring the COVID‐19 pandemic, the loneliness of older adults increased. Since loneliness and depressive symptoms may contribute to the development of suicidality, the pathways between loneliness, depressive symptoms, and suicidality should be examined more in depth. Therefore, the purpose of this study was to investigate the relationship between loneliness and suicidality among older Korean adults during the COVID‐19 pandemic, and to explore whether it is mediated by depressive symptoms.MethodsThe data used for this study was “2020 Chuncheon Elderly Life Survey,” and a total of 1200 adults aged 65 and over were included in the analysis. Suicidality was measured with the Depressive Symptom Inventory‐Suicidality Subscale (DSI‐SS). Loneliness was measured with the UCLA 3‐item Loneliness Scale, and depressive symptoms were measured with the Short form of Geriatric Depression Scale (SGDS). The mediating effect was tested using the PROCESS macro version 4.2 for SPSS.ResultsAdjusted for covariates, the indirect effect (path of loneliness to suicidality via depressive symptoms) was statistically significant, but the direct effect of loneliness on suicidality was not statistically significant.ConclusionThese findings suggest that loneliness is associated with depressive symptoms which in turn explain suicidality among older Korean adults during the COVID‐19 pandemic. Further research is required to understand the mechanisms underlying this.

Longitudinal analysis of growth and nutritional disparities across socio-demographics from early childhood to adolescence: Findings from the Indian cohort of the Young Lives Survey.

Previous studies generally used cross-sectional data and focused on under-five children to assess the risk factors for malnutrition among Indian children. Some recent studies have reported that recovery from or faltering in malnutrition is possible after five years of age, but socio-demographic subgroup disparities have not been explored. This study aims to find the longitudinal disparity in height-for-age Z-scores (HAZ) and body-mass-index-for-age Z-scores (BMIAZ scores) across various sub-groups of a cohort from childhood to adolescence. This study used a cohort from the Young Lives Survey, which followed children aged of 1-15 years between 2002 and 2016-17 in the states of Andhra Pradesh and Telangana, India. Mixed-effect models were applied to find the main, time, and interaction effects of HAZ scores and BMIAZ scores. In addition, an extended Kitagawa-Oaxaca-Blinder decomposition approach to assess group-based differences over time was used. The cross-sectional prevalence of stunting reduced across all subgroups, while thinness rose during the same period. The interactions of child sex, mother's education, place of residence, wealth index, and antenatal care with time were statistically significant at p <0.05. The gender disparity in adjusted HAZ score decreased from 0.214 units at 1 year to 0.011 units at 15 years, whereas BMIAZ score differential increased from 0.106 to 0.538 units over same timeframe. Disparities in scores were also observed across rural-urban, maternal education, social group, religion, socioeconomic status, maternal age at birth, antenatal care, and premature birth status. The study sheds light on the nuanced dynamics of paediatric growth, emphasising the importance of longitudinal approaches in understanding and addressing the health disparities across different stages of childhood and adolescence.

CMR phenotypes and clinical outcomes in NYHA class I versus II-IV hypertrophic cardiomyopathy: identifying high-risk asymptomatic patients

Abstract Background Cardiac myosin inhibition therapy can deliver symptomatic benefit for NYHA class≥II patients with obstructive hypertrophic cardiomyopathy (HCM) and is being actively explored for non-obstructive phenotypes. However, expanding interest in clinical outcome reduction supports growing need to identify high risk cohorts across both symptomatic and asymptomatic cohorts. We aimed to examine phenotypic characteristics of NYHA-I versus NYHA≥II patients with HCM and their association with future outcomes. Methods 727 patients with HCM from the CIROC Registry who completed simultaneous CMR and patient health assessments, inclusive of NYHA evaluation and quality of life surveys, were studied. Baseline clinical and CMR characteristics were compared between NYHA-I and NYHA≥II cohorts, followed by risk modelling for the prediction of major adverse cardiovascular events (MACE), defined as: all-cause mortality, heart failure hospitalization, ventricular arrhythmia, new onset atrial fibrillation, or stroke. Cox models were constructed to identify independent predictors of MACE. Results Of the 727 patients, 546 (75%) reported NYHA-I and 181 (25%) NYHA≥II symptoms. Baseline characteristics are shown in Table 1. Compared to NYHA≥II, NYHA-I patients were younger, more likely male, and had a lower prevalence of diabetes and hypertension. No meaningful differences in CMR chamber volumes, function, left ventricular (LV) mass, or fibrosis burden were observed. Over a median follow up of 3.7 years, 109 patients (15%) experienced MACE: 12% in NYHA-I and 23% in NYHA≥II sub-groups (p&amp;lt;0.001). Baseline LV mass z-scores (determined from sex-matched, BSA-indexed SCMR healthy reference values) were independently associated with MACE by multivariable Cox modelling. An optimal LV mass z-score threshold of 3.9 for prediction of MACE was identified and combined with NYHA status to stratify patients into 4 categories. Kaplan-Meier curves showed patients with LV Mass z-scores &amp;gt;3.9 experienced worse event-free survival in both NYHA sub-groups (Figure 1a). Cox modelling in the overall cohort (Figure 1b) showed NYHA-I patients with LV Mass z-scores &amp;gt;3.9 experienced a 2.2-fold increased risk (p=0.007) of MACE, this exceeding the risk of NYHA ≥II patients below this threshold. Separate NYHA I and ≥II sub-group multivariable models showed LV Mass z-score &amp;gt;3.9 to remain a strong and independent predictor of MACE, providing respective hazards of 2.6 and 4.7 (p=0.001 and &amp;lt;0.001). Conclusions NYHA-I patients with HCM experience significantly lower rates of MACE versus NYHA≥II. However, LV mass z-scoring permits powerful sub-stratification of these sub-groups, identifying NYHA-I patients with higher LV mass who will experience worse outcomes versus NYHA≥II patients with lower LV mass. This simple yet powerful stratification offers unique potential to identify asymptomatic patients with HCM who may benefit from targeted therapeutics to reduce future MACE.

Disability, poverty and health-service accessibility in the context of the COVID-19 pandemic: a population-based repeated cross-sectional study in Colombia

ObjectivesIn Colombia, 4.3% of the population 5 years or older lives with a disability. They face higher levels of poverty and social exclusion compared with persons without disabilities. This article...

Survey response rates in European comparative surveys: a 20-year decline irrespective of sampling frames or survey modes

AbstractThis paper assesses trends in three survey outcome rates within four prominent crossnationalcomparative surveys conducted in European countries in the 21st century: theEuropean Quality of Life Survey, the European Social Survey, the European ValuesStudy, and the International Social Survey Programme. These projects are recognisedfor their high-quality sampling and fieldwork procedures, extensive track records, andcommitment to rigorous methodological standards. The analysis is based on 753national surveys conducted on probability samples of the general population in 36European countries from 1999 to 2018. We investigated whether two essential surveycharacteristics, namely sampling frames and data collection modes, moderated thedecrease of survey outcome rates over time. To analyse these relationships, thesurvey year was included as the explanatory variable, and we applied multi-level linearregressions with surveys nested within countries. Additionally, the project name wasincorporated as a fixed factor, and the sampling frame and mode of data collectionwere control variables for the effect of time. Our study provides valuable insights intothe challenges of conducting high-quality Pan-European cross-national comparativesurveys over nearly two decades. We observed a consistent decline in survey outcomerates, irrespective of country or project. Neither the sampling frame nor the datacollection mode moderated this decline. Hence, even though personal register samplesand Face-to-Face interviews are often regarded as enhancements to overall surveyquality, their application does not effectively counter the factors causing a decline insurvey outcome rates.

Recurrent Flooding and Household Food Access in Central Java, Indonesia.

It is unknown how recurring flooding impacts household diet in Central Java. We aimed to assess how recurrent flooding influenced household food access over 22 years in Central Java by linking the Global Surface Water dataset (GSW) to the Indonesian Family Life Survey. We examined linear and nonlinear relationships and joint effects with indicators of adaptive capacity. We measured recurrent flooding as the fraction of district raster cells with episodic flooding from 1984-2015 using GSW. Food access outcomes were household food expenditure share (FES) and dietary diversity score (DDS). We fit generalized linear mixed models and random forest regression models. We detected joint effects with flooding and adaptive capacity. Wealth and access to credit were associated with improved FES and DDS. The effect of wealth on FES was stronger in households in more flood-affected districts, while access to credit was associated with reduced odds of DDS in more flood-affected districts. Flooding had more predictive importance for FES than for DDS. Access to credit, a factor that ordinarily improves food access, may not be effective in flood-prone areas. Wealthier households may be better able to adapt in terms of food access. Future research should incorporate land use data to understand how different locales are affected and further understand the complexity of these relationships.

The Relationship between Covid-19 and Consumption Patterns of Poor Households

Objective: This research aims to analyze the relationship between Covid-19 and Consumption Patterns of Poor Households. The phenomenon of the Covid-19 pandemic has caused various social and economic changes. Changes in behaviour and preferences are an important part of the research by emphasizing the analysis of changes in expenditure during the Covid-19 pandemic and post-Covid-19. Method:This research is in the form of quantitative descriptive, the type of data used by researchers is primary data using a questionnaire that refers to the IFLS (Indonesian Family Life Survey) questionnaire. Primary data includes questionnaires and poor people during and postpandemic in 2019 and 2022 in rural and urban areas. The research area includes several village comparisons of Bandar Lampung City, South Lampung Regency, and Pringsewu Regency. The multiple linear methods are performed with the t-test in pairs using the statistical tool Stata. Results: The results of the study concluded that in the different tests there was no difference in food expenditure during the Covid-19 and post-Covid-19 period, between urban and rural areas, because of the tendency to have both low food expenditures during the pandemic and increase in post- pandemic. The food consumption patterns of the two regions still tend to buy the same staples. There is a difference in non- food expenditures during the rural Covid-19 period is higher because health and urban costs are lower, in the post-Covid-19 rural areas are lower and urban areas are higher. Conclusion and suggestions: The advice to the government, as cases of the Covid-19 pandemic, rise again, is to focus on providing free health services to the poor, because the expenditure on health services is quite large during the covid-19 pandemic. The government is also expected to be able to provide prolonged food staples to poor households plus complementary ingredients such as fruits, vegetables, milk, meat, and foods with high nutrition and protein.

Does social capital enhance political participation in older adults? Multi-level evidence from the European Quality of Life Survey

This study explored the role of social capital for non-institutionalised and institutionalised political participation among older adults compared to younger age groups using European Quality of Life Survey data (EQLS) from 2016 and 33 countries (n = 36,908). Multilevel logistic regression analysis was employed to assess the association between individual- and country-level social capital and political participation. Findings revealed that, at the individual level, active associational engagement was positively related to both forms of political participation, while social trust and political trust were linked only to non-institutionalised participation—higher social trust and lower political trust were associated with a greater likelihood of participation. Country-level associational engagement was related to non-institutionalised political participation and country-level political trust with institutionalised participation. For older adults, active associational engagement had stronger individual and contextual effects on non-institutionalised political participation. These results enrich our understanding of political engagement in later life and highlight the unexplored potential for civic involvement among older adults.

MODELING HYPERTENSION DISEASE RISK IN INDONESIA USING MULTIVARIATE ADAPTIVE REGRESSION SPLINE AND BINARY LOGISTIC REGRESSION APPROACHES

In the pursuit of the Sustainable Development Goals (SDGs), health-related challenges, especially hypertension, remain a significant global issue. The third goal of the SDGs aims to improve the quality of life and well-being of all individuals, but hypertension is a serious problem that can hinder these goals. Often referred to as the "silent killer" by the World Health Organization (WHO), hypertension is exacerbated by low awareness. Globally, more than 1.28 billion adults suffer from hypertension, with most cases in lower to middle-income countries, including Indonesia. Indonesia has an alarming rate of hypertension incidence, ranking fifth highest in the world. Riset Kesehatan Dasar (Riskesdas) 2023 and the Indonesia Family Life Survey (IFLS) are critical for understanding hypertension risk factors in Indonesia. The IFLS data, obtained from www.rand.org, includes observations from October 2014 to April 2015, totalling 85 observations. Despite being over 10 years old, this dataset was selected because it remains the most recent comprehensive data available from RAND, representing 83% of the Indonesian population. The IFLS is conducted every 7-8 years, with the next wave of data expected soon. Most studies on hypertension globally and in Indonesia use parametric regression methods. However, a research gap exists as no studies have used Multivariate Adaptive Regression Splines (MARS) on IFLS data to analyze hypertension risk factors. This study addresses this gap by comparing binary logit regression and MARS. The analysis shows the Apparent Error Rate (APPER) for MARS is 84.706%, while for binary logistic regression it is 80%, indicating MARS is better at classifying hypertension data in Indonesia. Using MARS offers a novel approach to understanding hypertension risk factors in Indonesia. Despite the data's age, it remains relevant as primary causes and risk factors for hypertension have not changed, making the findings valuable for current health policy and strategies.

8008 Insulin-like Growth Factor-1 (IGF-1) Level Fluctuations and Patient Reported Outcomes (PROMS) During Treatment with Long-acting Somatostatin Receptor Ligands (SRLs) for Acromegaly: a Prospective Study

Abstract Disclosure: I. Remba-Shapiro: None. J.R. Schweizer: None. K.J. Liebert: Consulting Fee; Self; Crinetics, Recordati Rare Diseases, Novo Nordisk. K. Schilbach: None. M. Adams: Consulting Fee; Self; Chiesi. N.A. Tritos: None. M. Bidlingmaier: Consulting Fee; Self; Ipsen, Ionis Pharmaceuticals Inc., Novartis Pharmaceuticals, Novo Nordisk, Pfizer, Inc., Roche Pharmaceuticals. L.B. Nachtigall: Consulting Fee; Self; Crinetics. Grant Recipient; Self; Amryt, Recordati Rare Diseases. Background: SRLs are the most used medical therapy for acromegaly. Some patients report symptoms of acromegaly towards the end of the injection cycle even when IGF-1 levels are controlled. IGF-1 fluctuations within an injection cycle have been observed. In this study we investigated the variability of biochemical markers and PROMS in patients receiving long-acting SRLs. Methods: Subjects with acromegaly controlled with monthly lanreotide depot or octreotide LAR were recruited. Blood samples at 1 and 4 weeks after SLR injection were collected in 2 consecutive cycles. Clinical characteristics were evaluated. Quality of life (QoL) surveys included: Acromegaly Quality of Life Questionnaire (AcroQoL) (higher scores = better QoL) and Patient Assessed Acromegaly Symptom Questionnaire (PASQ) (higher scores = worse QoL). Week 1 vs. week 4 values were compared. Quest Diagnostics LC-MS assay was used to measure IGF-1. Coefficient of variation (CV = (IGF-1 SD)/(IGF-1 mean)%) of IGF-1 was calculated. Values ≤5% were interpreted as being a consequence of assay variability. Variables are presented as mean (SD) and compared using t-test; p &amp;lt;0.05 was considered significant. Results: Patients (6 women, 4 men) had a mean age of 56.1 (15.4) years. Eight underwent TSS. One had diabetes mellitus, 3 had hypertension. Mean IGF-1 index (IGF-1 x upper limit of normal) at screening was 0.63 (0.23). BMI was 27.7 (5.8) kg/m2. IGF-1 index at week 1 was 0.57 [0.16] vs. 0.61 [0.23] at week 4, p=0.271. Insulin levels were lower in week 1 vs. week 4 (7.3 [4.4] vs. 9.7 [6.0]mIU/mL p=0.041). There were no significant differences in GH, glucose, weight, blood pressure and ring size in week 1 vs. week 4. PASQ varied significantly within the injection cycle with higher scores in week 4 (18.1 [10.8]) compared to week 2 (16.1 [10.4] p=0.032) and week 3 (14.2 [8.8] p= 0.002). ACROQoL scores did not differ by injection phase. IGF-1 increased more than assay CV from week 1 to week 4 in 8/20 (40%) determinations. An ROC curve identified an IGF-1 index cutoff of 0.57 at week 4 (AUC: 0.812, p=0.021) as a predictor of IGF-1 index increase within the injection cycle (CV &amp;gt; 5%): sensitivity 88%, specificity 75%. Five patients had IGF-1 index &amp;gt; 0.57 at week 4 during both cycles (range 0.60-1.2). In this group, mean IGF-1 index was higher at week 4 vs. week 1 (0.77 [0.21] vs. 0.66 [0.14] p=0.026). The 5 patients with IGF-1 index &amp;lt; 0.57 at week 4 had no difference in IGF-1 index between week 4 and week 1 (0.48 [0.14] vs. 0.44 [0.09] p=0.144). Conclusions: This prospective study of patients with acromegaly controlled with long-acting SRLs demonstrates injection phase variability in self-reported symptoms by PASQ. An IGF-1 index &amp;gt; 0.57 at the end of the cycle may warrant injection phase-dependent monitoring. Larger studies to confirm the IGF-1 cutoff above which patients should be monitored in a cycle-dependent manner will allow an individualized approach to optimize management. Presentation: 6/2/2024

8652 Real World Impact of Cushing’s Syndrome: A Shared Global Story

Abstract Disclosure: L. Edwin: None. G. Jordan: None. Introduction: Cushing's Syndrome creates short- and long-term challenges to physical and mental health. Clinical and surgical outcome statistics have improved over time, but patients continue to report diagnosis delays, confusion about treatments, and the feeling of being “dropped” once cortisol is normalized. White matter is damaged by persistent high cortisol, and a return to eucortisol often unmasks new or worsened autoimmune, neuropsychological, physical, and other conditions. Hypothesis: Patients have been sharing best practices and supporting each other through patient networks for decades on topics that are misunderstood, dismissed, and under-treated in the clinical setting. Improvements to care will come faster if this kind of patient-created data is made widely available, and advocacy groups must establish an acceptable method to accomplish this. Methodology: A committee of patients reviewed the design and content of two large Quality of Life surveys conducted in recent years, then built a new survey for a larger international patient cohort. SurveyMonkey was used for layout and response collection. Spanish and French translations were done with DeepL then cleaned up by native speakers. The survey was then promoted within global patient advocacy organizations and on social media. The survey comprised over 150 questions and received 438 responses from 38 countries. Results: Respondents answered questions about their daily lives including physical, emotional, mental and social well-being. Examples: •75% of respondents are still trying to determine their “new normal”.•Over 80% report memory problems that did not exist before.•Almost 90% took much longer than six weeks to return to work in any capacity.•A third of male patients and a fifth of female patients report that their marriage or long-term relationship ended because of Cushing’s.•Almost half of respondents felt that their medical team was unable to support them beyond cortisol issues.•More than 50% who answered this survey have experienced suicidal thoughts due to the overwhelming nature of Cushing’s. Conclusion: Dr. Harvey Cushing, namesake of the disease, identified the most underrated element of the patient experience when he made his famous statement: “A physician is obligated to consider more than a diseased organ, more than even the whole man—he must view the man in his world.”The man in his world. The results of our study paint a picture of the ongoing burden of hypercortisolism that often starts seven or more years before an official diagnosis is made and continues indefinitely. Patients can help fast-track the identification of areas where more work needs to be done. It is therefore incumbent on a group of well-organized advocates to develop a structure that translates the patient voice into datasets that are useable by all doctors, researchers, and stakeholders in the Cushing’s community. Presentation: 6/3/2024

6766 Cortisol Pumps: Hospitalizations And Quality Of Life

Abstract Disclosure: A. Tiwari: None. R. Berry: None. A. Mokbel: None. A. Abotouk: None. A.R. Alrifai: None. J. Waleed: None. O. Alzohaili: None. Introduction: Oral regimens of exogenous cortisol fail to mimic physiologic levels. The discrepancy leads to complications, notably nausea, hyperglycemia, and susceptibility to infection. Finer control over cortisol delivery may be achievable with infusion pumps. While international groups have published their experiences with cortisol pumps, these studies often include less than ten patients. We share the largest, single-center cohort ever documented and the first from an American clinic. Methods: We conducted a retrospective cohort study. Through chart review, we identified all patients who received a cortisol pump at a private clinic; these pumps were originally designed to deliver insulin, but we repurposed them for patients with adrenal insufficiency. Clinic notes allowed collection of cortisol dosing pre- and post-exposure to the cortisol pump. We supplemented this information with telephone and digital surveys on the frequency of hospitalization, symptoms, and quality of life; patients provided verbal consent before participation. A Wilcoxon signed rank test and Fisher exact test evaluated significant differences between groups. Results: We identified thirty patients who received a cortisol infusion pump. Our study revealed a statistically significant decrease in hospitalization rate after exposure to a cortisol pump (n=26, mean difference = -5.94 hospitalizations per year, p=0.003), a decrease in the frequency of fatigue (n=25, p=0.0001) and a decrease in the frequency of hypotension (n=25, p=0.005). A validated, quality of life survey corroborated these findings with improvement in twenty-seven out of twenty-eight questions (n=22, p&amp;lt;0.05). However, we did not detect a statistically significant difference in the frequency of eighteen other symptoms nor cortisol dosing between pre- and post-exposure groups. Conclusion: Infusion pumps can better mimic physiological variations in cortisol than oral dosing regimens. We show the extent to which cortisol dosing may reduce hospitalization rate - and therefore cost - as well as improve quality of life. We hope our findings encourage the availability of infusion pumps for adrenal insufficiency, a smaller market that may not otherwise attract commercial investment for a dedicated, randomized trial. Presentation: 6/3/2024

Mechanisms linking prenatal environment and linear growth: the case of Ramadan during pregnancy.

Despite established links between prenatal nutritional deprivation and impaired offspring growth, the underlying dynamics and potential moderators remain largely unexplored. This study investigates the dynamics underlying Ramadan during pregnancy and its associations with children's linear growth, using data from the Indonesian Family Life Survey (1993 - 2015). We exploit Ramadan during pregnancy as a natural experiment, separating exposure from maternal background characteristics and season of birth effects. Employing OLS and logistic regressions, we explore two key mechanisms predicted by medical theory. First, the realization of health impairments in response to prenatal shocks is influenced by postnatal circumstances. Our results reveal significant growth impairments primarily in children raised under poor sanitary conditions, which is a risk factor for diminished linear growth by itself. Secondly, we assess whether prenatal Ramadan prompts epigenetic shifts towards earlier reproductive activity, potentially at the expense of height growth. Our data shows that prenatally exposed women tend to have their first childbirth at a younger age, though menarche onset remains unaffected. These results suggest that postnatal environments play a crucial role in mitigating sensitivity to prenatal shocks, highlighting the critical need for favorable living conditions for all children.

Patient Reported Burden of Indolent Systemic Mastocytosis in a Managed Care Organization

Indolent systemic mastocytosis (ISM), the most frequent subtype of SM, requires better understanding. To better understand the diagnostic journey, symptom severity, impact on quality of life and work/activities, and healthcare utilization of ISM. Survey data were collected from 40 adults with documented ISM meeting WHO 2016 criteria, including validated questionnaires [ISM Symptom Assessment Form (ISM-SAF©), Short Form Quality of Life Survey (SF-12v1)]. Spearman correlation coefficients determined the associations between the ISM-SAF© total symptom score (TSS) and SF-12v1 scores. ISM burden was compared based on moderate/severe compared to mild TSS scores using Kruskal-Wallis and Fisher's Exact tests. Patients were aged 56.0±13.0 years, 65.0% female, 62.5% White and 22.5% Hispanic patients. ISM diagnosis took >2 years in 40%, required ≥6 visits in 47.5%, and was considered moderately/extremely difficult in 50% of patients. Nearly half experienced symptoms daily and rated severity somewhat/ significantly worsened since diagnosis. The overall TSS was 27.4±16.2 (mean±SD). SF-12 Physical Component Summary (PCS) (46.7±11.4) and Mental Component Summary (MCS) (47.6±10.2) scores were lower than the general population score of 50. Moderate correlations (P<.001) were found between TSS and the PCS (ρ = -0.6406; p<.001) and MCS (ρ = -0.5104; p<.001). Compared to patients with mild severity (TSS<28; n=21), patients with moderate/severe severity (TSS≥28; n=19) evidenced significantly higher skin and gastrointestinal symptom scores (both, P≤.001). ISM's impact on ability to work for pay was associated with TSS (P=.004). Symptom-directed treatment had limited effect. ISM was self-reported as a burdensome condition in half the patients which markedly affected daily living.

Factors Associated with Health-Seeking Behavior in Indonesia: Evidence from the Indonesian Family Life Survey 2014

Background and Objectives: Health-seeking behavior is a critical determinant of health outcomes, particularly in countries like Indonesia. Given the increasing burden of noncommunicable diseases, understanding the factors that influence health-seeking behavior in this context is essential for developing more accessible and effective public health strategies. This study aimed to identify various factors associated with health-seeking behavior among patients with chronic diseases across Indonesia, especially in formal facilities. Materials and Methods: This study used a cross-sectional research design, utilizing Indonesian Family Life Survey (IFLS)-5 data. The inclusion criteria included respondents aged 20–74 years old with at least one chronic disease based on self-reported data. Respondents who did not receive treatment, practiced self-medication, or provided incomplete data were excluded. We used multivariate logistic regression to identify factors associated with health-seeking behavior in formal facilities. Results: The results revealed that 80.7% (n = 1993) of the 2471 respondents sought treatment in formal facilities, whereas 19.3% (n = 478) opted for informal facilities. Respondents who were Bugis (OR 9.187, 95% CI 2.182–38.683; p = 0.002), retired (OR 2.966, 95% CI 1.233–7.135; p = 0.015), did not smoke (OR 1.604, 95% CI 1.126–2.285; p = 0.009), made less than IDR 1,500,000 a month (OR 1.466, 95% CI 1.174–1.831; p = 0.000), had to travel more than 3 km to reach a treatment facility (OR 1.847, 95% CI 1.41–2.42; p = 0.000), or had more than one comorbidity (OR 1.396, 95% CI; p = 0.01) were more likely to seek treatment at formal facilities. Conclusions: These findings are expected to provide recommendations for policymakers, healthcare providers, and researchers to contribute to the development of targeted interventions that can improve healthcare access and utilization, ultimately enhancing health outcomes and equity in Indonesia.