Linear Logistic Regression Models Research Articles

Four-way decomposition of the effects of nutrient supplement and physical exercise on depression among older Chinese: a nationwide cross-sectional analysis

BackgroundStudies on the associations between nutrient supplement, physical exercise, and depression among persons 65 years and older in China are still lacking. We aimed to investigate the association between nutrient supplement and depression and to explore the role of physical exercise in this association.MethodsA total of 8,427 older Chinese adults from the Chinese Longitudinal Healthy Longevity Survey were included in this study. The Center for Epidemiologic Studies Depression Scale was used to assess participants’ depression, and nutrient supplement and physical exercise were evaluated using self-reports. Linear regression and logistic regression were performed to explore the association between nutrient supplement and depression, and a four-way decomposition method was used to explore the effects of nutrient supplement and physical exercise on depression.ResultsA total of 26.2% of participants suffered from depression. Prior to decomposition, multivariable linear regression and logistic regression models showed that older adults who received nutrient supplement had lower depression score (β: -0.704; 95% confidence interval [CI]: -1.004, -0.404) and a lower risk of depression (odds ratio: 0.710; 95% CI: 0.564, 0.894), especially for calcium and multivitamins. Four-way decomposition analysis suggested that physical exercise mediated the associations between nutrient (protein, calcium, iron, zinc, multivitamins, vitamin A/D, docosahexaenoic acid, and others) supplement and depression (all P < 0.05).ConclusionsCalcium or multivitamin supplements were associated with inverse depression, and the reason why this association existed could be partly explained by the mediating effect of physical exercise.

Association between cumulative body mass index exposure and cognitive function among elderly people aged 60 years and older in China

Objective: To analyze the relationship between cumulative body mass index (BMI) and cognitive score or cognitive impairment at different age groups among elderly adults aged≥60 years old. Methods: Participants were recruited from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR). A total of 27 227 participants aged≥60 years old, who completed at least 2 physical examinations between 1992-1994 and 2018-2021, and completed cognitive function tests from 2018 to 2021, were included in the final analysis. Cognitive score was assessed using the Minimum Mental State Examination (MMSE). Cognitive impairment was defined based on education level: illiterate individuals with MMSE≤17, primary school graduates with MMSE≤20, and secondary school graduates with MMSE≤24. Multivariate linear regression or multivariate logistic regression models were used to analyze the association between 10-year weighted cumulative BMI and cognitive score or cognitive impairment in the general population, as well as in specific age groups (including 60-64 years, 65-69 years, 70-74 years, and≥75 years). Restricted cubic spline was adopted to explore the dose-response relationship. Results: The age of enrolled participants was (72.3±5.8) years, and 10 639 (39.1%) were males. The mean MMSE score was (24.9±6.8), and 4 171 (15.4%) participants had cognitive impairment. In the general population, the MMSE score increased and the risk of cognitive impairment decreased with the increase in cumulative BMI when cumulative BMI was280 kg/m2 (β=0.095, 95%CI: 0.060-0.130; OR=0.962, 95%CI: 0.946-0.978). When cumulative BMI≥280 kg/m2, the associations between cumulative BMI level and MMSE score and cognitive impairment risk were not statistically significant (β=-0.105, 95%CI:-0.212-0.001; OR=1.047, 95%CI: 0.992-1.102). Subgroup analysis according to age groups revealed a potential"U-shaped"correlation between cumulative BMI and MMSE score or cognitive impairment risk in participants aged75 years old. For cumulative BMI levels280 kg/m2, the OR and 95%CI for cognitive impairment were 0.983 (0.904-1.069), 0.953 (0.919-0.987), and 0.951 (0.922-0.982) for each 10 kg/m2 increment in cumulative BMI in the 60-64, 65-69, and 70-74 years old groups, respectively. For cumulative BMI≥280 kg/m2, the OR and 95%CI were 1.548 (1.134-2.186), 1.037 (0.938-1.139), and 1.109 (1.014-1.208) in the 60-64, 65-69, and 70-74 age groups. Among those aged≥75 years old, the cumulative BMI level was statistically associated with the increased MMSE score and decreased cognitive impairment (β=0.132, 95%CI: 0.074-0.190; OR=0.961, 95%CI: 0.944-0.979). Conclusions: Overall, when cumulative BMI is280 kg/m2, an increase in cumulative BMI is associated with a reduced risk of cognitive impairment in the general population. However, the association varies among individuals aged75 years old and those≥75 years old when cumulative BMI is≥280 kg/m2. The findings highlight the necessity of personalized weight management strategies for elderly individuals across different age groups.

The waist-to-height ratio is a good predictor for insulin resistance in women with polycystic ovary syndrome

ObjectiveThis study aimed to explore the role of the waist-to-height ratio (WHtR) in assessing insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS).Materials and methodsWe enrolled 882 PCOS-afflicted women in a cross-sectional analysis to evaluate the association of the WHtR with IR. Their demographic characteristics, anthropometric parameters, and fasting blood samples were collected and measured. Moreover, IR was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR). We estimated the relationship between the WHtR and IR and the cut-off thresholds of the WHtR for IR using multivariable linear regression and logistic regression models, respectively.Result(s)The prevalence rate of IR was 51.9%. The patients with PCOS and IR displayed significantly increased values for body mass index (BMI), waist circumference (WC), WHtR, systolic blood pressure (SBP), diastolic blood pressure (DBP), free androgen index (FAI), HOMA-IR, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (ApoB). However, the patients with PCOS and IR showed a reduction in estradiol (E2), luteinizing hormone (LH), LH/FSH ratio, sex hormone binding globulin (SHBG), and high-density lipoprotein (HDL-C) values than those without IR. Moreover, BMI (log-transformed), WC, and HOMA-IR (log-transformed) were positively correlated with the WHtR. When adjusting for potential confounding variables, the WHtR was significantly associated with HOMA-IR (log-transformed), with a standardized regression coefficient of 0.271. Furthermore, the WHtR was significantly associated with an increased risk of IR, with the adjusted odds ratio (OR) of 3.15 (WHtR multiplied by 10). Additionally, the WHtR helped to identify IR in women with PCOS with an optimal cut-off point of 0.519 (Youden index = 0.433).Conclusion(s)The WHtR had a positive association with IR in women with PCOS. Hence, we suggest that the WHtR, as a simple, practical, and reliable anthropometric measure, can be used to predict the risk of IR in patients with PCOS.

Support vector regression model for the prediction of buildings’ maximum seismic response based on real monitoring data

Maximum drift ratio (MDR), one of the engineering demand parameters (EDPs), provides fundamental physical value for predicting building damage. Existing machine learning based prediction models mainly rely on numerical simulation data or structural experiments and are not appropriate for prediction of seismic response of real structures. The New Earthquake Data (NDE1.0) is the most comprehensive publicly available dataset of actual structural seismic response observations. Currently the prediction models using NDE1.0 are mainly based on linear or log-linear regression. In this study, based on the NDE1.0 flatfile, we develop a full-feature support vector regression (SVR) based MDR prediction model (SVR-MDR), treating all the available 41 characteristic parameters including structural information as input feature. To improve the model’s efficiency and practical applicability, we also establish a reduced-feature SVR model (RSVR-MDR) by selecting 10 fundamental parameters based on SHapley Additive exPlanations (SHAP) values and the accessibility of features. Our results demonstrate that SVR-MDR model outperform other machine learning models such as kernel ridge regression and decision tree models, and SVR-MDR and RSVR-MDR models outperform conventional loglinear regression and multinomial models, because SVR can map the complex nonlinear function of multiple variables and consider the available information of buildings especially the fundamental frequency. The proposed RSVR-MDR model have promising potential application for post-event seismic damage assessment and post-event emergency response in near real time.

An Analysis of Opioid Consumption and Patient Recovery after Hysterectomy by Surgical Approach.

Background: Minimally invasive hysterectomy is preferred to open hysterectomy due to lower morbidity, but recent data regarding the association of surgical approach with patient recovery and opioid consumption are lacking. Objective: To analyze how postoperative opioid use and return to baseline activity vary by surgical approach for hysterectomy. Study design: This was a retrospective cohort study including hysterectomy patients from the Michigan Surgical Quality Collaborative registry that was linked to the State of Michigan's prescription drug monitoring program. We analyzed two primary outcomes with respect to surgical approach: opioid consumption in the 30 days following surgery, measured in morphine milligram equivalents (MMEs), and return to baseline activity >4 weeks after surgery. Adjusting for demographics, comorbidities, preoperative opioid use, surgical indication, clinical events at 30 days postoperatively, and surgical approach, we used multivariable linear regression and logistic regression models to identify factors associated with our primary outcomes. Results: Lower opioid consumption was reported with minimally invasive hysterectomy, with mean postoperative opioid consumption (95% CI) of 32.70 (27.15-38.26) MMEs for vaginal, 39.91 (37.17-42.65) MMEs for laparoscopic, and 54.97 (48.81-61.13) MMEs for open hysterectomy. Other covariates associated with lower opioid consumption included older age and year of surgery in 2019 versus 2018. Predicted probability of return to baseline activities >4 weeks after surgery was 51% (44-57%), 43% (40-45%), and 64% (60-69%) for vaginal, laparoscopic, and open hysterectomy, respectively. Conclusion: Minimally invasive approaches to hysterectomy are associated with lower postoperative opioid consumption and a more rapid recovery relative to open hysterectomy.

Assessing diagnosis-related groups based direct medical expenditures of chronic disease patients in general hospital of lower southern Thailand

BackgroundAssessment of the cost-related burden of chronic diseases is important for making informed decisions. An effective and efficient methodology for examining medical expenditures is one of the most significant challenges for stakeholders. The objective of this study was to examine the role of the variables of diagnosis-related group (DRG) in determining the direct expense of chronic diseases in lower southern Thailand and suggest the determinants having high explainability.MethodsThe records of 6,147 patients admitted to Satun Hospital from 2014 to 2018 and diagnosed with chronic conditions were analyzed in this study. Descriptive analysis was used to summarize the main characteristics. Correlation was used to analyze the strength of the relationship. A log-linear regression model was used to evaluate the adjusted mean cost using determinants of DRG.ResultsThe overall average medical expense for chronic disease was Thailand Baht (THB) 17,985. Chronic kidney and chronic obstructive pulmonary diseases were the most expensive chronic diseases with an average expense of about THB 20,000 and 25,000. All the determinants were significantly contributing to overall expense of chronic disease with a p-value < 0.001. However, the length of stay, number of diagnoses, and number of procedures had high explainability in the expense model.ConclusionsThe expense assessment model plays a significant role in controlling and preventing the medical costs associated with chronic diseases. Healthcare administrators, stakeholders, and researchers need to make strategies by considering the results of this study to improve the DRGs-based hospital cost model.

Effective real-time transmission estimations incorporating population viral load distributions amid SARS-CoV-2 variants and pre-existing immunity.

Population-level viral load distribution, measured by cycle threshold (Ct), has been demonstrated to enable real-time estimation of Rt for SARS-CoV-2 ancestral strain. The generalizability of the framework under different circulating variants and pre-existing immunity remains unclear. We obtained the first Ct record of local COVID-19 cases from July 2020 to January 2023 in Hong Kong. The log-linear regression model, fitting on daily Ct mean and skewness to the Rt estimated by case count, was trained using data from wave 3 (i.e., ancestral strain with minimal population immunity), and we predicted Rt for wave 5, 6 and 7 (i.e., Omicron subvariants with > 70% vaccine coverage). Cross-validation was performed by training on the other 4 waves. Stratification analysis by disease severity was conducted to retrospectively evaluate the impact of the changing severity profiles. Trained with the ancestral dominated wave 3, our model can accurately estimate whether Rt was above 1, with the area under the receiver operating characteristic curve of 0.98 (95% confidence interval: 0.96, 1.00), 0.62 (95% CI: 0.53, 0.70) and 0.80 (95% CI: 0.73, 0.88) for three Omicron dominated waves 5 to 7, respectively. Models trained on the other four waves also had discriminative performance. Stratification analysis suggested the potential impact of case severity on model estimation, which coincided with the fluctuation of sampling delay. Our findings suggested that incorporating population viral shedding can provide timely and accurate transmission estimation with evolving variants and population immunity. Model application needs to account for sampling delay.

Associations of prenatal arsenic exposure with myopia in primary school children: Modifying effects of vitamin D levels

The increasing role of environmental pollutants and nutrients in the development of myopia. Further longitudinal evidence is needed to elucidate the effects of early-life environmental pollutants on myopia and nutrients to protect against pollutant-induced myopia. We used mother-child dyads from the Ma'anshan Birth Cohort (n = 2028) to explore the modifying effects of maternal vitamin D status of prenatal and childhood arsenic exposure with refractive parameters and myopia. We measured serum or plasma arsenic concentrations during three trimesters, in cord blood, in childhood (5-year-old), and performed cycloplegic refraction in children aged 7–9 years (n = 1616). Primary outcomes were myopia and refractive parameters including axial length (AL), corneal radius of curvature, and spherical equivalent refraction error. Linear regression, logistic regression, and multiple informant models were performed for the association of prenatal and childhood arsenic exposure with vision health. Sex- and vitamin D status stratification analyses were also conducted. Cord serum arsenic was positively associated with AL (β = 0.15, 95%CI: 0.01, 0.29) and the risk of developing myopia (OR = 1.72, 95%CI: 1.07,， 2.75). Among boys, a 1 ng/L increase in cord serum log10-transformed arsenic resulted in larger AL and a higher risk of myopia. In the vitamin D deficient group (<20 ng/mL), cord serum arsenic showed positive associations with AL (0.26 [0.06, 0.46]) and the risk of myopia (1.99 [1.01, 3.90]). Late pregnancy arsenic exposure likely affects offspring development of myopia, especially in boys. Maternal sufficient vitamin D may confer protective effects against the development of myopia.

Incompleteness and Misclassification of Maternal Deaths in Zimbabwe: Data from Two Reproductive Age Mortality Surveys, 2007–2008 and 2018–2019

IntroductionWe implemented two cross-sectional reproductive age mortality surveys in 2007–2008 and 2018–2019 to assess changes in the MMR and causes of death in Zimbabwe. We collected data from health institutions, civil registration and vital statistics, the community, and surveillance. This paper analyses missingness and misclassification of deaths in the two surveys.MethodsWe compared proportions of missed and misclassified deaths in the surveys using Chi-square or Fisher’s exact tests. Using log-linear regression models, we calculated and compared risk ratios of missed deaths in the data sources. We assessed the effect on MMRs of misclassifying deaths and analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and risk ratios calculated through Binomial exact tests.ResultsAll data sources missed and misclassified the deaths. The community survey was seven times [RR 7.1 (5.1–9.7)] and CRVS three times [RR 3.4 (2.4–4.7)] more likely to identify maternal deaths than health records in 2007–08. In 2018–19, CRVS [RR 0.8 (0.7–0.9)] and surveillance [RR 0.7 (0.6–0.9)] were less likely to identify maternal deaths than health records. Misclassification of causes of death significantly reduced MMRs in health records [RR 1.4 (1.2–1.5)]; CRVS [RR 1.3 (1.1–1.5)] and the community survey/surveillance [RR 1.4 (1.2–1.6)].ConclusionIncompleteness and misclassification of maternal deaths are still high in Zimbabwe. Maternal mortality studies must triangulate data sources to improve the completeness of data while efforts to reduce misclassification of deaths continue.

Abstract 4138301: Burden of Hyperlipidemia, Cardiovascular Mortality, and COVID-19: A Retrospective-Cohort Analysis of US Data

Background: Hyperlipidemia (HLD) is a major risk factor for cardiovascular disease (CVD). Little is known regarding temporal variation in CVD mortality related to HLD. The COVID-19 pandemic added complexity to factors influencing CVD mortality. Question: What are the yearly trends and impact of the COVID-19 pandemic on HLD-related CVD mortality in the United States? Methods: Mortality and demographic data for adults were obtained from CDC repository from 1999-2020, using ICD-10 codes HLD (E78.0-E78.5) and CVD (I00-I99). Age adjusted mortality rates (AAMR) per 1,000,000 population was standardized to the 2000 US population. Log-linear regression models evaluated mortality shifts. Average annual percentage change (AAPC) from 1999-2019 was used to calculate projected AAMR in 2020, subsequently compared to actual 2020 death rates to estimate pandemic-attributed excess deaths. Results: A total of 483,155 HLD-related CVD deaths were recorded between 1999-2020. Despite the CVD mortality decline in general population, HLD-related CVD AAMR rose from 36.33 [95% CI, 35.52-37.13] in 1999 to 99.77 [98.67-100.87] in 2019. Ischemic heart diseases (AAMR 49.39) were the most common causes of death while hypertension had the highest annual mortality increase (AAPC +10.23%) in populations with HLD. Higher HLD-related CVD mortality was observed in males (AAMR 104.87) than females (AAMR 61.93), in those ≥75 years (AAMR 646.45) than 35-75 years (AAMR 54.11), in non-Hispanic (NH) (AAMR 82.49) than Hispanic (AAMR 58.98) populations, and in rural (AAMR 89.98) than urban (AAMR 78.94) regions. NH Black populations (AAMR 84.35) and Western US regions (AAMR 96.88) had the highest HLD-related CVD. The first year of COVID-19 pandemic resulted in 10.55% excess HLD-related CVD death, with the most prominent increase in the 35-75 years age group (14.23%), Hispanic (17.96%), Black (14.82%), and urban (11.68%) populations. Conclusions: Our study revealed an increase in HLD-related CVD mortality which was exacerbated by the COVID-19 pandemic. Higher CVD mortality disproportionately affected males, Black, elderly (≥75 years), and rural populations with HLD. Further research is needed to validate our findings and identify contributing factors.

Burden of Hyperlipidemia, Cardiovascular Mortality, and COVID-19: A Retrospective-Cohort Analysis of US Data.

Hyperlipidemia is a major cardiovascular disease (CVD) risk factor, but limited data on its mortality trends in CVD over time. We assessed annual hyperlipidemia-related CVD mortality trends in the United States, including the COVID-19 pandemic's impact. Mortality data were obtained from CDC repository between 1999 and 2020 among patients ≥15 years old, using ICD-10 codes hyperlipidemia (E78.0-E78.5) and CVD (I00-I99). Age-adjusted mortality rates (AAMR) per 1,000,000 population was standardized to the 2000 US population. Log-linear regression models were used to evaluate mortality shifts. Average annual percentage change (AAPC) from 1999-2019 was used to project 2020 AAMR, estimating pandemic-attributed excess deaths. From 1999 to 2020, 483,155 hyperlipidemia-related CVD deaths occurred. Despite a general CVD mortality decline, hyperlipidemia-related CVD AAMR rose from 36.33 in 1999 to 99.77 in 2019. Ischemic heart diseases (AAMR 49.39) were the leading cause while hypertension had the highest mortality increase (AAPC +10.23%). Mortality rates were higher in males (AAMR 104.87), non-Hispanic (AAMR 82.49), and rural populations (AAMR 89.98). Highest mortality was observed in Black populations (AAMR 84.35), those ≥75 years (AAMR 646.45), and Western US regions (AAMR 96.88). During the first pandemic year, deaths exceeded projections by 10.55%, with notable increases among ages 35-75 (14.23%), Hispanic (17.96%), Black (14.82%), and urban (11.68%) groups. Hyperlipidemia-related CVD mortality has risen over the past two decades, further heightened by the COVID-19 pandemic, with higher impact on males, Black Americans, the elderly, and rural residents. Further study is needed to understand contributing factors and mitigate disparities.

Current and predicted disease burden in middle aged and elderly population aged 55 years and above in Shenzhen, 2016-2030

Objective: To analyze the disease burden in middle-aged and elderly population aged ≥55 in Shenzhen from 2016 to 2030 and provide evidence for the development of healthy aging strategies. Methods: The years of life lost (YLL), years lost due to disability (YLD), and the disability-adjusted life year (DALY) in this population from 2016 to 2022 were calculated. Joinpoint log-linear regression model was used to analyze the time trend. Bayesian age-period-cohort model and grey system model were used to predict YLL, YLD, and DALY in this population in 2030. Results: From 2016 to 2022, the crude DALY rate showed a transient fluctuation in age group 55-74 years, but a pronounced increase in age group ≥85 years. The proportions of YLL and YLD due to non-communicable diseases in all age groups was considerably higher than those due to communicable and nutritional diseases and injuries. In 2022, in all age groups, the YLL due to neoplasms (55-74 years old) and cardiovascular disease (≥75 years old) ranked first, and the YLD due to musculoskeletal disorder ranked first. By 2030, the causes of YLL and YLD ranking first in each age group would be remained, while the ranks of some causes would increase. Conclusions: The age specific characteristics of current and predicted disease burden differed in individuals aged ≥55 years. Therefore, it is necessary to allocate social and medical resources according to the disease burden pattern.

Carotid intima media thickness and glomerular filtration rate: a baseline analysis of the PolyIran-L trial.

The relationship between kidney and vascular health is acknowledged, but detailed information is still missing.This study examines the relationship of estimated glomerular filtration rate (eGFR) and carotid intima media thickness, providing insights into the association between atherosclerosis and kidney function. Participants older than 50years of age who were part of the PolyIran-L study, a trial nested in the Golestan Cohort Study, were included. The maximal intima media thickness of both common carotid arteries was evaluated using B-mode ultrasonography. Four different cut-off values for abnormal carotid intima media thickness were considered. Correlation of carotid intima media thickness and eGFR was assessed with linear correlation and multivariable binary logistic regression models after adjusting for several confounders. In total, 1562 participants (750 females, 48%) were included in this population-based study. Assuming the eGFR < 45 [mL/min/1.73 m2] group as reference in the crude analysis, those with eGFR ≥ 45 and < 60 [mL/min/1.73 m2] showed an association of being less likely to have carotid intima media thickness above the 0.8 cutoff. However, the fully adjusted analysis showed no significant statistical association between carotid intima media thickness and eGFR. This study did not support the independent association of eGFR and different carotid intima media thickness cutoffs. This pattern may be different in patients with severely decreased eGFR, a subset of cases in which it should be furtherinvestigated.

Paternal involvement and children's internalization of gender roles in early childhood

AbstractObjectiveThis study investigates the effects of paternal involvement on the frequency of gender‐incongruent activities in children's play at age 2.BackgroundRecent research suggests that paternal involvement is associated with more gender egalitarian attitudes in children and a more egalitarian distribution of housework tasks between sons and daughters. Although previous studies have tested the effects of paternal involvement on teenage children, the process of internalization of gender norms and roles in early childhood has not yet been investigated.MethodAnalyses are based on the French Elfe cohort with information at age 2 for 11,564 children born in 2011. Multivariate linear and multinomial logistic regression models were run separately for sons and daughters.ResultsPaternal involvement in early childhood was associated with more frequent gender‐incongruent activities in boys' but not in girls' play at age 2. The effect of paternal involvement further varied depending on the type of involvement: involvement in housework tasks and childcare was associated with more gender‐incongruent activities for sons but paternal participation in children's play increased the frequency of activities gender‐typed as masculine, independently of the child's sex.ConclusionPaternal involvement in housework and childcare in early childhood shapes gender‐typed activities in toddlers' play for sons but not for daughters. It contributes to “undoing gender” in play activities for boys and, in doing so, narrows the gender gap in children's play.

Weight gain during pregnancy and the probability of macrosomia in women with gestational diabetes

Objective. To analyze the association between gestational weight gain in women with gestational diabetes and an increased risk of macrosomia. Materials and methods. Cohort study with 139 pregnant women screened by a single-step oral glucose tolerance curve between 24-28 weeks of gestation were confirmed with gestational diabetes and sent to a hospital. Pre-pregnancy body mass index (BMI) was calculated from pre-pregnancy weight. Weight was measured at each prenatal consultation. The reference category was women with normal prenatal BMI who gained appropriate weight during pregnancy. At each visit, medical nutrition therapy (MNT) consisted of nutritional counseling, physical activity plan, and insulin therapy. Compliance with MNT was measured by capillary glucose measurements taken by each participant at home. Results. 74.8% were primiparous, and 28.8% had normal pre-pregnancy BMI. The no linear logistic regression model showed women with normal pre-pregnancy BMI had twice (OR= 2.08, 95%CI: 1.07,4.05) the possibility of macrosomia, compared to mothers with overweight or obesity, adjusting for Capurro index, number of children in the family, and percent of compliance MNT. Macrosomia was the most prevalent childhood complication (12.3%). Conclusion. Women with normal pre-pregnancy BMI who gained more weight during pregnancy were at higher risk of having macrosomic infants.

COVID-19 and sepsis-related excess mortality in the US during the first three years: A national-wide time series study.

The COVID-19 pandemic's global impact has been devastating, causing millions of deaths. Our study investigates excess sepsis-related mortality trends over three years during the pandemic. Using CDC's National Vital Statistics System data from January 2018 to March 2023, we projected sepsis-related deaths during the pandemic using a Poisson log-linear regression model. We compared observed versus predicted deaths and analyzed temporal trends by demographics and regions. Among the 753,160 deaths documented between March 2020 and March 2023, a significant downward trend was noted in sepsis-related mortality rates from March 2022 to March 2023, coinciding with the surge of the Omicron variant. The excess mortality rates were 170.6 per million persons (95% CI: 168.2-172.6), 167.5 per million persons (95% CI: 163.6-170.9), and 73.3 per million persons (95% CI: 69.4-76.6) in the first, second, and third years, respectively. Increased sepsis-related mortality was observed across all age subgroups, with the greatest increase noted in those aged 85 years and above compared to middle- and young-aged decedents. Disparities were also observed across racial/ethnic, sex/gender subgroups, and geographic regions. This study highlights the effectiveness of current policies and prevention measures in response to the long-term circulating of SARS-CoV-2 in the community.

Characteristics and outcomes of inpatients aged 85 and older with thoracolumbar vertebral fractures: impact on hospital stay and mortality

BackgroundThere is a gap in evidence about medical outcomes in oldest-old patients (aged 85 and older) with vertebral fractures (VFs). The aim of this study was to evaluate the impact of patient and fracture characteristics on “short-term” hospital outcomes.MethodsAll patients aged ≥ 85 presenting an acute or subsequent VF at our single level I spine center between 2019 and 2021 requiring hospital treatment were included. The data collection was conducted retrospectively. The primary parameters of interest were length of stay (LOS) and in-hospital mortality. Further outcome parameters were the occurrence of general (non-operative) complications and Intensive Care Unit (ICU) admission. For statistical analysis, linear and binary logistic regression modeling were performed.ResultsA total of 153 patients with an average age of 88.5 (range 85 to 99) met the inclusion criteria. Our patients were mostly female (68.6%) and moderately comorbid according to a Charlson Comorbidity Index (CCI) of 2.9. 58.8% had diagnosed osteoporosis. Fracture morphologies represented as “Osteoporotic Fracture” (OF) classification types were of central importance for undergoing operative treatment (OP) (p < 0.001), necessity for intensive care (p = 0.023), LOS (p = 0.014), and mortality (p = 0.018). 38.6% had OP. We recorded a complication rate of 59.5%, which highly influenced (p < 0.001) both primary outcome parameters. Overall, patients stayed 14.6 days with a mortality of 11.1%.ConclusionVFs are a severe event in oldest-old patients with a crucial risk of poor medical outcomes during hospitalization. The fracture morphologies are of central importance. However, little is known about the hospital stay of oldest-old inpatients with VFs. Considering an aging population, further investigations would be recommended.

Determining the Identity of Nucleotides and the Energy of Binding of tRNAs to Their Aminoacyl-tRNA Synthetases Using a Simple Logistic Model

This study showed that the predictor in logistic regression can be applied to estimating the Gibbs free energy of tRNAs’ recognition of and binding to their aminoacyl-tRNA synthetases. Then, 24 linear logistic regression models predicting different classes of tRNAs loaded with a corresponding amino acid were trained in a machine learning classification method, reducing the misclassification error to zero. The models were based on minimal subsets of Boolean explanatory variables describing the favorite presence of nucleotides or nucleosides localized in the different parts of the tRNA. In 90% of cases, they agree with the components of the consensus strand in a class of tRNAs loaded by a given amino acid. According to the proposed theoretical model, the values of the free energy for the entry of the recognition state in the process of tRNA charging were obtained, and the inputs from identity nucleotides and the tRNA strand backbone were distinguished. Almost all the resulting models indicated leading anticodon tandems defining the first and second positions of the anticodon (positions 35 and 36 of the tRNA strand) and the small sets (up to six positions) of the other nucleotides as the natural identity nucleotides most influential in the free energy balance. The magnitude of their input to this energy depends on the position in the strand, favoring positions −1, 35, and 36. The role of position 34 is relatively smaller. These identity attributes may not always be fully arranged in a real single adaptor molecule but were comprehensively present in a given tRNA class. A detailed analysis of the resulting models showed that the absolute value of the energy of binding the tandem 35–36 decreases with the number of identity positions, as well as with the decreasing number of possible hydrogen bonds. On the other hand, in these conditions, the absolute value of the energy of binding of other identity nucleotides increases. All the models indicate that the nucleotide-independent energy of the repulsion tRNA backbone decreases with the number of identity nucleotides. It was also shown that the total free energy change in entering the recognition state increases with the amino acid mass, making this process less spontaneous, which may have an evolutionary reference.

Association between acute tobacco exposure and fractional exhaled nitric oxide in patients with chronic obstructive pulmonary disease: National health and Nutrition Examination Survey (NHANES) 2007–2012

BackgroundFractional exhaled nitric oxide (FeNO) is a marker of type 2 airway inflammation. Tobacco exposure can lower FeNO levels. However, the effect of acute tobacco exposure on FeNO in patients with chronic obstructive pulmonary disease (COPD) is unclear. This study aimed to investigate the relationship of acute tobacco exposure with FeNO and eosinophils in COPD patients. MethodsThis retrospective cohort study included 445 patients with COPD based on the 2007–2012 National Health and Nutrition Examination Survey. Serum cotinine levels were examined to assess environmental tobacco smoke exposure. The patients were divided into five groups based on cotinine levels: Q1 (first quintile), Q2 (second quintile), Q3 (third quintile), Q4 (fourth quintile) and Q5 (fifth quintile). Logistic regression models and linear logistic regression models were used to evaluate the relationship between serum cotinine and FeNO and EOS levels. ResultsApproximately 16.5 % (75/445) of the participants had elevated FeNO (>25 bbp). In the unadjusted model, COPD patients with the lowest quintile of serum cotinine levels (0.011–0.0185 ng/mL) had higher FeNO levels compared to those with the highest quintile (≥309 ng/mL) (odds ratios (OR), 5.86 [2.11–16.20]). These findings remained consistent even after adjusting for covariates of demographics, lifestyle, diabetes, coronary heart disease, tumours, hypertension, using oral or inhaled steroids within 2 days, asthma and respiratory symptoms within 7 days. Furthermore, a standard deviation increase of ln-transformed cotinine levels was associated with decreased FeNO levels (OR, 0.45 [0.33, 0.60]). No significant correlation was observed betweenserum cotinine and blood eosinophils. After high extents of tobacco exposure, no correlation was found between FeNO and eosinophils.Our findings indicate that high cotinine levels are associated with decreased FeNO in COPD patients but not with blood eosinophils. This reveals that smoking may affect FeNO levels in patients with COPD, whereas it does not appear to influence blood eosinophil levels.

Childhood maltreatment, adulthood obesity and incident type 2 diabetes: a retrospective cohort study using UK Biobank.

This study aims to explore the association of childhood maltreatment with obesity and type 2 diabetes (T2D) in adulthood, and whether obesity is a mediator of the latter. In a retrospective cohort study using UK Biobank data, participants recalled childhood maltreatment. Linear regression, logistic regression, and Cox proportional hazard models were used to investigate the associations with body mass index (BMI), obesity, and T2D, adjusted for sociodemographic factors. Decomposition analysis was used to examine the extent to which T2D excess risk was attributed to BMI. Of the 153,601 participants who completed the childhood maltreatment questions, one-third reported some form of maltreatment. Prevalence of adult obesity and incidence of T2D were higher with the number of reported childhood maltreatment types. People who reported ≥3 types of childhood maltreatment were at higher risk of obesity (OR 1.55, 95% CI 1.47-1.63) and incident T2D (HR 1.65, 95% CI 1.52-1.80). Excess T2D risk among those reporting maltreatment could be reduced by 39% if their BMI was comparable to participants who had not been maltreated, assuming causality. People who recalled maltreatment in childhood are at higher risk of T2D in adulthood, partly due to obesity.