Low-risk Patterns Research Articles

Rate of atrial fibrillation by Holter-Stroke Risk Analysis in undetermined TIA/rapidly improving stroke symptoms patients.

Holter-SRA (Stroke Risk Analysis) is an automated analysis of ECG monitoring for Atrial Fibrillation (AF) detection. The aim of this study was to evaluate the rate of AF in undetermined TIA/Rapidly improving stroke symptoms (RISS) patients. Prospective study of undetermined TIA/RISS patients who presented to the emergency department. Early vascular studies (angio CT, transthoracic echocardiography and ECG) were performed in emergency department. The Holter-SRA device was placed for 2 h and the patients were classified into: confirmed AF, high risk of AF or low risk of AF. Prolonged ambulatory monitoring (7 days) was carried out every month for patients with a high-risk pattern. The results were evaluated until definitive detection of AF or low-risk pattern. The endpoints were rate of AF and vascular recurrence at 90 days. Over a period of 24 months, 83 undetermined TIA/RISS patients were enrolled. The mean age was 70 ± 10 years and 61% were men. The median ABCD2 score was 4 points (1-7). After 2 h of monitoring in the emergency department, AF was detected in one patient (1.2%), 51 patients with a low-risk pattern and 31 patients (37.3%) showed a high-risk pattern of AF. During the ambulatory monitoring, of the 31 patients high risk pattern patients, AF was diagnosed to 17 cases and of the 51 patients with a low-risk pattern, one case experienced a recurrent vascular due to undetected AF (1.9% false negative). Three patients (3.6%) suffered a vascular recurrence within the first 90 days, before AF diagnosis. In our study, AF was detected in 22.9% of the 83 patients with indeterminate TIA/RISS. Holter-SRA has allowed us to increase the detection of AF, especially those patients with a high-risk pattern in the first 3 months.

Early childhood trajectories of domain-specific developmental delay and gestational age at birth: An analysis of the All Our Families cohort.

To describe developmental domain-specific trajectories from ages 1 through 5 years and to estimate the association of trajectory group membership with gestational age for children born between ≥34 and <41 weeks gestation. Using data from the All Our Families cohort, trajectories of the domain-specific Ages & Stages Questionnaire scores were identified and described using group-based trajectory modeling for children born ≥34 and <41 weeks of gestation (n = 2664). The trajectory groups association with gestational age was estimated using multinomial logistic regression. Across the five domains, 4-5 trajectory groups were identified, and most children experienced changing levels of risk for delay over time. Decreasing gestational age increases the Relative risk of delays in fine motor (emerging high risk: 1.46, 95% CI: 1.19-1.80; resolving moderate risk: 1.11, 95% CI: 1.03-1.21) and gross motor (resolving high risk: 1.21, 95% CI: 1.04-1.42; and consistent high risk: 1.64, 95% CI: 1.20-2.24) and problem solving (consistent high risk: 1.58 (1.09-2.28) trajectory groups compared to the consistent low risk trajectory groups. This study highlights the importance of longitudinal analysis in understanding developmental processes; most children experienced changing levels of risk of domain-specific delay over time instead of having a consistent low risk pattern. Gestational age had differential effects on the individual developmental domains after adjustment for social, demographic and health factors, indicating a potential role of these factors on trajectory group membership.

Patterns and Transitions of Nonsuicidal Self-Injury Outcome Expectancies and Their Associations with Nonsuicidal Self-Injury among Adolescents.

Nonsuicidal self-injury (NSSI) outcome expectancies (i.e., the expectations that certain outcomes will follow NSSI) have been confirmed to predict NSSI engagement. However, it remains unclear whether adolescents hold different patterns of NSSI outcome expectancies and therefore vary in their risks of NSSI engagement. Moreover, little is known about whether patterns transition over time, influencing the development of NSSI. Additionally, possible gender differences in the patterns and their transitions need to be explored. This study aims to address these research gaps. A total of 679 adolescents (55.8% females; Mage = 15.19, SDage = 1.40) completed questionnaires and were surveyed semiannually for three times. Using latent profile analysis, regular latent transition analysis, and random intercept latent transition analysis, this study identified four patterns of NSSI outcome expectancies: High Affect Regulation and Moderate Negative Expectancies, Low Negative Expectancies, High Negative Expectancies, and High Communication and Negative Expectancies. The first two patterns showed high risks of NSSI, whereas the latter two patterns showed low risks of NSSI. Low Negative Expectancies was an unstable pattern. It had higher probabilities of transitioning to another high-risk pattern than transitioning to the low-risk patterns. The other three patterns had high stability. Gender had no significant effects on the four patterns or their transitions. The findings highlight the combined effects of NSSI outcome expectancies and underscore that NSSI outcome expectancies may change over time. Prevention and interventions targeting multiple factors corresponding to these expectancies should be developed.

The routine clinical use of fluorodeoxyglucose PET/CT to confirm treatment response in pyogenic spine infection.

Response of pyogenic spine infection to antibiotic therapy is usually based on nonspecific symptoms and inflammation markers. Abnormalities on MRI persist too long to influence therapy. Is FDG-PET/CT a timely and robust predictor of successful therapy? Retrospective study. Sequential FDG-PET/CTs done to assess treatment response over a 4-year period. Recurrence of infection after stopping treatment was the endpoint. One hundred seven patients enrolled. First treatment response scan showed no signs of infection in 69 patients (low risk). Twenty-four additional patients underwent additional treatment after an initial positive scan with low-risk pattern on follow-up imaging. After stopping antibiotics, none had clinical recurrence of infection. One had positive cultures at surgery for negative predictive value of 0.99. Thirty-eight patients had evidence of residual infection. Abnormalities in 28 were comparable to what is seen with untreated infection (high-risk). Twenty-seven received additional treatment until resolution. Antibiotics were stopped in 1 who suffered recurrence. Ten had low-grade/localized abnormalities consistent with infection (intermediate-risk). Signs of infection resolved in 3 after additional treatment. Of the remaining 7 patients who had minor residual abnormalities when antibiotics were stopped, 1 had recurrent infection for a positive predictive value of 0.14. Risk stratification proposed: A low-risk scan with only inflammation at a destroyed joint indicates negligible risk of recurrence. Unexplained activity in bone, soft tissue or spinal canal indicates high risk with further antibiotics recommended. Most patients with subtle or localized findings (intermediate risk) did not experience recurrence. Stopping therapy could be considered under careful observation.

D-dimer trends elaborate the heterogeneity of risk in hospitalized patients with COVID-19: A multi-national case series from different waves.

Variable D-dimer trends during hospitalization reportedly result in distinct in-hospital mortality. In this multinational case series from the first and second waves, we show the universality of such D-dimer trends. We reviewed 405 patients with COVID-19 during the first wave admitted to three institutions in the United States, Italy, and Colombia, and 111 patients admitted to the U.S. site during the second wave and 55 patients during the third wave. D-dimer was serially followed during hospitalization. During the first wave, 66 (15%) patients had a persistently-low pattern, 33 (8%) had early-peaking, 70 (16%) had mid-peaking, 94 (22%) had fluctuating, 30 (7%) had late-peaking, and 112 (26%) had a persistently-high pattern. During the second and third waves, similar patterns were observed. D-dimer patterns were significantly different in terms of in-hospital mortality similarly in all waves. Patterns were then classified into low-risk patterns (persistently-low and early-peaking), where no deaths were observed in both waves, high-risk patterns (mid-peaking and fluctuating), and malignant patterns (late-peaking and persistently-high). Overall, D-dimer trends were associated with an increased risk for in-hospital mortality in the first wave (overall: HR: 1.73) and stayed the same during the second (HR: 1.67, p < 0.001) and the third (HR: 4.4, p = 0.001) waves. D-dimer behavior during COVID-19 hospitalization yielded universal categories with distinct mortality risks that persisted throughout all studied waves of infection. Monitoring D-dimer behavior may be useful in the management of these patients.

Evolving Pattern Improves the IMWG 2/20/20 Classification for Patients with Smoldering Multiple Myeloma

Introduction: Smoldering multiple myeloma (SMM) is a monoclonal gammopathy defined by the presence of an M-protein in serum ≥30 g/L and/or ≥500 mg/24h in urine and/or ≥10% of plasma cells in bone marrow, in the absence of CRAB symptoms or very high-risk criteria (SLiM). Multiple scales are available to stratify the risk of SMM progression. In clinical practice, the most used are the PETHEMA model and the 2/20/20 model established by the Mayo Clinic and validated by the International Myeloma Working Group (IMWG). These scales, in addition to providing prognostic information, allow us to guide patient follow-up and could support the start of treatment in high-risk patients. On the other hand, SMM can develop an evolving pattern, characterized by a progressive increase of the M-protein that is associated with a higher risk of progression to symptomatic multiple myeloma (MM). The objective of this study is to explore whether the incorporation of the evolving pattern to the IMWG score allows for a more accurate identification, particularly of high-risk patients. Materials and methods: Clinical records of patients diagnosed with SMM between 2011 and 2020 in a single hospital center, excluding those who met SLiM criteria, were reviewed. Progression to symptomatic MM was established according to the IMWG criteria. The evolving pattern was defined as the progressive increase of at least 10% or 25% in the M-protein size within the first 12 months from diagnosis when baseline M-protein was ≥30 g/L or <30 g/L, respectively (Ravi et al, Blood Cancer J 2016, Fernandez de Larrea et al, Leukemia 2018). The evolving type was analyzed as a time-dependent covariate. Results: Ninety three patients were initially included in the study; however, 10 patients were finally excluded: 9 for presenting SLiM criteria (1 with >60% bone marrow plasma cells, 9 with a free light chain ratio >100) and 1 for missing data. Median follow-up was 3.2 years (IQR 2-5) with a rate of progression (RP) at 2 and 4 years of 20% (95%CI 12-30) and 33.7% (95%CI 23-46), respectively. Using IMWG risk stratification model, the 2-year RP was 3.3% (95%CI 0.5-21) in low-risk patients, 9.3% (95%CI 2-32) in intermediate-risk patients, and 54 % (95%CI 35-75) in high-risk patients. Regarding the evolving pattern, it was recognized in 25% of patients. Median time from SMM diagnosis and recognition of evolving type was 9 months (IQR 6-12). The RP at 2 and 4 years was 48% (95%CI 29-71) and 65% (95%CI 44-85) for evolving type. After adding the evolving classification to IMWG model, we created a new prognostic classification system that divides patients into three risk groups: low (IMWG low or intermediate risk and non-evolving pattern), intermediate (IMWG low or intermediate risk and evolving pattern, or high risk and non-evolving pattern) and high (IMWG high risk and evolving pattern), with a 2-year RP of 2.4% (95%CI 0.3-15), 20% (95%CI 9-43) and 88.9% (95%CI 61-99), respectively. The cumulative incidence of progression to MM for the three risk groups using the IMWG and the new Evolving-2/20/20 system is represented in Figure 1A, whereas in Figure 1B the reclassification of patients with the new Evolving-2/20/20 system is shown. Regarding the validation of this score, the area under the curve (AUC) of the new score was greater than that of the IMWG and that of the evolving score independently (2y-AUC PETHEMA 0.65, IMWG 0.83, Evolving 0.77, Evolving-2/20/20 0.89; P=0.02). In addition, concordance was superior with the new score Evolving-2/20/20 (C-index 0.93) compared with PETHEMA (0.73), IMWG (0.86) and evolving (0.85) by themselves. The specificity and the positive predictive value for detecting high-risk patients at 2 years with the new model was very high (98% and 88%, respectively) compared to the other risk stratification models (PETHEMA 59% and 27%; IMWG 83 and 52%; Evolving 83% and 49%, respectively). Decision curve analysis indicated that the score was clinically useful. Conclusions: The dynamic addition of the evolving pattern to the IMWG classification (Evolving-2/20/20 system) in patients with SMM, allows more precise risk stratification and the detection of those with very high risk of progression. These patients could benefit from more intensive follow-up and may be eligible for early treatment strategies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Alcohol Consumption Post-Liver Transplantation: A Cross-Sectional Study

Background: Listing patients with alcohol-associated liver disease (ALD) for liver transplant (LT) remains challenging especially due to the risk of alcohol resumption post-LT. We aimed to evaluate post-LT alcohol consumption at a Portuguese transplant center. Methods: We conducted a cross-sectional study including LT recipients from 2019 at Curry Cabral Hospital, Lisbon, Portugal. A pretested survey and a validated Portuguese translation of the Alcohol Use Disorder Identification Test (AUDIT) were applied via a telephone call. Alcohol consumption was defined by patients’ self-reports or a positive AUDIT. Results: In 2019, 122 patients underwent LT, and 99 patients answered the survey (June 2021). The mean (SD) age was 57 (10) years, 70 patients (70.7%) were males, and 49 (49.5%) underwent ALD-related LT. During a median (IQR) follow-up of 24 (20–26) months post-index LT, 22 (22.2%) recipients consumed any amount of alcohol: 14 had a drink monthly or less and 8 drank 2–4 times/month. On drinking days, 18 patients usually consumed 1–2 drinks and the remainder no more than 3–4 drinks. One patient reported having drunk ≥6 drinks on one occasion. All post-LT drinking recipients were considered low risk (score <8) as per the AUDIT score (median [IQR] of 1 [1–2]). No patient reported alcohol-related problems, whether self-inflicted or toward others. Drinking recipients were younger (53 vs. 59 years, p = 0.020), had more non-ALD-related LT (72.7 vs. 44.2%, p = 0.018) and active smoking (31.8 vs. 10.4%, p = 0.037) than abstinent ones. Conclusion: In our cohort, about a quarter of LT recipients consumed alcohol early posttransplant, all with a low-risk pattern according to the AUDIT score.

Mode Of Transport, Genetic Susceptibility, And Incidence Of Coronary Heart Disease

PURPOSE: Using an inactive transport mode, such as cars, is a risk factor of coronary heart disease (CHD). However, whether the associations of transport mode with CHD vary by genetic susceptibility to CHD are unknown. This study aims to investigate the interaction between genetic susceptibility and transport mode in relation to incidence of CHD. METHODS: We included 364,560 white British participants from UK Biobank with no CHD at baseline. Genetic risk for CHD was quantified through polygenic risk scores, calculated based on 300 single-nucleotide polymorphisms related to CHD risk. Categories of transport mode included exclusive use of cars and more active patterns of travel (e.g., walking, cycling and public transport), separately for non-commuting (e.g., getting about; in the full sample [n = 364,560]) and commuting (in the sub-set [n = 188,816] who responded to the commuting question). Hazard ratios (HR) for incident CHD (n = 9,686; median 12.1-year follow-up), as well as the interaction between genetic risk and travel modes were estimated using Cox regression with age as the underlying timescale. RESULTS: The HRs of CHD were 1.45 (95% CI: 1.37-1.53) and 2.06 (95% CI: 1.96-2.17) for middle and high genetic risk, respectively, compared with low genetic risk, after adjusting for age, sex, lifestyle factors and other confounders. Compared with an active mode of transport, hazards of CHD were higher for exclusive use of cars for either non-commuting [HR: 1.08(1.04-1.13)] or commuting [HR: 1.16(1.08-1.25)], after adjusting for confounders including genetic susceptibility. Compared with the joint reference category of low genetic risk and active travel patterns for non-commuting, the hazards for CHD were relatively higher for exclusive use of cars for non-commuting in combination with moderate [HR:1.59(1.47-1.72)]or high genetic risk [HR: 2.23(2.07-2.40)]: similar joint associations were observed for the commuting categories combined with three categories of genetic risk. CONCLUSIONS: Exclusive use of cars for either commuting or non-commuting was associated with an increased risk of CHD at all levels of genetic risk including high genetic risk. Community-based interventions customized to individuals with high genetic risk should focus on promoting a more active transport mode to prevent CHD.

In utero myelomeningocele repair and high-risk bladder pattern. a prospective study.

ABSTRACTObjectivesHigh-risk bladder pattern can be defined by Urodynamic Evaluation (UE) as overactive bladder with detrusor leak point pressure higher than 40 cmH2O and/or higher filling pressures also above 40 cmH2O. We wanted to evaluate response to treatment in myelomeningocele patients operated in utero in this subgroup.Patients and MethodsFrom our prospective cohort of in utero MMC we have identified patients in the high-risk group. Treatment consisted of anticholinergics (Oxybutynin 0.2 mg/Kg) 2 or 3 times daily in association with CIC. At every UE, patients were reclassified in high-risk or low-risk patterns. Patients not responding were proposed bladder reconstruction or diversion according to age.ResultsBetween 2011 to 2020, we have been following 121 patients and 60 (49.6%) of them were initially categorized as high-risk. The initial UE was performed at a mean age of 7.9 months and detrusor overactivity was found in 83.3% (mean maximum pressure of 76.5cmH20). When evaluating patients with 2 or more UE, we identified 44 patients (follow-up: 36.8months). It was observed in the group of patients who underwent 2 to 5 UE, that response to treatment was validated by the finding of 40% of low-risk bladder patterns in the second UE and between 62% to 64% in the third to the fifth UE. The incidence of surgery was 13.3%.ConclusionsEarly urological treatment of high-risk bladder pattern was effective in approximately 60%. We reinforce the need to correctly treat every patient with myelomeningocele, in accordance with UE, whether undergoing in utero or postnatal treatment.

Clinical correlation of lymphovascular invasion and Silva pattern of invasion in early-stage endocervical adenocarcinoma: proposed binary Silva classification system

Silva invasion pattern can help predict lymph node metastasis risk in endocervical adenocarcinoma. We analysed Silva pattern of invasion and lymphovascular invasion to determine associations with clinical outcomes in stage IA and IB1 endocervical adenocarcinomas. International Federation of Gynecology and Obstetrics (FIGO; 2019 classification) stage IA-IB1 endocervical adenocarcinomas from 15 international institutions were examined for Silva pattern, presence of lymphovascular invasion, and other prognostic parameters. Lymph node metastasis status, local/distant recurrences, and survival data were compared using appropriate statistical tests. Of 399 tumours, 152 (38.1%) were stage IA [IA1, 77 (19.3%); IA2, 75 (18.8%)] and 247 (61.9%) were stage IB1. On multivariate analysis, lymphovascular invasion (p=0.008) and Silva pattern (p<0.001) were significant factors when comparing stage IA versus IB1 endocervical adenocarcinomas. Overall survival was significantly associated with lymph node metastasis (p=0.028); recurrence-free survival was significantly associated with lymphovascular invasion (p=0.002) and stage (1B1 versus 1A) (p=0.002). Five and 10 year overall survival and recurrence-free survival rates were similar among Silva pattern A cases and Silva pattern B cases without lymphovascular invasion (p=0.165 and p=0.171, respectively). Silva pattern and lymphovascular invasion are important prognostic factors in stage IA1-IB1 endocervical adenocarcinomas and can supplement 2019 International Federation of Gynecology and Obstetrics staging. Our binary Silva classification system groups patients into low risk (patterns A and B without lymphovascular invasion) and high risk (pattern B with lymphovascular invasion and pattern C) categories.

Patterns of six behaviors and psychosomatic symptoms in adolescents: A six-province study in China

BackgroundPsychosomatic symptoms are often related with behaviors. However, the association between different behaviors and their latent patterns and psychosomatic health status is unclear. Current study aimed to identify the patterns of six behaviors and explore the association between different patterns and psychosomatic symptoms in a school-based sample of Chinese adolescents. MethodsFrom November 2015 to January 2016, the study enrolled 22,628 students from six cities in China (15.36 ± 1.79 years). Six behaviors [unintentional injury (UI), non-suicidal self-injury (NSSI), suicidal behaviors (SB), drinking, smoking, screen time (ST)] and psychosomatic symptoms (psychological and physical symptoms) were measured by self-report validated questionnaires. ResultsSix behaviors were all related to psychosomatic symptoms, among which SB was the strongest. Four patterns of behaviors were be identified as follows: low-risk pattern (64.0%), substance use pattern (4.5%), injury pattern (28.8%) and high-risk pattern (2.7%). Logistic regression analysis of psychological symptoms indicated that compared with low-risk pattern, high-risk pattern had the highest risk, followed by injury pattern, substance use pattern showed the lowest risk. Compared with low-risk pattern, the results of physical symptoms suggested the degree of risk was high-risk pattern, injury pattern and substance use pattern, respectively. LimitationsCross-sectional data were used in the study that could not evaluate causal relationships between six behaviors and psychosomatic symptoms. ConclusionsSix behaviors and their latent patterns are related to psychosomatic symptoms among Chinese adolescents differently, so different intervention and prevention protocol need to be taken for different patterns of adolescents.

Fall Patterns Predict Mortality After Hip Fracture in Older Adults, Independent of Age, Sex, and Comorbidities.

Falls are the most frequent cause of hip fracture. We aimed to investigate whether specific fall patterns have predictive value for mortality after hip fracture. In this cohort study, data of individuals presented to the Severance Hospital, Seoul, Korea, between 2005 and 2019 due to fragility hip fracture (n = 1986) were analyzed. Fall patterns were defined as causes, activities leading to falls, and a combination of both, based on electronic medical records using pre-specified classification from a prior study on video-captured falls. Mean age of study subjects were 77 years (71% women) and 211 patients (10.6%) died during follow-up (median 544 days). Indoor falls at home had a higher mortality than outdoor falls (11.9 vs. 8.0%, p = 0.009). Among 16 fall patterns, incorrect weight shift while sitting down (adjusted hazard ratio [aHR] 4.03) or getting up (aHR 2.01), collapse during low-risk activity (aHR 2.39), and slipping while walking (aHR 2.90, p < 0.01 for all) were associated with increased mortality compared to outdoor falls, after adjustment for age, sex, and Charlson comorbidity index (CCI), constituting a high-risk pattern. High-risk fall patterns were associated with a higher risk of mortality (aHR 2.56, p < 0.001) than low-risk patterns (aHR 1.37, p = 0.080) and outdoor falls (referent; log rank p < 0.001), which improved mortality prediction when added to a base model including age, sex, and CCI (integrative area under receiver-operating characteristics curve 0.675 to 0.698, p < 0.001). Specific fall patterns were associated with higher mortality in older adults with hip fracture, independent of age, sex, and comorbidities.

Cancer prevalence in the subcategories of the indeterminate class III (AUS/FLUS) of theBethesda system for thyroid cytology: a meta-analysis.

The indeterminate cytologic report represents a major challenge in the field of thyroid nodule. The indeterminate class III of the Bethesda classification system (i.e., AUS/FLUS) includes a heterogeneous group of subcategories characterized by doubtful nuclear and/or architectural atypia. The study aim wastoconduct a systematic review and meta-analysis to evaluate the rate of malignancy in each subcategory of Bethesda III. PubMed, CENTRAL, and Scopus databases were searched until April 2020. Original articles reporting data on the subcategories of Bethesda III were included. The histological diagnosis was the reference standard to classify true/false negative and true/false positive cases. The pooled cancer prevalence in each subcategory of Bethesda III was estimated using a random-effects model. Twenty-three papers with 4241 nodules were included. Overall, 1163 (27.4%) were malignant. The cancer rate observed in the subcategories ranged from 15%, in "Hürthle cell aspirates with low risk pattern", to 44%, in "Focal cytologic atypia". The overall cancer rate found in the Bethesda III ranged more largely than that originally estimated (10-30%) and varied among any scenarios. These evidence-based data represent a reference for the clinical management of these patients.

Longitudinal Associations of Pubertal Timing and Tempo With Adolescent Mental Health and Risk Behavior Initiation in Urban South Africa

PurposeIn high-income countries, early and rapid pubertal development is consistently associated with poor adjustment and increased risk behavior in adolescence. This study contributes to the meager knowledge of these associations in lower income countries. MethodsWe used longitudinal data from 1,784 urban black South Africans in the Birth to Twenty Plus cohort. We used regression analyses to assess associations between age at menarche and latent classes of pubertal timing and tempo and adolescent internalizing and externalizing emotional and behavioral problems, eating attitudes, and patterns of health risk behavior initiation. ResultsRelatively earlier and faster pubertal timing and tempo were associated with increased health risk behavior initiation (e.g., adjusted odds ratio [95% confidence interval] high- vs. low-risk pattern = 5.7 [1.7, 19.06] for male genital development; adjusted odds ratio = 3.45 [1.13, 10.49] for female breast development). Among males, earlier and faster pubertal timing and tempo were associated with increased externalizing problems in early adolescence and increased oppositional defiant problems in midadolescence, whereas later and slower pubertal timing and tempo were associated with decreases. Among females, earlier and faster pubertal timing and tempo were associated with increased internalizing and externalizing problems in midadolescence and increased dieting behaviors in early and late adolescence (β [95% confidence interval] = 2.51 [.87, 4.15] for pubic hair development), whereas later and slower pubertal timing and tempo were associated with decreases. ConclusionsIn this urban South African cohort, relatively earlier and faster pubertal development was detrimental to mental health and risk behavior activity, whereas later and slower maturation was somewhat protective.

Local and network-level dysregulation of error processing is associated with binge drinking

Binge drinking refers to the pattern of alcohol consumption that brings blood alcohol levels to or above legal intoxication levels. Commonly practiced by young adults, it is associated with neurofunctional alterations, raising health-related concerns. Executive deficits may contribute to the inability to refrain from excessive alcohol intake. As a facet of cognitive control, error processing allows for flexible modification of behavior to optimize future outcomes. It is highly relevant to addiction research, as a failure to inhibit excessive drinking results in relapses, which is a hallmark of alcohol use disorder. However, research on local and system-level neural underpinnings of inhibition failures as a function of binge drinking is limited. To address these gaps, functional magnetic resonance imaging (fMRI) was used to examine local changes and interregional functional connectivity during response inhibition errors on a Go/NoGo task. Young adult binge drinkers (BDs) performed equally well as light drinkers (LDs), a group of demographically matched individuals who drink regularly but in low-risk patterns. In contrast, BDs exhibited greater fMRI activity to inhibition errors contrasted with correct NoGo trials in the rostral anterior (rACC) and posterior cingulate cortices (PCC), as well as right middle frontal gyrus (R-MFG). Furthermore, BDs showed increased connectivity between the rACC and right lateral prefrontal cortex, in addition to greater connectivity between the R-MFG and the left ventrolateral and superior frontal cortices. Imaging indices were positively correlated only with alcohol-related measures, but not with those related to moods, disposition, or cognitive capacity. Taken together, greater error-related activity and expanded functional connectivity among prefrontal regions may serve a compensatory role to maintain efficiency of inhibitory control. Aligned with prominent models of addiction, these findings accentuate the importance of top-down control in maintaining low-risk drinking levels. They provide insight into potentially early signs of deteriorating cognitive control functions in BDs and may help guide intervention strategies aimed at preventing excessive drinking habits.

Spatial Modelling of Under-five Mortality in Lesotho with Reference to 2014 Demographic and Health Surveillance Dataset

Background: Lesotho is the country located in the Sub-Saharan region of Africa countries where under-five mortality (U5M) is still a big issue due to some significant social and demographic risk factors. Hence, the investigation of some social and demographic factors that are associated with the U5M, is a critical problem that needs due consideration. Methods: This study used the 2014 Lesotho Demographic and Health Survey (LDHS) that had a sample of over 9000 representative households. Individually, data consisting of a nationally representative sample of 9,543 households in the 2014 Lesotho Demographic and Health Survey were analysed. The Random Walk second-order (RW2) model was adopted for analysis. Maps construction and modelling were done through the spatially structured and unstructured random effects using the Gaussian Markov Random Field and a zero-mean Gaussian process, respectively. The full Bayesian inference was adopted to produce the results using the Integrated Nested Laplace Approximation (INLA) function in R-software. Results: In this study, age at death of an under-five child was found to have a linear association with the U5M in Lesotho. The non-stationary models outperform the stationary models. The low-risk pattern was found in the north of Lesotho, and the highest risk occurs in the centre through the south, east, west, southeast, and northwest. Breastfeeding has contributed significantly to under-five mortality to most of Lesotho districts. Conclusion: This study adopted the newly developed statistical models to model and mapped the U5M in Lesotho. The full Bayesian inference was used to produce the results using R-INLA package. The findings from this study can help introduce new policies that will help reduce disparity in Lesotho.

Spatio-Temporal Variation of Gender-Specific Hypertension Risk: Evidence from China.

Previous studies which have shown the existence of gender disparities in hypertension risks often failed to take into account the participants’ spatial and temporal information. In this study, we explored the spatio-temporal variation for gender-specific hypertension risks in not only single-disease settings but also multiple-disease settings. From the longitudinal data of the China Health and Nutrition Survey (CHNS), 70,374 records of 21,006 individuals aged 12 years and over were selected for this study. Bayesian B-spline techniques along with the Besag, York, and Mollie (BYM) model and the Shared Component Model (SCM) model were then used to construct the spatio-temporal models. Our study found that the prevalence of hypertension in China increased from 11.7% to 34.5% during 1991 and 2015, with a higher rate in males than that in females. Moreover, hypertension was found mainly clustered in spatially adjacent regions, with a significant high-risk pattern in Eastern and Central China while a low-risk pattern in Western China, especially for males. The spatio-temporal variation of hypertension risks was associated with regional covariates, such as age, overweight, alcohol consumption, and smoking, with similar effects of age shared by both genders whereas gender-specific effects for other covariates. Thus, gender-specific hypertension prevention and control should be emphasized in the future in China, especially for the elderly population, overweight population, and females with a history of alcohol consumption and smoking who live in Eastern China and Central China.

Identifying trajectories of alcohol use in a sample of secondary school students in Ontario and Alberta: longitudinal evidence from the COMPASS study.

Despite evidence indicating a rapid progression in use of alcohol during adolescence, little is known about the ways patterns of drinking develop over time. This study investigated patterns of alcohol use within a cohort of youth in Ontario and Alberta and the probability of changes between patterns. The sample consists of two-year linked longitudinal data (school year 2013/14 to 2014/15) from 19 492 students in Grades 9 to 12 in 89 secondary schools across Ontario and Alberta, Canada, who participated in the COMPASS study. The latent class analysis used two self-reported items about the frequency of drinking (measured as none, monthly, weekly, or daily use) and the frequency of binge drinking (measured as none, less than or once a month, 2-4 times a month, or more than once week) to characterize patterns of alcohol use. The effects of gender, ethnicity and cannabis and cigarette use on alcohol use patterns were examined. The study identified four drinking patterns: non-drinker, periodic drinker (reported monthly drinking and no binge drinking), low-risk drinker (reported monthly drinking and limited binge drinking) and high-risk regular drinker (reported drinking 1-3 times a week and binge drinking 2-4 times a month). Non-drinker was the most prevalent pattern at baseline (55.1%) and follow-up (39.1%). Periodic drinkers had the highest likelihood of an increase in alcohol consumption, with 40% moving to the low-risk pattern. A notable proportion of participants returned to a lower severity pattern or transitioning out of drinking. There are four distinct youth alcohol-use patterns. The high probability of transitioning to drinking during the secondary school years suggests the need for preventive interventions in earlier stages of use, before drinking becomes habitual.

Patterns of alcohol consumption and alcohol-related harm among European university students.

To compare patterns of alcohol consumption and alcohol-related harm from a survey of university students sampled from universities in Denmark, England, Germany, Italy, Portugal and Switzerland. A total of 2191 university students (70% female, 90% white ethnic group, age range 18-25) completed the survey. Participants completed measures of demographic variables (age, age of onset, ethnic group and sex) and the Alcohol Use Disorders Identification Test (AUDIT), which was the primary outcome. Sixty-three percent of the sample scored negative for harmful drinking on the AUDIT (<8), with 30% categorized as hazardous drinkers, 4% harmful drinkers and 3% with probable dependence. Analysis of variance, including demographic factors as covariates, identified a main effect of country on AUDIT scores F(5, 2086) = 70.97, P < 0.001, partial eta square = 0.15. AUDIT scores were highest in England (M = 9.99; SD = 6.17) and Denmark (M = 9.52; SD = 4.86) and lowest in Portugal (M = 4.90; ° = 4.60). Post hoc tests indicated large effect size differences between scores in Denmark and England and scores in all other countries (0.79 < d < 0.94; all P's < 0.001). European university students in our sample mainly reported low risk patterns of alcohol consumption and alcohol-related harm. However, students from Northern European countries had significantly higher AUDIT scores compared with students from Central and Southern European countries. Research is needed to replicate the present study using nationally representative samples to estimate the prevalence of alcohol use disorders among university students in different European countries.

Similar to Adiponectin, Serum Levels of Osteocalcin are Associated with Mammographic Breast Density in Postmenopausal Women.

Breast cancer is the most common type of cancer in Canadian women and worldwide. Mammographic density is a well-established breast cancer risk. Recent evidence suggested inverse correlations among adiponectin, osteocalcin, and the risk developing breast cancer. The objective of the study was to evaluate the relationship between breast density and adiponectin and osteocalcin concentrations. A cross-sectional study was performed in 239 women, age range 40 to 60. Mammographic density, serum adiponectin, and osteocalcin levels were measured. According to the Wolfe method, participants were divided into those with low-risk and high-risk pattern mammograms. The study population included 107 premenopausal and 132 postmenopausal women. Parameters were no different between women with low-risk and high-risk patterns. In obese postmenopausal women, the high-risk pattern mammogram group had significantly higher values of adiponectin and osteocalcin compared with the low-risk pattern group. Multiple linear regression analyses showed that adiponectin and osteocalcin levels were associated with high-risk pattern mammograms. Adiponectin and osteocalcin levels were directly associated with high-risk pattern mammograms in obese postmenopausal women. These results do not support the use of adipokines as biomarkers; nevertheless, the most important factor is to assess the risk through breast density.