Lower Total Scores Research Articles

Association between new Life’s Essential 8 and the risk of all-cause and cardiovascular mortality in patients with hypertension: a cohort study

BackgroundThe American Heart Association recently introduced a new model for cardiovascular health (CVH) known as Life’s Essential 8 (LE8). The impact of LE8 on hypertensive individuals is currently unclear. In our study, we investigated the correlation between comprehensive and individual CVH indicators as defined by LE8, and the mortality rates in hypertension patients.MethodsWe analyzed a total of 8,448 hypertensive individuals aged ≥ 20 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2016. These participants were nonpregnant and noninstitutionalized. We identified their mortality by linking their data to the National Death Index until December 31, 2019. The overall cardiovascular health (CVH) was assessed using the LE8 score, which ranged from 0 to 100. Additionally, we evaluated the scores for each component of diet, physical activity, tobacco/nicotine exposure, sleep duration, body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure. The CVH were categorized into low (0–49), moderate (50–79), and high (80–100) CVH.ResultsOver an average follow-up period of 7.41 years, 1,482 (17.54%) of the participants died, among which 472 deaths were attributed to CVD. When compared to adults with lower total CVH scores, those with elevated total CVH scores displayed a 37% reduced risk of mortality from all causes (adjusted hazard ratio [aHR] = 0.63, 95% confidence interval [CI] = 0.45–0.88). In relation to CVD-specific mortality, the corresponding aHRs for moderate and high total CVH scores were 0.76 (0.60–0.97) and 0.54 (0.31–0.94), respectively. Furthermore, after adjusting for potential confounders, it was observed that higher scores on the LE8 index were associated with a reduced risk of both all-cause mortality (aHR for every 10-score increase, 0.91; 95% CI = 0.86–0.96) and CVD-specific mortality (aHR for every 10-score increase, 0.82; 95% CI = 0.75–0.90). Notably, a linear dose–response relationship was observed in this association. Similar patterns were identified in the relationship between health behavior and both all-cause and CVD-specific mortality.ConclusionsAchieving a higher CVH score, as per the new LE8 guidelines, has been found to be associated with a reduced risk of mortality from all causes and specifically from CVD in patients with hypertension. Therefore, public health and healthcare initiatives that focus on promoting higher CVH scores could potentially yield significant benefits in terms of reducing mortality rates among individuals with hypertension.

Health literacy and associated factors in China: findings from the Wa ethnic group.

The health literacy of ethnic groups in remote areas of China is far from satisfactory. However, the health literacy of ethnic groups in China remains unclear. This study aimed to explore the health literacy of the "advancing directly" ethnic group and its influencing factors. A cross-sectional study was conducted using a staged sampling method among the Wa ethnic group, who have rapidly transitioned directly from the traditional lifestyle of slash-and-burn cultivation to modern societies. We used the Health Literacy Questionnaire (HLQ) to assess health literacy. We defined low health literacy as less than 60% of the total score and adequate health literacy as more than 80% of the total score. A total of 668 individuals met the inclusion criteria and the mean age was 42.19 (SD 10.56) years. The mean HLQ total score was 29.9 (SD 10.56). The prevalence of adequate health literacy was 0.89%. There were significant differences between the low and the non-low health literacy groups in terms of gender, age, education, marital status, occupation, residing place, current smoking status, and waist circumference (all p < 0.05). Multiple linear regression analysis showed that women (t = 9·418, p < 0.001), older age (B = -0.0091, t = -2.644, p = 0.008), low educational level (B = 0.766, t = 6.018, p < 0.001), current smoking (B = -2.66, t = -3.038, p = 0.008), and residence far from township (B = -5.761, t = -4.1, p < 0.001) were associated with low HLQ total score. Our findings suggest that the health literacy of the Wa ethnic group is far from favorable. It indicates the need for increased efforts in improving the health literacy of "advancing directly" ethnic groups.

The effects of childhood trauma on nonsuicidal self-injury and depressive severity among adolescents with major depressive disorder: The different mediating roles of positive and negative coping styles

ObjectiveWe aimed to examine whether positive and negative coping styles mediated the influences of childhood trauma on NSSI or depressive severity in adolescents with major depressive disorder (MDD). MethodsThe Children's Depression Inventory (CDI), the Ottawa Self-Injury Inventory Chinese Revised Edition (OSIC), the short-form Childhood Trauma Questionnaire (CTQ-SF), and the Simplified Coping Style Questionnaire (SCSQ) were evaluated in 313 adolescents with MDD. ResultsMDD adolescents with NSSI had higher CTQ-SF total score, emotional and sexual abuse subscale scores, but lower CDI total and subscale scores compared to the patients without NSSI. The multiple linear regression analysis revealed that emotional abuse (β = 0.075, 95 % CI: 0.042–0.107) and ineffectiveness (β = −0.084, 95 % CI: −0.160 ∼ −0.009) were significantly associated with the frequency of NSSI in adolescents with MDD, but emotional abuse (β = 0.884, 95 % CI: 0.570–1.197), sexual abuse (β = 0.825, 95 % CI: 0.527–1.124) and negative coping style (β = 0.370, 95 % CI: 0.036–0.704) were independently associated with the depressive severity in these adolescents. Furthermore, the mediation analysis demonstrated that positive coping style partially mediates the effect of childhood trauma on NSSI (Indirect effect = 0.002, 95 % bootCI: 0.001–0.004), while the negative coping style partially mediates the relationship between childhood trauma and depressive severity (Indirect effect = 0.024, 95 % bootCI: 0.005–0.051) in adolescents with MDD. LimitationsA cross-sectional design, the retrospective self-reported data, the small sample size. ConclusionOur findings suggest that coping styles may serve as mediators on the path from childhood trauma to NSSI or depressive severity in MDD adolescents.

Social skills in patients with obsessive-compulsive disorder before and after treatment.

We aim to investigate whether: 1) social skills (SS) are impaired in obsessive-compulsive disorder (OCD); 2) SS would change over the course of treatment; and 3) severity of OCD, age of onset of OCD symptoms and illness duration would be associated with SS impairments. 41 treatment-naive patients with OCD and 34 control participants (CP) were assessed using a SS inventory. Patients were reevaluated 12-weeks after standardized treatment. Group differences, as well as the treatment effect on OCD symptomatology over time, were analyzed with independent and paired tests, respectively. OCD severity, age at illness onset and illness duration were tested as predictors of SS. Patients had lower total SS scores compared to controls (p-value < 0.001). After treatment, although OCD symptomatology (p-value < 0.001) improved, there was no statistical difference in SS performance (p-value = 0.673). Earlier age of onset of OCD symptoms predicted worse SS total score (p-value = 0.016). This study suggests that, despite the amelioration of OCD symptomatology, there was no alteration in Social Skills (SS) performance. Subsequent treatment investigations incorporating larger sample sizes and extended follow-up periods could elucidate whether enhancements in social skills are likely to manifest over time.

Quality of Life and Employment among Patients with Epilepsy

Abstract Background/Aims: Seizures significantly affect quality of life among patients with epilepsy, while employment significantly contributes to quality of life in general. Thus, in our study, we aimed to determine how the demographic and disease-related characteristics of patients with epilepsy impact quality of life and employment. Methods: Our sample included 202 patients who had been diagnosed with epilepsy for at least a year and who applied to the Neurology Polyclinic between October 2023 and March 2024. Data about patients’ characteristics were collected using a sociodemographic information form, while quality of life was measured using the Turkish Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Results: On average, patients were 29.07 ± 10.84 years old and had had epilepsy for 10.5 ± 8.92 years. Patients’ lowest mean score on the QOLIE-31’s subscales was for Total Quality of Life, whereas their highest mean score was for Social Function. The total quality of life score of patients with low education level and low income was found to be significantly lower. Among other results, patients with a seizure frequency of 6 or more per month had significantly lower scores on all subscales except Emotional Well-Being, and patients with refractory epilepsy and/or receiving polytherapy had significantly lower total scores and scores on all subscales. Conclusions: Our results indicate that employment does not significantly affect quality of life among patients with epilepsy, whereas their clinical features do. Even so, physicians should take all conditions into account to ensure the highest-possible quality of life for patients with epilepsy.

Association between Cerebral Small Vessel Disease and Plasma Levels of LDL Cholesterol and Homocysteine: Implications for Cognitive Function

Background: Investigate the correlation between low-density lipoprotein (LDL) cholesterol, homocysteine and cognitive function in patients with cerebral small vessel disease (CSVD). Methods: 240 patients with CSVD confirmed by head MRI in the Department of Neurology from January 2020 to December 2023 were retrospectively included in the study. All the patients had complete blood biochemical examination, and their cognitive function was evaluated by Montreal Cognitive Assessment Scale (MoCA), and after correcting for the factor of years of education, the patients were divided into a group of normal cognition (MoCA ≥26, 70 patients) and a group of cognitive function (MoCA ≥26, 70 patients) according to the scores. After correcting for the factor of years of education, the patients were divided into the normal cognitive function group (70 cases with MoCA ≥26) and the cognitive dysfunction group (170 cases with MoCA &lt;26) according to their scores. The general information of the two groups and the patients' cognitive function characteristics, including visuospatial and executive ability, naming, attention and calculation, language, abstraction, delayed memory, and orientation, were compared, and the independent influences on the occurrence of cognitive dysfunction in patients with CSVD were analyzed by two-category multifactorial logistic regression. Results: Compared with the group with normal cognitive function, the cognitive dysfunction group had lower years of education and higher homocysteine, and the differences were statistically significant (P &lt; 0.05). Compared with the group with normal cognitive functioning, the cognitive dysfunction group had lower MoCA total scores, lower visuospatial and executive ability, naming, attention and calculation, language, abstraction, delayed memory, and orientation scores, and the differences were statistically significant (P &lt; 0.05). Two-category multifactorial logistic regression analysis showed that low-density lipoprotein cholesterol (OR=2.756, 95% CI:0.673-0.938, P=0.012) and homocysteine (OR=1.859, 95% CI: 1.024-1.324, P=0.016) were the independent factors influencing cognitive dysfunction in CSVD patients. The lower the risk of cognitive impairment in CSVD patients, the higher the plasma LDL cholesterol and homocysteine levels, the higher the risk of cognitive impairment in CSVD patients. Conclusion: Plasma LDL cholesterol and homocysteine levels are associated with and may be predictors of cognitive dysfunction in patients with CSVD.

Efficacy of powder of ginsengporia and atractylodis macrocephalae combined with aerobic exercise in the treatment of obese T2DM: A randomized controlled clinical trial

BackgroundTo explore the efficacy of powder of ginsengporia and atractylodis macrocephalae combined with aerobic exercise in the treatment of obese T2DM and its influence on glucose and lipid metabolism indices. ResultsBoth groups of patients were given metformin drug treatment. The control group was given aerobic exercise intervention, and the observation group was given ginsengporia and atractylodis macrocephalae on the basis of the control group. The total effective rate of the observation group (95.74%) was higher than that of the control group (82.98%) (P < 0.05). After treatment, the main symptoms of the observation group were less (P < 0.05), such as thirst and lack of desire to drink, fatigue, loss of appetite, limb numbness and tingling, sticky stool, scanty dark urine, and lower total score. FPG, 2hPG, and HbA1c were lower (P < 0.05), FINS, HOMA-IR, and HOMA-β were higher (P < 0.05), TG, TC, and LDL-C were lower, and HDL-C levels were higher in the observation group (P < 0.05). After treatment, Nesfatin-1 and adiponectin were lower, visfatin and leptin were higher (P < 0.05), and GIP and GLP-1 levels were higher in the observation group (P < 0.05). No significant difference was found in the incidence of adverse reactions between the two groups (P > 0.05). ConclusionsPowder of ginsengporia and atractylodis macrocephalae combined with aerobic exercise is effective in treating obese T2DM, which can alleviate clinical symptoms and the disorder of glucose and lipid metabolism, and improve the islet function and gastrointestinal function.How to cite: Liu G, Kanti Das S. Efficacy of powder of ginsengporia and atractylodis macrocephalae combined with aerobic exercise in the treatment of obese T2DM: A randomized controlled clinical trial. Electron J Biotechnol 2024;71. https://doi.org/10.1016/j.ejbt.2024.04.006.

ECAS correlation with metabolic alterations on FDG-PET imaging in ALS

Background: Cognitive impairment is observed in up to 50% of patients with amyotrophic lateral sclerosis (ALS). The Edinburgh Cognitive and Behavioral ALS Screen (ECAS) is an ALS-specific multi-domain screening tool. Few studies have examined the relationship between ECAS scores and [18F]fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) findings. Objective: To assess the relationship between ECAS scores and glucose metabolism patterns on [18F]FDG -PET images in ALS. Methods: We collected [18F]FDG-PET images from 65 patients with ALS and 39 healthy controls. ECAS scores were collected on all patients and we calculated the correlation to [18F]FDG-PET in order to investigate the potential links between cognition and glucose metabolism. Results: We observed hypometabolism in the frontal cortex, insula, and limbic system, together with hypermetabolism in the cerebellum in patients with ALS compared to controls. A lower ECAS total score was associated with lower glucose metabolism in the right orbitofrontal gyrus and higher glucose metabolism in lateral occipital, medial occipital, and cerebellar regions, among patients with ALS. Similar results, although less widespread, were observed in the analyses of ECAS ALS-specific scores. Conclusions: The metabolic patterns in [18F]FDG -PET show that changes in the glucose metabolism of corresponding areas are related to cognitive dysfunction in ALS, and can be detected using the ECAS.

Predictors associated with the rate of progression of nigrostriatal degeneration in Parkinson's disease.

Parkinson's disease (PD) manifests as a wide variety of clinical phenotypes and its progression varies greatly. However, the factors associated with different disease progression remain largely unknown. In this retrospective cohort study, we enrolled 113 patients who underwent 18F-FP-CIT PET scan twice. Given the negative exponential progression pattern of dopamine loss in PD, we applied the natural logarithm to the specific binding ratio (SBR) of two consecutive 18F-FP-CIT PET scans and conducted linear mixed model to calculate individual slope to define the progression rate of nigrostriatal degeneration. We investigated the clinical and dopamine transporter (DAT) availability patterns associated with the progression rate of dopamine depletion in each striatal sub-region. More symmetric parkinsonism, the presence of dyslipidemia, lower K-MMSE total score, and lower anteroposterior gradient of the mean putaminal SBR were associated with faster progression rate of dopamine depletion in the caudate nucleus. More symmetric parkinsonism and lower anteroposterior gradient of the mean putaminal SBR were associated with faster depletion of dopamine in the anterior putamen. Older age at onset, more symmetric parkinsonism, the presence of dyslipidemia, and lower anteroposterior gradient of the mean putaminal SBR were associated with faster progression rate of dopamine depletion in the posterior putamen. Lower striatal mean SBR predicted the development of LID, while lower mean SBR in the caudate nuclei predicted the development of dementia. Our results suggest that the evaluation of baseline clinical features and patterns of DAT availability can predict the progression of PD and its prognosis.

Sexual function in women with endometriosis and pelvic floor myofascial pain syndrome.

To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests. There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG. Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.

Chilean children's adherence to sustainable healthy diets and its associations with sociodemographic and anthropometric factors: a cross-sectional study.

To describe adherence to sustainable healthy diets among a sample of 958 Chilean pre-schoolers (3-6years) and explore associations between adherence and child and maternal sociodemographic and anthropometric characteristics. Children's adherence to sustainable healthy diets was calculated from single multiple-pass 24-h dietary recalls using the Planetary Health Diet Index for children and adolescents (PHDI-C). Higher PHDI-C scores (max score = 150 points) represent greater adherence. Adjusted linear regression models were fitted to explore associations between PHDI-C scores and child and maternal characteristics. Children obtained low total PHDI-C scores (median 50.0 [IQR 39.5-59.8] points). This resulted from low consumption of nuts & peanuts, legumes, vegetables, whole cereals, and vegetable oils; a lack of balance between dark green and red & orange vegetables, inadequate consumption of tubers & potatoes and eggs & white meats, and excess consumption of dairy products, palm oil, red meats, and added sugars. Mean PHDI-C total score was significantly higher (50.6 [95%CI 49.6, 51.7] vs 47.3 [95%CI 45.0, 49.5]) among children whose mothers were ≥ 25years compared to those with younger mothers. Positive associations were observed between scores for fruits and maternal education, vegetables and maternal age, added sugars and child weight status, while negative associations were observed between fruits and child age, and vegetable oils and maternal education. Scores for dairy products PHDI-C component were lower among girls. Adherence to sustainable healthy diets was low among this sample of Chilean children and was significantly associated with maternal age, being lower among children whose mothers were younger.

The relationship among the functional levels, dyskinetic movements and participation in children with dyskinetic cerebral palsy

Background &amp; Objective: This study aimed to investigate the relationship between the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), the Eating and Drinking Ability Classification System (EDACS), the Communication Function Classification System (CFCS), dyskinetic movements and participation levels in children with dyskinetic cerebral palsy (DCP) to attain a comprehensive functional profile of DCP. Methods: Forty children with DCP aged between 5-18 years were included. Functional classification systems: GMFCS, MACS, CFCS, EDACS levels investigated. The Dyskinesia Impairment Scale (DIS) was used for evaluate dyskinetic movements: dystonia and choreoathetosis. Assessment of Life-Habits-Questionnaire (LIFE-H) was used for evaluate participation. Spearman’s correlation test was used to evaluate the relationship among functional classification levels, DIS subscales and LIFE-H subdomains. Multivariate simple linear regression, backward model was used to explain relations between LIFE-H subdomains, DIS subscales, GMFCS, MACS, EDACS and CFCS. Results: The mean age was 12.88±4.57 years. Correlations were found between GMFCS-MACS, GMFCS-EDACS, MACS-EDACS, CFCS-MACS, GMFCS-CFCS and EDACS-CFCS (p&lt;0.05); between GMFCS and dystonia upper extremity, dystonia lower extremity total score, dystonia total score (p&lt;0.05); between MACS and dystonia upper extremity, dystonia lower extremity total score, dystonia total score, and dystonia mouth total score (p&lt;0.05). LIFE-H Social-Roles Total Score, Daily-Living-Activities Total Score, LIFE-H-Total-Score were correlated with GMFCS, MACS, EDACS and CFCS (p&lt;0.05). The results of regression analysis showed GMFCS and MACS levels are strong predictors of participations (p&lt;0.05). Conclusions: To plan participatory intervention programs, it is important to understand the levels of participation and differences among children with DCP subtypes according to the ICF framework.

Are associations between adherence to the 2018 WCRF/AICR cancer prevention recommendations and risk of cancers modulated by multimorbidity? Findings from the UK Biobank prospective cohort study

Approximately 40% of cancers in the UK are attributable to modifiable, lifestyle risk factors such as overweight and obesity and low dietary fibre intake(1). The WCRF and AICR published ten lifestyle- based Cancer Prevention Recommendations with the aim of reducing the risk of cancer and other non-communicable diseases(2). In the UK Biobank cohort, we have found reduced risk of cancer overall and of breast and colorectal cancers with greater adherence to these Cancer Prevention Recommendations (i.e., healthier lifestyles). The present study aimed to investigate whether the magnitude of these associations is modified by the presence of co-morbidities, such as diabetes and cardiovascular disease, at baseline.We used data from 94,778 participants (53% female, mean age 56 years) from the UK Biobank prospective cohort study, recruited between 2006 and 2010 and free from cancer at baseline. Adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations was calculated from dietary, physical activity, and body composition data using a standardised score(3). Multimorbidity (list of 43 chronic diseases) was self-reported at baseline and categorised into: 0, 1, 2, or 3+ chronic illnesses. Incident cancer cases were identified using population-based cancer registries available until July 2019 for England and Wales and October 2015 for Scotland. Participants were categorised into approximate score tertiles, and the lowest tertile (lowest adherence, 0-3.5 points) was used as the reference category. Cox proportional hazard models were used to investigate associations between total score and incidence of cancer, adjusting for confounders, and to test for an interaction between total score and multimorbidity.55,191 (58%) participants had one chronic illness at baseline and 8,430 (9%) had ≥3. Mean total 2018 WCRF/AICR score was 3.8 (SD 1.0) points, and participants with the presence of chronic illnesses had a significantly lower total score (mean for ≥3 illnesses = 3.58 points vs 3.96 points for participants without chronic illness, p&lt;0.001). During a median follow-up of 8 years, 3,303 individuals developed cancer. When investigating associations between score tertiles and the risk of cancer overall, there was a significant interaction between the total score and multimorbidity (HR for interaction: 1.59, p=0.002). There was also evidence for an interaction between total score and multimorbidity with breast cancer risk (HR for interaction: 1.23, p=0.030), but no evidence of an interaction between total score and multimorbidity for risk of colorectal cancer.We found stronger associations between total adherence score and the risk of cancer in participants with ≥3 chronic illnesses. This suggests that the chemoprotective effects of greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations may be particularly beneficial for individuals with multimorbidity.

Female sexual function in long-term cervical cancer survivors compared with healthy women and women affected by benign gynecological disorders

ObjectiveTo compare the female sexual function between cervical cancer survivors and healthy women or with benign gynecological diseases. Study designFrom January 1, 2010 to January 31, 2019, a case-control study was conducted to compare the female sexual function of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a routine gynecological examination (n=46) or for a benign gynecological disorder (symptomatic, n=113; asymptomatic, n=26).We prospectively assessed the female sexual function using the Female Sexual Function Index (FSFI). For the contrastive analysis hypothesis, we employed R statistical software. ResultsCervical cancer survivors reported lower sexual activity rates than controls, in general, did (47.12% vs. 88.65%, p=0.0001), and, particularly, compared with healthy and symptomatic controls (47.12% vs. 82.61%, p=0.003; 47.12% vs. 87.61%, p=0.0001, respectively).Sixty and fifty-eight hundredths percent of the cervical cancer survivors experienced female sexual dysfunction, mainly due to hypoactive sexual desire (93.27%). Female sexual dysfunction was diagnosed in 64.32% of the controls, with sexual arousal disorders being the most common diagnosis (44.86%).Compared with controls, cervical cancer survivors exhibited considerably lower FSFI total scores and in sexual desire and lubrication domains (p <0.000; p <0.0001; p=0.023). ConclusionsCervical cancer survivors had worse female sexual function and less sexual activity than controls did, although scores in both groups were in range of FSD. Rates of female sexual dysfunction were similar across cervical cancer survivors and controls, with hypoactive sexual desire and sexual arousal disorders as the most common diagnoses, respectively.

#1098 Utilizing a novel individual patient performance score for mortality prediction in hemodialysis patients

Abstract Background and Aims Chronic kidney disease (CKD) management has advanced significantly over recent years, yet mortality rates among hemodialysis (HD) patients remain high. This study aims to assess the impact of changes in an individualized patient performance score (IPPS) on survival in a large cohort of HD patients. Method This multicentre, observational, prospective cohort study included HD patients across 19 countries, starting from January 1st, 2022. We followed these patients for one year, categorizing them based on their survival status at year's end. We calculated the mean IPPS monthly, from June to December 2021, and divided the patients into tertiles based on their December 2021 scores. Subsequently, we formed five groups based on their IPPS dynamics over six months. We used Kaplan-Meier and Cox regression analyses to evaluate survival, presenting the results as hazard ratios (HR) and 95% confidence intervals (95% CI). A p-value below 0.05 was considered statistically significant. The IPPS, ranging from 0 to 100, was calculated based on eight key performance areas, with higher scores indicating better medical performance: Vascular Access (20 points): type of vascular access, episodes of thrombosis and infection); HD adequacy (20 points): eKt/V, blood flow and treatment time; Anemia (20 points): hemoglobin concentration, transferrin saturation, ferritin; Arterial hypertension (10 points): mean arterial pressure; Mineral Bone disease (15 points): iPTH, plasmatic phosphorus and calcium; Fluid status (5 points): percentage of interdialytic fluid gain; Nutrition (5 points): plasmatic albumin and phosphorus and Others (5 points): influenzae vaccination, transplantation status and hospitalization events. The final score is obtained by the weighted sum of positive clinical factors, subtracted from the weighted sum of negative clinical factors and is reported as a number ranging from 0 to 100, with a higher score representing a better medical performance. Results The study included 10 458 HD patients. In the survival analysis, a significant increase in mortality odds was observed in patients with a stable IPPS of 72 or lower, compared to those with a score consistently above 86. Patients transitioning from the lowest to the highest tertile in six months had a mortality HR similar to those consistently in the highest tertile. On the other hand, patients showing a decrease in IPPS score from the highest to the lowest tertile in the same period had a mortality HR similar to the intermediate group (Table 1). Conclusion A lower total IPPS score (&amp;lt;72) was associated with a threefold increase in mortality risk compared to scores above 86. An increase in IPPS from the lowest to the highest tertile correlated with a significant reduction in mortality, equating to the survival rates of patients consistently scoring high. These findings underscore the potential of IPPS as a valuable tool for guiding clinical interventions in the HD population to enhance patient survival.

#1097 Linking changes in individual performance scores to survival outcomes in chronic hemodialysis patients

Abstract Background and Aims Chronic kidney disease (CKD) management has advanced significantly over recent years, yet mortality rates among hemodialysis (HD) patients remain high. This study aims to assess the impact of changes in an individualized patient performance score (IPPS) on survival in a large cohort of HD patients. Method This multicentre, observational, prospective cohort study included HD patients across 19 countries, starting from January 1st, 2022. We followed these patients for one year, categorizing them based on their survival status at year's end. We calculated the mean IPPS monthly, from June to December 2021, and divided the patients into tertiles based on their December 2021 scores. Subsequently, we formed five groups based on their IPPS dynamics over six months. We used Kaplan-Meier and Cox regression analyses to evaluate survival, presenting the results as hazard ratios (HR) and 95% confidence intervals (95% CI). A p-value below 0.05 was considered statistically significant. The IPPS, ranging from 0 to 100, was calculated based on eight key performance areas, with higher scores indicating better medical performance: Vascular Access (20 points): type of vascular access, episodes of thrombosis and infection); HD adequacy (20 points): eKt/V, blood flow and treatment time; Anemia (20 points): hemoglobin concentration, transferrin saturation, ferritin; Arterial hypertension (10 points): mean arterial pressure; Mineral Bone disease (15 points): iPTH, plasmatic phosphorus and calcium; Fluid status (5 points): percentage of interdialytic fluid gain; Nutrition (5 points): plasmatic albumin and phosphorus and Others (5 points): influenzae vaccination, transplantation status and hospitalization events. The final score is obtained by the weighted sum of positive clinical factors, subtracted from the weighted sum of negative clinical factors and is reported as a number ranging from 0 to 100, with a higher score representing a better medical performance. Results The study included 10 458 HD patients. In the survival analysis, a significant reduction in mortality odds was observed in patients with a stable IPPS of 72 or lower, compared to those with a score consistently above 86. Patients transitioning from the lowest to the highest tertile in six months had a mortality HR similar to those consistently in the highest tertile. On the other hand, patients showing an improvement in IPPS score from the lowest to the highest tertile in the same period had a mortality HR similar to the intermediate group (Table 1). Conclusion A lower total IPPS score (&amp;lt;72) was associated with a threefold increase in mortality risk compared to scores above 86. An increase in IPPS from the lowest to the highest tertile correlated with a significant reduction in mortality, equating to the survival rates of patients consistently scoring high. These findings underscore the potential of IPPS as a valuable tool for guiding clinical interventions in the HD population to enhance patient survival.

Caregiver-reported barriers to care for children and adults with Williams Syndrome

Individuals with Williams syndrome (WS) may experience a variety of medical, behavioral, and educational concerns. The primary objective of this study was to assess barriers to health care for patients with WS, primarily using the Barriers to Care Questionnaire (BCQ), and to assess whether various demographic factors are correlated with these barriers. A REDCap survey was distributed using the Williams Syndrome Association Research Registry. 319 caregivers of individuals with WS in the United States completed the BCQ. On the BCQ, lower scores indicate more barriers to care. Younger age was associated with lower scores for both the pragmatics and the skills subscales while lower income levels and increased distances to providers knowledgeable about WS were consistently associated with lower total BCQ scores.

Cross-sectional association of continuous glucose monitoring-derived metrics with cerebral small vessel disease in older adults with type 2 diabetes.

To examine cross-sectional associations between continuous glucose monitoring (CGM)-derived metrics and cerebral small vessel disease (SVD) in older adults with type 2 diabetes. In total, 80 patients with type 2 diabetes aged ≥70 years were analysed. Participants underwent CGM for 14 days. From the CGM data, we derived mean sensor glucose, percentage glucose coefficient of variation, mean amplitude of glucose excursion, time in range (TIR, 70-180 mg/dl), time above range (TAR) and time below range metrics, glycaemia risk index and high/low blood glucose index. The presence of cerebral SVD, including lacunes, microbleeds, enlarged perivascular spaces and white matter hyperintensities, was assessed, and the total number of these findings comprised the total cerebral SVD score (0-4). Ordinal logistic regression analyses were performed to examine the association of CGM-derived metrics with the total SVD score. The median SVD score was 1 (interquartile range 0-2). Higher hyperglycaemic metrics, including mean sensor glucose, TAR >180 mg/dl, TAR >250 mg/dl, and high blood glucose index and glycaemia risk index, were associated with a higher total SVD score. In contrast, a higher TIR (per 10% increase) was associated with a lower total SVD score (odds ratio 0.73, 95% confidence interval 0.56-0.95). Glycated haemoglobin, percentage glucose coefficient of variation, mean amplitude of glucose excursions, time below range and low blood glucose index were not associated with total cerebral SVD scores. The hyperglycaemia metrics and TIR, derived from CGM, were associated with cerebral SVD in older adults with type 2 diabetes.

Insight into sleep quality and its relationship with emotional intelligence: results of a cross-sectional study among Italian university students.

This study aimed to investigate sleep habits and examine the relationship between sleep quality and its potential predictors, namely Emotional Intelligence (EI) and perceived health status. The present cross-sectional study was conducted between February 13 and February 28, 2023, at the "Magna Græcia" University of Catanzaro, in the Southern part of Italy. The study involved undergraduate students who were 18 years or older, proficient in the Italian language, and with no restrictions on the major attended. They completed a self-administered survey on socio-demographic information, health status, sleep quality (Pittsburgh Sleep Quality Index-PSQI), EI, and perceived health status. The majority of the sample (59.6%) was enrolled in medical or life science majors. The results showed a high prevalence of poor sleep quality and sleep latency was identified as the most affected aspect of it. The female gender and the self-perceived health status were the strongest predictors of poor sleep quality. Poor sleepers showed lower emotional clarity, emotional repair, and total EI scores. Moreover, as age increased, the odds of being classified as a poor sleeper increased by 7%. The survey highlights that poor sleep health is still a significant issue and empowering individuals to make proactive decisions to adopt healthy lifestyles in the early phase of life is of paramount importance. The study exhibited the interesting role of EI in influencing sleep quality, highlighting that when emotional events are insufficiently regulated, it may result in sleep disturbances. Therefore, the promotion of sleep quality requires an integrated yet innovative approach including emotion regulation.

Academic performance among pharmacy students using virtual vs. face-to-face team-based learning

Introduction This study compares pharmacy students’ performance using face-to-face (FTF) team-based learning (TBL) vs. virtual TBL across multiple courses and different academic levels while accounting for student demographic and academic factors. Methods The study included pharmacy students from different academic levels (P1–P3) who were enrolled in three didactic courses taught using FTF TBL and virtual TBL. Multiple generalized linear models (GLMs) were performed to compare students’ performance on individual readiness assurance tests (iRATs), team readiness assurance tests (tRATs), team application exercises (tAPPs), summative exams, and total course scores using FTF TBL vs. virtual TBL, adjusting for students’ age, sex, race, and cumulative grade point average (cGPA). Results The study involved a total of 356 pharmacy students distributed across different academic levels and learning modalities: P1 students [FTF TBL (n = 26), virtual TBL (n = 42)], P2 students [FTF TBL (n = 77), virtual TBL (n = 71)], and P3 students [FTF TBL (n = 65), virtual TBL (n = 75)]. In the P1 cohort, the virtual TBL group had higher iRAT and tRAT scores but lower tAPP scores than the FTF TBL group, with no significant differences in summative exams or total course scores. For P2 students, the virtual TBL group had higher iRAT and tRAT scores but lower summative exam scores and total course scores than the FTF TBL group, with no significant differences in tAPP scores. In the P3 student group, the virtual TBL group had higher iRAT, tRAT, tAPP, summative exam, and total course scores than the FTF TBL group. Conclusions Students’ performance in virtual TBL vs. FTF TBL in the pharmacy didactic curriculum varies depending on the course content, academic year, and type of assessment.