Male Subgroup Research Articles

Transition from metabolically healthy to unhealthy overweight/obesity and risk of cardiovascular disease incidence: A systematic review and meta-analysis

AimsDiscrepant results have been demonstrated regarding the cardiovascular (CV) risk of populations with metabolically healthy overweight/obesity (MHO) who were transitioned into metabolically unhealthy states. So, the objective of this systematic review and meta-analysis was to estimate the risk of cardiovascular diseases (CVD) incidence in individuals with transitional MHO phenotype. Data synthesisA literature review was done in PubMed, Scopus, EMBASE, and google scholar databases. Pooled HRs for all fatal and nonfatal CV events were computed using random-effect models for transitional MHOs in general as well as for each sex subgroup separately.This systematic review and meta-analysis included a total of 7 prospective observational studies with a total of 7,720,165 participants, published between 2018 and 2020. The mean follow-up duration of participants was 11.7 (5.5) years. Overall, the transitional MHO individuals had a significant risk of CVD incidence [HR = 1.42, 95% CI (1.24–1.60)]. In addition, in both male and female subgroups, unstable MHO phenotype demonstrated a significant CVD risk and HRs for incident CVD in males and females were 1.51 (1.07–1.96) and 1.71 (1.08–2.34), respectively. ConclusionTransition from MHO to unhealthy state throughout follow-up elevated the risk of CVD in both male and female groups. This can explain the association between MHO and incidence of CV events especially with longer follow up period. Registration code in prosperoCRD42021270225.

The relationship between estimated glucose disposal rate and bone turnover markers in type 2 diabetes mellitus.

To investigate the relationship between estimated glucose disposal rate (eGDR) and bone turnover markers in patients with type 2 diabetes mellitus (T2DM). This is a cross-sectional study, which recruited 549 patients with T2DM. The eGDRs of patients were calculated based on the presence of hypertension, glycated hemoglobin, and body mass index. All patients were divided into high-eGDR group and low-eGDR group using the median of eGDR as the boundary. The patients were further divided into two subgroups: males and postmenopausal females. The lower the eGDR, the more severe was insulin resistance. The levels of osteocalcin (OC), type I collagen carboxyl-terminal peptide (β-CTX), and type I procollagen amino-terminal peptide (PINP) were significantly lower in the low-eGDR group than those in the high-eGDR group. The eGDR was positively correlated with OC, β-CTX, and PINP in all patients, and in the male subgroups. In the postmenopausal female subgroup, there was no correlation between eGDR and OC, β-CTX, or PINP. In addition, this positive correlation remained after adjusting for other factors in multilinear regression analysis. Our study was the first to demonstrate that eGDR is positively correlated with bone turnover markers in patients with T2DM. This correlation was observed among the male patients with T2DM but not among postmenopausal female patients with T2DM.

The Positive Relationship Between the Low-Density Lipoprotein Cholesterol/Apoprotein B Ratio and Bone Turnover Markers in Patients With Type 2 Diabetes.

BackgroundDyslipidemia may contribute to low bone turnover in patients with type 2 diabetes (T2D) through mediating oxidative stress and atherosclerosis. The low-density lipoprotein cholesterol/apoprotein B (LDL-C/Apo B) ratio is a surrogate marker of small and density low-density lipoprotein cholesterol (sd-LDL-C), a most harmful group of LDL-Cs. The present study aimed to investigate the association between the LDL-C/Apo B ratio and bone turnover in patients with T2D.MethodsThis study was a cross-sectional study enrolled patients with T2D from January 2021 to December 2021. Each participant was assessed for lipid profiles, bone turnover markers (BTMs), lumbar spine (L1-L4) and hip dual-energy X-ray absorptiometry (DXA) scans. Osteoporosis was diagnosed as a T-score lower than or equal to -2.5 at the spine or hip.ResultsA total of 335 patients with T2D were enrolled in the study, and the LDL-C/Apo B ratio ranged from 0.78 to 4.00. Along with the LDL-C/Apo B ratio tertile ascending, osteocalcin (OC), C-terminal telopeptide (CTx) and N-terminal propeptide of type-I procollagen (PINP) levels gradually increased (all p < 0.05). There were no differences in lumbar spine and hip T-score, proportion of osteoporosis (all p > 0.05) among the three subgroups. The LDL-C/Apo B ratio was positively correlated with lnOC (r = 0.244, p < 0.001), lnCTx (r = 0.226, p < 0.01) and lnPINP (r = 0.211, p < 0.001). These significant positive correlations persisted even when divided into male and female subgroups. Furthermore, three multiple linear regression analyses were constructed to investigate the independent association of the LDL-C/Apo B ratio with the BTMs levels. After adjusting for other clinical parameters, the LDL-C/Apo B ratio was still significantly associated with OC level (β = 0.199, t = 3.348, p < 0.01), CTx level (β = 0.238, t = 4.084, p < 0.001) and PINP level (β = 0.162, t = 2.741, p < 0.01).ConclusionThe LDL-C/Apo B ratio was significantly and positively associated with BTMs in patients with T2D. In clinical practice, more attention should be paid to the patients with T2D whose LDL-C/Apo B ratio is relatively low for the purpose of maintaining bone health.

Menopause Is a Key Factor Influencing Postprandial Metabolism, Metabolic Health and Lifestyle: The ZOE PREDICT Study

ObjectivesThe menopause transition is associated with unfavourable alterations in metabolic and cardiovascular health. However, as an age-related biological event, it is difficult to untangle effects of age from menopause. Here, we investigate the impact of menopause on cardiometabolic health, lifestyle and diet in pre- and post-menopausal females and age-matched subgroups (including males) in the densely phenotyped ZOE PREDICT 1 cohort (NCT03479866). MethodsDemographic information, diet, cardiometabolic blood biomarkers and postprandial responses (lipid and glucose) to standardized test meals in clinic and free-living settings were assessed (n = 1002). Self-reported pre- (n = 366), peri- (n = 55) and post-menopausal (n = 207) females (aged 18–65 y) and an age-matched subgroup (aged 47–56 y) of males (n = 76), pre- (n = 83) and post-menopausal females (n = 64) were identified. Linear regression analysis assessed differences in cardiometabolic health, anthropometry, lifestyle and diet (adjusted for sex, age, BMI, menopausal hormonal treatment and smoking status). ResultsPost-menopausal females had poorer fasting and postprandial blood measures (glucose, HbA1c, inflammation (GlycA), glucose2hiauc and insulin2hiauc; by 6, 5, 4, 42 and 4% respectively) and sleep quality (12%) and higher sugar intakes (12%) compared with pre-menopausal females (p < 0·05 for all). In age-matched females, postprandial glycemia was significantly higher in post- versus pre-menopausal females (p < 0·05), including clinic postprandial glucose peak0-2h (7·6 ± 1·2 vs 7·2 ± 1·0), glycemic variability (using a continuous glucose monitor (CGM)) (18 ± 4% vs 16 ± 4%) and glucose2hiauc (CGM) following a standardized (typical UK/US nutrient composition) meal (13440 ± 5804 vs 12547 ± 5488). Compared to age-matched males, females (pre- and post-menopausal) had lower systolic blood pressure and ASCVD 10y risk (p < 0.05) and post-menopausal females only had worse glycemic variability (p < 0·001). ConclusionsIn the largest, in-depth nutrition metabolic study of menopause to date, we demonstrate unfavourable links between menopause transition and postprandial glycemic responses, sleep and diet. This emphasises the value of incorporating menopause as a factor in the delivery of nutrition advice. Funding SourcesZOE Ltd

ADIPOSITY AND VASCULAR AGEING: WHICH PARAMETER BETTER CORRELATES?

Objective: The increase in stiffness of large arteries is one of the mechanisms that could play a role in the association between obesity and increased risk of cardiovascular (CV) events. Carotid-femoral pulse wave velocity (cfPWV) represents a validated measure of large arteries stiffness and a good proxy of arterial ageing. We aimed at evaluating which body composition parameters better correlated with cfPWV and whether this correlation differed between men and women. Design and method: cfPWV was measured in all subjects; body composition was evaluated by bioimpedance analysis and waist circumference (W). Furthermore, each subject was characterized by sex, age, height, weight, body mass index (BMI), brachial blood pressure (BP) and heart rate. A linear correlation was used to define the relationship between cfPWV and parameters. Univariate and multivariate analysis were performed in male and female subgroup separately to select the main determinants of arterial stiffness, considering the following parameters: age, mean BP (mBP), BMI, W, fat mass (FM) and skeletal muscle mass (SMM). We enrolled 69 subjects (37 men, 32 women) with average age 34.5 years (min 19-max 76). Results: cfPWV was significantly correlated with age (r = 0.65, p &lt; .0001), and mBP (r = 0.38, p &lt; .01). Among the body composition parameters, W, BMI and FM percentage were significantly correlated with cfPWV (respectively: r = 0.48, r = 0.42, r = 0.41; p &lt; .0001). Multivariable regression analysis in men revealed that age and mBP were significant determinants of cfPWV (respectively: b = 0.042, p = 0.002; b = 0.051, p = 0.004). Conversely, multivariate analysis in women showed that age, FM and SMM are retained as main determinants of increased cfPWV (respectively: b = 0.079; p &lt; 0.0001; b = 0.217, p = 0.012; b = 0.125, p = 0.011). Conclusions: Irrespectively of gender, age is the main determinant of arterial stiffness. Our results demonstrated that the relationship between adiposity and arterial stiffness is verified only in female subjects. This suggests that this relationship is influenced by complex and not fully known mechanisms. Moreover, technical factors (algorithm and indirect methods to assess body composition) contribute to uncertainty regarding which parameter exploring adiposity is more accurate in stratifying CV risk. The present study recalls attention on possible gender-specific determinants of arterial ageing.

Triglyceride Glucose Index for Predicting Major Adverse Cardiovascular Events in Chinese Patients with Hypertension.

We conducted a longitudinal study (from February 2017 to July 2017) to explore whether the triglyceride glucose index (TyG) index has a prognostic value for major adverse cardiovascular events (MACE) among high-risk Chinese hypertensives. The study population were from 6 districts of Tianjin, China. Finally, a total of 2250 patients were enrolled in this 3.5year cohort study. The patients were divided into two groups according to the cut-off value of the TyG index: Low-TyG group (n = 901, TyG ≤ 8.87), High-TyG group (n = 1349, TyG > 8.87). Univariate and multivariate Cox regression analyses were used to estimate the relationship between the TyG and MACE. In multivariate cox regression analyses, the hazard ratio (HR) (95% confidence interval (CI)) of the high-TyG group was 1.313 (1.010, 1.708) compared with the low-TyG group. In those with an age ≤65years and male subgroups, the prediction value of TyG was higher, and the risk of occurrence of MACE greater after adjusting other risk factors. The TyG index is an indicator to predict the development of MACE in hypertensive patients.

Consistency evaluation of target heart rate determined by anaerobic threshold and by resting heart rate in patients with coronary artery disease after percutaneous coronary intervention

Objective: To evaluate the consistency on the determination of target heart rate by simple calculation method based on resting heart rate and by anaerobic threshold method in cardiopulmonary exercise test (CPET) for patients with coronary artery disease after percutaneous coronary intervention (PCI). Methods: This study was a diagnostic test. Patients with coronary artery disease who underwent the first PCI in the Department of Cardiology of Peking University People's Hospital from October 2011 to April 2021 were enrolled. Patients were further divided into subgroups according to gender, age (<60 years group and ≥60 years group), with or without myocardial infarction history (myocardial infarction group and angina pectoris group) and whether β blockers were applied. The general clinical data of patients, resting heart rate (RHR) and anaerobic threshold heart rate in CPET were collected through the electronic medical record system. The simple target rate (RHR plus 20 or 30 bpm) and the target rate calculated by anaerobic threshold (anaerobic threshold heart rate minus 10 bpm) were both calculated in each patient. Consistency test of target heart rate derived by above the two methods was shown by intra-class correlation (ICC) and Bland-Altman plots. Results: A total of 439 patients were included, age was (56.2±8.8) years, body mass index was (25.77±2.34) kg/m2, there were 382 males (87.0%). The target heart rate determined by anaerobic threshold method was (90.0±11.8)bpm, and the simple target heart rate determined by RHR plus 20 bpm was (91.0±8.4)bpm. There was no significant difference on the target heart rate derived from the two calculation methods (P=0.091). The simple target heart rate determined by RHR plus 30 bpm was (101.0±8.4)bpm, which was significant higher than that determined by anaerobic threshold method (P<0.001). In the following analysis, RHR plus 20 bpm was defined as the simple target heart rate. The ICC value of target heart rate determined by anaerobic threshold and resting rate plus 20 bpm was 0.529(95%CI 0.458-0.593, P<0.001). Bland-Altman plots analysis showed that the ratio of the simple target heart rate and the target heart rate determined by anaerobic threshold method was 1.03±0.11 and the 95% limits of agreement (LOA) were 0.812-1.245. In the subgroup of patients aged<60 years (n=247), the ICC value was 0.492, the ratio by Bland-Altman plots analysis was 1.02±0.11 and LOA was 0.814-1.234; in the subgroup of patients aged ≥60 years (n=192), the ICC value was 0.566, the ratio by Bland-Altman plots analysis was 1.03±0.11 and LOA was 0.810-1.260. In male subgroup(n=382), the ICC value was 0.540, the ratio by Bland-Altman plots analysis was 1.03±0.11 and LOA was 0.813-1.246; in female subgroup(n=57), the ICC value was 0.445, the ratio by Bland-Altman plots analysis was 1.03±0.11 and LOA was 0.810-1.240.In myocardial infarction subgroup (n=186), the ICC value was 0.568, the ratio by Bland-Altman plots analysis was 1.02±0.11 and LOA was 0.810-1.227; in angina pectoris subgroup (n=253), the ICC value was 0.495, the ratio by Bland-Altman plots analysis was 1.04±0.11 and LOA was 0.813-1.260. In the subgroup of patients with β blockers (n=353), the ICC value was 0.520, the ratio by Bland-Altman plots analysis was 1.03±0.11 and LOA was 0.810-1.252; in the subgroup of patients without β blockers (n=86), the ICC value was 0.570, the ratio by Bland-Altman plots analysis was 1.02±0.10 and LOA was 0.821-1.219. Conclusions: The simple target heart rate determined by RHR plus 20 bpm is consistent with the target heart rate determined by anaerobic threshold in patients with coronary artery disease after PCI. But the simple target heart rate determined by RHR plus 20 bpm can't replace the target heart rate determined by anaerobic threshold in this patient cohort.

Optimization of the method of measuring left ventricular end-diastolic diameter in cardiac magnetic resonance as a predictor of left ventricular enlargement

The objective of the study was to optimize the method of measuring left ventricular end-diastolic diameter (LVEDD) in cardiac magnetic resonance (CMR) as a predictor of left ventricular end-diastolic volume (LVEDV). The study group consisted of 78 patients (age 55.28 ± 17.18) who underwent 1.5 T CMR examination. LVEDD measurements in the short axis, in the long axis in the 2-chamber, 3-chamber and 4-chamber views were made by 2 radiologists. The repeatability of LVEDD measurements was assessed. The sensitivity and specificity of various methods of measuring LVEDD as a predictor of left ventricular enlargement (diagnosed based on LVEDV) were assessed. The correlation coefficients between LVEDD measurements made by researcher A and B were 0.98 for the long axis measurements in the 2-chamber and 3-chamber view, and 0.99 for measurements made in the short axis and in the long axis in the 4-chamber view. The lowest LVEDD measurements variability was recorded for the short axis measurements (RD 0.02, CV 1.38%), and the highest for the long axis measurements in the 3-chamber view (RD 0.04, CV 2.53%). In the male subgroup, the highest accuracy in predicting left ventricular enlargement was characterized by the criterion “LVEDD measured in the long axis in the 2-chamber view > 68.0 mm” (accuracy 94.1%). In the female subgroup, the highest accuracy in predicting left ventricular enlargement was achieved by the criterion “LVEDD measured in the short axis > 63.5 mm” (96.3%). In summary, the measurement made in the short axis should be considered the optimal method to LVEDD measure in CMR, considering the repeatability of measurements and the accuracy of left ventricular enlargement prediction.

P390 ADIPOSITY AND VASCULAR AGEING: WHICH PARAMETER BETTER CORRELATES?

Abstract The increase in stiffness of large arteries is one of the mechanisms that could play a role in the association between obesity and increased risk of cardiovascular (CV) events. Carotid–femoral pulse wave velocity (cfPWV), known as an independent CV risk factor, represents a validated measure of large arteries stiffness and a good proxy of arterial ageing. We aimed at evaluating which body composition parameters better correlated with cfPWV and whether this correlation differed between men and women. cfPWV was measured in all subjects with Sphigmocor by sequentially recording electrocardiogram–gated carotid and femoral artery waveforms; body composition was measured by bioimpedance analysis and waist circumference (W). Furthermore, each subject was characterized by sex, age, height, weight, body mass index (BMI), brachial blood pressure (BP) and heart rate. A linear correlation was used to define the relationship between cfPWV and parameters. Univariate and multivariate analysis were performed in male and female subgroups separately to select the main determinants of arterial stiffness, considering the following parameters: age, mean BP (mBP), BMI, W, fat mass (FM) and skeletal muscle mass (SMM). We enrolled 69 subjects (37 men, 32 women) with average age 34.5 years (min 19–max 76). cfPWV was significantly correlated with age (r = 0.65, p&amp;lt;.0001), and mBP (r = 0.38, p&amp;lt;.01). Among the body composition parameters, W, BMI and FM percentage were significantly correlated with cfPWV (respectively: r = 0.48, r = 0.42, r = 0.41; p&amp;lt;.0001). Multivariable regression analysis in men revealed that age and mBP were significant determinants of cfPWV (respectively: b = 0.042, p = 0.002; b = 0.051, p = 0.004). Conversely, multivariate analysis in women showed that age, FM and SMM are retained as main determinants of increased cfPWV (respectively: b = 0.079; p &amp;lt; 0.0001; b = 0.217, p = 0.012; b = 0.125, p = 0.011). Irrespectively of gender, age is the main determinant of arterial stiffness. Our results demonstrated that the relationship between adiposity and arterial stiffness is verified only in female subjects. This suggests that this relationship is influenced by complex and not fully known mechanisms. Moreover, technical factors (algorithm and indirect methods to assess body composition) contribute to uncertainty regarding which parameter exploring adiposity is more accurate in stratifying CV risk. The present study recalls attention on possible gender–specific determinants of arterial ageing.

Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis.

Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.

Gender-Differentiated Poverty among Migrant Workers: Aggregation and Decomposition Analysis of the Chinese Case for the Years 2012–2018

The relative poverty statuses of female and male migrant workers are complex: (i) as a group, migrant workers are relatively better off than their rural hometown fellow residents but are deprived compared to the long-term residents of the cities to which they have immigrated, and (ii) gender differences exist between female and male subgroups, resulting from the interaction of gender bias and empowerment. The former can be further decomposed into characteristic-led bias and bias arising from discrimination. However, little is known about the different facets of gender-differentiated poverty that pose challenges for migrant workers. This study used data collected from Chinese Family Panel Studies (CFPS) during the period 2012–2018 to address this research deficiency. This study conducted a poverty aggregation using a multidimensional relative poverty index system based on the Alkire and Foster (A–F) method to offer an overview of the gender differences in the overall relative poverty statuses of Chinese migrant workers. Further, to validate the existence of gender bias, this study conducted a decomposition analysis based on unconditional quantile regression (UCQR) of the explanatory model of relative poverty. The results of the combination of the aggregation and decomposition analysis data imply that, despite the gender discrimination that female migrant workers encounter, they are generally better off than male migrant workers due to their slight characteristic-led advantages and, more importantly, their autonomous poverty reduction activities. This study theoretically contributes to an in-depth understanding of gender differences in migrant workers’ relative poverty. In addition, this study advocates more targeted and sustainable poverty reduction solutions. For instance, more targeted payment transfer and long-term (vocational development, entrepreneurship, and lifestyle) empowering projects should be highlighted.

The respecting the circle of life teen pregnancy prevention intervention: Its impact among different subgroups of Native American youth

PurposeThis study reports the differential impact of an evidence-based teen pregnancy prevention program among subgroups of participating Native American youth. MethodsThis randomized controlled trial included N = 534 Native Americans ages 11–19. Participants were randomly assigned 1:1 (intervention: 266; control: 268) to the Respecting the Circle of Life intervention (RCL) versus a control condition. Logistic and linear regression was used to examine intervention impact at 9- and 12- months post-intervention among the subgroups of males, females, younger (11–14 years) and older (15–19 years) youth. ResultsGirls and boys in the intervention group (RCL) had improved condom self-efficacy (Adjusted mean difference (AMD) and 95% CI girls: 0.56 (0.34–0.79); boys: 0.55 (0.32–0.77); both p < 0.0001) and contraceptive use self-efficacy at 9 months (AMD (95% CI) girls: 0.40 (0.16–0.63); boys: 0.40 (0.17–0.63); girls p = 0.001, boys p = 0.0009) compared to those in the control group. Study group differences were sustained for girls at 12 months but not for boys (condom use self-efficacy AMD (95% CI) girls: 0.54 (0.34–0.75); contraceptive use self-efficacy girls: 0.47 (0.24–0.70); both p < 0.0001). Boys in the RCL group had higher 12-month sexual/reproductive health knowledge (AMD (95% CI) boys: 2.15 (0.45–3.85); p = 0.01) compared to those in the control group, but girls did not. Girls in the RCL group had increased intention to use a condom at 12 months (OR (95 %CI): 1.69 (1.00–2.86); p = 0.05) compared to those in the control group, whereas boys in the RCL group had decreased intention to have sex in the next year at 9 months (OR (95% CI): 0.39 (0.21–0.73); p = 0.003) compared to boys in the control group. RCL Participants ages 11–14 had improved sexual/reproductive health knowledge at 12 months (AMD (95% CI): 1.96 (0.79–3.13); p = 0.001) compared to control participants of the same age. They also had improved condom and contraceptive use self-efficacy at 9 months (condom use self-efficacy AMD (95% CI): 0.65 (0.46–0.83); contraceptive use self-efficacy: 0.47 (0.28–0.65); both p < 0.0001) and 12-months (AMD (95% CI): 0.43 (0.25–0.61); 0.35 (0.16–0.54); p < 0.0001 and p = 0.0004, respectively) compared to control participants of the same age. There were no statistically significant impacts among participants ages 15–19. ConclusionThis is one of the first analyses of the differential impact of an evidence-based teen pregnancy prevention program conducted among subgroups of Native youth. Results guide dissemination and future research efforts, including that RCL is particularly effective among youth who are under the age of 15 at the time of participation, and that additional tailoring will optimize this program for older adolescents.

Association of Nucleostemin Polymorphisms with Chronic Hepatitis B Virus Infection in Chinese Han Population.

Background: Chronic hepatitis B virus infection (CHB) is a common infectious disease that poses a global economic and health burden due to its high morbidity and mortality. Studies have demonstrated that host genetic factors play critical roles in the susceptibility and outcome of CHB. Aims: In this study, we aimed to assess the potential role of genetic variants of the nucleostemin (NS) gene with respect to CHB susceptibility. Materials and Methods: Four single nucleotide polymorphisms (SNPs) in the NS gene were genotyped in 446 patients with CHB and 399 healthy controls all of Chinese Han origin using the polymerase chain reaction-ligation detection reaction method. Results: The results showed that the three SNPs, rs3733039, rs1866268, and rs11177, were significantly associated with CHB. After a Bonferroni correction, the positive association of the rs3733039 SNP with CHB remained significant. Further analyses based on gender demonstrated that these SNPs are associated with CHB in both the female and male subgroups. After correction for multiple comparisons, all three SNPs in the female group were associated with CHB, whereas only the rs1866268 SNP in the male group was associated with CHB. Haplotype analysis showed that the C-C-G and T-T-T haplotypes in the block consisting of rs3733039-rs1866268-rs11177 were significantly associated with CHB. Conclusion: Our study demonstrated a genetic association between SNPs in the NS gene and the risk of CHB in the Chinese Han population for the first time. Thus, variations in the NS gene might serve as potential genetic biomarkers of CHB.

Is headache during pregnancy a higher risk for serious secondary headache cause? A HEAD study report.

Pregnancy is defined as a 'red flag' in headache assessment. We aimed to describe the prevalence and causes of serious secondary headache in pregnant ED patients. Unplanned secondary analysis of HEAD Study/HEAD Colombia data. 3.2% (117/3643) of ED headache patients aged 18-50 years were pregnant, of whom six (5.1%) had a serious secondary cause identified. The proportion of patients with serious headache causes was not significantly different between pregnant female, non-pregnant female and male patient subgroups (P= 0.89). Inclusion of pregnancy as a 'red flag' in ED headache assessment is not supported by these data.

Association of DNA Methylation Patterns in 7 Novel Genes With Ischemic Stroke in the Northern Chinese Population.

Background: Ischemic stroke is a highly complex disorder. This study aims to identify novel methylation changes in ischemic stroke. Methods: We carried out an epigenome-wide study of ischemic stroke using an Infinium HumanMethylation 850K array (cases:controls = 4:4). 10 CpG sites in 8 candidate genes from gene ontology analytics top-ranked pathway were selected to validate 850K BeadChip results (cases:controls = 20:20). We further qualified the methylation level of promoter regions in 8 candidate genes (cases:controls = 188:188). Besides, we performed subgroup analysis, dose-response relationship and diagnostic prediction polygenic model of candidate genes. Results: In the discovery stage, we found 462 functional DNA methylation positions to be associated with ischemic stroke. Gene ontology analysis highlighted the “calcium-dependent cell-cell adhesion via plasma membrane cell adhesion molecules” item, including 8 candidate genes (CDH2/PCDHB10/PCDHB11/PCDHB14/PCDHB16/PCDHB3/PCDHB6/PCDHB9). In the replication stage, we identified 5 differentially methylated loci in 20 paired samples and 7 differentially methylated genes (CDH2/PCDHB10/PCDHB11/PCDHB14/PCDHB16/PCDHB3/PCDHB9) in 188 paired samples. Subgroup analysis showed that the methylation level of above 7 genes remained significantly different in the male subgroup, large-artery atherosclerosis subgroup and right hemisphere subgroup. The methylation level of each gene was grouped into quartiles, and Q4 groups of the 7 genes were associated with higher risk of ischemic stroke than Q1 groups (p < 0.05). Besides, the polygenic model showed high diagnostic specificity (0.8723), sensitivity (0.883), and accuracy (0.8777). Conclusion: Our results demonstrate that DNA methylation plays a crucial part in ischemic stroke. The methylation of these 7 genes may be potential diagnostic biomarker for ischemic stroke.

The relationships between resilience, care environment, and social-psychological factors in orphaned and separated adolescents in Western Kenya

ABSTRACT The relationships between care environment, resilience, and social factors in orphaned and separated adolescents and youths (OSAY) in western Kenya are complex and under-studied.Survey responses from OSAY living in Charitable Children’s Institutes (CCI) and family-based care settings (FBS) in Uasin Gishu County, Kenya were used to examine the associations between 1) care environment and resilience; 2) care environment and factors thought to promote resilience (e.g. social, family, and peer support); and 3) resilience and these same resilience-promoting factors, using multivariable linear and logistic regressions. This cross-sectional study included 1202 OSAY (50.4% female) aged 10–26 (mean = 16; SD = 3.5). The mean resilience score in CCIs was 71 (95%CI = 69–73) vs. 64 (95%CI = 62–66) in FBS. OSAY in CCIs had higher resilience (β = 7.67; 95%CI = 5.26–10.09), social support (β = 0.26; 95%CI = 0.14–0.37), and peer support (β = 0.90; 95%CI = 0.64–1.17) than those in FBS. OSAY in CCIs were more likely to volunteer than those in FBS (OR = 3.72; 95%CI = 1.80–7.68), except in the male subgroup. Family (β = 0.42; 95%CI = 0.24–0.60), social (β = 4.19; 95%CI = 2.53–5.85), and peer (β = 2.13; 95%CI = 1.44–2.83) relationships were positively associated with resilience in all analyses. Volunteering was positively associated with resilience (β = 5.85; 95%CI = 1.51–10.19). The factor most strongly related to resilience in both fully adjusted models was peer support. This study found a strong relationship between care environment and resilience. Care environment and resilience each independently demonstrated strong relationships with peer support, social support, and participating in volunteer activities. Resilience also had a strong relationship with familial support. These data suggest that resilience can be developed through strategic supports to this vulnerable population. Abbreviations: 95%CI - 95% Confidence intervalAMPATH - Academic Model Providing Access to HealthcareCASSS - Child and Adolescent Social Support ScaleCCI - Charitable Children’s InstitutesCTQ - Childhood Trauma QuestionnaireFBS - Family-based care settingICAST-CH - ISPCAN Child Abuse Screening Tool for Children a HomeMSPSS - Multidimensional Scale of Perceived Social SupportMTRH – Moi Teaching and Referral HospitalMU - Moi UniversityOSAY - Orphaned and separated adolescents and youthsOSCAR - Orphaned and Separated Children’s Assessments Related to Their Health and Well-BeingOR - Odds ratioRS14 - Resilience ScaleSD - Standard deviationSDQ - Strengths and Difficulties QuestionnaireSE - Standard ErrorUG - Uasin Gishu

Effect of treatment modality on the long-term survival of patients with early glottic squamous cancer: a retrospective cohort study based on the SEER database.

BackgroundThe optimal treatment strategy for patients with early glottic (T1–2N0M0) squamous cancer remains unclear.MethodsA retrospective population-based analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to balance treatment arms, and Cox regression analysis was used to determine prognostic factors for survival. Kaplan-Meier analysis, log-rank tests, and competing risk analysis were used to compare survival outcomes between treatment modalities (surgery vs. radiotherapy).ResultsAmong the 3,994 eligible patients in this study, surgery was associated with improved cancer-specific survival (CSS) and overall survival (OS) compared with radiotherapy (log-rank test, P<0.05). This survival trend favoring surgery was consistent in the T1a, well/moderately differentiated grade, male, and all age subgroups. However, after the baseline characteristics were balanced with PSM, the survival outcomes (CSS and OS) did not differ significantly between the surgery and radiotherapy groups. Interestingly, surgery was associated with a 39% reduced risk of cancer-related death compared with radiotherapy in patients aged ≥70 years (hazard ratio 0.61; 95% CI: 0.43–0.87; P=0.006). However, this survival trend favoring surgery was not observed in younger patients (age <70 years), T stage subgroups, male or female subgroups, or in any of the pathological grade subgroups.ConclusionsIn patients with early glottic squamous cell carcinoma undergoing surgery or radiotherapy, there is no sufficient evidence favoring one method over another in terms of survival. However, surgery is recommended in patients aged ≥70 years because, in this group, it was associated with improved survival outcomes compared with radiotherapy.

Association Between Triglyceride-Glucose Index and the Risk of Type 2 Diabetes Mellitus in an Older Chinese Population Aged Over 75 Years.

BackgroundThe association between the triglyceride–glucose (TyG) index and type 2 diabetes mellitus (T2DM) in older adults has not been fully understood. This research aims to explore the association between the TyG index and the incidence of T2DM in an older Chinese population aged over 75 years.MethodsThis longitudinal analysis study was performed based on a database from a health check screening program in China. The participants were stratified based on the quintile ranges of the TyG index (Q1 to Q5 groups). T2DM was defined as fasting plasma glucose (FPG) ≥ 7.00 mmol/L and/or self-reported T2DM. The cumulative incidences of T2DM in various quintile groups were estimated by the Kaplan–Meier method. The Cox proportional hazard model was used to examine the independent impact of the TyG index on the risk of T2DM during the follow-up period. Subgroup analysis was performed by gender and BMI to further validate the credibility of the results.ResultsDuring the follow-up period, a total of 231 new-onset T2DM cases were recorded among the 2,571 individuals aged over 75 years. After adjusting confounding factors, elevated TyG index independently indicated a higher risk of T2DM (HR = 1.89; 95% CI, 1.47–2.44; p < 0.01). Higher TyG index quintile groups (Q3 to Q5) also presented with a higher risk of T2DM (hazard ratio (HR) = 1.36, 1.44, and 2.12, respectively) as compared with the lowest quintile group (Q1). Subgroup analysis showed that increased TyG index led to a higher risk of T2DM with HR = 2.35 (95% CI, 1.73–3.19), 1.90 (95% CI, 1.27–2.83), 2.95 (95% CI, 1.94–4.50), and 1.72 (95% CI, 1.25–2.35) in male subgroup, female subgroup, BMI < 24 kg/m2 subgroup, and BMI ≥ 24 kg/m2 subgroup, respectively.ConclusionsTriglyceride–glucose index independently correlated with the risk of incident T2DM in Chinese adults aged over 75 years. The TyG index might be useful in monitoring T2DM in the older populations.

Central Obesity Is Associated with Variations in TSH and ACTH Levels among Euthyroid Obese Individuals.

Introduction The interactions of central obesity and body composition with thyroid hormones and the hypothalamus-pituitary-adrenal (HPA) axis are unclear; both central obesity and body composition have an impact on energy homeostasis. Our study aimed to investigate the association between body composition and pituitary hormones, including the HPA axis and pituitary-thyroid axis, in a Chinese population of euthyroid overweight and obese individuals. Methods This was a cross-sectional study. Overweight and obese patients who regularly visited the multidisciplinary team (MDT) for obesity at Peking University First Hospital were enrolled in the study. Thyroid function, morning serum ACTH and cortisol levels, thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), body composition, and metabolic indicators, including liver function and the lipid profile, were measured at the first visit. Statistical analysis was performed using SPSS version 21.0 (IBM, USA). Results In total, 441 patients with overweight or obesity were enrolled (male/female, 123/318). Patients were assigned to four groups according to the thyroid-stimulating hormone (TSH) level stratified by quartiles, and increased body mass index (BMI) was revealed in the highest TSH quartile group (p=0.002). Hip circumference (HC) of patients in the highest TSH quartile group was significantly increased (p=0.021). Morning ACTH levels and fasting insulin levels were significantly elevated in patients in the highest TSH quartile group (p=0.027 for fasting insulin, p < 0.001 for ACTH). In the female subgroup, patients in the highest TSH quartile group showed increases in BMI (p=0.010), waist circumference (WC) (p=0.007), muscle mass of the lower extremities (p=0.020), fasting C-peptide (p=0.031), and ACTH (p=0.002). In the male subgroup, patients in the highest TSH quartile group exhibited higher BMI (p=0.017), HC (p=0.036), and ACTH (p=0.003). Among patients in the highest ACTH quartile group, there was an elevated proportion of males (p=0.003), and FT3 (p=0.005), fasting insulin (p=0.037), and cortisol (p < 0.001) levels were increased. Weight (p < 0.001), BMI (p < 0.001), WC (p < 0.001), HC (p < 0.001), muscle mass of the upper extremities (p=0.003), muscle mass of the lower extremities (p=0.005), and total muscle mass (p=0.003) were elevated in patients in the highest ACTH quartile group. HC was found to be an independent factor after adjustment for other confounders and was positively associated with the TSH level (p=0.004 for the regression model, B = 0.152, p=0.004). Conclusions BMI is positively correlated with TSH and ACTH levels in both male and female obese individuals. The ACTH level was positively associated with male sex and increased BMI and muscle mass. Hip circumference was an independent factor that was positively related to TSH levels.

Exploring racial and gender disparities in voice biometrics

Systemic inequity in biometrics systems based on racial and gender disparities has received a lot of attention recently. These disparities have been explored in existing biometrics systems such as facial biometrics (identifying individuals based on facial attributes). However, such ethical issues remain largely unexplored in voice biometric systems that are very popular and extensively used globally. Using a corpus of non-speech voice records featuring a diverse group of 300 speakers by race (75 each from White, Black, Asian, and Latinx subgroups) and gender (150 each from female and male subgroups), we explore and reveal that racial subgroup has a similar voice characteristic and gender subgroup has a significant different voice characteristic. Moreover, non-negligible racial and gender disparities exist in speaker identification accuracy by analyzing the performance of one commercial product and five research products. The average accuracy for Latinxs can be 12% lower than Whites (p < 0.05, 95% CI 1.58%, 14.15%) and can be significantly higher for female speakers than males (3.67% higher, p < 0.05, 95% CI 1.23%, 11.57%). We further discover that racial disparities primarily result from the neural network-based feature extraction within the voice biometric product and gender disparities primarily due to both voice inherent characteristic difference and neural network-based feature extraction. Finally, we point out strategies (e.g., feature extraction optimization) to incorporate fairness and inclusive consideration in biometrics technology.