Medical Risk Factors Research Articles

MetSCORE: a molecular metric to evaluate the risk of metabolic syndrome based on serum NMR metabolomics

BackgroundMetabolic syndrome (MetS) is a cluster of medical conditions and risk factors correlating with insulin resistance that increase the risk of developing cardiometabolic health problems. The specific criteria for diagnosing MetS vary among different medical organizations but are typically based on the evaluation of abdominal obesity, high blood pressure, hyperglycemia, and dyslipidemia. A unique, quantitative and independent estimation of the risk of MetS based only on quantitative biomarkers is highly desirable for the comparison between patients and to study the individual progression of the disease in a quantitative manner.MethodsWe used NMR-based metabolomics on a large cohort of donors (n = 21,323; 37.5% female) to investigate the diagnostic value of serum or serum combined with urine to estimate the MetS risk. Specifically, we have determined 41 circulating metabolites and 112 lipoprotein classes and subclasses in serum samples and this information has been integrated with metabolic profiles extracted from urine samples.ResultsWe have developed MetSCORE, a metabolic model of MetS that combines serum lipoprotein and metabolite information. MetSCORE discriminate patients with MetS (independently identified using the WHO criterium) from general population, with an AUROC of 0.94 (95% CI 0.920–0.952, p < 0.001). MetSCORE is also able to discriminate the intermediate phenotypes, identifying the early risk of MetS in a quantitative way and ranking individuals according to their risk of undergoing MetS (for general population) or according to the severity of the syndrome (for MetS patients).ConclusionsWe believe that MetSCORE may be an insightful tool for early intervention and lifestyle modifications, potentially preventing the aggravation of metabolic syndrome.

Retrospective Analysis of Paraparalysis/Paraparesis Post Aortic Aneurysm Endovascular Repair

Abstract Objective Paralysis post TEVAR is a challenging complication, this study discusses its incidence, Risk factors, clinical outcome, reversibility, protective strategy and associated mortality. Methods Retrospective study Conducted on patients underwent thoracic and thoracoabdominal aortic Aneurysm Endovascular Repair in Last 11 years (January 2012 till June 2022) in single center as regard incidence, personal history, medical and surgical risk factors, preventive strategies, reversibility of paralysis and associated mortality. Data was obtained from records; paralysis was diagnosed through clinical examination immediately after emergence from anesthesia and frequently post operatively in SICU or even word and after discharge in follow-up outpatient clinic visits. Results A study carried on 137 patients, 15 patients of them developed lower limb paralysis with incidence of 10.9%, 3 patients of them (23.1%) developed paralysis immediately post operative, 4 patients developed paralysis in day 1 post operative (30.8%). And the rest of patients developed delayed onset paralysis (more than 24 Hour post procedure), The latest one developed paralysis 26 days post operative, 8 of paralyzed patients had spinal cord imaging (MRI) 4 of them (50%) didn’t show any abnormality and 3 of them (37.5%) showed spinal cord ischemia and 1 patient didn’t tolerate the MRI machine so the study was discontinued. According to reversibility, 9 patients had complete reversal of their motor and sensory symptoms to the baseline preoperative status. 2 patients had partial reversal of their symptoms, and 4 patients had persistent symptoms without any improvement despite the routine management that included elevating MAP and draining CSF to less than 10 mmHg in order to maintain spinal cord perfusion pressure at level of 80 mmHg and giving naloxone. Data showed 12 out of 81 patients (14.8%) who had functioning spinal drain developed paralysis. Duration of procedure is the most affecting risk factor on paralysis, patients with mean duration of 270 minutes had higher risk of paralysis. Conclusion Prediction of paralysis post TEVAR is still difficult and data analysis showed that the duration of procedure is the only statistically significant variable that we can rely on.

Preconception health risk factors documented in general practice electronic medical records

BackgroundDocumenting medical and lifestyle preconception health risk factors in electronic medical records (EMRs) could assist general practitioners (GPs) to identify those reproductive-aged women who could most benefit from preconception care...

Preterm Infant's Heart Rate Variability Near Birth Predicts Autonomic Symptoms at Age 3 to 5 Years.

Aims To describe the autonomic function of premature infants born between 28 and 32 weeks of gestation, without medical risk factors, at the age of 3 to 5 years and to assess whether it's possible to predict the appearance of autonomic deficits in these children at this age range. Methods This follow-up study included 40 out of 55 premature infants born between weeks 28 and 32 during 2018 to 2020. During 2022 to 2023 parents were asked to report on medical and developmental follow-up and treatment, functional characteristics of the autonomic system, and the age at which walking was achieved. Results Approximately 27% of the participants (11 out of 40) presented autonomic symptoms at 3 to 5 years of age. A predictive relationship was noted between the function of the heart rate control system near birth and the presence of autonomic dysfunctions at ages 3 to 5. Fourteen of 40 children received neurodevelopmental treatments. However, children with autonomic symptoms were not treated for their symptoms. Conclusion These preliminary findings provide valuable insights into the autonomic function of children born premature and the potential predictive relationship between early autonomic measures and later autonomic dysfunctions. It also highlights the need for increased awareness and intervention strategies for addressing autonomic issues in premature infants to support their overall well-being.

СУИЦИДАЛЬНАЯ АКТИВНОСТЬ В СТАТИСТИЧЕСКОЙ РЕТРОСПЕКЦИИ

Purpose. To determine the statistical features of the frequency of suicides in the Grodno region with regard to time intervals as well as medical and social risk factors for suicide. Material and methods. In the present study we used statistical data for the Grodno region for the period 2004-2023 concerning the population size and the number of suicides as well as the maps of analysis of the causes of suicides committed in 2010-2023 (n=1520). Results. The established statistical features of the frequency of suicides in the Grodno region indicate that suicidal activity, as a population feature, is independent of the population size; it is determined and has characteristic dynamics over annual intervals and extremes within the year, month, week and day. In the structure of pre-suicide, medical and social factors not related to health conditions and comorbid with alcohol abuse predominate. Сonclusions. The established in the study statistical patterns of suicidal activity of the population of the Grodno region, which are quantitatively associated with time intervals within the day, week, month and year and qualitatively with the dominant medical and social characteristics present in pre-suicide, indicate that suicide is a population feature and causes of suicides in particular cases are determined by the suicider’s inheriting of some features of a society as an element and a formal model of this society.

Nurses' knowledge of medical device-related pressure injuries and risk factors: A descriptive study at a large medical centre from Palestine.

Nurses' knowledge of pressure injuries causes and risk factors helps to prevent their occurrences and protect the patient. To assess the level of knowledge of medical device-related pressure injuries and to identify risk factors that affect the knowledge. A cross-sectional design was used in this study considering a convenience sample from critical care nurses. The nurses were invited to complete the Medical Device-Related Pressure Injuries Knowledge Questionnaire. About 71 nurses participated in the study. The mean score of MDRPI_KQ was 23.28 ± 4.14 out of 36. Mann-Whitney Test did not show statistically significant relationships between the MDRPI_KQ mean score and related variables (p > 0.05). The regression results indicated that the three predictors explained 46.4% of the variance (R2 = 0.215, F(3, 6.114) = 3.75, p = 0.001). It was found that the Frequency of encountering a patient with MDRPIs significantly predicted MDRPI_KQ score, job position, and assuming the care responsibility for MDRPIs in the department. Poor knowledge of pressure injuries can negatively affect patient care so training programs and policies should be developed based on the level of knowledge and practices of the staff to be more effective.

Illness is more prevalent than injury in trail runners participating in a mountainous ultra trail race

ABSTRACT Objectives Trail running is a popular off-road sport involving running in natural environments over various terrains, often in remote locations. This study aims to investigate the epidemiology and risk factors of injuries and illnesses, i.e. medical encounters, on race day among trail runners in a high-altitude ultra trail race. Methods This descriptive cross-sectional study on an ultra trail race (38 km, 65 km and 100 km) in South Africa, included participants 18 years or older. Of the 331 race participants, 285(86.1%) consented to participate in the study. Data collection included demographic details, injuries (body region, specific body area, tissue type, pathology) and illnesses (organ system, symptom cluster, etiology). Risk factor analysis includes sex, age, weight, height, race distance, illness and injury history, training and running experience. Frequency (n, %), prevalence (%) and odds ratios (OR; 95%CI) are reported. Results Eighty-nine (31.2%) individuals reported 131 medical encounters [49 injuries (37.4%); 82 illnesses (62.6%)]. Injuries were sustained by 14.7% of athletes, and 22.5% reported illnesses. For injuries, the lower limb was mainly involved (n = 41; 83.7%). Most injuries affected the foot (n = 18; 36.7%), ankle (n = 10; 20.4%) and knee (n = 7; 14.3%). Tissue types mainly involved skin (n = 21; 42.8%), ligament (n = 7; 14.3%) and muscle (n = 7; 14.3%). Multiple (n = 45; 54.9%) and gastrointestinal (n = 17; 20.7%) organ systems were mainly involved in illnesses. Only 100 km runners reported dehydration (n = 28; 31.5%), and one in every six of these runners (n = 5; 17.9%) did not finish. Runners reporting fatigue (n = 21; 23.6%) had a high (n = 8; 38.1%) did not finish rate. Two in every five participants (n = 36; 40.4%) with a medical encounter, did not finish. No medical encounter-associated risk factors were identified. Conclusions Illnesses were more common than injuries during the mountainous ultra trail race. Sustaining a medical encounter increased the chance of not completing the race. Further research on the epidemiology of race day medical encounters in trail running is required.

QOL-50. THE ROLE OF TUMOR SIZE IN COGNITIVE FUNCTIONING AMONG SURVIVORS TREATED FOR MEDULLOBLASTOMA

Abstract BACKGROUND Medical and treatment variables, including presence of post-operative cerebellar mutism syndrome (CMS), shunt placement, craniospinal radiation, and total radiotherapy (RT) dose, have been evaluated as potential risk factors for adverse cognitive effects among pediatric patients diagnosed and treated for medulloblastoma. Larger brain tumor size is associated with increased risk of medical complications, but cognitive risk of larger tumor size remains unknown. METHODS Cognitive scores were examined for 40 participants diagnosed and treated for medulloblastoma. The age-appropriate Wechsler Intelligence Scale was administered at the start of RT and up to 10 years post-RT (M=4.96, SD=3.78). A total of 162 evaluations were examined across participants. Linear mixed models examined change in Wechsler Index scores over time since RT based on tumor size, which was dichotomized at the median diameter (small ≤4.6cm versus large &amp;gt;4.6cm), covarying for maternal education, total RT dose, and presence of CMS. RESULTS Patients (72.5% male) were diagnosed with medulloblastoma and began RT at a mean age of 8.89 years. Groups did not differ on demographic or medical variables with the exception of presence/absence of CMS, with a higher proportion of patients diagnosed with CMS having large-size tumors (40%) versus small-size tumors (5%). Tumor size did not predict change in IQ, working memory, or processing speed performance over time since RT after accounting for covariates. CMS was associated with significant decline in processing speed (p&amp;lt;.001) and IQ over time (p&amp;lt;.05); RT dose was associated with significant working memory and IQ decline (both p&amp;lt;.05); and maternal education was associated with decline in processing speed, working memory, and IQ (all p&amp;lt;.05). CONCLUSIONS While tumor size may be associated with treatment intensity and other medical risk factors, CMS and RT dose significantly increase cognitive risk, independent of tumor size. Lower socioeconomic status also increases cognitive risk post-RT, which may illuminate pathways for prevention and intervention efforts.

A Retrospective Review of Men Referred to a Dedicated Erectile Dysfunction Clinic in Secondary Care.

Background and objectives Erectile dysfunction (ED) is a multifactorial disease associated with many medical co-morbidities and risk factors commonly encountered in primary care. Initial management includes lifestyle changes and the treatment of any identifiable conditions. Guidelines exist recommending the assessment and management of sufferers with clear indications for referral to secondary care. With the outbreak of COVID-19, non-urgent medical services, including ED, were suspended, creating a significant waiting list for these patients. The aim of this study was to review the management of men in both primary and secondary care who had been referred to a dedicated ED service. Materials and methods A retrospective review of men referred to secondary care between June 2018 and April 2021 with ED was undertaken, reviewing whether the guidelines published by the National Institute for Health and Care Excellence (NICE) and GP Notebook for the assessment, initial treatment, and referral were followed by the primary care clinician. A secondary aim was to recordthe outcome of those men after review in a secondary carededicated ED clinic. Results One hundred and forty-eight men were reviewed in the ED clinic, with 55 men (37.2%) requiring an intervention that was appropriate to have been delivered in primary care. The majority of those (76.3%) were successfully managed with a phosphodiesterase inhibitor. Of those treated in secondary care, almost 60% required a second-line therapy, such as a vacuum device or the administration of alprostadil, with 14 men (15%) necessitating the surgical implantation of a penile prosthesis. Conclusion With a rise in both the prevalence and incidence of ED, primary care physicians have a pivotal role in the screening and initial assessment of patients with ED, with evidence suggesting that a significant proportion can be successfully managed in this setting.

Somatic amplification and addiction profile as risk factors for medication overuse headache with chronic migraine

IntroductionOveruse of analgesics can lead to medication-overuse headache (MOH) in chronic migraine (CM) patients, and is often linked to addiction. This study explores the addiction-related characteristics and somatic amplification in patients with, CM with medication overuse headache (CM+MOH), CM, and healthy controls.Methods73 CM patients and 70 CM+MOH, along with 63 healthy controls, participated in the study. Assessments included a Sociodemographic Form, Migraine Disability Assessment Scale (MIDAS), Addiction Profile Index (API), Addiction Profile Index-Clinical Version (API-C), and the Somatosensory Amplification Scale (SSAS).ResultsSubstance use characteristics, craving, motivation for use, and addiction severity scores were higher in the CM+MOH group than in both the CM and the control group. Specifically, the SSAS scores within the CM+MOH group surpassed those of both the CM and control groups. In the CM+MOH group, SSAS scores were a strong predictor of the amount of analgesic usage. Besides, craving and motivation for substance use scores significantly predicted the number of days analgesic taken per month in the CM+MOH groupConclusionCM patients with MOH exhibit a pronounced association with addiction, and a heightened manifestation of somatic symptoms. Addressing addiction characteristics and psychosomatic amplification is important to ensure comprehensive management.

A prospective observational study examining weight and psychosocial change in adolescent and adult eating disorder inpatients admitted for nutritional rehabilitation using a high-energy re-feeding protocol

BackgroundHigh-energy re-feeding protocols are increasingly utilised for nutritional rehabilitation in adolescents with anorexia nervosa (AN), however, concern persists that adults with AN may be at greater risk of developing complications. In addition, research on psychological outcomes of eating disorder (ED) inpatient treatment programs, and outcomes of high-energy protocols in avoidant restrictive food intake disorder (ARFID) and bulimia nervosa (BN), is limited. This study of an ED inpatient program using a high-energy protocol, compared changes in weight and psychosocial outcomes between adolescents and adults, and identified medical risk factors associated with deviation from the protocol.MethodThis prospective observational study took place in a voluntary ED treatment program in a private hospital. Weight, height, and psychosocial questionnaires (ED Examination-Questionnaire, Depression Anxiety Stress Score, Clinical Impairment Assessment and AN/BN Stage of Change) were collected from consenting adolescents (16–20 years) and adults (> 20 years) on admission and discharge. Medical tolerance to the high-energy protocol was assessed daily. Independent samples t-tests and paired samples t-tests were applied to normally distributed data, and Mann–Whitney U tests and Wilcoxon signed-rank tests to skewed data. P-values < 0.05 were considered significant statistically.ResultsNinety-seven participants were recruited. The majority (n = 91, 94%) were female and most (n = 80, 83%) had AN. Forty-two (43%) were adolescents and 55 (57%) were adults. In participants with AN, weight change (Δ) was significant [median Δ 8.0 (interquartile range (IQR) 4.3) kg]. There was no difference in rate of weight change between adolescents and adults with AN [mean Δ 1.8 (standard deviation (SD) 0.5) kg/week vs. Δ 1.8 (SD 0.6) kg/week; p = 0.841, respectively]. One (1%) participant with AN did not tolerate the high-energy protocol due to oedema. Participants achieved positive change in psychosocial questionnaire scores (p < 0.001) after the the specialist ED program, with no difference between adolescents and adults (p > 0.05).ConclusionsThis voluntary ED treatment program using a high energy re-feeding protocol was effective in achieving positive weight and psychological change for adolescents and adults with minimal adverse events. This indicates that the specialist ED program has both nutritional and psychological benefits.

TOTAL KNEE ARTHROPLASTY FOLLOWING SEPTIC ARTHRITIS: A LONGITUDINAL STUDY OVER 20 YEARS

ObjectivesPost-infective arthritis is an important sequalae of septic arthritis(SA). While total knee arthroplasty(TKA) is an effective treatment for said arthritis, previous SA brings challenges for treatment planning. Using prospectively collected data from a cohort of patients with knee SA, this study aims to determine the proportion of patients requiring eventual TKA, and risk factors of developing prosthetic joint Infection(PJI).MethodsAll cases of 1st episode knee SA from 01/01/2000 to 31/12/2020 were identified in the Auckland region. Patient records and NZJR records of all cases were searched to identify subsequent TKA. PJI following arthroplasty was identified using ICM criteria.Univariate and multivariate analysis was performed to determine risk factors for developing PJI.Results854 cases of native SA were identified. Of these, 71 (8.3%) progressed to TKA. Average time from completion of SA treatment to TKA was 3.8 years (SD 3.4). At an average follow-up of 7.8 years(1–19.6), 11(15.5%) developed PJI and required reoperation in the form of; DAIR (n =5), revision (n= 6). A further 4 were readmitted for superficial infections. Five-year and ten-year implant survival was 90.0% and 87.1%, significantly lower than average survival of TKA in the NZJR (97.3% at 5 years and 95.7% at 10). Average time between completion of SA treatment and TKA was 2.1 years in those developing PJI, vs 4.1 years in those who did not(p = 0.0019). 4.8% of cases developed PJI when TKA was performed &gt;5 years after SA, compared with 20% risk of PJI within 5 years(p=0.16). Multivariate analysis showed no significant impact of pre-defined medical risk factors or demographic on outcomes.ConclusionA significant percentage of patients required TKA following knee SA. Time lapsed from SA treatment completion to TKA is an important risk factor for developing PJI.

A Scoping Review of Mental Health Needs and Challenges among Medical Students within South African Universities.

The mental health of medical students is a growing concern worldwide, with studies indicating high levels of stress, anxiety, and depression among this population. In a South African context, this review aims to review the existing literature on mental health needs and challenges among medical students in South Africa. The rationale for this review is crucial to identify gaps, understand unique contextual factors, and inform the development of targeted interventions and support tailored to the specific needs of South African medical students. This review followed a scoping review framework by Arksey and O'Malley which consists of five stages. The review was initiated in December 2023. The search process was conducted on the following electronic databases: PubMed, Psych-info, Scopus, Google Scholar, and Science Direct. The search terms of this review were "Medical students" OR "Mental health", OR "Challenges", OR "South Africa", OR "Universities" OR "Needs", OR "Support systems", OR "Mental health interventions". This study included articles published in English between 2010 and 2023. After a thorough review of the literature, only eight articles met the inclusion criteria. This study excluded articles that were not published in English, articles published before 2010, full-text articles that could not be retrieved, and studies that did not address the mental health needs and challenges faced by medical students and risk factors contributing to mental issues among South African medical students. The review yielded only three themes utilizing Creswell's Tesch method of data analysis. (1) Prevalence of mental health disorders, (2) risk factors contributing to poor mental health, and (3) available university support systems and interventions. Therefore, the unique aspect of our review lies in shedding light on the underexplored intersections between mental health and the unique context of medical education in South Africa. This includes examining the impact of historical, cultural, and institutional factors on the mental health and well-being of medical students, which has not been comprehensively addressed in previous literature in terms of the South African context. The findings of this review highlight the importance of implementing comprehensive mental health support programs within medical education institutions to address the needs of students and promote their well-being.

Effectiveness of patient reminders on influenza vaccination coverage among adults with chronic conditions: A feasibility study in Australian general practices

BackgroundInfluenza vaccination is recommended for Australians 18+ years old with medical risk factors, but coverage is suboptimal. We aimed to examine whether automatic, opportunistic patient reminders (SMS and/or printed) before appointments with a general practitioner increased influenza vaccination uptake. MethodsThis clustered non-randomised feasibility study in Australian general practice included patients aged 18–64 years with at least one medical risk factor attending participating practices between May and September 2021. Software installed at intervention practices identified unvaccinated eligible patients when they booked an appointment, sent vaccination reminders (SMS on booking and 1 h before appointments), and printed automatic reminders on arrival. Control practices provided usual care. Clustered analyses adjusted for sociodemographic differences among practices were performed using logistic regression. ResultsA total of 12,786 at-risk adults attended 16 intervention practices (received reminders = 4066; ‘internal control’ receiving usual care = 8720), and 5082 individuals attended eight control practices. Baseline influenza vaccination uptake (2020) was similar in intervention and control practices (∼34%). After the intervention, uptake was similar in all groups (control practices = 29.3%; internal control = 30.0%; intervention = 31.6% (p-value = 0.203). However, SMS 1 h before appointments increased vaccination coverage (39.3%, adjusted OR = 1.65; 95%CI 1.20;2.27; number necessary to treat = 13), especially when combined with other reminder forms. That effect was more evident among adults with chronic respiratory, rheumatologic, or inflammatory bowel disease. ConclusionThese findings indicate that automated SMS reminders delivered at proximate times to appointments are a low-cost strategy to increase influenza vaccination among adults at higher risk of severe disease attending Australian general practices.

P016 Cardiovascular disease and rheumatoid arthritis among people with a history of cancer

Abstract Background/Aims Cardiovascular disease (CVD) is connected to many comorbidities and vascular diseases. Cancer also has certain inflammatory impact on the physiological mechanisms. However, the precise connection between these variables are unknown. In this research, we determined if there was an association between cardiovascular disease and overall mortality and how this connection may be modified by rheumatoid arthritis. Methods The National Health and Nutrition Examination Survey (NHANES) survey was conducted by the National Center for Health Statistics (NCHS) for the six cycles or years of 1999 to 2010 with mortality follow-up through December 31, 2019. This data is published biennially. Our study was conducted on participants with a history of cancer that were aged 40 years or older living in the United States with cardiovascular disease. CVD was determined by a history of stroke, congestive heart failure, coronary heart disease, and myocardial infarction. History of cancer was considered positive if the respondent answered “yes” to the question “Ever told you had cancer or malignancy”. We assessed RA status by using the arthritis question. We determined diabetes by healthcare worker diagnosed recall of the diagnosis of the disease. In this prospective analysis that we performed Complex Samples Cox regression with adjustment for known confounders to determine the relationship of chronic kidney disease and mortality, and if rheumatoid arthritis has an overall relationship in those living with diabetes. Results Among individuals living with cancer and rheumatoid arthritis, percent mortality for males was 58.2% and for females was 61.9%. For overall mortality, crude hazard ratio (HR) for diabetes was 2.13 (95% confidence interval [CI], 1.39-3.25 p &amp;lt; 0.001). The adjusted HR was elevated, 1.86 (CI 1.17-2.96, p = 0.01), among people with cardiovascular disease who also had rheumatoid arthritis but close to 1.0 (1.36 CI 1.09-1.70, p = 0.01) among individuals with cardiovascular disease who had no rheumatoid arthritis, after adjusting for medical (cardiovascular disease, asthma, chronic kidney disease, chronic obstructive pulmonary disease, and obesity) and demographic risk factors (gender and age). Similar patterns do not exist in the general population. Conclusion Among individuals has had a history of cancer, not only does cardiovascular disease lead to two times higher overall mortality but also rheumatoid arthritis occurrence impacts the relationship between cardiovascular disease and overall mortality even after controlling for potential medical and demographic confounders. Cardiovascular is the primary cause of death in many high- and middle-income countries in the world. More prevention efforts need to be made in order to prevent CVD and treat rheumatoid arthritis. Disclosure J. Khubchandani: None. S. Banerjee: None. C. Onukogu: None. R. Gonzales-Lagos: None.

P040 Obesity and rheumatoid arthritis among individuals with low education

Abstract Background/Aims Poor education is connected to many diseases including cardiovascular diseases (CVD) and some CVD-related risk factors such as obesity. However, precisely how this relationship occurs is unknown. In this research we will be exploring how the connection between obesity and overall mortality is modified by rheumatoid arthritis (RA). Methods Our study was conducted on participants that were aged 20 years or older living in the United States with a education level of only some high school. We assessed RA status by using the arthritis question in the National Health and Nutrition Examination Survey (NHANES) survey conducted by the National Center for Health Statistics (NCHS) for the years of 1999 to 2010 with mortality follow-up to December 2019. We determined obesity by calculating BMI and setting a cutpoint at 30 kg/m2. Education level was determined through self-reported data. Chronic Kidney Disease was determined using the Cockcroft-Gault equation. Prospective analysis was performed using complex samples Cox regression with adjustment for known confounders to determine the relationship of obesity and mortality, and if RA has an overall relationship in those with low education. Results Among individuals with low education and RA, percent mortality was 32.3% among males and 32.6% among females with mean follow-up of 9.3 years. For overall mortality, the age and sex-adjusted hazard ratio (HR) for obesity was 1.18 (95% confidence interval [CI], 1.05-1.34 p = 0.01). The adjusted HR was elevated, 1.56 (CI 1.06-2.32, p = 0.03), among people with obesity who also had RA but close to 1.0 (1.21 CI 0.99-1.47, p = 0.06) among individuals with obesity who had no RA, after adjusting for medical (chronic obstructive pulmonary disease, history of cancer, cardiovascular disease, chronic kidney disease, and diabetes) and demographic risk factors (poverty-income-ratio, age, military service, citizenship, and gender). Conclusion We found that among individuals with low education, not only does obesity lead to 18% higher overall mortality but also RA occurrence impacts the relationship between obesity and overall mortality even after controlling for potential confounders. Education and health literacy are especially important in the preventing and treating RA especially in those who have obesity. With cardiovascular disease having the highest rate of mortality, risk factors for CVD such as obesity must be prevented. Disclosure J. Khubchandani: None. S. Banerjee: None.

P113 Rheumatoid arthritis modifies the relationship between depression and overall mortality among African Americans

Abstract Background/Aims Rheumatoid arthritis (RA) has been known to be connected with many comorbidities and vascular diseases. Depression is two times more common in the RA population versus the general population. In this research, we will demonstrate the effect of depression on overall mortality and how the connection is influenced by rheumatoid arthritis among African Americans. Methods The National Health and Nutrition Examination Survey (NHANES) is a survey completed by non-institutionalized population of the United States. All respondents from the NHANES survey, who were 20 years or older and African American between the years 2005-2010 were included in the analysis with follow-up through December 31, 2019. Healthcare diagnosed self-reported information was used for the determination of RA. We determined depression by Patient Health Questionnaire (PHQ-9) with score ≥ 10. Analysis was performed using complex samples Cox regression to determine the relationship of depression on all-cause mortality and how rheumatoid arthritis influences this. Results Percent mortality among African American individuals with rheumatoid arthritis was 23.34% (CI 17.18%-29.34%) among males and 20.83% (CI 15.8-25.8) among females with mean follow-up of 10.1 years. For overall mortality, the age and sex-adjusted hazard ratio (HR) for depression was 2.52 (95% confidence interval [CI], 1.34-4.74 p = 0.01). The adjusted HR was elevated, 3.82 (CI 1.07-13.58, p = 0.04), among people with depression who also had rheumatoid arthritis but close to 1.0 (1.79 CI 0.47-6.88, p = 0.37) among individuals with depression who had no rheumatoid arthritis, after adjusting for medical (tobacco use, hypertension, and obesity) and demographic risk factors (poverty-income-ratio, age, and gender). Conclusion Among African Americans, we found that not only does depression lead to 2.5 times higher overall mortality but also rheumatoid arthritis occurrence affects this relationship even after controlling for potential confounders. As for treatment, African Americans are treated less with Disease-Modifying Anti-Rheumatic Drugs (DMARDS) than Caucasians according to previous research. Prevention and treatment programs for rheumatoid arthritis and screening for depression are especially important to treat comorbidities and to implement social change. Disclosure S. Banerjee: None. J. Khubchandani: None. M. Mesidor: None. P. Lane: None. R. Gonzales-Lagos: None.

Development and validation of a nomogram to predict medication risk based on a knowledge, attitude and practice (KAP) survey of residents in Shanxi Province, China.

Unsafe medication practices and medication errors are a major cause of harm in healthcare systems around the world. This study aimed to explore the factors that influence the risk of medication and provide medication risk evaluation model for adults in Shanxi province, China. The data was obtained from the provincial questionnaire from May to December 2022, relying on the random distribution of questionnaires and online questionnaires by four hospitals in Shanxi Province. Multiple linear regression analysis was used to explore the factors affecting the KAP score of residents. Univariate and multivariate logistic regression was used to determine the independent risk factors, and the nomogram was verified by receiver operating characteristic curve, calibration and decision curve analysis. A total of 3,388 questionnaires were collected, including 3,272 valid questionnaires. The average scores of drugs KAP were 63.2 ± 23.04, 33.05 ± 9.60, 23.67 ± 6.75 and 33.16 ± 10.87, respectively. On the evaluation criteria of the questionnaire, knowledge was scored "fair", attitude and practice were scored "good". Sex, monthly income, place of residence, insurance status, education level, and employment were regarded as independent risk factors for medication and a nomogram was established by them. Males, low-income, and low-educated people are important factors affecting the risk of medication. The application of the model can help residents understand the risk of their own medication behavior and reduce the harm of medication.

A Second Trimester Prediction Algorithm for Early-Onset Hypertensive Disorders of Pregnancy Occurrence and Severity Based on Soluble fms-like Tyrosine Kinase 1 (sFlt-1)/Placental Growth Factor (PlGF) Ratio and Uterine Doppler Ultrasound in Women at Risk.

Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of <one consisted of the following cutoffs: PI 1.44 (93.75% sensitivity, 95.24% specificity), RI 0.69 (87.5% sensitivity, 100% specificity) and sFlt-1/PlGF ratio 102.74 (93.75% sensitivity, 95.2% specificity). These algorithms may significantly enhance the prediction accuracy of preeclampsia compared to traditional risk factors. The combination of the sFlt-1/PlGF ratio with mean uterine PI and RI in particular displayed an improved performance in the prediction of severe preeclampsia with the above-mentioned complications, compared to the biochemical markers or uterine Doppler parameters used alone. Therefore, HDP screening strategies should increasingly focus on implementing such algorithms for women who are initially regarded as high risk based on traditional risk factors, in order to properly diagnose HDP and properly limit or manage the later maternal and fetal complications.

Prevalence of Intracranial Aneurysms Identified by Screening a General Population in North America: Association with Lifestyle and Medical Risk Factors (P2-5.011)

Prevalence of Intracranial Aneurysms Identified by Screening a General Population in North America: Association with Lifestyle and Medical Risk Factors (P2-5.011)