Middle Group Research Articles

Determinants of pre-conception care awareness among young and middle-aged women in the Morena district of Madhya Pradesh

Pre-conception care pertains to any preventive, promotive, and curative interventions for improving the health outcomes of women. Contrary to the growing burden of intergenerational transmission of chronic diseases, women lacked awareness and access to services for pre-conception care. Considering this, we conducted a cross-sectional study to assess the awareness, perceptions, and practices of pre-conception care among women from young and middle-aged groups in the Morena district of Madhya Pradesh. It was a cross-sectional study conducted with 383 women of reproductive age group (15-40 years) using a structured and pre-validated quantitative questionnaire. Out of 383 women, 171 belonged to the younger age group (15-24 years) and 212 to the middle-aged group (25-40 years). More than 50% of women had not heard of pre-conception care, and more than 90% of women in both groups had low dietary diversity. Middle-aged women had higher pre-conception care compared to younger women (βeta coefficient (95% Confidence Interval); p-value: 0.49 (0.03, 0.95); 0.03).

Effects of Medication Period and Gastrin Levels on Endoscopic Gastric Mucosal Changes in Long-Term Proton Pump Inhibitor Users

Background/Objectives: Proton pump inhibitor (PPI) use has increased worldwide, including in continuous and longer-term users. Recent reports highlight PPI-related endoscopic gastric mucosal changes, including fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cracked and cobblestone-like mucosa (CCLM), and black spots. PPI use elevates gastrin levels because of acid inhibition, and hypergastrinemia might be relevant to these findings. In this cross-sectional study, we retrospectively examined gastric mucosal changes in long-term PPI users, focusing on medication period and gastrin levels. Methods: We enrolled 57 patients who received a PPI (>1 year) at two clinics between January 2021 and March 2022. Participants were classified according to medication period: 1 < 5, 5–10, and ≥10 years. Gastrin levels were categorized as low, middle, and high (<250, 250–500, and ≥500 pg/mL, respectively). Odds ratios (OR) were estimated to assess the risk of endoscopic findings. Results: Of the 57 patients, 6 (10.5%), 25 (43.9%), and 26 (45.6%) were PPI users of 1 < 5, 5–10, and ≥10 years, respectively. There were no significant differences in the incidence of endoscopic findings among the medication periods. Low, middle, and high gastrin groups included 21 (36.8%), 21 (36.8%), and 15 (26.3%) patients, respectively. CCLM incidence was significantly elevated in higher gastrin level groups: middle (OR, 6.60; 95% confidence interval [CI], 1.46–29.75; p = 0.014) and high (OR, 9.00; 95% CI, 1.79–45.23; p = 0.0008) (p-trend = 0.0171). No significant differences were observed for other findings. Conclusions: No elevated risk of PPI-related gastric epithelial changes in long-term PPI users was observed time-dependently. Notably, higher gastrin levels were positively associated with CCLM development, irrespective of the medication period.

Are we there yet? Closing the gap of prostate cancer presentation disparities in Ireland.

The Irish Prostate Cancer Outcomes Research (IPCOR) Study collected longitudinal data on men newly diagnosed with Prostate Cancer (PC). Understanding the nuances of disease presentation is essential, considering the high incidence of PC in Ireland. This study aims to characterise disease presentation features, identify factors related to socio demographic disparities in presentation following opportunistic screening, and shed light on potential inequality challenges within Ireland's healthcare structure. Data were collected on demographics, diagnosis, and treatment of 6,816 men newly diagnosed with PC across 16 hospitals in the Republic of Ireland from February 2016 to January 2020. A complete case analysis was carried out, complemented by a sensitivity analysis for addressing sites with high rates of missing values. Multivariable logistic regression was conducted to examine the association between various predictor variables and the initial presentation to the urology clinic subsequent to opportunistic screening. A multivariable logistic regression model revealed that the type of hospital was a key determinant in post-opportunistic screening presentation, with patients in public hospitals 45.7% more likely to be presented following screening compared to those in private hospitals. Urban residents were 34% more likely to present following screening than rural ones. Age negatively influenced presentation following screening likelihood, decreasing by 3.4% yearly. Our research has highlighted the key features of PC presentation in Ireland, revealing potential inequalities affecting mainly urban populations, middle socioeconomic groups, and individuals with inadequate healthcare coverage. While the differences we observed in various groups may appear subtle and may indicate the success of the Rapid Access Prostate Clinics, they are still significant in pinpointing specific populations that require special attention. By addressing these nuanced differences in access to healthcare, socioeconomic status, and urban versus rural residence and implementing tailored strategies, we can work towards closing disparity gaps in PC, ultimately leading to improved health outcomes and equity across all population segments.

Association Between Atopic Dermatitis and Meniere's Disease: Nationwide Cohort Study.

Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by relapsing and remitting episodes. Although AD is well-known for its association with other allergic conditions, its relationship with Meniere's disease has not been thoroughly investigated. This study aimed to explore the potential correlation between AD and Meniere's disease. This study utilized data from the National Health Insurance Service-National Sample Cohort, a nationwide population-based database. The AD group was selected from a cohort of 1 million individuals randomly extracted from database. A non-AD group was obtained through Propensity Score Matching. The AD group comprised 84,579 individuals, with an equal number of individuals in the non-AD (control) group. The overall hazard ratio (HR) for Meniere's disease in the AD group was 1.44 (95% confidence interval (CI): 1.31-1.6). Subgroup analysis showed an adjusted HR of 0.42 (95% CI: 0.38-0.48) for Meniere's disease in males, 4.99 (95% CI: 4.45-5.62) in the middle-aged group (40-59 years), and 8.21 (95% CI: 7.21-9.35) in the older age group (≥60 years). Additionally, the adjusted HRs for developing Meniere's disease were higher in patients with comorbidities, including allergic rhinitis (1.18 [95% CI, 1.07-1.32]), allergic contact dermatitis (1.32 [95% CI, 1.19-1.48]), and allergic conjunctivitis (1.54 [95% CI, 1.32-1.82]). Long-term follow-up revealed that the prevalence of Meniere's disease was 1.44 times higher in the AD group compared to the control group. Moreover, older age, female sex, allergic rhinitis, allergic contact dermatitis, and allergic conjunctivitis were identified as factors that increase the risk of developing Meniere's disease. 3 Laryngoscope, 2024.

Effect of a multicomponent school-based intervention with parental involvement on socioeconomic inequalities in smoking initiation: equity impact analysis of the TOPAS study

BackgroundAs prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in...

Fear of COVID-19 and mental health status among the medical students of a selected medical college in Bangladesh.

COVID-19 pandemic and mental health of people are related to each other. To assess the relationship between fear of COVID-19 (FCOV) and the psychological status of medical students of Bangladesh. A total of 967 medical students and intern doctors of Sher-E-Bangla Medical College participated in this cross-sectional study. FCOV was measured using the Fear of COVID-19 Scale (FCV-19S). Mental health status was assessed using the Depression Anxiety Stress Scale (DASS-21). Correlation between these two variables was done followed by general linear model to assess the relationship of other covariates with mental health. FCOV had a highly significant relationship with mental health (DASS-21 and all its components, p < 0.001 for all). Females suffered more from fear than males except the interns. Clinical students, students with middle income groups, students residing with the families, and students having family members in health services exhibited more FCOV compared to their counterparts. When we looked at the DASS-21 and its components, females suffered more from stress. Having family members in health services was related to higher anxiety and stress with higher DASS-21 scores as well. Students who expressed their lives to be affected by COVID-19 had higher DASS-21 and its components compared to those whose lives were not affected as such. Students residing with their families revealed increased stress. FCOV and life affected by COVID-19 were constantly related to DASS-21 and its components (p < 0.001), adjusted for other variables. Fear of COVID-19 is associated with poor mental health of medical students.

Use of the Brief-BESTest partially instrumented with accelerometry to detect balance deterioration in middle-age

BackgroundMost standardized balance tests cannot detect subtle balance deterioration in middle age, or identify those at higher risk for accelerated balance decline due to a ceiling effect.AimsTo determine whether the Brief Balance Evaluation Systems Test (Brief-BESTest), partially instrumented with accelerometry, can detect balance deterioration in middle age and identify individuals with poor balance.MethodsWe studied young (25.3 ± 2.3 years), early middle-aged (47.7 ± 2.6 years), and late middle-aged adults (60.6 ± 3.6 years), with 25 participants in each age group. Subjects wore an accelerometer on their lower back while performing the Brief-BESTest. Balance measurements included the Brief-BESTest total and sub-measures scores, and postural sway during the Brief-BESTest standing tasks, calculated by the 95% confidence ellipse trajectory of the center of mass (COM-95% ellipse).ResultsCompared to the two middle-aged groups, young adults had better total Brief-BESTest and sub-measures scores, apart from the Stability-in-Gait sub-measure, and less postural sway during the Sensory-Orientation sub-measure. The total Brief-BESTest scores as well as the Biomechanical-Constraints and Sensory-Orientation sub-measures differed also between early and late middle-aged adults. Both the Brief-BESTest total scores and the Sensory-Orientation postural sway values demonstrated increased variation with age, allowing to identify subjects with poor balance. A moderate negative correlation (r = -0.43) was found between the Brief-BESTest total score and the COM-95% ellipse size, and a moderate agreement (k = 0.56) in identifying subjects with poor performance in the early but not the late middle age group.ConclusionsThe Brief-BESTest test combined with accelerometry could be a suitable screening tool to identify middle-aged people with early balance deterioration and potentially identify those with poor balance and a possible higher risk for falls. Clinicians and policymakers can use our findings to implement balance assessment programs in patients < 65 years, leading to preventive strategies before the risk increases.

Tanshinone IIA inhibits the apoptosis process of nerve cells by upshifting SIRT1 and FOXO3α protein and regulating anti- oxidative stress molecules and inflammatory factors in Cerebral Infarction Model

: Background as a prevalent cerebrovascular disorder, cerebral infarction (CI) has garnered extensive attention globally due to its high incidence and substantial fatality rate. Ischemia-reperfusion injury (IRI) exacerbates not only neuronal demise but also amplifies neural functional impairment. Tanshinone IIA (Tan IIA) has been identified to confer protection against IRI, yet the precise underlying mechanisms remain elusive. This work aimed to delve into the mechanistic role of Tan IIA in CI, with the goal of furnishing more distinct theoretical substantiation for its clinical application. Methods initially, a middle cerebral artery embolization model group (MCAO) model was established, followed by the categorization of rats into distinct groups based on different administration modes. Therapeutic effects were evaluated through indices including mortality rate, cerebral tissue water content, CI proportion, and neural functional scoring. Meanwhile, cellular apoptosis rates in hippocampal and cortical tissues, as well as levels of oxidative stress molecules (OSM), Sirtuin 1 (SIRT1), Forkhead box O3 (FOXO3α), and inflammatory factors, were examined to explore the mechanism of action. Results this work revealed that within varying doses of Tan IIA groups, as dosage escalated, mortality rate, cerebral edema severity, CI proportion, and neural functional scoring gradually diminished. Notably, the 35 mg/kg dose group exhibited the most significant reductions, with decreases of 74.9%, 12.7%, 47.5%, and 54% respectively. Cellular apoptosis rates in hippocampal and cortical tissues displayed a stepwise descending trend, with the 35 mg/kg dose group showcasing the largest reduction. SIRT1 and FOXO3α proteins exhibited a steady increase, with the 35 mg/kg dose group manifesting respective elevations of 87.9% and 65.5%, the highest among all groups. Antioxidant molecules glutathione (GSH) and superoxide dismutase (SOD) contents progressively increased, whereas malondialdehyde (MDA) and nitric oxide (NO) content decreased. The 35 mg/kg dose group recorded the highest increments of 49.1% and 58.1% for GSH and SOD content, while achieving the greatest reductions of 55.6% and 56.2% for MDA and NO content. Expression of inflammatory factors, namely tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6), gradually declined, with reductions of 42.1%, 32.2%, and 29.1% respectively in the 35 mg/kg dose group, exhibiting drastic differences (P < 0.05). Conclusion In conclusion, this research elucidates that Tan IIA improves cerebral edema and neural function by elevating intracellular expression of SIRT1 and FOXO3α proteins, modulating OSM and inflammatory factors. These findings yielded robust experimental support for the potential use of Tan IIA as a therapeutic agent for CI.

Clinical characteristics and bloodstream infection pathogens by gram-negative bacteria in different aged adults: A retrospective study.

This study aims to determine the characteristics and distribution of pathogenic bacteria in bloodstream infections (BSIs) by gram-negative bacteria in adults. One hundred seventy-one adult patients with BSIs who were treated at the Affiliated Hospital of Chengde Medical College between January 2018 and January 2020 were included in this study. The patients were assigned to the young- and middle-aged group and elderly group based on age. General patient data were analyzed. More elderly patients had BSIs and gram-negative bacteria than young- and middle-aged patients. The incidence of underlying diseases in elderly patients was significantly higher than the young- and middle-aged patients (P < .01). The composition of Brucella spp. was significantly different between the elderly group and young- and middle-aged group (P < .05). There were significantly more gallbladder infections in the elderly group than the young- and middle-aged group, and significantly fewer elderly patients had no definite infection sites than the young- and middle-aged group (P < .05). The incidence of complications and in-hospital mortality in the elderly group was higher than the young- and middle-aged group (P < .05). BSIs caused by gram-negative bacteria mainly involved elderly patients. BSIs were characterized by complications and a poor prognosis, as well as pathogenic bacteria and primary infection sites.

A Study on the Influence of Beaconism on Immigration Propensity among Youth and Middle-aged Chinese Individuals

Abstract: In 21st-century China, the phenomenon of migration is becoming increasingly common. Some people migrate to improve their standard of living, while others are inspired by the call of Beaconism to go to other countries in search of an imagined utopia. This study investigates the spread of Beaconism on the Chinese internet and its influence on the immigration propensity of young and middle-aged Chinese individuals. Through literature analysis and case studies, the paper elucidates the connotation and characteristics of Beaconism, as well as its dissemination mechanism on platforms such as immigration intermediaries and social media. The findings indicate that Beaconism has a significant impact on the immigration motives, destination choices, and value systems of the young and middle-aged groups, characterized by a blind pursuit of Western civilization and a neglect of traditional culture. This research provides a new perspective for understanding the immigration phenomenon in China and offers prospects for future research.

The association between the knowledge, perception, and practice of dietary supplement among Chinese adults

IntroductionRapid growth has been found in the market of dietary supplements (DSs) in China. However, studies about the knowledge level, intentions, and behavior related to DS remained limited in the Chinese population. This study aimed to explore the knowledge level, perception, and practice toward DS among Chinese adults.MethodsThis is a cross-sectional design among 1,714 participants aged between 18 and 65 years. A total of 54.1% of participants reported purchasing supplements in the past 6 months. Knowledge levels were assessed with a score from 1 to 10 based on correct answers to 10 binary questions about supplements.ResultsOnly 29.1% of participants answered seven or more questions correctly, while 7.9% answered three or fewer questions correctly. Participants with high and middle knowledge levels were more likely to seek medical advice when experiencing discomfort symptoms and were less likely to choose DS, with corresponding odd ratios (ORs) of 1.58 (95% CI: 1.16, 2.13) and 0.69 (95% CI: 0.52, 0.91) in high knowledge group and ORs of 1.36 (95% CI: 1.03, 1.80) and 0.96 (95% CI: 0.72, 1.30) in middle knowledge group (Pfor trend = 0.003 and 0.028, respectively). No significant differences were found in the motivation of DS use between knowledge levels. Although higher knowledge levels were associated with less spending on DS (OR high = 0.69; 95% CI: 0.49, 0.99; OR middle = 0.88; 95% CI: 0.64, 1.20; Pfor trend = 0.038), it did not guarantee better and more accurate awareness toward DS use.DiscussionIn conclusion, there is a growing demand for supplements among Chinese adults, but a significant gap between knowledge and behavior exists, affecting decision-making behaviors regarding DS.

Acceptance of Human Papillomavirus (HPV) vaccine among the parents of eligible daughters (9-15 years) in Bangladesh: A nationwide study using Health Belief Model.

To align with the 2030 vision of the World Health Organization (WHO) to ensure 90% of girls receive the HPV vaccine before turning 15, Bangladesh has recently started the (HPV) vaccine campaign nationwide. Therefore, our study aimed to assess the level of its acceptance among parents of eligible daughters in Bangladesh. This nationwide cross-sectional study was conducted among the self-identified parents of daughters in the age group of 9-15 years between June 28 and August 2, 2023. A total of 2,151 parents were conveniently selected from all eight divisions of Bangladesh. Data was collected through face-to-face interviews using a semi-structured questionnaire. The Health Belief Model was used to appraise respondents' beliefs concerning HPV and its vaccination. Adjusted odds ratios (AOR) with a corresponding 95% confidence interval (CI), and a p-value of <0.05 was considered statistically significant. R Studio (Version 2023.09.0+463) was used as an interface for data analysis, while R (the programming language) was used for statistical computations. The mean age of the study participants was 38.18 (±5.86) years. The overall acceptance rate of the HPV vaccine was 86.61% (95%CI: 85.09-88.02). The vaccine acceptance level was positively associated with all the domains of the HBM (p<0.001), except in the perceived barrier domain (p = 0.489). After adjustment for other factors, it was found that higher age was associated with a decreased acceptance (AOR: 0.92; 95% CI: 0.89-0.95). The urban residents exhibited 42% lower odds of vaccine acceptance than rural (AOR: 0.58; 95% CI: 0.36-0.92). Similarly, participants of the middle-income group had 44% lower odds than the lower-income group (AOR: 0.56; 95% CI: 0.32-0.97). Our study found a reasonably good level of acceptance of the HPV vaccine among the parents of eligible daughters. Multiple factors such as younger age, urban residence, belonging to the middle income group, history of regular routine health check-ups, knowledge of cervical cancer, positive perception about benefits of the vaccine, and positive cues to actions were associated with HPV vaccine acceptance.

Redivision of reference intervals of the red blood cell distribution width in a healthy Chinese population based on natural geographic environment

Revealing the spatial distribution and regional differences of red blood cell distribution width (RDW) reference values in the healthy Chinese population is important for the monitoring, diagnosis and prevention of the top chronic diseases in the disease spectrum in China. Medical indicator data were matched with geographical data and environmental pollution data to predict RDW reference values for the whole region of China using ridge regression analysis, support vector machine and BP neural network. Taylor diagrams and assignment methods were used to select the optimal model, and the spatial distribution was mapped according to the prediction results of the optimal model, and the intervals of RDW reference values for different age groups of healthy people in China were redefined. It was suggested that the reference values of RDW in the young and middle-aged groups in China were divided into low-value areas in the north (12.31,12.80) and high-value areas in the south (12.80,13.18); the reference values of RDW in the elderly group were divided into low-value areas in the north (11.28,12.60) and high-value areas in the south (12.60,13.91).In turn, it can provide a more accurate reference basis in the monitoring, diagnosis and prevention of chronic diseases at the top of the disease spectrum.

Based on Serum Pharmacochemistry and Metabolomics Studied the Pharmacodynamic Material Basis and Mechanism of Rubi Fructus (Fupenzi) in Improving the Symptom of Kidney-Yang Deficiency.

Rubi fructus (Fupenzi) is the immature fruit of East China Rubi fructus, which is widely used in medicine, food, health food and other fields. Since ancient times, Fupenzi has been considered to be an important medicine for tonifying the kidney in terms of nourishing the liver and kidney, fixing essence and reducing urine, but its effective components and mechanism are not clear. In this paper, the effective components of Rubi fructus were analyzed by detecting the components of Fupenzi in vivo and in vitro. Adenine was used to replicate the model of kidney yang deficiency, and organ index, biochemical index and histopathology were used to evaluate the effect of different doses of Fupenzi on tonifying kidney yang. Metabonomics technique was used to analyze the metabolic regulation mechanism of Fupenzi in improving kidney yang deficiency syndrome. The results showed that 61 chemical constituents of Fupenzi were identified in vitro, including 18 flavonoids, 19 organic acids, 5 coumarins, 8 terpenoids, 7 amino acids and 4 other components. A total of 51 chemical components were identified, including 30 prototype components and 21 metabolic components, which may be the effective components of Fupenzi. The results of pharmacodynamics showed that compared with the model group, the renal index, testicular index and epididymal index of rats in each Fupenzi group were significantly improved (p<0.01), cAMP significantly increased (p<0.05), cGMP decreased (p<0.05) and cAMP/cGMP ratio increased significantly (p<0.05). The content of ACTH in low dose group increased significantly (p<0.05), while the content of ACTH in middle and high dose groups increased, but there was no significant difference. The results of HE staining showed that compared with the model group, the kidney, testis and epididymis of rats in each treatment group were significantly improved. In general, these changes may be mainly through primary bile acid biosynthesis, linoleic acid metabolism, steroid hormone biosynthesis, β-alanine metabolism, glutathione metabolism, porphyrin and chlorophyll metabolism, unsaturated fatty acid biosynthesis, arachidonic acid metabolism, arginine and proline metabolism and other metabolic pathways to improve adenine-induced metabolic disorders in rats with kidney-yang deficiency syndrome.

Colonoscopy is associated with lower colorectal cancer occurrence and mortality in the older population: A population-based cohort study.

We aimed to evaluate the association between colonoscopy (CS) and colorectal cancer (CRC) occurrence and related mortality in an older population. This retrospective, nationwide, population-based cohort study used data of adults aged ≥40 years from the Health Insurance Review and Assessment Service database. After excluding CS within 6 months of CRC diagnosis during enrollment, CRC occurrence and related mortality were compared between CS and non-CS groups using a time-dependent Cox proportional hazard model. Sub-group analysis was conducted among four age groups: young, middle age, old, and very old. Results Among 748,989 individuals followed for 9.64±0.99 years, the CS group had a 65% lower CRC occurrence (adjusted hazard ratio [HRa]: 0.35, 95% confidence interval [95%CI]: 0.32-0.38) and 76% lower CRC-related mortality (HRa: 0.24, 95%CI: 0.18-0.31) after 5 years than the non-CS group. CS was associated with the most significant reduction in CRC occurrence in the middle age group (HRa: 0.32, 95%CI: 0.29-0.35) and CRC-related mortality in the young age group (HRa: 0.04, 95%CI: 0.01-0.33); the very old age group had the least reduction in both CRC occurrence and CRC-related mortality (HRa: 0.44, 95%CI: 0.33-0.59 and HRa: 0.28, 95%CI: 0.15-0.53, respectively). Conclusion We found a significant association between colonoscopy and reduction in CRC occurrence and CRC-related mortality in adults aged ≥ 40 years after 5 years of follow-up; however, these associations were weaker in the very old group. Research is needed on the association between colonoscopy and older age.

BCAA was more closely associated with visceral fat area than subcutaneous fat area in patients of type 2 diabetes mellitus: a cross-sectional study

BackgroundBranched-chain amino acid (BCAA) has been reported to be associated with obesity, the association of BCAA with visceral fat area (VFA) and subcutaneous fat area (SFA) remained unclear in patients with type 2 diabetes.MethodsThis cross-sectional study was conducted in 284 patients with type 2 diabetes mellitus. Enzyme-linked immunospecific assay was used to measure levels of serum BCAA and branched-chain keto acid (BCKA). VFA and SFA were measured with bio-impedance analysis method. The association between BCAA and VFA was calculated using Pearson correlation and multivariable linear regression analysis.ResultsThere were significant differences in the means of body mass index, waist circumstance, SFA and VFA among the three groups divided by total BCAA tertiles (all p < 0.05). Compared to patients with lower levels of serum BCAA (the lower tertile group), the means of VFA and SFA were significantly larger in the middle and upper tertile groups (all p < 0.05). However, the differences in above obesity parameters were nonsignificant according to various BCKA tertiles. Pearson correlation analysis also demonstrated that BCAA levels were positive associated with each obesity parameter (p < 0.05). Nevertheless, multivariable linear regression analysis showed that levels of serum BCAA were correlated with VFA, BMI and WC (all p < 0.05) rather than SFA after adjusted for other confounders.Conclusionslevels of serum BCAA were more closely correlated with VFA than SFA, prospective studies should be warranted to further explore the mechanism mediating BCAA and visceral fat accumulation in Human beings.Clinical trial numberNot applicable.

Prognostic significance of fibrinogen levels in sepsis-associated acute kidney injury: unveiling a nonlinear relationship and clinical implications

BackgroundFibrinogen plays a pivotal role in the inflammatory cascade and is intricately linked to the pathogenesis of sepsis. Nevertheless, its significance as a prognostic marker for sepsis-associated acute kidney injury (SA-AKI) remains uncertain. This study aimed to investigate the association between fibrinogen levels and 28-day mortality with sepsis-associated acute kidney injury.MethodThe fibrinogen levels of patients admitted to the intensive care unit of Beth Israel Deaconess Medical Center between 2008 and 2019 were retrospectively assessed, and those diagnosed with SA-AKI were divided into low, middle and high fibrinogen level groups according to tertiles. Multivariate Cox proportional hazards model was used to assess the 28-day mortality risk of the SA-AKI patients.ResultsA total of 3,479 patients with SA-AKI were included in the study. Fibrinogen demonstrated an independent association with 28-day mortality, yielding a hazard ratio (HR) of 0.961 (95% confidence interval [CI]: 0.923-0.999, P = 0.0471). Notably, a non-linear relationship between fibrinogen levels and 28-day mortality was observed, with the threshold observed at approximately 1.6 g/l. The effect sizes and corresponding CIs below and above this threshold were 0.509 (0.367, 0.707) and 1.011 (0.961, 1.064), respectively. Specifically, the risk of mortality among SA-AKI patients decreased by 49.1% for every 1 g/l increment in fibrinogen, provided that fibrinogen levels were less than 1.6 g/l.ConclusionIn patients with SA-AKI, a non-linear relationship was identified between fibrinogen levels and 28-day mortality. Particularly, when their fibrinogen levels were less than 1.6 g/l, a concomitant decrease in 28-day mortality was observed as fibrinogen levels increased.

Things seen and unseen: 2. Anaemia affects urban rich Nigerian adolescents more than other socio‑economic status groups.

Background: Anaemia is very prevalent globally and is thought to be linearly associated with wealth and to affect females and rural residents more than males and urban residents. Objectives: This study was designed to investigate this thought in a population of adolescents in Ebonyi State, Nigeria. Methods: Standard clinical protocols were used. A total of 362 adolescents (63.5% females) were studied. Anaemia was diagnosed on the basis of the World Health Organization (WHO) criteria. Results: Aggregate anaemia was found in 50.0% of the general population (43.9% males, 53.5% females) and was most prevalent in the urban upper socio‑economic status (SES) group (62.3%; 70.0% females, 52.2% males). Severe anaemia was present in 7.2% of the general population (9.1% males, 6.1% females). It was most prevalent amongst the 10-11 years age bracket (15.6%). Moderate and mild anaemia were found in 22.4% and 20.4% of the general population and in 13.0%, 11.4%, 8.3% and 6.0% of the urban upper, rural, urban low and middle SES groups, respectively. But in the rural area group, severe anaemia existed without wide sex variations. Moderate anaemia was most prevalent in the urban middle and upper SES groups (29.0% and 26.4%, respectively) with a clear female preponderance. Mild anaemia was the least prevalent (15.3%) in the urban middle SES group. Conclusions: The higher prevalence of severe anaemia in boys and the higher burden in the urban higher SES group warrant a rethink of the public health interventions used in Nigeria. Adolescent boys and urban upper SES groups should be targeted in nutrition interventions related to anaemia.

Age-Related Influence on Static and Dynamic Balance Abilities: An Inertial Measurement Unit-Based Evaluation.

Balance control, a complex sensorimotor skill, declines with age. Assessing balance is crucial for identifying fall risk and implementing interventions in the older population. This study aimed to measure age-dependent changes in static and dynamic balance using inertial measurement units in a clinical setting. This study included 82 healthy participants aged 20-85 years. For the dynamic balance test, participants stood on a horizontally swaying balance board. For the static balance test, they stood on one leg. Inertial measurement units attached to their bodies recorded kinematic data, with average absolute angular velocities assessing balance capabilities. In the dynamic test, the younger participants had smaller average absolute angular velocities in most body parts than those of the middle-aged and older groups, with no significant differences between the middle-aged and older groups. Conversely, in the single-leg stance tests, the young and middle-aged groups outperformed the older group, with no significant differences between the young and middle-aged groups. Thus, dynamic and static balance decline at different stages with age. These results highlight the complementary role of inertial measurement unit-based evaluation in understanding the effect of age on postural control mechanisms, offering valuable insights for tailoring rehabilitation protocols in clinical settings.

Local environment perceived in daily life and urban green and blue space visits: Uncovering key factors for different age groups to access ecosystem services

Inequality in access to green and blue spaces is a major issue in the field of environmental justice. Various factors significantly influence visitations to these spaces, including residential, commuting, and shopping areas. However, studies have mainly focused on residential environments. Analyzing the coupling of environmental and socioeconomic factors, including age, income, and childhood experience, and examining the direct and indirect effects of these factors for different age groups are needed to better understand the detailed context of inequalities in access to ecosystem services. We conducted a questionnaire survey and analysis to address these needs in an urban setting. The results demonstrate that several land use categories (i.e., agricultural lands in residential areas, grasslands near shopping areas, and deciduous forests near commuting destinations) positively correlated with visitation frequency, suggesting the lack thereof may be the cause of access inequalities. In particular, the perimeter per unit area of some land cover types, which shows the complexity of the form of each land cover category, was found to be a significant factor. We identified inequality in nature experience to be the key factor correlated with inequality in nature visits among the young age group. For the middle-aged and old age groups, nature-relatedness was positively correlated with visitation frequency. Proper design of the local environment, such as through land use planning, can be an effective measure for all age groups. For instance, long-bordered green areas in the Monsoon Asian region are an attractive traditional landscape, with high accessibility and a comfortable thermal environment. The key factors for each age group should be considered in spatial design and inclusive information-sharing to reduce inequality in access to ecosystem services.