Logistic Regression Models Research Articles

Sleep health characteristics and positive mental health in Canadian youth: A cross-sectional analysis of the Health Behaviour in School-aged Children study.

This study investigated the associations between specific sleep health characteristics and indicators of positive mental health among Canadian youth in grades 6-10. We used cross-sectional data from the Canadian 2017/2018 Health Behaviour in School-aged Children study, a nationally representative sample of Canadian students. Our analyses included 14,868 participants (53.1% girls). We assessed the following self-reported characteristics of sleep health: nighttime insomnia symptoms, sleep duration, problems with daytime wakefulness, and weekend catch-up sleep. Positive mental health measures included self-reported life satisfaction, positive affect, self-efficacy, and self-confidence. Logistic regression models were used to assess associations while controlling for confounders. Participants who had no or little nighttime insomnia symptoms, who met sleep duration recommendations, who had no or rare daytime wakefulness problems, and who had no or little weekend catch-up sleep were more likely to report high life satisfaction (range of adjusted odds ratios=1.29-2.50), high positive affect (range of adjusted odds ratios=1.35-3.60), high self-efficacy (range of adjusted odds ratios=1.22-2.54), and high self-confidence (range of adjusted odds ratios=1.28-2.31). Almost all of the associations remained significant in the gender- and age-stratified analyses. The findings suggest that good sleep health is associated with higher odds of positive mental health among Canadian youth in grades 6-10. Further research is needed to understand the temporality of the associations and the underlying mechanisms.

Critical care unit bed availability and postoperative outcomes: a multinational cohort study.

Critical care beds are a limited resource, yet research indicates that recommendations for postoperative critical care admission based on patient-level risk stratification are not followed. It is unclear how prioritisation decisions are made in real-world settings and the effect of this prioritisation on outcomes. This was a prespecified analysis of an observational cohort study of adult patients undergoing inpatient surgery, conducted in 274 hospitals across the UK and Australasia during 2017. The primary outcome was postoperative morbidity at day 7. Logistic regression models were used to evaluate the relationship between critical care admission and patient and health system factors. The causal effect of critical care admission on outcome was estimated using variation in critical care occupancy as a natural experiment in an instrumental variable analysis. A total of 19,491 patients from 248 hospitals were eligible for analysis, of whom 2107 were directly admitted to critical care postoperatively. Postoperative morbidity occurred in 2829/19,491 (15%) patients. Increasing surgical risk was associated with critical care admission, as was increased availability of critical care beds (odds ratio (95%CI) 1.04 (1.01-1.06), p = 0.002) per available bed; however, the probability of admission varied significantly between hospitals (median odds ratio 3.05). There was no evidence of a difference in postoperative morbidity with critical care admission (odds ratio (95%CI) 0.91 (0.57-1.45), p = 0.710). Postoperative critical care admission is variable and related to bed availability. Statistical methods that adjust for unobserved confounding lowered the estimates of harm previously reported to have been associated with postoperative critical care admission. Our findings provide a rationale for a clinical trial which would evaluate any potential benefits for postoperative critical care admission for patients in whom there is no absolute indication for admission.

Relationship between per-fluoroalkyl and polyfluoroalkyl substance exposure and insulin resistance in nondiabetic adults: evidence from NHANES 2003-2018

BackgroundStudies have linked per- and polyfluoroalkyl substances (PFAS) to chronic metabolic diseases. However, the relationship between PFAS exposure and insulin resistance (IR), a key pathophysiological basis of these metabolic diseases, in nondiabetic individuals have yet to be determined. MethodsThis study analyzed data from 3909 participants (aged ≥20) from the NHANES 2003-2018 to investigate the associations between serum levels of seven PFAS and and IR indicators, including including HOMA-IR, HOMA-β, fasting insulin, QUICKI, and TyG index. Linear and logistic regression models were used, along with a restricted cubic spline to assess dose-response. Weighted quantile sum (WQS) regression and quantile g-computation (qgcomp) models were used to assess the association between mixed PFAS exposure and IR. ResultsLinear regression revealed that elevated exposure to PFOS [β (95% CI): 0.04 (0.02, 0.06)], PFOA [0.04 (0.01, 0.06)], and Me_PFOSA_AcOH [0.04 (0.02, 0.06)] was associated with a higher TyG index in adults. Notably, Me_PFOSA_AcOH was negatively associated with IR when assessed by HOMA-IR >2.6 [OR (95% CI): 0.88 (0.79, 0.98)], although this was not supported by linear regression findings. When IR was defined by a TyG index >8.6, exposure to the highest quartiles of PFOS, PFOA, and Me_PFOSA_AcOH was associated with an increased risk of IR by 63%, 42%, and 85%, respectively [1.63 (1.21, 2.20); 1.42 (1.06, 1.92); 1.85 (1.37, 2.50)]. PFOS, PFOA, and Me_PFOSA_AcOH demonstrated a nonlinear dose-response relationship with IR risk. The WQS and qgcomp models revealed significant positive correlations with the TyG index. ConclusionMixed PFAS exposure in US nondiabetic adults was positively associated with IR, as indicated by the TyG index, particularly for PFOS, PFOA, and Me_PFOSA_AcOH. Further research is needed to establish causality, and reinforcing environmental risk mitigation strategies to reduce PFAS exposure is recommended.

An Analysis of the Effect of Skew Rolling Parameters on the Surface Quality of C60 Steel Parts Using Classification Models

This paper presents the experimental and numerical results of a study on producing axisymmetric parts made of the C60-grade steel by skew rolling. The experimental part of this study involved conducting the skew rolling process with varying parameters, including the forming angle α, tool angle θ, chuck velocity Vu, and reduction ratio δ. Their effect on the quality of produced parts was examined and described by the roughness parameter Ra. Numerical calculations involved the use of machine learning models to predict the quality class of produced parts. The highest prediction accuracy of the results was obtained with the random forest and logistic regression models. Metrics such as precision, recall and accuracy were used to evaluate the performance of individual models. Confusion matrices and ROC curves were also employed to illustrate the performance of the classification models. The results of this study will make it possible to prevent the formation of spiral grooves on the circumference of steel parts during the rolling process.

Temporal Trends in Single- and Multiple-Sports Team Participation Among Adolescents in the United States: Analysis Using the Youth Risk Behavior Surveillance System, 1999-2019

Background: It is unclear how levels of sport participation have changed among adolescents in the United States (US) in recent years, particularly considering evidence of increasing sport professionalization and attrition. Purpose: To evaluate the differences and trends in single- and multiple-team sport participation among US high school students between 1999 and 2019. Study Design: Descriptive epidemiology study. Methods: Using the Youth Risk Behavior Surveillance System of the US Centers for Disease Control and Prevention, a biannual representative survey of US high school students, data on self-reported sport participation (no participation, single team, multiple teams) within the previous year were evaluated. Differences in sport participation prevalence between 1999 and 2019 were assessed in sex strata by grade, race/ethnicity, and US region. Weighted trends using the National Center for Health Statistics Guidelines for Analysis of Trends and logistic regression models were employed for analyses. Results: The study sample over the 20-year period (N = 149,404) was 49.8% female; the majority were in ninth grade (27.7% female, 28.7% male), were non-Hispanic White (56.1% female, 56.8% male), and resided in the Southern US (57.6% female, 57.4% male). Among girls, 27.2% (95% CI, 25.8-28.6) reported multiple sports team participation in 1999, while 21.3% (95% CI, 20.1-22.6) reported the same in 2019. Among boys, 39.5% (95% CI, 38.4-40.7) reported multiple sports team participation in 1999 versus 29.1% (95% CI, 27.7-30.6) in 2019. Analyses of trends indicated that girls experienced increasing trends in single-sport team participation (β = 0.04, SE = 0.01, P < .001). Among boys, there were increasing trends in no sport participation (β = 0.06, SE = 0.01, P < .001), while multiple-sport team participation decreased over the 20-year period (β = −0.10, SE = 0.01, P < .001). Disparities in trends were observed among female and male groups by race/ethnicity, grade, and region. Conclusion: Sport participation over a 20-year period in the US decreased significantly for boys and increased for single-sports teams among girls. Sport specialization may be contributing some of the observed trends, though limitations in the data require additional research to confirm these hypotheses. Tailored efforts to increase sport participation among both sexes is needed.

Gender-specific factors of suicidal ideation among high school students in Yunnan province, China: A machine learning approach.

Suicidal ideation (SI) assumes a pivotal role in predicting suicidal behaviors. The incidence of SI among high (junior and senior) school students is significantly higher than that of other age groups. The aim of this study is to explore the gender differences in SI among high school students in Yunnan Province. A total of 6180 students in grades 7-12 in Yunnan province, China from May 2021 to May 2022 participated in this survey. Univariate analysis was employed to describe the influencing factors of male and female students' SI. Subsequently, data were stratified by gender. Adopting machine learning technique, including Least Absolute Shrinkage and Selection Operator (Lasso) and Boruta algorithm, and logistic regression model to estimate the direction and effect magnitude of the influencing factors. The prevalence of SI was significantly higher for females (31.34%) than males (16.73%). The logistic regression model was established using the variables screened by Boruta algorithm, indicated that anxiety, depression, suffering emotion abuse or emotion neglect in childhood, non-suicidal self-injury, evening chronotype are common risk factors for SI in male and female students. Notably, female students who exhibited aggressive behavior, have experienced bullying, and were in the junior high school learning stage were more likely to report SI than their male counterparts. Females showed more vulnerability to SI than males especially among females in junior high school, reporting aggressive behavior and bullying experiences. Tailored prevention strategies, informed by these gender-related distinctions, should be developed and implemented.

Curvilinear relationship was found between visceral adiposity index and stress urinary incontinence among US adult women: A cross-sectional study.

The purpose of this study was to find out the relation between visceral adipose index (VAI) levels and stress urinary incontinence (SUI) in adult women. From the National Health and Nutrition Examination Survey (NHANES) 2007-2020, females aged 20 or above were identified for this study. Visceral adiposity was determined using the VAI score, and the assessment of urinary incontinence was carried out through a correlation questionnaire. Logistic regression models and restricted cubic spline (RCS) regression were employed to analyze the relationship between VAI levels and SUI. Among the 6522 participants, 2672 (41.0%) were reported SUI. Multivariate logistic regression revealed significantly higher odds of SUI with increasing VAI levels (Q4 vs. Q1), adjusted odds ratio (aOR) = 1.53 (CI: 1.29-1.81, p < 0.001). RCS regression indicated a curvilinear relationship between VAI and SUI (p = 0.003). In threshold analysis, aOR for developing SUI was 1.18 (CI: 1.11-1.26, p < 0.001) for participants with VAI < 4.73, suggesting an 18% increased risk of SUI with each unit increase in VAI. No association between VAI and SUI was observed when VAI was ≥4.73. Our study has revealed a significant curvilinear relationship between VAI and SUI within a large and representative sample of women. Future research is necessary to evaluate the relationship between the two and explicate the underlying mechanisms of this relationship.

Dose escalation of biologics in biologic-naive patients with Crohn's disease: Outcomes from the ODESSA-CD study.

Dose escalation of biologics may restore response in patients with Crohn's disease (CD) who experience inadequate response or loss of response, but the rates of dose escalation and subsequent adverse clinical outcomes have not been well characterized. To evaluate the rate of dose escalation of biologics and associated adverse clinical outcomes and economic outcomes in biologic-naive patients with CD. ODESSA-CD (real wOrld Dose EScalation and outcomeS with biologics in IBD pAtients with Crohn's Disease) was a retrospective cohort study conducted using claims data from IBM MarketScan databases. Adults with CD with at least 1 claim for an index drug (adalimumab, infliximab, ustekinumab, or vedolizumab) between January 1, 2017, and December 31, 2018, and no claims for biologics in the 6 months prior (ie, biologic naive) were included. Follow-up ended on June 30, 2020. Cox proportional hazards models and logistic regression models were used to compare the rate of dose escalation and the likelihood of adverse clinical outcomes and costs after dose escalation, respectively. Of the 2,664 eligible patients, most (71.4%) were younger than 50 years and 50.5% were male. The rate of dose escalation was higher with the anti-tumor necrosis factor α (TNFα) treatments adalimumab (hazard ratio [HR] = 1.703; P < 0.0001) and infliximab (HR = 1.690; P < 0.0001) compared with vedolizumab, but there was no significant difference between ustekinumab and vedolizumab (HR = 0.842; P = 0.730). After dose escalation, the likelihood of infection, sepsis, and inflammatory bowel disease-related hospitalization did not differ among biologics (anti-TNFα vs vedolizumab: odds ratio [OR] = 1.141, P = 0.599; ustekinumab vs vedolizumab: OR = 0.891; P = 0.836); however, corticosteroid use was more likely with anti-TNFα treatment than with vedolizumab (OR = 1.740, P = 0.002). Among patients whose dose was escalated, index drug costs were likely to be higher with anti-TNFα treatment and ustekinumab than with vedolizumab (anti-TNFα vs vedolizumab: ratio of expected cost = 1.429, P = 0.002; ustekinumab vs vedolizumab: ratio of expected cost = 3.115, P < 0.0001). Patients who were biologic naive and received ustekinumab or vedolizumab were less likely to undergo dose escalation than those who received anti-TNFα treatment. Adverse clinical outcomes after dose escalation were similar among these biologics but with different costs. These analyses may inform providers and payers of the clinical and economic implications of dose escalation.

Impact of Renin-angiotensin system inhibitors on response to PD1/L1 inhibitors in patients with Metastatic Renal Cell Carcinoma

BackgroundThe renin-angiotensin-aldosterone system (RAAS), traditionally associated with blood pressure and fluid regulation, also plays a role in tumorigenesis. Renin-angiotensin-aldosterone system inhibitors (RAASI), including angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs), have been shown to improve outcomes in various malignant neoplasms. In metastatic urothelial cancer, the use of RAASI have been associated with higher rates of tumor regression in patients receiving immunotherapy (IO) with PD1/L1 inhibitors. This is thought to be due to RAASI-induced downregulation of TGF-beta, for which increased expression is a known mechanism of PD1/L1 inhibitor resistance. We hypothesized that concurrent RAASI in patients with mRCC receiving IO is associated with increased tumor regression. MethodsWe conducted a retrospective analysis of patients with mRCC receiving IO as a first- or second-line therapy from 2016-2023 at the University of Virginia. A logistic regression model was used to evaluate the impact of concurrent RAASI on tumor regression. The primary endpoint was any regression of tumor on imaging. ResultsData were available for 128 patients with mRCC who received IO as a first- (n=91, 71.0%) or second- (n=37, 28.9%) line treatment. Patients who received RAASI during IO were more likely to have tumor regression compared to patients who were not on concurrent RAASI (OR 3.84 [95% CI 1.81-8.47, p=<0.001). This held true regardless if patients received IO as a first-line (OR 2.83 [95% CI 1.2-6.94], p=0.0173) or second-line (OR 9.5 [95% CI 1.89-73.1], p=0.005) treatment. ConclusionsOur hypothesis generating study suggests that in our mRCC population, concurrent use of RAASI in patients receiving IO was associated with a significantly increased likelihood of tumor regression. These findings highlight the potential therapeutic advantage of RAASI in combination with IO for mRCC patients. Further exploration of this association is warranted in prospective studies to improve treatment outcomes for this patient population. MicroAbstractRenin-angiotensin-aldosterone system inhibitors (RAASI) have been shown to improve outcomes in various malignancies. In this retrospective, single-center study, we found that concurrent use of RAASI in patients with mRCC receiving IO is associated with a significantly increased likelihood of tumor regression. Our findings suggest the potential therapeutic advantage of RAASI in combination with IO for mRCC patients.

Validation of lymphovascular invasion as a predictor of lymph-node invasion in squamous cell carcinoma of the penis.

The aim of this study was to validate lymphovascular invasion (LVI) as a predictor of lymph-node invasion (LNI) in squamous cell carcinoma of the penis (SCCP). Within the Surveillance, Epidemiology, and End Results database (2010-2020), we identified SCCP patients who underwent lymphadenectomy with known LVI status. Univariable logistic regression models (LRMs) addressed LNI. Harrell's concordance index (c-index) quantified accuracy after 2000 bootstrap resamples for internal validation. Multivariable LRMs included the most informative, statistically significant predictors. Subgroup analyses were repeated in organ-confined (T1b-T2) and non-organ confined (T3-T4) stages. Of 586 SCCP patients, 219 (37%) had LVI. LVI was associated with higher rate of LNI (66 vs. 43%; P<0.001). Positive predictive value of LVI was 66 vs. 57% for negative predictive value. In multivariable LRMs, LVI independently predicted LNI (Odds ratio [OR]: 2.41; P<0.001). Bootstrap-adjusted c-index of multivariable model was 0.570 without LVI vs. 0.639 with LVI. In subgroup analyses, LVI independently predicted LNI in organ-confined (OR: 2.23; P<0.001) and in non-organ confined stages (OR: 3.10; P<0.001). In subgroup analyses, addition of LVI increased c-index from 0.530 to 0.595 in organ-confined and from 0.599 to 0.682 in non-organ confined. The current study validates LVI as an independent predictor of LNI in SCCP. LVI increases the accuracy of LNI predictions in the overall cohort as well as in organ-confined and non-organ confined stages. However, stage and grade even with the added consideration of LVI are not accurate enough to provide LNI prediction in individual patients.

Association Between Urinary Rare Earth Element Levels and Metabolic Syndrome: A Cross-sectional Study in the Minority Population of Guangxi in China.

This study aimed to investigate the association between rare earth elements (REEs) and metabolic syndrome (MetS). We used a cross-sectional design based on the baseline data of the Prospective Cohort Study of Chronic Diseases in Ethnic Minority Natural Population in Guangxi in China. Logistic regression and BKMR models were employed to evaluate the association between REEs and risk of MetS. Although REEs were not significantly associated with MetS, certain elements such as La, Pr, and Nd were negatively associated with abdominal obesity, whereas Ce, Pr, Nd, and Dy were positively associated with hypertension. BKMR models suggested a U-shaped relationship between mixed REEs and MetS, with varying effects on abdominal obesity and high blood pressure. This study suggests that exposure to REEs may be associated with a reduced risk of abdominal obesity and an increased risk of high blood pressure.

Morphometrics of polypoidal choroidal vasculopathy lesions and choroidal vascular associated with treatment response using swept-source optical coherence tomography angiography

PurposeTo evaluate quantitative metrics of neovascularization lesions and choroidal vascular using swept-source optical coherence tomography angiography (SS-OCTA) in polypoidal choroidal vasculopathy (PCV) eyes, and investigate the relationship between imaging biomarkers and treatment outcomes of intravitreal anti-vascular endothelial growth factor (VEGF). MethodsWe retrospectively recruited 56 PCV patients. Choroidal features included subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI). Quantitative metrics of neovascularization lesions included total vessel length (TVL), average vessel length (AVL), junction density (JD), total number of endpoints (TNE), and mean lacunarity (ML). We performed multivariate logistic and linear regression models to determine the prognostic factors for functional and morphological outcomes. ResultsBy comparison, functional good-responders had poorer best corrected visual acuity, higher TNE, and lower ML at baseline. Morphological good-responders had higher central retinal thickness, higher TNE, lower TVL and AVL, lower ML, lower SFCT and CVI. High-shrinkage of vessel area subgroup had higher JD and TNE, lower TVL and AVL, lower ML, lower SFCT and CVI. Multivariate analysis showed good morphological response was correlated with lower SFCT (P < 0.01). High-shrinkage subgroup was correlated with lower AVL (P = 0.017) and higher TNE (P < 0.01). ConclusionQuantitative metrics of neovascularization lesions and choroidal characteristics using SS-OCTA had the potential to be imaging biomarkers for predicting the response to anti-VEGF treatment. PCV lesions with higher TNE and lower AVL tended to appear higher shrinkage of vessel area, and lower SFCT was correlated with good morphological response.

Market Factors, Not Quality, Influence Reimbursement for Pancreaticoduodenectomy in an Era of Price Transparency.

The Centers for Medicare and Medicaid Services (CMS) price transparency rule tries to facilitate cost-conscious decision-making. For surgical services, such as pancreaticoduodenectomy (PD), factors mediating transparency and real-world reimbursement are not well described. The Leapfrog Survey was used to identify United States hospitals performing PD. Financial and operational data were obtained from Turquoise Health and CMS Cost Reports. Chi-square tests and modified Poisson regression evaluated associations with reimbursement disclosure. Two-part logistic and gamma regression models estimated effects of hospital factors on commercial, Medicare, and self-pay reimbursements for PD. Of 452 Leapfrog hospitals, 295 (65%) disclosed PD hospital or procedure reimbursements. Disclosing hospitals were larger (beds >200: 81.0% vs. 71.3%, p = 0.04), reported higher net margins (0.7% vs. -2.1%, p = 0.04), more likely for-profit (26.1% vs. 6.4%, p < 0.001), and teaching-affiliated (82.0% vs. 65.6%, p < 0.001). Nonprofit status conferred hospitalization reimbursement increases of $8683-$12,329, while moderate market concentration predicted savings up to $5066. Teaching affiliation conferred reimbursement increases of $4589-$16,393 for hospitalizations and $644 for procedures. Top Leapfrog volume ratings predicted an increase of up to $7795 for only Medicare hospitalization reimbursement. Nondisclosure of hospital and procedural reimbursements for PD remains a major issue. Transparency was noted in hospitals with higher margins, size, and academic affiliation. Factors associated with higher reimbursement were non-profit status, academic affiliation, and more equitable market share. Reimbursement inconsistently tracked with PD quality or volume measures. Policy changes may be required to incentivize reimbursement disclosure and translate transparency into increased value for patients.

Identifying Oncology Patients at High Risk for Potentially Preventable Emergency Department Visits Using a Novel Definition.

Patients with cancer visit the emergency department (ED) frequently. While some ED visits are necessary, others may be potentially preventable ED visits (PPEDs). Reducing PPEDs is important to improve quality of care and reduce costs. However, a robust definition and the characteristics of patients at risk remain unclear. This study aimed to describe oncology-related PPEDs and identify characteristics of patients at the highest risk for PPEDs to help target interventions and minimize avoidable ED visits. A retrospective study was conducted using four clinical and administrative databases. All ED visits by oncology patients between April 1, 2019, and April 1, 2021, were identified. A novel definition of PPEDs was explored, specifically visits that resulted in immediate discharge from the ED or admissions <48 hours. Trends in ED use, including PPEDs, were evaluated using descriptive statistics, logistic regression, and machine learning (ML) modeling. During the 2-year period, 6,689 oncology patients visited the ED (N = 13,415 visits). A total of 62.1% of visits were classified as PPEDs. PPEDs were most common among patients with stage I to III breast cancer and those on systemic therapy. Characteristics of patients at high risk for non-PPEDs included stage IV disease with either lung or GI carcinomas and shorter distances to the ED. The highest-performing ML model yielded an AUC of 0.819. Our novel definition of PPEDs appears promising in identifying oncology patients who could avoid the ED with targeted interventions. This work demonstrated that patients with early-stage disease, those with breast cancer, and those on systemic therapy are at the highest risk for PPEDs and may benefit from proactive interventions to avoid the ED. Although our definition requires validation, using ML models for more robust predictive modeling appears promising.

Comorbid depression and anxiety and their association with health care resource utilization among individuals with type 1 diabetes in the United States.

Type 1 diabetes mellitus (T1DM) is a prevalent chronic endocrine disorder and accounts for 5%-10% of all diabetes cases worldwide. T1DM can have a substantial impact on health care utilization. Although it is well known that individuals with diabetes are at a greater risk of mental health disorders, specific evidence addressing the health care burden of comorbid depression/anxiety in people affected by T1DM is lacking. To assess health care resource utilization (HCRU) among adults with T1DM and comorbid depression or anxiety. We identified individuals aged 18 to 64 with a T1DM diagnosis from January 1, 2017, to December 31, 2021, using a 25% random sample of the IQVIA PharMetrics Plus for Academics database. The index date was the date of the first medical claim with a T1DM diagnosis. Eligibility required continuous medical and prescription coverage for 12 months before (baseline) and after (follow-up) the index date. Comorbid depression/anxiety and baseline characteristics were assessed during the baseline period. The following 2 mutually exclusive groups were created: individuals with T1DM and comorbid depression/anxiety, and those with only T1DM. To balance baseline demographic and clinical characteristics between the groups, we implemented 1:1 propensity-score matching. We assessed all-cause, diabetes-related, and major adverse cardiovascular event-related HCRU during the follow-up period. Logistic (binary) and negative binomial (count) regression models examined the association between comorbid depression/anxiety and HCRU across types of health care settings. Out of 6,491 eligible individuals with T1DM, 1,168 (18%) had either depression or anxiety. In the matched cohort of 2,314 individuals, those with T1DM and comorbid depression/anxiety had significantly higher odds of all-cause emergency department visits (odds ratio = 1.67; 95% CI = 1.39-2.00) and higher rates of physician office visits (incidence rate ratio = 1.37; 95% CI = 1.27-1.47) and other outpatient encounters (incidence rate ratio = 1.23; 95% CI = 1.13-1.34) than those with only T1DM. Findings were similar for diabetes-related and major adverse cardiovascular event-related HCRU. Comorbid depression/anxiety among individuals with T1DM results in significantly higher HCRU than T1DM alone. The findings underscore the importance of effective management of comorbid depression/anxiety in the T1DM population.

Impact of CCR5Δ32 on the risk of infection, Staphylococcus aureus carriage, and plasma concentrations of chemokines in Danish blood donors

The CC chemokine receptor 5 (CCR5) is a suggested receptor for Staphylococcus aureus leukotoxin ED. Homozygosity for the Δ32 deletion (CCR5Δ32) protects against human immunodeficiency virus infection and possibly also against leukotoxin ED. We examined the impact of CCR5Δ32 on the susceptibility to S.aureus infection, all-cause infections, and S.aureus nasal carriage, respectively, and on the concentrations of circulating chemokines in blood donors. We included 95,406 participants from the Danish Blood Donor Study (DBDS) genotyped for >650,000 single nucleotide polymorphisms. The CCR5Δ32 (rs333, MAF: 0.12) was imputed from a reference panel and validated. Infectious outcomes were identified by diagnosis codes and redeemed prescription of antibiotics in national health registers. Data on S.aureus nasal carriage and forty-seven inflammatory biomarkers were available for 6721 and 7811 participants, respectively. Cox, logistic, and linear regression models adjusted for relevant confounders were used to explore said associations. During more than 700,000 person-years of observation, we found that CCR5Δ32 was associated with neither an increased risk of redeemed dicloxacillin, hospital-treated S.aureus-associated infection (replicated in 345,996 Icelanders), redeemed antibiotics, all-cause infection, and nor with S.aureus nasal carriage. We discovered an association between CCR5Δ32 and elevated CCL4 concentrations, which were 1.26-fold higher in Δ32-heterozygotes (95%-CI: 1.23-1.30) and 2.64-fold higher in Δ32-homozygotes (95%-CI: 2.41-2.90) compared with wildtype homozygotes. Conversely, concentrations of CCL2, CXCL-10, and CCL11 were slightly lower among Δ32-heterozygotes. Results from this CCR5Δ32 high-prevalent cohort do not support the idea that CCR5Δ32 affects the risk of S.aureus carriage or infection to any relevant degree, in this northern European context. CCL4 was the main chemokine affected by CCR5Δ32 and was observed in higher concentration among Δ32-carriers. This study cannot rule out that S.aureus is a previous driver of CCR5Δ32 selection. The Health Research Fund of Central Denmark Region, Aarhus University, Danish Administrative Regions, Bio- and Genome Bank Denmark, Danish Blood Donor Research Foundation, Aase & Ejnar Danielsens Foundation, Højmosegård Grant, National Institute of Allergy and Infectious Diseases, and A.P. Møller Foundation for the Advancement of Medical Science.

Associations of mixed metals exposure with cognitive impairment risk: a cross-sectional study in Chinese adults.

Associations between exposure to single metals and cognitive impairment or related outcomes have been reported in many previous studies. However, co-exposure to more than one metal is common situation. In recent years, studies on the effects of exposure to multiple metals on cognitive impairment or related outcomes have increased, but remain very limited, with a focus on populations with occupational exposure to metals, children, and adolescents. The potential relationships between exposure to metal mixtures and risk of cognitive impairment in adults remain to be clarified. To determine the associations between blood metal mixtures and cognitive impairment risk. Inductively coupled plasma mass spectrometry (ICP-MS) was utilized to detect the blood levels of lead (Pb), iron (Fe), copper (Cu), calcium (Ca), magnesium (Mg), and zinc (Zn). Multivariable logistic regression and Bayesian kernel machine regression (BKMR) models were employed to assess the relationships of exposure to these blood metal mixtures with the risk of cognitive impairment. It was found that four metals (Pb, Fe, Cu, and Mg) were positively correlated with cognitive impairment in each single metal model. The association of Pb and Cu remained significant after adjusting for these six metals, with the odds ratios (95% confidence intervals) in the highest quartiles of 9.51 (4.41-20.54, p-trend <0.01) and 4.87 (2.17-10.95, p-trend <0.01), respectively. The BKMR models indicated that co-exposure levels of Ca, Cu, Fe, Mg, Pb, and Zn were related to increased risk of cognitive impairment at ≥25th percentile compared with median, and Pb and Cu mainly contributed to the joint effect. In addition, the interaction effects of Mg and Pb/Pb and Cu on the risk of cognitive impairment were observed. Co-exposure of six metals (Pb, Fe, Cu, Ca, Mg, and Zn) increased the risk of cognitive impairment in Chinese adults, with Pb and Cu likely to have greater impact. Potential interaction effects of Mg and Pb, Pb and Cu on the risk of cognitive impairment may exist.

External validation of a multimodality deep-learning normal tissue complication probability model for mandibular osteoradionecrosis trained on 3D radiation distribution maps and clinical variables

Background and purposeWhile the inclusion of spatial dose information in deep learning (DL)-based normal-tissue complication probability (NTCP) models has been the focus of recent research studies, external validation is still lacking. This study aimed to externally validate a DL-based NTCP model for mandibular osteoradionecrosis (ORN) trained on 3D radiation dose distribution maps and clinical variables. Methods and materialsA 3D DenseNet-40 convolutional neural network (3D-mDN40) was trained on clinical and radiation dose distribution maps on a retrospective class-balanced matched cohort of 184 subjects. A second model (3D-DN40) was trained on dose maps only and both DL models were compared to a logistic regression (LR) model trained on DVH metrics and clinical variables. All models were externally validated by means of their discriminative ability and calibration on an independent dataset of 82 subjects. ResultsNo significant difference in performance was observed between models. In internal validation, these exhibited similar Brier scores around 0.2, Log Loss values of 0.6–0.7 and ROC AUC values around 0.7 (internal) and 0.6 (external). Differences in clinical variable distributions and their effect sizes were observed between internal and external cohorts, such as smoking status (0.6 vs. 0.1) and chemotherapy (0.1 vs. −0.5), respectively. ConclusionTo our knowledge, this is the first study to externally validate a multimodality DL-based ORN NTCP model. Utilising mandible dose distribution maps, these models show promise for enhancing spatial risk assessment and guiding dental and oncological decision-making, though further research is essential to address overfitting and domain shift for reliable clinical use.

Effectiveness of synchronous teledentistry consultations in facilitating treatment compliance of rural pediatric patients

BackgroundLimited access to pediatric oral health care in rural US areas is a substantial dental public health problem. In 2010, the Eastman Institute for Oral Health at the University of Rochester, initiated a synchronous teledentistry program to enhance oral health screenings, treatment planning, and treatment completion for rural pediatric patients who reside in the Western region of New York. MethodsData from dental records of all pediatric patients who were participants in the teledentistry program from its inception on April 13, 2010 through December 31, 2022, were reviewed. Multiple logistic regression models were used to study the association between treatment compliance rate and age, sex, treatment modality, and impact of the COVID-19 pandemic. ResultsData from the dental records of 1,168 children were reviewed. Nine hundred fifty-four children (81.6%) completed the recommended treatment within 6 months of synchronous teledentistry consultation. Treatment completion rates varied significantly according to treatment modality. In-office consultation had the highest rate (96.8%), followed by oral sedation (89.7%) and operating room treatment (89.5%). Nitrous oxide (66.7%) had the lowest rate (P < .0001). Children recommended for nitrous oxide anxiolysis had the lowest odds of completing treatment (odds ratio, 0.25; 95% CI, 0.18 to 0.36; P < .0001) compared with other treatment modalities. Being older decreased the likelihood of completing treatment (odds ratio, 0.92; 95% CI, 0.85 to 0.99; P = .02). The COVID-19 pandemic did not significantly affect compliance rates. ConclusionsSynchronous teledentistry consultations with rural pediatric patients and their guardians or caregivers can effectively facilitate treatment completion for children with complex treatment needs in underserved areas. Practical ImplicationsSynchronous teledentistry is a practical adjunct tool to be considered in dental offices.

Primary care seeking among adults with chronic neck and low back pain in Norway: A prospective study from the HUNT study linked to Norwegian primary healthcare registry.

To describe the frequency of primary care seeking for neck or back-related conditions among people with chronic neck and low back pain and to develop prediction models of primary care seeking and frequent visits. We included participants of the Trøndelag Health Study (HUNT4, 2017-19) in Norway who self-reported chronic neck and/or low back pain in the preceding year, and extracted data of primary care visits from the Norwegian primary healthcare registry. We investigated a total of 23 potential predictors and used multivariable logistic regression models to predict primary care seeking for neck or back-related conditions and frequent visits by healthcare provider (i.e., the highest quartile of number of visits). Among the 15,352 HUNT4 participants with chronic neck and/or low back pain, 6231 participants (40.6%) sought primary care for neck or back-related conditions (median = 5 visits, IQR 2-15) within 2 years after the study. Participants who consulted physical therapists sought care the most frequently (median = 10 visits, IQR 3-26). Discrimination of the best-fit prediction model of primary care seeking and frequent visits by healthcare provider, assessed by C-statistic, ranged from 0.66-0.76. Participants who made frequent primary care visits in the preceding year were highly likely to continue frequent care seeking in the following 2 years. Around 40% of people seek primary care for chronic neck and low back pain, and frequent care seeking may continue for years. Future studies should investigate strategies to reduce recurrent primary care visits, especially seeking physical therapist care, and promote self-management of chronic pain. People with chronic neck and low back pain who seek physical therapist care had the highest frequency of care seeking, underscoring the significant burden on healthcare systems. The high frequency of visits and associated healthcare expenditures highlight the critical need for effective and valuable primary care for chronic pain management. To mitigate recurrent visits and reduce costs, it is essential to provide patients with evidence-based treatments and self-management interventions.