Moderate Scores Research Articles

Associations of Neighborhood Food and Physical Activity Environments in Young Adulthood With Cardiovascular Health in Midlife: The CARDIA Study.

Adults who maintain ideal cardiovascular health (CVH) profiles up to midlife have lower risk of several chronic diseases and better quality of life. Some evidence suggests that individual-level exposures earlier in life shape midlife CVH, but the impact of neighborhood-level exposures over the life course remains understudied. Participants were 3017 Black and White men and women aged 18 to 30 years at baseline (1985-1986), recruited from Birmingham, Alabama; Minneapolis, Minnesota; Chicago, Illinois; and Oakland, California, as part of the CARDIA (Coronary Artery Risk Development in Young Adults) study. Measures of the neighborhood food and physical activity environment were linked to participant addresses collected at baseline. CVH was measured on the basis of the American Heart Association's Life's Simple 7 criteria in young adulthood and 30 years later (2015-2016) when participants were midlife (aged 48-60 years). Associations of young adult neighborhood food environment and physical activity resources with midlife CVH (moderate versus high and low versus high) were examined using multinomial logistic regression. Models were adjusted for young adult sociodemographic factors. Participants who lived farther away from a major park in young adulthood were more likely to have low versus high CVH scores (odds ratio, 1.54 [95% CI, 1.22-1.96]) and more likely to have moderate versus high CVH scores (odds ratio, 1.39 [95% CI, 1.12-1.73]) in midlife. No other neighborhood measures were significantly associated with CVH. Young adulthood may be a sensitive period in which having convenient access to physical activity-promoting resources may help them establish healthy habits that can carry into midlife.

Knowledge, attitude, and practice regarding dengue vaccine: a baseline study of community members and health providers in Indonesia.

Despite recent behavioral interventions aimed at reducing the burden of dengue, persistent unfavorable related behaviors in the Indonesian community suggest that vaccination could be effective. However, before this is implemented nationally, public perception and acceptance of the vaccine should be assessed in addition to health providers' points of view. This study aimed to assess the knowledge, attitudes, and practices (KAP) of community members and health providers in Indonesia. A cross-sectional survey was conducted in six districts of three Indonesian provinces. Respondents included both community members and health providers living within the territory of the selected primary health care centers. Pretested questionnaires were used to gather information on the sociodemographic characteristics and KAPs regarding dengue vaccines. An independent t-test was performed to compare the mean KAP scores between community members and health providers, while a logistic regression analysis was used to identify the predictors in each domain. Only 18.5% of health providers possessed high knowledge of the dengue vaccine versus only 12.5% of community members. Approximately one-third of the health providers versus one-fourth of community members displayed a high to moderate score for attitudes about dengue vaccines. Dengue vaccination practices demonstrated a more favorable score for both health providers and community members at 59.1% and 41.1%, respectively. No individual sociodemographic characteristics were associated with KAPs; rather, only education was correlated with better dengue vaccination practices. We also found that good knowledge of dengue was the only factor associated with all domains. Our findings highlight the urgent need to deliver educational interventions to health providers and community members in Indonesia to improve their awareness of dengue vaccines.

Mối tương quan giữa một số chỉ số trên cộng hưởng từ bó tháp trong tiên lượng khả năng phục hồi chức năng vận động ở bệnh nhân nhồi máu não vùng trên lều

Object: Correlation between some indices on pyramidal tract magnetic resonance in predicting motor function recovery in patients with supratentorial cerebral infarction. Method: Cross-sectional description with longitudinal follow-up includes 31 patients with supratentorial cerebral infarction within seven days and had an MRI at Bach Mai Hospital from January 2023 to December 2023. Result: The proportion of male patients with ischemic stroke predominated (61,3%). Hemiplegia was the most common symptom of ischemic stroke which damaged the path of the corticospinal tract. At three months after the stroke, no patient had severe NIHSS score ; the percentage of patients with mild and moderate NIHSS score was 61,3% and 38,7%, respectively. According to mRS, 25 patients (80,6%) recovered well after three months. The patient group, who had the axons did not go through the infarct lesion, had higher at rate of better motor function recovery after three months than the other groups who had the axons go through partly or completely inside the infarction lesion (respective rates were 64,5% and 16,1%); p<0,05. FA index of the axons in the infarct side of the poor recovery group was smaller than the good recovery group, p<0.05. Conclusion: The axonal signal, location versus the infarct lesion, and FA index of the axons in the infarct side are the factors that significantly predictive of motor recovery after three months in ischemic stroke patients.

Knowledge, attitudes, and self-reported practices regarding plagiarism among health researchers in Egypt and Lebanon: a multicenter questionnaire study

To enhance efforts against plagiarism, a deeper understanding of its various aspects is essential. This cross-sectional questionnaire study assessed the knowledge, attitudes, subjective norms, and self-reported plagiarism practices among health researchers in Egypt and Lebanon. A validated questionnaire was distributed to postgraduate students and faculty members across 15 universities through personal emails and health researcher-specific social media platforms. Out of 283 respondents, the mean knowledge score was 14.8 ± 3.7 out of a possible 27.0, indicating moderate knowledge of plagiarism. Attitudes toward plagiarism were moderately permissive, with an average score of 62.2 ± 10.9, out of a maximum of 90.0. Subjective norms received a moderate score of 33.6 ± 6.7, where a favorable score should be low (10–23) suggesting that participants perceive society as disapproving of plagiarism and believe its prevalence is low. The mean self-reported Plagiarism Severity Score (PSS) was 4.1 ± 3.6, reflecting a low level of self-reported plagiarism, with a maximum possible score of 18. Multivariable analysis revealed a negative correlation between subjective norms and the PSS (β = −0.194, CI [−0.196: −0.010]). This finding is counterintuitive, as one would typically expect that a lower subjective norms score (indicating stronger disapproval of plagiarism), would correlate with fewer acts of plagiarism. One possible explanation for this result is the presence of negative perceptions of organizational justice—such as feelings of being unfairly treated—which might lead to higher rates of self-reported research misconduct. We recommend that universities in the Arab Middle East region develop research ethics training programs that include responsible conduct in research. However, it is essential for academic leaders to assess and address the research integrity climate within their institutions, as organizational injustice could undermine the effectiveness of these educational efforts.

The association between Planetary Health Diet Index and the risk of colorectal cancer: a case-control study

Background Despite the beneficial effects of a plant-based diet on colorectal cancer (CRC), no study has yet investigated the relationship between a Planetary Health Diet Index (PHDI) and CRC in the Iranian population. Therefore, the present case-control study aimed to assess the relationship between this index and CRC. Methods The current research was conducted on 71 patients with CRC (case group) and 142 (control group) admitted to hospitals in Tehran, Iran. The PHDI (0-150 points) was calculated based on a semi-quantitative food frequency questionnaire. Conditional logistic regression was applied to evaluate the association between CRC and PHDI and its sub-scores. Results After adjusting for the role of potential confounders, lower odds of CRC were observed in the second tertile of the total ratio score (odds ratio (OR) = 0.334; 95% confidence interval (CI): 0.127–0.878, P = 0.026) and the last tertile of PHDI (OR = 0.407; 95% CI: 0.183–0.907, P = 0.028), total adequacy score (OR = 0.261; 95% CI: 0.110–0.622, P = 0.002), and total moderation score (OR = 0.380; 95% CI: 0.162–0.891, P = 0.026) in comparison to the first tertile of each index. Conclusions The current study’s findings indicated a reverse relationship between PHDI, total adequacy, moderation, and ratio scores with the CRC odds. However, it is suggested that more research be performed in this field in the future to confirm the results of this study.

Hospital pharmacists’ education, career paths, and continuous education: A cross-sectional survey in Batna, Algeria

Background: This cross-sectional survey aimed to evaluate the perspectives of 61 hospital pharmacists in Batna, Algeria, regarding education, career choices, and continuous education (CE). Methods: Convenience sampling was employed to select pharmacists working in public health hospitals within the Wilaya of Batna. Data were collected using a structured questionnaire administered through Google Forms between December 20, 2023, and March 20, 2024. The questionnaire covered demographics, reasons for choosing the pharmacy profession, perceived relevance of university studies to current job, satisfaction with career trajectory, and engagement in CE. Results: The study found that 73.8% of respondents were female, with a mean age of 37.74 years and an average of 10.34±3.38 years of work experience. The most influential factor in choosing pharmacy was valuing a respectable job (3.69±1.51). Regarding education relevance, respondents rated their university studies to their current job with a moderate mean score of 2.97±1.16, with the fifth and fourth years emerging as the most relevant years of study to their current job (3.25±1.36 and 3.11±1.31, respectively). Factors influencing job selection included work environment, location of work, and level of responsibility. Over 50% had either not engaged in any CE or had done so more than a year ago, while barriers preventing engagement in CE included the lack of national protocols and personal time. Conclusion: It is urgent to improve the alignment between pharmacy education and job roles and implement CE activities through a national protocol. Additionally, targeted strategies are warranted to enhance job satisfaction and retention among hospital pharmacists in Algeria.

Large-scale multi-center CT and MRI segmentation of pancreas with deep learning

Automated volumetric segmentation of the pancreas on cross-sectional imaging is needed for diagnosis and follow-up of pancreatic diseases. While CT-based pancreatic segmentation is more established, MRI-based segmentation methods are understudied, largely due to a lack of publicly available datasets, benchmarking research efforts, and domain-specific deep learning methods. In this retrospective study, we collected a large dataset (767 scans from 499 participants) of T1-weighted (T1 W) and T2-weighted (T2 W) abdominal MRI series from five centers between March 2004 and November 2022. We also collected CT scans of 1,350 patients from publicly available sources for benchmarking purposes. We introduced a new pancreas segmentation method, called PanSegNet, combining the strengths of nnUNet and a Transformer network with a new linear attention module enabling volumetric computation. We tested PanSegNet’s accuracy in cross-modality (a total of 2,117 scans) and cross-center settings with Dice and Hausdorff distance (HD95) evaluation metrics. We used Cohen’s kappa statistics for intra and inter-rater agreement evaluation and paired t-tests for volume and Dice comparisons, respectively. For segmentation accuracy, we achieved Dice coefficients of 88.3% (±7.2%, at case level) with CT, 85.0% (±7.9%) with T1 W MRI, and 86.3% (±6.4%) with T2 W MRI. There was a high correlation for pancreas volume prediction with R2 of 0.91, 0.84, and 0.85 for CT, T1 W, and T2 W, respectively. We found moderate inter-observer (0.624 and 0.638 for T1 W and T2 W MRI, respectively) and high intra-observer agreement scores. All MRI data is made available at https://osf.io/kysnj/. Our source code is available at https://github.com/NUBagciLab/PaNSegNet.

Impact of Data Pre-Processing Techniques on XGBoost Model Performance for Predicting All-Cause Readmission and Mortality Among Patients with Heart Failure

Background: Heart failure poses a significant global health challenge, with high rates of readmission and mortality. Accurate models to predict these outcomes are essential for effective patient management. This study investigates the impact of data pre-processing techniques on XGBoost model performance in predicting all-cause readmission and mortality among heart failure patients. Methods: A dataset of 168 features from 2008 heart failure patients was used. Pre-processing included handling missing values, categorical encoding, and standardization. Four imputation techniques were compared: Mean, Multivariate Imputation by Chained Equations (MICEs), k-nearest Neighbors (kNNs), and Random Forest (RF). XGBoost models were evaluated using accuracy, recall, F1-score, and Area Under the Curve (AUC). Robustness was assessed through 10-fold cross-validation. Results: The XGBoost model with kNN imputation, one-hot encoding, and standardization outperformed others, with an accuracy of 0.614, recall of 0.551, and F1-score of 0.476. The MICE-based model achieved the highest AUC (0.647) and mean AUC (0.65 ± 0.04) in cross-validation. All pre-processed models outperformed the default XGBoost model (AUC: 0.60). Conclusions: Data pre-processing, especially MICE with one-hot encoding and standardization, improves XGBoost performance in heart failure prediction. However, moderate AUC scores suggest further steps are needed to enhance predictive accuracy.

Exploring the knowledge and attitudes towards metabolic dysfunction associated fatty liver disease (MAFLD): Validation and correlations of MAFLD-knowledge questionnaire and MAFLD-attitude questionnaire

BackgroundMetabolic dysfunction associated fatty liver disease (MAFLD) is a highly prevalent non-communicable disease whose prevalence is reaching pandemic proportions. Its implications constitute a major public health concern. To date, no validated tool measures knowledge and attitudes towards MAFLD in young adults in the Middle East and North Africa region. ObjectiveTo establish and validate questionnaires that measure knowledge and attitudes towards MAFLD. MethodsMAFLD-Knowledge Questionnaire (KQ) and MAFLD-Attitudes Questionnaire (AQ) were developed by disease content experts and piloted on a group of 20 students. The questionnaire was next administered to 406 university students aged 18–24 years. The dimensionality of the instrument was tested using exploratory factor analysis and consistency with Cronbach's alpha. Finally, known-group validity was assessed by comparing the knowledge and attitudes of those with poor versus good knowledge. ResultsFor the knowledge questionnaire, 28 out of 32 questions had good loading and were thus included. Based on Exploratory Factor Analysis (EFA), there were 4 domains with Kaiser–Meyer–Olkin (KMO) 0.95 and Bartlett test with P < 0.001, with very good internal consistency (Cronbach's alpha 0.88). For the attitudes questionnaire, 17 items were extracted all with adequate loading. EFA revealed 3 domains with KMO of 0.95 and very good internal consistency (Cronbach's alpha 0.81). Known group validity showed a significant difference between the attitudes of subjects with poor and moderate knowledge and poor and high knowledge scores but not between moderate and high knowledge scores. ConclusionWe developed and validated two questionnaires, one for the assessment of knowledge and the other for attitudes towards MAFLD in young adults. Further studies are needed to confirm dimensionality and reproducibility in different populations and age groups.

Parents' and guardians' experiences of barriers and facilitators in accessing autism spectrum disorder diagnostic services for their children: a qualitative systematic review.

The objectives of this review were to comprehensively identify the best available qualitative evidence about parents' and guardians' experiences of barriers and facilitators in accessing autism spectrum disorder (ASD) diagnostic services for their children; and to develop recommendations based on the review for addressing barriers to timely diagnosis and early intervention. Early identification of ASD is a priority because the best chance for improving symptoms occurs through early and intensive intervention. A definitive ASD diagnosis is often a prerequisite for children to access publicly funded services, yet obtaining a diagnosis in itself can be stressful, frustrating, and time-consuming for many families. It is essential to understand the barriers and facilitators parents and guardians face in accessing ASD diagnostic services for their children. This qualitative systematic review considered studies conducted worldwide that included parents and guardians of children up to 18 years of age who had accessed or who were attempting to access ASD diagnostic services for their children. This review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. A literature search included CINAHL (EBSCOhost), CINAHL Plus (EBSCOhost), MEDLINE (EBSCOhost), APA PsycINFO (EBSCOhost), Social Services Abstracts (ProQuest), ERIC (EBSCOhost), and Embase. Gray literature sources included ProQuest Dissertations and Theses, Google Scholar, Google, OpenGrey, other online resources (government and organizational websites), and reference lists of retrieved records. No language, date, or country limits were applied to the searches. Retrieved records from the academic databases, gray literature, and reference lists of retrieved records were screened, with potentially relevant records examined in full against the inclusion criteria. Eligible studies were critically appraised for methodological quality and those included in this review were subjected to data extraction of descriptive details and study findings relevant to the review question. Study findings were synthesized and assigned confidence scores. All reviewers agreed upon the categories and finalized synthesized findings. The 36 included studies varied in qualitative research designs with high methodological quality. There were approximately 661 eligible participants, and 55 credible and unequivocal research findings. The research findings yielded 6 categories and 3 synthesized findings with moderate confidence scores. Parents' and guardians' ability to access ASD diagnostic services for their children is affected by i) encountering health care providers who actively listened to and addressed parents' and guardians' concerns instead of dismissing them, providing a sense of support and validation; ii) facing extended waiting times and associated financial burdens resulting in frustration and associated financial impact when delays occurred; and iii) encountering health care providers lacking specialized knowledge about ASD contributing to parents' and guardians' confusion due to inaccurate or conflicting diagnoses related to ASD comorbidities. Many parents described their journey in accessing ASD assessment and diagnostic services for their children as cumbersome. Parents' and guardians' experiences were affected by the level of perceived support by and knowledge of health care providers; confusion surrounding inaccurate/mixed diagnoses related to ASD; lengthy delays; and systemic and contextual barriers in navigating the pathway to ASD assessment and diagnosis that included socioeconomic and cultural disparities. PROSPERO CRD42018100127.

The Association between the Social Vulnerability Index and Adverse Neonatal Outcomes.

Identifying underlying social risk factors for neonatal intensive care unit (NICU) admission is important for designing interventions to reduce adverse outcomes. We aimed to determine whether a patient's exposure to community-level stressors as measured by the social vulnerability index (SVI) is associated with NICU admission. Retrospective cohort study (2014-2018) of patients delivering a liveborn ≥ 22 weeks' gestation at a quaternary care center. Patient addresses were used to assign each individual a composite SVI and theme score. The primary exposure was a composite SVI score categorized into tertiles. The primary outcome was NICU admission. Secondary outcomes included NICU length of stay and neonatal morbidity composite. Multivariable logistic regression was performed to estimate the association between composite SVI and outcomes (low SVI as referent). We secondarily compared mean composite and theme SVI scores; individual components of each theme were also compared. From 2014 to 2018, 13,757 patients were included; 2,837 (21%) had a neonate with NICU admission. Patients with higher SVI were more likely to self-identify as Black race and have medical comorbidities. Living in areas with moderate or high SVI was not associated with NICU admission (moderate SVI adjusted odds ratio [aOR]: 1.13, 95% confidence interval [CI]: 0.96-1.34; high SVI aOR: 1.12, 95% CI: 0.95-1.33). Moderate SVI was associated with increased neonatal morbidity (aOR: 1.18, 95% CI: 1.001-1.38). In an analysis of SVI as a continuous variable, mean SVI scores were significantly higher in individuals who had an infant admitted to the NICU. Those requiring NICU admission lived in areas with lower per capita income and a higher number of mobile homes (p < 0.001). Patients living in areas with moderate or high SVI were not shown to have higher odds of having a neonate admitted to the NICU. Neonatal morbidity was higher in those living in areas with moderate SVI. Increased access to social services may improve neonatal outcomes. · Mean SVI scores are higher in those with a neonate admitted to the NICU.. · There was no observed association between moderate and high SVI scores and NICU admission.. · Moderate SVI is associated with an increased odds of overall neonatal morbidity.. · Greater exposure to low income may be associated with NICU admission..

Sex sifferences in lifes essential eight and its association with mortality among adults without known CVD

Abstract Background The American Heart Association’s Life’s Essential 8 (LE8) score is a helpful tool to quantify cardiovascular health (CVH) metrics. Sex differences in relation to LE8 and its association with mortality are not known. Methods The National Health and Nutrition Examination Survey (NHANES) between 2009 and 2018 was utilized to evaluate the prevalence of health metrics included in LE8 among adult patients, stratified by sex. Health metrics were further subdivided into health behaviors (diet, physical activity, nicotine exposure, and sleep) and health factors (body mass index, non–high density lipoprotein cholesterol, blood glucose, and blood pressure). LE8 scores were also evaluated based on age, race/ethnicity, and socioeconomic status. Cox proportional hazard models were used to evaluate the association between the levels of CVH and risk of all-cause and cardiovascular mortality. Results Among 22,761 participants, 52% were female. Overall CVH score was similar in both females and males (65.8 vs. 65.9). Females had higher health factors score (64.3 vs. 63.1, p &amp;lt;0.001) and lower health behaviors score (67.2 vs 68.6, p &amp;lt;0.001). Amongst individual metrics, blood pressure score was higher in females (73.2 vs. 67.7, p &amp;lt;0.001) while males had higher physical activity score (70.6 vs. 54.9, p &amp;lt;0.001). For individuals under 65 years of age, overall CVH and health factors scores were higher in females while in those age 65 or older, males had higher scores. The most prominent sex differences were noted in non-Hispanic Black females who had significantly lower CVH scores than Black males. High or moderate LE8 scores vs. low LE8 scores demonstrated lower all-cause and CV mortality in both sexes (p-interaction 0.98 and 0.9). High or moderate health behaviors scores also demonstrated a significant association with lower all-cause and CV mortality, with the reduction in mortality being more prominent in females (p-interaction 0.01 and 0.03). Conclusions We demonstrate important sex differences in CVH metrics along with notable variations based on age and race/ethnicity. Furthermore, we highlight sex differences in the association of CVH metrics with mortality. These findings underscore the importance of designing and implementing effective strategies for both sexes, aimed at targeting these specific factors.

Clinical validated risk prediction model for development of heart failure after contemporary breast cancer treatment

Abstract Background Patients receiving breast cancer (BC) treatment are at risk for heart failure and cardiomyopathy (HF/CM). European Society of Cardiology (ESC) cardio-oncology guidelines recommend baseline cardiovascular (CV) assessment, however, there is limited data about cardiotoxicity risk specific to patients with BC. Our aim was to develop and validate model for prediction of HF/CM in women receiving contemporary treatment for invasive early-stage BC. Methods We assembled a cohort women diagnosed with Stage I-III BC from 2008-2020 and followed through 2021 in a large health care plan. Women age &amp;gt;80, with history of HF/CM, and women who received both anthracyclines and trastuzumab were excluded, leaving N=26,044 for analysis. Study cohort was randomly split into derivation (60%) and validation (40%) datasets. Elastic-net penalized Cox proportional hazard model was created using the derivation dataset to select risk factors and to calculate the panelized coefficient which defined the HF/CM risk score. Risk score system was assessed by Hosmer-Lemeshow goodness-of-fit test and area under the ROC curve (AUC). Event rates of &amp;lt;5% constituted low risk; 5-14% moderate; and &amp;gt;15% high risk category. Incident HF/CM events were examined using Kaplan-Meier approach in derivation and validation datasets. Results HF/CM risk score had high discrimination ability and sufficiently good model of fit regarding HF/CM events (P value=0.163 and 0.667 from Hosmer–Lemeshow test;AUC 0.751 and 0.764, in derivation and validation sets, respectively). There were 10% of women in the high risk; 30% in moderate; and 60% in low-risk group. Variables associated with the higher HF/CM risk score included age, receipt of anthracycline-based chemotherapy or anti-HER2 therapy, presence of hypertension, diabetes, or history of other CV conditions at baseline. The score pattern showed major effect of age, with anthracycline and anti-HER2 therapy increasing the risk across all age groups (Figure 1). Kaplan-Meier analysis of incident HF/CM over 14 years after BC diagnosis showed significantly lower number of HF/CM events in low risk compared to moderate and high-risk score groups (p&amp;lt;0.0001, Figure 2). Conclusion Our robust risk prediction model for HF/CM among women with early-stage BC provides a new tool to identify women at higher CV risk and inform cardiac function monitoring during and after BC treatment. Our findings may guide further validation studies and build evidence for the cardiotoxicity risk stratification in patients with BC.Risk Score for HF/CM by Age/ChemoTxK-M curves of freedom from HF/CM

Differential prognostic significance of platelet reactivity based on ischemic risk after percutaneous coronary intervention

Abstract Background High platelet reactivity (HPR) in patients underwent percutaneous coronary intervention (PCI) is a potential risk factor of adverse cardiovascular events. It is not well understood in which patients HPR is particularly clinically important. Purpose We aimed to elucidate the prognostic value of high platelet reactivity (HPR), across varying levels of ischemic risk categorized by the CHADS-P2A2RC score in a large registry. Methods We retrospectively analyzed 11,714 patients who underwent PCI in the PTRG-DES registry. Ischemic risk was stratified using the CHADS-P2A2RC score into low (score ≤ 1), moderate (score 2–3), and high (score ≥ 4) groups. HPR was defined as a P2Y12 Reaction Unit (PRU) value ≥252. The incidence of major adverse cardiac and cerebrovascular events (MACCE) during 5- year follow-up was the primary outcome. Results During the median follow-up of 37.6 months (IQR, 12.0–60.8), a total of 709 MACCEs (6.1%) (392 deaths [3.3%], 172 non-fatal MI [1.5%], 62 ST [0.5%] and 181 non-fatal stroke [1.5%]), and 324 cases of major bleeding (2.8%) occurred. The high-risk group has the highest incidence of MACCE during 5-year follow-up unadjusted HR of 4.206, 95% CI 3.204–5.521. Among the 2,577 low-risk patients, HPR did not significantly affect MACCE incidence (HR 1.366, 95% CI 0.798–2.336, p=0.253). In the moderate-risk cohort of 5,417 patients, HPR conferred a modest increase in MACCE risk (HR 1.289, 95% CI 1.008–1.649, p=0.043). Notably, the high-risk group demonstrated a significant association between HPR and MACCE (HR 1.385, 95% CI 1.135–1.692, p&amp;lt;0.001). Conclusion HPR is a potent risk factor of long-term outcomes following PCI, especially in patients with a high ischemic risk based on CHADS-P2A2RC scoring. The results highlight the varying impact of platelet reactivity depending on the level of ischemic risk, indicating the importance of tailored antiplatelet therapy in high-risk group to improve clinical outcomes.

Association between CHA2DS2-VASc score and left atrial function by speckle tracking echocardiography in patients with sinus rhythm

Abstract Background The CHA2DS2-VASc score is a scoring system that was first used for the risk assessment of cerebrovascular or thromboembolic events in patients with atrial fibrillation (AF). The factors that constitute the CHA2DS2-VASc scoring system can all individually have an impact on LA function. The application of this scoring system can also be applied to patients without AF. The LA structural remodeling and/or functional impairment play a part in the pathogenesis and development of AF and independent of rhythm, may result in atrial hemostasis and confer a prothrombotic diathesis, resulting in thromboembolic stroke. Speckle- tracking echocardiography (STE) makes it possible to measure LA function with relatively high accuracy and at the very early stage even in the absence of LA enlargement. Purpose The aim of our study was to assess the left atrial function in patients with sinus rhythm with different CHA2DS2-VASc scores (low, moderate and high) by speckle tracking echocardiography and to identify the association between them. Methods This study was conducted using prospectively collected data (1st May, 2022 to 30th October 2022) from patients with sinus rhythm and different CHA2DS2-VASc scores (50 Low risk score patients (1 for females and 0 for males), 50 moderate risk score patients (2 for females and 1 for males) and 50 high risk score patients (≥3 for females and ≥2 for males) After obtaining an informed consent, all volunteers underwent thorough history taking, 12 lead ECG and conventional transthoracic echocardiography and speckle-tracking echocardiography. Results LA strain during the reservoir (LASr) and conduit phases (LAScd) were statistically significantly lower in the high-risk score group (33.2 ± 7.1 and 20.3 ± 5.7) than the moderate-risk score group (36.9 ± 6.1 and 23.5 ± 4.8, p = 0.005 and 0.003 respectively) and low -risk score group (40.6 ± 5.6 and 26.9 ± 3.9, p &amp;lt; 0.001). In addition, LASr and LAScd were statistically significantly lower in moderate- risk score group (36.9 ± 6.1 and 23.5 ± 4.8) than the low -risk score group (40.6 ± 5.6 and 26.9 ± 3.9 ,p=0.007 and 0.001 respectively). Conclusion Higher CHA2DS2-VASc scores were associated with decreased LA strain during the reservoir and conduit phases as markers of LA function with relatively high accuracy and at the very early stage even in the absence of LA enlargement.

A risk score for ventricular arrhythmia in mitral valve prolapse

Abstract Background Prior studies have identified that complex and frequent ventricular ectopy (cfVE) predicts sudden death in patients with mitral valve prolapse (MVP). Purpose To develop a risk stratification score which predicts rates of cfVE in patients with MVP based on clinical, ECG and echocardiographic features. Methods Data was collected on 637 patients aged 18–90 years with MVP at our institution between 2016-2019. Complex and frequent ventricular ectopy was defined as the presence of &amp;gt; 1% premature ventricular contraction (PVC) burden or non-sustained ventricular tachycardia on Holter monitoring or &amp;gt; 1 PVC on 12-lead ECG. Univariate analysis was performed to identify independent predictors of cfVE. Factors found to be statistically significant on univariate analysis were then evaluated using multivariate logistic regression. Variables analyzed included age greater than 65, moderate or greater mitral regurgitation, female gender, African American race, atrial fibrillation, coronary artery disease, congestive heart failure, inferior or lateral T wave inversion, bileaflet (vs. unileaflet) prolapse, myxomatous mitral valve morphology, mitral annular dysjunction, left ventricular ejection fraction less than 40%, left ventricular hypertrophy, diabetes, and hypertension. Risk points were attributed to multivariate predictors of cfVE using their odds ratios. Predicted probability of cfVE, derived by logistic regression, was used to categorize scores into low, moderate, and high risk. Rates of cfVE were compared between risk groups using Pearson’s Chi-squared test. All-cause mortality was compared between risk score groups with Kaplan-Meier analysis. Results Complex and frequent ventricular ectopy was present in 182 (28.6%) patients. Multivariate predictors of cfVE were mitral annular disjunction (MAD, OR 3.2, 95% CI 1.9-5.4), bileaflet (vs. unileaflet) prolapse (OR 2.1, 95% CI 1.4-3.3), congestive heart failure (OR 2.2 95% CI 1.3-3.7) and inferior or lateral T wave inversion (TWI, OR 2.1, 95% CI 1.3-3.2). Risk points of 1.5 for MAD and 1 for bileaflet prolapse, CHF and TWI were totaled to group patients into low (score 0, n=274, 43.0%), moderate (score 1-2, n=276 ,43.3%) and high (score 2.5-4.5, n=87,13.7%) risk groups. Rates of cfVE were 11.7% for low, 35.5% for moderate and 59.8% for high-risk groups (p&amp;lt;0.0001). On Kaplan Meier analysis, risk group significantly correlated with mortality (p&amp;lt;0.0008). Conclusion In patients with MVP this risk stratification tool, using the presence of mitral annular disjunction, bileaflet prolapse, history of congestive heart failure and T-wave inversion, represents a viable method of predicting risk of cfVE, which correlates with all-cause mortality.Univariate and multivariate analysisKaplan-Meier Curve

Characteristics of sick-listed employees diagnosed with a mental disorder in Germany

Abstract Purpose Employees with mental disorders (MDs) are more likely to exit the labour market prematurely. In Western European countries, characteristics of employees diagnosed with a MD have not been reported comprehensively, hampering targeting the risk group and developing preventive interventions. The aim was to describe the socio-demographic, health, treatment, organisation, job and labour market characteristics of employees diagnosed with a MD in Germany and their gender differences. Methods This cross-sectional study uses baseline data from sick-listed (≥6 weeks) employees diagnosed with a MD, aged 20-60 years, who were patients in the German mental health care, and recruited in the context of a return to work (RTW) intervention evaluation trial (RTW-PIA study). Descriptive T-tests/Chi-2 tests were applied. Results 484 individuals (58.5% female; 31% highly educated, average age 42.6) were included, of which 88.4% had affective disorders. Most were salaried employees working full-time, employed in large companies and having permanent contracts. 65.5% reported moderate depressions and the average work ability was 3.9 on a 0-10 scale. 74.2% had a positive RTW prognosis; 15.3% scored high levels of RTW self-efficacy. Gradual RTW (GRTW) was perceived the most important requirement for RTW (76.9%). More than 60% had discussed various work-related topics during therapy; further RTW-measures were prepared among 47.7%. Almost 60% received a recommendation for GRTW. Significant gender differences were found among the socio-demographic, health, job and labour market characteristics. Conclusions This study gives insights into a hardly investigated group. Almost two thirds had moderate depressions, 84.7% had low RTW self-efficacy and a very low average work ability. This highlights the vulnerability of persons with MDs in the labour market and suggest an urgent need for more work-related (health-)care. Gender differences need to be better addressed in mental health research. Key messages • Comprehensive knowledge of the characteristics of sick-listed employees diagnosed with MDs is crucial for targeting interventions to promote RTW. • Moderate depression scores, low RTW self-efficacy and very low work ability highlight the vulnerability of persons with MDs in the labour market, suggesting an urgent need for more work-related care.

Association of R2-CHA2DS2-VASc score and clinical outcomes after bioprosthetic valve replacement: Subanalysis from BPV-AF registry

Abstract Background Although bioprosthetic valve (BPV) replacements are becoming more common, there are limited studies about prognostic prediction method for patients after BPV replacement. R2-CHA2DS2-VASc score is modified CHA2DS2-VASc score by adding reduced estimated glomerular filtration rate (eGFR &amp;lt; 60 mL/min/1.73m2). It is increasingly used for the prediction of cardiovascular (CV) events in patients with atrial fibrillation (AF), device implantation, and acute coronary syndrome. Purpose We aimed to evaluate the predictive value of R2-CHA2DS2-VASc score for future CV events in patients after BPV replacement. Methods BPV-AF, an observational, multicenter, prospective registry, enrolled AF patients that underwent BPV replacement. Patients were stratified into three risk groups according to their R2-CHA2DS2-VASc score as follows; low (scores, 0–1), moderate (scores, 2–4), and high (scores, 5–11). The primary outcome measure was a composite of stroke, systemic embolism, CV events including heart failure hospitalization, and cardiac death. Results A total of 766 patients were included in the analysis. The mean age was 80.3 years and 419 patients (54.7%) were female. Mean R2-CHA2DS2-VASc score was 4.1±1.5. Low, moderate, and high R2-CHA2DS2-VASc score groups consisted of 12 (1.6%), 178 (23.2%), and 576 (75.2%) patients, respectively. Median follow up period was 491 (interquartile range: 393-561) days. Kaplan-Meier analysis showed higher incidence of the composite CV events in high R2-CHA2DS2-VASc score group (Log rank test; p&amp;lt;0.01). Multivariate Cox proportional hazards regression analysis revealed that the R2CHA2DS2-VASc score as a continuous variable was an independent predictor of CV events (hazard ratio 1.33, 95% confidence interval 1.18 to 1.51, p&amp;lt;0.01). Conclusion The R2-CHA2DS2-VASc score is useful for CV risk stratification in AF patients after BPV replacement.Cumulative Incidence for Composite CV Ev

Exploring the lived experiences of adults using home enteral nutrition and their caregivers: A meta-aggregation qualitative systematic review.

Home enteral nutrition (HEN) provides nutrition through a tube to individuals at home who cannot meet their needs by mouth. Systematic reviews have explored the experiences of HEN subpopulations, such as those with head and neck cancers. Given HEN services care for adults with various underlying conditions, a synthesis of the experiences of all adults using HEN and their caregivers is warranted. The purpose of this study is to summarize the experiences of HEN adult users and their caregivers regardless of underlying condition. Medline, PsychINFO, EmBase and CINAHL were systematically searched in January 2024. Studies with qualitative results and adult participants and focused on HEN were included. Studies with participants in nursing facilities, results using word counts, or not in English were excluded. Study quality was assessed using the Johanna Briggs Institute (JBI) qualitative checklist. Study design and participants' details were extracted. Themes were collated using the JBI meta-aggregative method. Forty studies (n = 732) were included. Three synthesized findings were identified: positive experiences (very low ConQual score), negative experiences (low ConQual score), and facilitators and coping mechanisms (moderate ConQual score). Although more negative than positive experiences were reported, users and caregivers who developed coping mechanisms or accessed supports viewed HEN as a worthwhile experience. Those with few supports or coping mechanisms did not. Based on this review, it is proposed that before starting HEN, users and caregivers should be made aware of the available supports and coping mechanisms. As negative experiences arise, healthcare providers should help users and caregivers access supports to improve their experiences.

How do medical students perceive the role of artificial intelligence in management of gastroesophageal reflux disease?

Background Artificial intelligence (AI) has significantly revolutionized the diagnosis and treatment of various medical and surgical conditions, including gastroesophageal reflux disease (GORD). AI has the potential to enhance diagnostic and treatment capabilities, contributing to overall advancements in healthcare. The current study aimed to investigate the medical students’ views regarding the use of AI in GORD management. Methods An anonymous, self-administered questionnaire was distributed among undergraduate medical students of various grades within different national medical institutions. The questionnaire comprised three sections, addressing sociodemographic data, knowledge, and attitudes. Knowledge and attitudes were assessed through 5- and 7-item questionnaires, respectively. The knowledge scores constituted a scale of 0–5. This reflected varying levels of understanding. Categories include poor knowledge (two or less), moderate knowledge (three), and good knowledge (4 and 5). Attitudes were classified as negative, neutral, or positive based on 50% and 75% cutoff points, with scores below 50% indicating negative attitudes, 50–75% considered neutral, and scores above 75% reflecting positive attitudes. Results A total of 506 medical students participated, including 273 females and 233 males, with a ratio of 1.2–1. The majority fell within the age range of 20–26 years. Additionally, 388 participants (76.7%) reported grade point averages (GPAs) higher than 4. Regarding knowledge, 9% demonstrated a poor score of knowledge, while 33% had a moderate knowledge score. However, 65% of the participating students held a neutral attitude toward the role of AI in GORD management, with 6.9% expressing a negative stance on the matter. Conclusion Although AI is highly involved in GORD management, the study revealed that medical students and interns possess a limited perception of this emerging technology. This may highlight the necessity for active involvement in AI education within the medical curricula.