Moderate Association Research Articles

Social Support and the Association Between Certain Forms of Violence and Harassment and Suicidal Ideation Among Transgender Women - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020.

Violence and harassment toward transgender women are associated with suicidal thoughts and behaviors, and social support might moderate such association. This analysis explored the association between certain forms of violence and harassment and suicidal ideation and moderation by social support. Better understanding of these associations could guide mental health services and structural interventions appropriate to lived experiences of transgender women. This cross-sectional analysis used data from CDC's National HIV Behavioral Surveillance Among Transgender Women. During 2019-2020, transgender women were recruited via respondent-driven sampling from seven urban areas in the United States for an HIV biobehavioral survey. The association between experiencing certain forms of violence and harassment (i.e., gender-based verbal and physical abuse or harassment, physical intimate partner abuse or harassment, and sexual violence) and suicidal ideation was measured using adjusted prevalence ratios and 95% CIs generated from log-linked Poisson regression models controlling for respondent-driven sampling design and confounders. To examine moderation, the extents of social support from family, friends, and significant others were assessed for interaction with certain forms of violence and harassment; if p interaction was <0.05, stratified adjusted prevalence ratios were presented. Among 1,608 transgender women, 59.7% experienced certain forms of violence and harassment and 17.7% reported suicidal ideation during the past 12 months; 75.2% reported high social support from significant others, 69.4% from friends, and 46.8% from family. Experiencing certain forms of violence and harassment and having low-moderate social support from any source was associated with higher prevalence of suicidal ideation. Social support from family moderated the association between experiencing certain forms of violence and harassment and suicidal ideation (p interaction=0.01); however, even in the presence of high family social support, experiencing certain forms of violence and harassment was associated with higher prevalence of suicidal ideation. Social support did not completely moderate the positive association between experiencing violence and harassment and suicidal ideation. Further understanding of the social support dynamics of transgender women might improve the quality and use of social support. Policymakers and health care workers should work closely with transgender women communities to reduce the prevalence of violence, harassment, and suicide by implementing integrated, holistic, and transinclusive approaches.

Potentially pathogenic multidrug-resistant &lt;i&gt;Vibrio&lt;/i&gt; sp. isolated from dumpsites in Rivers State, Nigeria

Vibrio sp. is associated with several disease conditions. An assessment of the pathogenic potential of such strains is key in assessing the risk these organisms could pose to human health. This study therefore was aimed at analyzing the pathogenic potential of MDR Vibrio sp. isolated from select dumpsites in Port Harcourt, Rivers State. Two dumpsites in Port Harcourt, Rivers State were assessed for the presence of Vibrio sp. using standard microbiological techniques involving a pre-enrichment using alkaline peptone water, culture on Thiosulfate-citrate-bile salts-sucrose and biochemical characterisation. Following antimicrobial susceptibility testing using the standard Kirby Bauer disc diffusion method, pathogenic potential was assessed based on haemolytic activity and biofilm forming potential. Results showed that the highest rates of resistance were against cefuroxime (68.8%) while the lowest resistance rates (3.2%) were against the quinolone antibiotics (ofloxacin and ciprofloxacin). In total, 38 antibiograms were observed among the 93 isolates with AUG-CAZ-CRX-CXM noted as the most commonly occurring antibiogram. Only 31.2% (29/93) of isolates were multidrug resistant. A total of 47.3% of the test isolates exhibited pathogenic potential (either haemolytic ability or biofilm forming potential), with more (37.6%) exhibiting biofilm forming potential. A co-occurrence of both pathogenic characteristics was observed in only 6 (13.6%) isolates. Of the 93 isolates, a co-occurrence of MDR and pathogenic potential was observed in 16.1% of isolates (15/93). This study shows a moderate association between potentially pathogenic multidrug resistance Vibrio sp. and the sampled dumpsites indicating a low potential public health risk because of the non-pathogenic nature of strains isolated.

P398 The Burden of Psychiatric Manifestations in Inflammatory Bowel Diseases: A Systematic Review with Meta-analysis

Abstract Background Psychiatric manifestation in individuals with inflammatory bowel disease (IBD) has been the subject of extensive research, but uncertainties remain regarding its precise magnitude, its impact on intestinal disease, and the whole burden of psychiatric manifestations.This systematic review aims to synthesize available evidence on the prevalence and impact of psychiatric disorders in patients with IBD. Methods A systematic search of PubMed/MEDLINE, EMBASE, and SCOPUS databases was performed to identify relevant studies published between January 2010 and January 2023. Cross-sectional, case-control, cohort, registry, and population studies that addressed the prevalence of depression, anxiety, bipolar disorder, and schizophrenia in patients with IBDs and that met the specific inclusion criteria were selected. A meta-analysis to assess the strength of association between IBD and selected psychiatric disorders was also performed. Data extraction and quality assessment were performed. Results The search yielded a total of 3209 articles. 193 met the inclusion criteria, but only 26 studies provided the complete data for the analysis (Table 1). Overall, the prevalence of psychiatric comorbidities was found to be significantly higher in IBD compared with the general population. The analysis revealed a moderate but significant association between IBD and depression, with a pooled odds ratio (OR) of 1.42 (95%CI 1.33-1.52). (Fig.1) Also, anxiety emerged as a prevalent comorbidity in IBD with a pooled OR of 1.3 (95%CI =1.22-1.44). Evidence on the relationship between bipolar disorders and IBD was limited and mixed, with a pooled OR of 1.64 (95%CI=1.20-2.24), despite a substantial heterogeneity (I2=94.01%). Only three studies examined the association between schizophrenia and IBD, providing widely heterogeneous results, with an inconclusive OR (p= 0,73), estimated at 0.93 (95%CI=0.62-1.39). Conclusion This systematic review with meta-analysis highlights that patients with IBD, both CD and UC, frequently experience psychiatric comorbidities such as depression, anxiety, bipolar disorders, and, to a lesser extent, schizophrenia. These disorders are more prevalent in IBD patients than in the general population. Depression and anxiety are particularly prevalent. Bipolar disorder is still an underexplored area in the context of IBD. Data on the relationship between schizophrenia and IBD is sparse and inconclusive and requires further research. Given the high prevalence of psychiatric comorbidities in IBD patients, the results of this systematic review underscore the need for a deeper understanding of these associations and early identification and tailored interventions for mental health in patients with IBD to improve their quality of life.

Influence of Medical Practitioners’ Attitude on the Prescription Behaviour for Generic Medicines

The study is an attempt to find out vital areas related to doctors’ attitude towards generic medicines limiting its mass use. Attitude of medical practitioners, one factor amongst several, was chosen to evaluate doctors’ behaviour towards generic medicines. Most of the countries in the world, rich or poor, are taking more interest in generic medicines due to rising healthcare costs. In India, out of pocket expenses towards healthcare costs are one of the highest in the world besides affordability issue due to its demographics. Generic medicines offer as an alternative to expensive medicines. Government is promoting use of generic medicines; doctors are being advised to write prescription in generic names; however, there are several challenges in its mass use. The study is of national importance as it addresses the issue of low generic prescriptions despite unaffordable access to expensive branded medicines. A questionnaire constructed descriptive, cross-sectional study was conducted in North India in 2020 amongst 228 medical practitioners at primary, secondary and tertiary healthcare centres. Spearman’s rank correlation computed to assess the association between attitude and prescription of generic medicines was found to be positively correlated between the two variables indicating a significant moderate association between them. Attitude of doctors towards generic medicines has been found to be playing a significant role in influencing doctors in prescribing generic medicines which explains limited use of generic drugs.

The cumulative effects of stigma-related stress: Chronic stigma-related stress exposure exacerbates daily associations between enacted stigma and anxious/depressed affect

PurposeSexual and gender minority individuals are at elevated risk for mood and anxiety disorders compared to heterosexual and cisgender individuals. Ecological momentary assessments studies have implicated experiences of enacted stigma (i.e., biased treatment) by linking these experiences with elevations in anxious and depressed affect. The current study utilizes a theory from the broader stress and affect literature to determine whether chronic enacted stigma exposure amplifies individuals’ negative affective reactions to experiences of enacted stigma at the daily level. MethodsWe used data from a 30-day ecological momentary assessment study with 429 sexual minority women and gender diverse sexual minorities assigned female at birth (SMWGD) living in the US in 2020–21 to determine whether concurrent and prospective event-level associations between enacted stigma, anxious/depressed affect, and perceived coping efficacy were moderated by chronic enacted stigma exposure. ResultsResults demonstrate that individuals with moderate to high chronic stigma exposure experience larger increases in anxious/depressed affect and larger decreases in perceived coping efficacy following daily experiences of enacted stigma. Further, these effects of daily stigma on anxious/depressed affect persist for longer among individuals with high chronic stigma exposure. Interestingly, chronic stigma exposure did not moderate associations between daily general stressors (i.e., those unrelated to identity) and affect or perceived coping efficacy, suggesting that these effects are specific to stigma-related stressors. ConclusionsThese results help to advance our understanding of both long-term and daily effects of exposure to enacted stigma, highlighting the potentially profound cumulative effects of stigma exposure and the need to intervene in this cycle.

Demographic predictors of bedtime procrastination in the Japanese population

Bedtime procrastination (BP) is prevalent and problematic, with no previous study conducted in Japan. This study developed the Japanese version of the Bedtime Procrastination Scale (BPS), assessed its validity, and investigated the relationship between BP, demographic features, and sleep outcomes. Participants were divided into two samples (N = 252 and N = 630). Sample 1 involved a longitudinal study to confirm test–retest reliability of the BPS. Sample 2 involved a cross-sectional study to assess confirmatory factor analysis, criterion-related validity, construct validity, and determine the internal consistency of the BPS. The relationship between BP and demographic features (gender, age, and employment status) and sleep outcomes (Athens Insomnia Scale, sleep hours, sleep onset latency, and sleep efficiency) was investigated using Sample 2. The BPS showed good internal consistency (Cronbach’s α coefficients = .90–91), test–retest reliability (ICC = .86), and one factor model was valid; CFI = .95, TLI = .94, RMSEA = .10, and SRMR = .04. The BPS had a moderate positive association with general procrastination, moderate negative associations with self-control, sleep quality, and sleep duration on weekdays, and those who answered “yes” to the item “Do you have trouble with bedtime procrastination?” had higher BPS scores. BPS scores were moderately higher for younger participants (≤ 40 years), slightly higher for females, and non-significantly different between employment statuses. The BPS showed a significant positive correlation with insomnia symptoms, weak positive association with sleep efficiency on weekdays and holidays, and no significant association with sleep onset latencies on holidays and weekdays. This study provides new data on demographic predictors of BP in Japan. No clear effects of gender and employment status were found, but age was a strong predictor of BP, where younger age groups had a higher BP risk.

Compensatory latency time delays during consecutive perturbations in older adults with and without kinesiophobia

BackgroundFear of movement has been related to lower limb activation patterns in older adults. However, insight into consecutive perturbations on stepping strategy while considering fall-related confidence is unknown. Research questionAre there latency time delays following three consecutive slip perturbations between subjects with and without kinesiophobia when considering limb dominance and fall efficacy differences? MethodsThere were 15 older adults with kinesiophobia and 15 age- and body mass index (BMI)-matched control subjects. The subjects stood on the platform during three consecutive perturbations (250, 300, and 400 msec excursions), which were produced by a Bertec device. The subjects completed questionnaires to evaluate the psychological features of their fall-related fear (Tampa Scale for Kinesiophobia: TSK) as well as the modified fall efficacy scale (FES). The latency times (msec) measured the time it took for a subject to respond to a translation. ResultsOverall, the results of the FES demonstrated a moderate negative association with the TSK (r = −0.52, p = 0.004). There was a significant group difference for the FES (t = 2.78, p = 0.01). The FES demonstrated significant positive correlation coefficients (ranging from 0.40 to 0.51) and significant negative correlation coefficients (ranging from −0.41 to −0.61), except for the slow perturbations. The groups demonstrated a significant interaction on consecutive latency times and limb side (F = 5.84, p = 0.02). The latency time during the fast perturbations on the dominant limb (F = 5.53, p = 0.02) was significantly shorter in the kinesiophobia group. SignificanceThe control group demonstrated confidence during fall-related activities, but the latency times were significantly different between groups when considering the dominant limb following repeated slip perturbations. The kinesiophobia group demonstrated shorter latency times on the dominant limb to protect against potential fall-risks from perturbations. The group interactions on limb side and consecutive perturbations need to be considered with fall-related confidence and improved standing balance in older adults with kinesiophobia.

The Gender-Sensitive Depression Screening GSDS-26 - Polish adaptation and validation of the tool and links to gender stereotypes.

The study aimed to create a Polish version of the Gender-Sensitive Depression Screening (GSDS-26) by AM Möller-Leimkühler and to assess its validity and reliability. The tool measures the overall level of depression and the following factors: depressiveness, stress perception, aggressiveness, emotional control, alcohol consumption, and risky behavior. The relationships between depression measured by the GSDS 25 and the subjects' adjustment to stereotypical male roles were also checked. The study included 1,087 participants - 746 men and 341 women from a nonclinical group. In addition to the adapted method, the Beck's Depression Inventory (BDI), Gotland Male Depression Scale (GMDS) by Rutz and Conformity to Masculine Norms Inventory (CMNI-22) by Mahalik were used. The results of the exploratory and confirmatory factor analysis confirmed the adopted six-factor structure. Cronbach's alpha coefficients were satisfactory and comparable to the original version, i.e., the overall score was α = 0.92, the score for five of the six subscales α was between 0.80 and 0.85, and for the alcohol consumption subscale α = 0.63. The GSDS-26 scores, as in the original, showed weak to moderate associations with the subjects' adjustment to stereotypical male roles. The GSDS-26 has satisfactory psychometric properties and is suitable for use in studies of levels of depression specific to men.

Clinical characteristics and assessment of structural and functional myocardium changes in patients with nonspecific connective tissue disorder

Early non-invasive diagnosis of structural changes in the heart plays an important role in optimizing approaches to preventing dangerous rhythm disorders at a young age.Aim: To study the phenotypic features of nonspecifi c connective tissue disorder (NCTD) in relation to the myocardial strain and the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with cardiac arrhythmias and NCTD.Results. There was an association between a local longitudinal left ventricular (LV) strain and pectus excavatum (r1 = 0.234, p = 0.008), joint hypermobility syndrome (r1 = 0.406, p = 0.026), spinal scoliosis (r1 = 0.266, p = 0.003), mitral valve prolapse (MVP) (r1 = 0.519, p = 0.003), diagnostic threshold of NCTD (r1 = 0.395, p = 0.031) in patients with arrhythmias and NCTD;there was an inverse weak to moderate association of body mass index (BMI) and myocardial strain in a number of LV segments. There was a signifi cant relationship between NT-proBNP and diagnostic threshold of NCTD (r1 = 0.496, p = 0.001), mitral valve prolapse (r1 = 0.469, p = 0.002).Conclusion. Chest deformity, spinal scoliosis, joint hypermobility, mitral valve prolapse and BMI decrease in patients with arrhythmic syndrome and NCTD are associated with the myocardial strain and NT-proBNP level that can be used for the early identifi cation of myocardial remodeling in this patient cohort.

Trait irritability and temporal discounting: Exploring potential sociocultural moderators

Irritability is linked with poor clinical outcomes in adults. However, few studies have examined the mechanisms linking these associations, and none examine whether sociocultural factors moderate these associations. Given evidence that both pediatric irritability and lower social class are associated with preferences for smaller immediate versus larger delayed rewards (i.e., temporal discounting [TD]), the present study examines irritability, social class, and TD rates in two independent adult samples (N = 362; N = 415). We also examine if resource predictability and uncertainty moderate irritability-TD associations. Trait irritability was unrelated to TD rates in either sample. Higher subjective and objective social class and higher rates of predictability in one's life were associated with lower TD rates, but only in Sample 2 and only for one of the TD tasks. Only beliefs about uncertainty in one's life interacted with trait irritability to predict TD rate and was limited to Sample 2 and one TD task. These results suggest that trait irritability in a non-clinical adult sample is not related to impulsive decision-making assessed via TD tasks and highlight the importance of sociocultural factors in irritability research.

A Shadow of Doubt: Is There Implicit Bias Among Orthopaedic Surgery Faculty and Residents Regarding Race and Gender?

Orthopaedic surgery continues to be one of the least diverse medical specialties. Recently, increasing emphasis has been placed on improving diversity in the medical field, which includes the need to better understand existing biases. Despite this, only about 6% of orthopaedic surgeons are women and 0.3% are Black. Addressing diversity, in part, requires a better understanding of existing biases. Most universities and residency programs have statements and policies against discrimination that seek to eliminate explicit biases. However, unconscious biases might negatively impact the selection, training, and career advancement of women and minorities who are underrepresented in orthopaedic surgery. Although this is difficult to measure, the Implicit Association Test (IAT) by Project Implicit might be useful to identify and measure levels of unconscious bias among orthopaedic surgeons, providing opportunities for additional interventions to improve diversity in this field. (1) Do orthopaedic surgeons demonstrate implicit biases related to race and gender roles? (2) Are certain demographic characteristics (age, gender, race or ethnicity, or geographic location) or program characteristics (geographic location or size of program) associated with the presence of implicit biases? (3) Do the implicit biases of orthopaedic surgeons differ from those of other healthcare providers or the general population? A cross-sectional study of implicit bias among orthopaedic surgeons was performed using the IAT from Project Implicit. The IAT is a computerized test that measures the time required to associate words or pictures with attributes, with faster or slower response times suggesting the ease or difficulty of associating the items. Although concerns have been raised recently about the validity and utility of the IAT, we believed it was the right study instrument to help identify the slight hesitation that can imply differences between inclusion and exclusion of a person. We used two IATs, one for Black and White race and one for gender, career, and family roles. We invited a consortium of researchers from United States and Canadian orthopaedic residency programs. Researchers at 34 programs agreed to distribute the invitation via email to their faculty, residents, and fellows for a total of 1484 invitees. Twenty-eight percent (419) of orthopaedic surgeons and trainees completed the survey. The respondents were 45% (186) residents, 55% (228) faculty, and one fellow. To evaluate response biases, the respondent population was compared with that of the American Academy of Orthopaedic Surgeons census. Responses were reported as D-scores based on response times for associations. D-scores were categorized as showing strong (≥ 0.65), moderate (≥ 0.35 to < 0.65), or slight (≥ 0.15 to < 0.35) associations. For a frame of reference, orthopaedic surgeons' mean IAT scores were compared with historical scores of other self-identified healthcare providers and that of the general population. Mean D-scores were analyzed with the Kruskal-Wallis test to determine whether demographic characteristics were associated with differences in D-scores. Bonferroni correction was applied, and p values less than 0.0056 were considered statistically significant. Overall, the mean IAT D-scores of orthopaedic surgeons indicated a slight preference for White people (0.29 ± 0.4) and a slight association of men with career (0.24 ± 0.3), with a normal distribution. Hence, most respondents' scores indicated slight preferences, but strong preferences for White race were noted in 27% (112 of 419) of respondents. There was a strong association of women with family and home and an association of men with work or career in 14% (60 of 419). These preferences generally did not correlate with the demographic, geographic, and program variables that were analyzed, except for a stronger association of women with family and home among women respondents. There were no differences in race IAT D-scores between orthopaedic surgeons and other healthcare providers and the general population. Gender-career IAT D-scores associating women with family and home were slightly lower among orthopaedic surgeons (0.24 ± 0.3) than among the general population (0.32 ± 0.4; p < 0.001) and other healthcare professionals (0.34 ± 0.4; p < 0.001). All of these values are in the slight preference range. Orthopaedic surgeons demonstrated slight preferences for White people, and there was a tendency to associate women with career and family on IATs, regardless of demographic and program characteristics, similar to others in healthcare and the general population. Given the similarity of scores with those in other, more diverse areas of medicine, unconscious biases alone do not explain the relative lack of diversity in orthopaedic surgery. Implicit biases only explain a small portion of the lack of progress in improving diversity, equity, inclusion, and belonging in our workforce and resolving healthcare disparities. Other causes including explicit biases, an unwelcoming culture, and perceptions of our specialty should be examined. Remedies including engagement of students and mentorship throughout training and early career should be sought.

The Association Between Physical Function and Hyperkyphosis in Older Females: A Systematic Review and Meta-analysis.

Thoracic hyperkyphosis may adversely influence physical function in older adults, but the literature is mixed and confounded by possible sex differences. This systematic review and meta-analysis aimed to examine the association between hyperkyphosis and physical function in older females. Scopus, ISI Web of Science, Cochrane Library, PubMed, CINAHL, and PEDro databases were searched through 2021 for studies that included measures of thoracic hyperkyphosis and physical function with extractable data for women older than 60 years. Studies were excluded if they were qualitative, case reports, case series, ecological studies, reviews, or were not published in English. The study quality and risk of bias were assessed using checklists from the National Heart, Lung, and Blood Institute. Data were synthesized using Cohen's d effect size and 95% confidence interval (CI), and random-effects models were used for the meta-analyses. Three cohort and 22 cross-sectional studies of fair to good quality met the inclusion criteria. Eight studies reporting single-group data showed a moderate association between greater kyphosis angles and lower physical function ( d = -0.57; 95% CI -0.73, -0.40). Fourteen studies reporting 2-group data showed a large negative effect on physical function for groups with greater kyphosis angles ( d = -1.16; 95% CI -1.53, -0.78). Three studies that reported multivariate data also tended to show negative associations between physical function and hyperkyphosis. Limitations include a relative lack of causal evidence; confirming causation requires additional longitudinal studies. Studies have assessed various physical function categories, including strength, gait, and balance. Future studies could determine the categories of function most affected so that preventive interventions could target hyperkyphosis appropriately. Hyperkyphosis was associated with lower physical function in older women. Three cohort studies suggest that greater kyphosis angles may predict greater loss of physical function over time. These results imply that therapies that help to minimize hyperkyphosis may help preserve function in older women.

A psychometric evaluation of the Life Attitudes Schedule-Short Form

The Life Attitudes Schedule-Short Form (LAS-SF) is a measure of suicide proneness featuring various conceptual models. We tested four competing LAS-SF factor structures, as well as construct validity with mental health and suicide metrics. Community dwelling adults (N = 488) completed an online cross-sectional survey. Results supported a four factor (i.e., death-related, health-related, injury-related, and self-related subscales) LAS-SF structure with one higher order factor. Death-related, injury-related, and self-related subscales demonstrated moderate positive associations with mental health and suicidal ideation. Death-related and self-related subscales showed links with suicidal ideation, as well as suicide and depression risk (controlling for other factors). This study is important in highlighting suicide proneness theory may need to be refined. LAS-SF uses include possible risk screening in clinical settings and future focus on the psychological death aspects of the LAS-SF in prospective research. Study limitations include lack of sample diversity and cross-sectional design.

School Climate Perception among Latinx and White Students: An Examination of Intersecting Race/Ethnicity and Socioeconomic Identities in Context

Limited research has explored how the characteristics of student and teacher racial/ethnic composition may explain students’ perceptions of school climate. This study used stratified analysis to assess the associations of two prominent diversity aspects (i.e., student racial/ethnic diversity and teacher racial/ethnic diversity) with students’ perceived school climate. Particularly, this study controlled for student- and school-levels demographic characteristics among 41,237 Latinx students and 23,819 White students from 7th grade to 12th grade enrolled in 250 California public schools. The findings indicated that higher teacher racial/ethnic diversity had a mild to moderate positive association with perceived school attitudes to parental participation (Economically Disadvantaged Latinx: β = 0.20, p < .05; Economically Disadvantaged White: β = 0.37, p < .01) and perceived school equity and safety (Economically Disadvantaged Latinx: β = 0.16, p < .05; Economically Disadvantaged White: β = 0.19, p < .05) among Latinx and White students from economically disadvantaged backgrounds. Only Latinx students from economically disadvantaged backgrounds perceived less favorable school safety and equity in schools with a higher student racial/ethnic diversity (Economically Disadvantaged Latinx: β = −0.20, p < .05). Results have implications for addressing school climate disparities at an organizational level. Impact Statement Although ecological theories have proposed that school climate perception is constructed by contextual and individual characteristics interactively, relatively little research has attempted to understand how school demographic compositions, such as teacher and student racial/ethnic diversity, interact with students’ intersecting social identities in shaping perceived school climate. This study provided empirical evidence of the positive influences of teacher racial/ethnic diversity on perceived school climate. This effect was observed among White and Latinx students from economically disadvantaged backgrounds. Latinx students from economically disadvantaged backgrounds perceived less safety and equity in schools with higher racial/ethnic diversity.

Association of PCSK-9 with the Biomarkers of Type-2 Diabetes and its Complications in the Indian Population: a Pilot Study.

Proprotein convertase subtilisin/kexin type-9 (PCSK-9) is a serine protease with profound effects on plasma LDL-C, the major risk factor for cardiovascular diseases (CVDs). However, plasma PCSK-9 level and its association with the biomarkers of CVDs, diabetes, and associated complications have not yet been reported in the northeastern population of India. Of the total cohort (n = 233), we analyzed healthy controls (HC; n = 50), freshly diagnosed type-2-diabetes mellitus (T2DM-FD; n = 46), T2DM treated (T2DM-T; n = 49), diabetic nephropathy (T2DM-N; n = 43), and diabetic dyslipidemia (T2DM-DL; n = 45) subjects. Plasma PCSK-9 and other biological determinants associated with T2DM, CVD, and nephrotic dysfunction were assessed. The level of plasma PCSK-9 in HC, T2DM-FD, T2DM-T, T2DM-N, and T2DM-DL groups was found to be 184.1 ± 13.83, 183.1 ± 24.4.3, 241.8 ± 75.42, 403.7 ± 85.94, and 641.3 ± 135.5 ng/mL, respectively, indicating its role in the severity of the here-mentioned complications. Moreover, plasma PCSK-9 levels further showed a significant correlation with the biomarkers of hyperglycemia, particularly HbA1c, as well as LDL-C in T2DM-FD, T2DM-N, and T2DM-DL subjects of the Indian population, while moderate association in T2DM-T subjects. Our first-of-its-kind clinical study aiming to quantify the circulatory PCSK-9 level in the Indian population concluded that elevated PCSK-9 was significantly associated with the severity of diabetes and associated complications. Moreover, such elevation in PCSK-9 might be attributed to the lipid- and glucoselowering medication-induced SREBP-2-dependent mechanisms. Since our conclusion is based on a pilot study, further cohort studies in larger populations of India are required to get a generalization regarding the role of PCSK-9 in DM and associated complications.

Sex Differences and Association Between Modified Balance Error Scoring System Error and Sway Index Scores in Collegiate, Club Sport, and High School Athletes

The Modified Balance Error Scoring System (mBESS) remains the standard balance tool for evaluating sport-related concussion. Discrepancies between error and objective sway scoring remain a topic of assessment measures. The purpose was to examine sex differences between error and sway index scores and association between scores on the mBESS in collegiate and high school athletes. 119 athletes completed the mBESS on a Biodex BioSway. Measures consisted of mBESS errors and sway index scores produced by the BioSway. No sex differences were observed on mBESS errors and sway index scores by competition level and the overall sample. Moderate associations were observed between error and sway index scoring for single and tandem stances.

Social media use, knowledge, attitudes, and risky sexual behavior of HIV transmission: A survey among boarding school adolescent students in Indonesia.

Social media has many positive and negative influences on individuals, especially for adolescents related to HIV. However, little is known about how social media impacts HIV-related outcomes among adolescents in boarding schools. This study aims to investigate the social media use, knowledge, attitudes, and sexual behavior at risk of HIV transmission and their relationship with the demographic characteristics of adolescent students at boarding schools. This study was school-based and used a cross-sectional design. The questionnaires were used to assess social network site usage, knowledge, attitudes, and risky behavior. Cluster random sampling involved students (n = 214) from three boarding schools in Cirebon City, West Java, Indonesia, in 2022. Chi-square tests and Cramer's V were used to explore correlations between social and demographic factors. A considerable number of adolescent students exhibited high social media addiction (58.4%), with the majority possessing limited knowledge of HIV transmission (54.7%). Additionally, nearly half displayed a negative attitude towards preventing HIV transmission (47.2%), while only a small fraction engaged in risky behavior (2.8%). Bivariate analysis revealed that social media use was moderately associated with the type of social media application (φc = 0.246, p <0.05). Knowledge of HIV transmission exhibited a moderate correlation with age (φc = 0.331, p <0.05), education level (φc = 0.240, p <0.001), and exposure to information (φc = 0.269, p <0.001). Similarly, attitudes toward HIV prevention demonstrated moderate associations with age (φc = 0.341, p = 0.001), education level (φc = 0.317, p <0.001), and exposure to information (φc = 0.266, p <0.001). Furthermore, risky sexual behavior exhibited a strong association with exposure to pornographic content (φc = 0.730, p <0.001). The study found a high prevalence of social media usage among adolescents, coupled with low knowledge about HIV, negative attitudes, and risky behavior. Significant relationships were observed between social media use, knowledge, attitudes, and risky sexual behavior related to HIV transmission and demographic characteristics. This study emphasizes the vital role of nurses and healthcare professionals in implementing targeted educational interventions in boarding schools to address gaps in HIV risk knowledge influenced by social media, ultimately improving strategies for adolescents' sexual health.

Diastolic function assessment with four-dimensional flow cardiovascular magnetic resonance using automatic deep learning E/A ratio analysis

BackgroundDiastolic left ventricular dysfunction is a powerful contributor to the symptoms and prognosis of patients with heart failure. In patients with depressed left ventricular systolic function the EA ratio is the first step to defining the grade of diastolic dysfunction. Doppler echocardiography is the preferred imaging technique for diastolic function assessment, while CMR is less established as a method. Previous 4D Flow-based studies have looked at the EA ratio proximally to the mitral valve, requiring manual interaction. In this study we compare an automated, deep learning-based, and two semiautomated approaches for 4D Flow CMR-based EA ratio assessment to conventional, gold standard echo-based methods. MethodsNinety-seven subjects with chronic ischemic heart disease underwent a cardiac echo followed by an MRI investigation. 4D Flow-based EA ratio values were computed using three different approaches; two semi-automated, assessing the EA ratio by measuring the inflow velocity (MVvel) and the inflow volume (MVflow) at the mitral valve plane, and one fully automated, creating a full LV segmentation using a deep learning-based method within which the EA ratio could be assessed without constraint to the mitral plane (LVvel). ResultsMVvel, MVflow, and LVvel EA ratios were strongly associated with Echo EA ratio (R2= 0.60, 0.58, 0.72). LVvel peak E and A showed moderate association to Echo peak E and A, while MVvel values were weakly associated. MVvel and MVflow EA ratios were very strongly associated with LVvel (R2= 0.84, 0.86). MVvel peak E was moderately associated with LVvel, while peak A showed strong association (R2= 0.26, 0.57). Discussion and ConclusionPeak E, peak A and EA ratio are integral to the assessment of diastolic dysfunction and may expand the utility of CMR studies in patients with cardiovascular disease. While underestimation of absolute peak E and A velocities was noted, the EA ratio measured with all three 4D Flow methods was strongly associated with the gold standard Doppler echocardiography. The automatic, deep learning-based method performed best, with the most favorable runtime of ~40seconds. As both semiautomatic methods associated very strongly to LVvel, they could be employed as an alternative for estimation of EA ratio.

Delta4-based Dosimetric Error Detection in Volumetric-modulated Arc Therapy: Clinical Significance and Implications.

Volumetric-modulated arc therapy (VMAT) is an efficient method of administering intensity-modulated radiotherapy beams. The Delta4 device was employed to examine patient data. The utility of the Delta4 device in identifying errors for patient-specific quality assurance of VMAT plans was studied in this research. Intentional errors were purposely created in the collimator rotation, gantry rotation, multileaf collimator (MLC) position displacement, and increase in the number of monitor units (MU). The results show that when the characteristics of the treatment plans were changed, the gamma passing rate (GPR) decreased. The largest percentage of erroneous detection was seen in the increasing number of MU, with a GPR ranging from 41 to 92. Gamma analysis was used to compare the dose distributions of the original and intentional error designs using the 2%/2 mm criteria. The percentage of dose errors (DEs) in the dose-volume histogram (DVH) was also analyzed, and the statistical association was assessed using logistic regression. A modest association (Pearson's R-values: 0.12-0.67) was seen between the DE and GPR in all intentional plans. The findings indicated a moderate association between DVH and GPR. The data reveal that Delta4 is effective in detecting mistakes in treatment regimens for head-and-neck cancer as well as lung cancer. The study results also imply that Delta4 can detect errors in VMAT plans, depending on the details of the defects and the treatment plans employed.

Equilíbrio ocupacional na população saudável chilena e sua relação com autoeficácia e qualidade de vida

Abstract Introduction Occupational balance has been related to various health and well-being situations. In 2021, the Occupational Balance Questionnaire was translated into Spanish (OBQ-E), however, to date, there are no studies on its application in the Latin American population. Objective To evaluate the psychometric properties of the Spanish version of the OBQ (OBQ-E) in a representative sample of healthy Chilean adults and from them to establish the relationship between occupational balance and self-efficacy and quality of life in this population. Method A cross-sectional observational study has been conducted. A total of 153 healthy adults participated. OBQ-E was applied. Psychometric properties were performed. A correlation analysis was performed to identify the relationship with self-efficacy and quality of life. Results A bifactorial model for OBQ-E is confirmed: occupational pattern and occupational meaning. There is a moderate association between occupational balance and the other two variables: self-efficacy and quality of life, specially related to mental health. Conclusion This study has validated the OBQ-E instrument to be applied in the healthy adult Chilean population, and has determined the statistical relationship between occupational balance, self-efficacy, and quality of life. This research has shown the relevance of occupational balance in a healthy population.