Multivariable Linear Regression Models Research Articles

Impact of COVID-19 on women living with HIV who are survivors of intimate partner violence

BackgroundWomen living with HIV (WLWH) experience higher rates of intimate partner violence (IPV) compared to women without HIV, but there has been minimal research to date on the impact of the COVID-19 pandemic on the lived experiences of WLWH who are IPV survivors.MethodsThis is a secondary analysis of COVID-19 impact using baseline data from an ongoing, prospective, micro-longitudinal cohort study of HIV care engagement among WLWH who have experienced lifetime IPV. We measured the impact of COVID-19 along key domains (i.e., physical health, day-to-day life, sexual/relationship behavior, substance use, HIV care, mental health, financial status, and having conflict with partners). Using independent t-tests or Fisher’s exact tests, and Pearson’s chi-squared tests, we compared women with and without ongoing IPV across sociodemographic characteristics, psychiatric disorders, substance use, and COVID-19 impact domains. We then built separate multivariate linear regression models for each of the different COVID-19 impact domains; ongoing IPV exposure was the primary explanatory variable of interest.ResultsEnrolled participants (n = 84) comprised a group of women (mean age 53.6y; SD = 9.9) who were living with HIV for a mean 23.3 years (SD = 10), all of whom had experienced lifetime IPV. Among 49 women who were currently partnered, 79.6% (n = 39) reported ongoing IPV. There were no statistically significant differences between those experiencing ongoing IPV and those who were not (or not partnered) in terms of demographic characteristics, substance use, or mental health. In multivariate models, ongoing IPV exposure was not associated with any COVID-19 impact domain. Anxiety and depression, however, were associated with COVID-19-related physical health, HIV care, and relationship conflict. Hispanic ethnicity was significantly associated with COVID-19-related physical health. More severe cocaine and opioid use were also significantly associated with COVID-19-related impact on day-to-day life.ConclusionsAmong this sample of WLWH who are all lifetime IPV-survivors, nearly half had ongoing IPV exposure. The COVID-19 public health emergency period affected WLWH in varied ways, but impacts were most profound for women experiencing concurrent mental health and substance use problems. Findings have important implications for future interventions to improve women’s health and social outcomes.

Environmental impact of the diet of young Portuguese and its relationship with adherence to the Mediterranean Diet.

To estimate, in a cohort of young Portuguese adults, the environmental impact (greenhouse gas (GHG) emissions, land use, energy used, acidification and potential eutrophication) of diet according to adherence to the Mediterranean Diet (MD). Data from 1554 participants of the Epidemiologic Health Investigation of Teenagers in Porto (EPITeen) were analysed. Food intake and MD adherence were determined using validated questionnaires. The environmental impact was evaluated with the EAT-Lancet Commission tables, and the link between MD adherence and environmental impact was calculated using adjusted multivariate linear regression models. Higher adherence (high vs. low) to the MD was associated with lower environmental impact in terms of land use (7.8 vs. 8.5 m2, p = 0.002), potential acidification (57.8 vs. 62.4g SO2-eq, p = 0.001) and eutrophication (21.7 vs. 23.5g PO4-eq, p < 0.001). Energy use decreased only in the calorie-adjusted model (9689.5 vs. 10,265.9kJ, p < 0.001), and GHG emissions were reduced only in a complementary model where fish consumption was eliminated (3035.3 vs. 3281.2g CO2-eq, p < 0.001). Meat products had the greatest environmental impact for all five environmental factors analysed: 35.7% in GHG emissions, 60.9% in energy use, 72.8% in land use, 70% in acidification and 61.8% in eutrophication. Higher adherence to the MD is associated with lower environmental impact, particularly in terms of acidification, eutrophication, and land use. Reducing meat consumption can contribute to greater environmental sustainability.

Associations of coping and health-related behaviors with medical students’ well-being and performance during objective structured clinical examination

Objective structured clinical examination (OSCE) is a valid method to evaluate medical students’ competencies. The present cross-sectional study aimed at determining how students’ coping and health-related behaviors are associated with their psychological well-being and performance on the day of the OSCE. Fourth-year medical students answered a set of standardized questionnaires assessing their coping (BCI) and health-related behaviors before the examination (sleep PSQI, physical activity GPAQ). Immediately before the OSCE, they reported their level of instant psychological well-being on multi-dimensional visual analogue scales. OSCE performance was assessed by examiners blinded to the study. Associations were explored using multivariable linear regression models. A total of 482 students were included. Instant psychological well-being was positively associated with the level of positive thinking and of physical activity. It was negatively associated with the level of avoidance and of sleep disturbance. Furthermore, performance was negatively associated with the level of avoidance. Positive thinking, good sleep quality, and higher level of physical activity were all associated with improved well-being before the OSCE. Conversely, avoidance coping behaviors seem to be detrimental to both well-being and OSCE performance. The recommendation is to pay special attention to students who engage in avoidance and to consider implementing stress management programs.Clinical trial: The study protocol was registered on clinicaltrial.gov NCT05393206, date of registration: 11 June 2022.

Patient experiences with outpatient opioid use disorder treatment before and during COVID-19: results from a survey of Medicaid members.

Background: Payers are increasingly interested in quality improvement for opioid use disorder (OUD) treatment, including incorporating patient experiences. Medicaid is the largest payer for OUD treatment, yet we know little about the treatment benefits Medicaid members report, how these vary across members, or changed with the COVID-19 pandemic.Objective: To examine Medicaid members' report of outpatient treatment benefits, employment, and housing outcomes before and during the pandemic.Methods: A representative sample of 1,032 Virginia Medicaid members (52% women) receiving OUD treatment completed a survey of treatment benefits, health status and social needs. A reported treatment benefit index was created based on seven self-reported items. Multivariable linear regression models, pooled and stratified by time (pre-COVID-19/COVID-19), assessed member characteristics associated with reported treatment benefit, employment and housing outcomes.Results: Members reported strong treatment benefit (mean: 21.8 [SD: 5.9] out of 28 points) and improvements in employment (2.4 [1.3] out of 5) and housing (2.8 [1.2] out of 5). After adjustment, mental distress (regression coefficient: -3.00 [95% CI:-3.97;-2.03]), polysubstance use (-1.25 [-1.99;-0.51]), and food insecurity (-1.00 [-1.71;-0.29]), were associated with decreased benefits from treatment. During COVID-19, justice-involved individuals reported decreased benefits (-2.17 [-3.54; -0.80]) compared to before the pandemic (-0.09 [-1.4-;1.24] p < .05).Conclusions: Medicaid members receiving outpatient OUD treatment reported positive treatment benefits, and housing and employment outcomes. However, those with comorbid health and social conditions often benefited the least. As payers move toward quality improvement and value-based purchasing initiatives, collecting and integrating patient reported outcomes into quality metrics is critical.

Alcohol and Binge Drinking Frequency and Hypertension: a national cross-sectional study in the U.S.

The relationship between alcohol consumption and hypertension is multifaceted and a major public health concern. The association becomes even more complicated when hypertension is undiagnosed. This study investigates how alcohol consumption patterns are linked to measured, diagnosed, undiagnosed, and composite hypertension (any indications of hypertension from blood pressure readings, professional diagnosis, or reported medication use) in the United States. Data from the National Health and Nutrition Examination Survey (NHANES) 2015-2020, a nationally representative cross-sectional study, were analyzed in 2023-24. The final analytic sample was 12,950 participants. Complex-survey weighted multivariable linear and logistic regression models estimated the effect of different alcohol consumption levels on hypertension. Descriptive findings show that those who consumed alcohol more than three times weekly exhibited the highest prevalence of measured (52.5%), undiagnosed (27.0%), and composite hypertension (69.4%) compared to other levels of alcohol drinking. Multivariable linear regression analysis indicated a notable elevation in systolic (4.8 unit) and diastolic (2.46 unit) blood pressure among individuals with frequent binge drinking episodes compared to individuals with infrequent drinking. Logistic regression models estimated that drinking over three times weekly increases the odds of measured, undiagnosed, and composite hypertension by 64%, 70%, and 54%, respectively, while frequent binge drinking episodes raise these odds by 82%, 65%, and 47%. Contrary to some studies suggesting moderate alcohol intake has protective cardiovascular effects, the findings did not corroborate a "J-shaped" curve. This underscores the importance of regular blood pressure monitoring among individuals with binge drinking episodes and emphasizes the need for public health interventions to mitigate alcohol consumption and its associated hypertension risks.

Association between body mass index and early renal function after kidney transplantation: observational and Mendelian randomization study.

Introduction The relationship between BMI and early renal function recovery after kidney transplantation is important due to the rising global obesity rates. Methods A retrospective study on 320 patients who received allograft kidney transplantation at Guangxi Medical University Hospital explored the BMI-kidney function relationship using various statistical methods. Mendelian randomization（MR） was also employed to investigate causality. Results Based on the univariate analysis, multivariate linear regression models, and trend analysis, it was found that there were significant positive correlations between BMI and creatinine, urea, and cystatin C on the 7th day after kidney transplantation (P&lt;0.05). The sensitivity analysis further confirmed these correlations in different gender stratification, adolescents, and adults. However, the positive correlation with cystatin C was only significant in males. Additionally, after conducting smooth curve fitting analysis and threshold saturation analysis, it was revealed that the negative correlation between early renal function recovery was most significant when BMI was between 22.0-25.5kg/m2, and early postoperative renal function may be optimal when BMI was at 22.2kg/m2. Finally, the MR analysis confirmed a causal relationship between BMI and renal failure, as indicated by the IVW method (P=0.003), as well as the weighted median estimator (P=0.004). Conclusion This study on kidney transplant patients found that maintaining a BMI within the range of 22.0 to 25.5 kg/m2, with an optimal BMI of 22.2 kg/m2, improves early renal function recovery. This correlation holds true for different age groups and genders. Monitoring and controlling BMI in high-risk patients can enhance post-transplantation renal function.

Development of an artificial neural network based-prediction model for bond strength of FRP bars in concrete

Fiber-reinforced polymer (FRP) bars have garnered increasing attention in recent years due to their superior corrosion resistance, offering a potential solution to the significant drawback of steel corrosion in concrete. For the widespread utilization of FRP bars in concrete structures, determining the bond strength between FRP bars and concrete is a crucial topic. This study seeks to develop a prediction model to estimate the bond strength of FRP bars in concrete, utilizing an extended dataset from 1010 pull-out tests. Initially, the study evaluates the applicability of several bond strength formulas from existing codes. Subsequently, two prediction models, namely a multivariate linear regression model and an artificial neural network (ANN) model, are introduced for estimating the bond strength of FRP bars in concrete. The results indicate that the correlation between the evaluation values of existing formulas and the experimental value is very low. This is because these formulas have not yet been updated to encompass the expanded usage scopes of FRP bars with various surface processing methods and types of concrete. While the multivariate linear regression model outperforms these formulas, its accuracy is still relatively low; in contrast, the ANN demonstrates superior performance, achieving an R^2 value for both the validation and test set of more than 0.92. The findings highlight that, when considering a broader range of applications, the ANN serves as a robust tool for accurately predicting the bond strength of FRP bars in concrete, in comparison to traditional formulas and linear regression models. This assessment approach provides engineers with a convenient, high-precision tool for designs utilizing various forms of FRP bars and diverse types of concrete in practical design scenarios

Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study

BackgroundThe potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy.MethodsThis was a prospective pilot cohort of pregnant people between 23 to 36 weeks’ gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters.ResultsAmong the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p = 0.01, MAP: β 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p = 0.01, DBP: β 8.1, p < 0.001, and MAP: β 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP.ConclusionsWhen including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1–9.6 mmHg higher SBP, 6.1–8.1 mmHg higher DBP, and 6.2–8.8 mmHg higher MAP than people without anxiety.

The Impact of Telehealth on Obstetrical Outcomes during the COVID-19 Pandemic.

Nationwide, obstetric clinics modified prenatal care to include telehealth visits in response to the COVID-19 pandemic, enabling the opportunity to investigate its impact on patient outcomes. We hypothesized that use of prenatal telehealth visits would increase the number of prenatal visits, decrease the frequency of urgent triage/emergency department (ED) visits, and improve perinatal outcomes. To determine the impact of telehealth on number of obstetric prenatal visits and urgent triage/ED visits amidst the COVID-19 pandemic. This is a retrospective cohort of patients from a federally qualified health center (FQHC) in central Texas. Patients with a singleton gestation who delivered after 32 weeks were included. Comparison groups were made between those patients who delivered between May 2020 to December 2020 (presumed modified prenatal visit schedule with in-person and telehealth) and those patients delivering between June 2019 to February 2020 (the traditional care model with in-person visits only). Multivariable linear and logistic regression models were used to estimate differences in the number of prenatal visits and unscheduled triage/ED visits. A total of 1654 patients were identified with 801 (48.4%) patients undergoing modified prenatal care and 853 (51.6%) patients receiving traditional care during the study period. No significant differences were seen in overall prenatal attendance or triage/ED presentations. However, when stratified by parity, multiparous patients undergoing modified prenatal care were less likely to experience an urgent triage/ED presentation (8.7% vs. 12.7%; odds ratio, 1.69; 95% confidence interval, 1.10-2.61). When compared to a traditional prenatal visitation cohort pre-pandemic, patients who received modified telehealth prenatal care during the COVID-19 pandemic had similar prenatal attendance and unscheduled emergency presentations. However, multiparous patients experienced a decreased rate of unscheduled emergency presentations. Supplementing prenatal care with telehealth may provide overall comparable prenatal care delivery.

Retrieval algorithm of chlorophyll-a concentration for coastal waters based on ridge regression

Abstract. In this paper, we use the multiple scattering near-infrared aerosol correction model of SeaDAS to execute the atmospheric correction for Terra/Aqua MODIS remote sensing data, and also use three standard operational chlorophyll-a concentration inversion algorithms built in SeaDAS, named OC2, OC3, and OC4, to carry out chlorophyll-a concentration inversion in the Yellow Sea and East China Sea. We validate the inversion results using in-situ measured chlorophyll-a concentration data collected from the Yellow Sea and East China Sea in 2003. The results show that the inversion results of OC3 and OC4 algorithm are significantly larger than in-situ measured values, and the results of the OC2 algorithm are closer to the measured values. In view of the shortcomings of these algorithms, we proposes a chlorophyll-a concentration inversion model based on ridge regression, and carry out chlorophyll-a concentration inversion test using MODIS images covering the Yellow Sea and East China Sea 2003. The results indicate that, the new inversion model can effectively overcome the deficiencies of OC2, OC3, and OC4 algorithms. The inversion model can effectively overcome the covariance problem of OC2, OC3 and OC4 algorithms on the multivariate linear regression model, and the model passed the F-test (F=25.893, p=0.000&lt;0.05), the mean absolute percentage error (MAPE) between the inversion values and the in-situ measured values was 21.8%, the root mean squared error (RMSE) was 0.325, and the coefficient of determination (R2) was 0.847. The accuracy and the fit degree of the new model were significantly better than those of the OC2, OC3 and OC4 algorithms. Therefore, the chlorophyll-a concentration inversion model based on ridge regression can effectively invert the chlorophyll-a concentration in the offshore.

Gender-specific associations between sleep quality, sleep duration and cognitive functioning among older Indians: findings from WHO-SAGE study

BackgroundSleep is an essential component of human health and well-being, playing a crucial role in several cognitive processes, including attention, memory, and executive function. In this study, we aimed to examine the association between sleep quality, sleep duration and cognitive functioning among older men and women in India.MethodsData come from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE), India wave-2, which was conducted in 2015 in six selected states of India, representing different country regions. The sample included 6,396 older adults aged 50 years and above. We used multivariable linear regression models to examine the associations between sleep quality, sleep duration and cognitive function, separately among older men and women.ResultsOlder men and women with poor sleep and short duration sleep had lower mean scores of cognition than their peers with good sleep and age-appropriate sleep duration. Poor sleep (aCoef: -5.09, CI: -8.66, -1.51) and short duration sleep (aCoef: -5.43, CI: -7.77, -3.10) were negatively associated with cognitive functioning among older men and the associations remained significant among older men with poor sleep (aCoef: -2.39, CI: -3.78, -1.00) and short duration sleep (aCoef: -4.39, CI: -6.46, -2.31) after adjusting for a large number of socio-demographic, health and behavioral factors. Similarly, poor sleep (aCoef: -3.15, CI: -5.79, -0.52) and short duration sleep (aCoef: -2.72, CI: -4.64, -0.81) were associated with cognitive functioning among older women, however, the associations were insignificant when the potential confounders were adjusted.ConclusionsThis study provides evidence for the significant association between sleep health and cognitive functioning in older Indian adults, especially older men, with poor sleep quality and insufficient sleep duration being detrimental to their cognitive health. Healthcare providers should routinely screen for sleep quality and age-appropriate sleep duration in their older adult patients and consider sex/gender-tailored sleep interventions as part of cognitive health management strategies.

The Association Between Early Initiation of Systemic Corticosteroids and the Hospital Length of Stay in Patients With Multisystem Inflammatory Syndrome in Children.

Patients with multisystem inflammatory syndrome in children (MIS-C) often require hospital admission. Treatment of MIS-C has included intravenous immunoglobulin, systemic corticosteroids, and/or immunomodulators. There is no standardized approach to when steroids should be initiated during treatment. The study objective was to determine whether early initiation of steroids in patients with MIS-C is associated with the duration of hospital length of stay (LOS). This is a single-center retrospective cohort study of patients younger than 21 years who were hospitalized with MIS-C between March 2020 and September 2021 and received steroids. Cases were obtained from an institutional MIS-C log. Patients with culture proven sepsis and/or those who received intravenous immunoglobulin or steroids within the previous 30 days were excluded. We used a multivariable linear regression model, controlling for potential confounders, to assess the association between early steroids and LOS. A total of 56 patients hospitalized with MIS-C were identified; 38 received systemic corticosteroids and were included in the study. The mean time from admission to steroid administration was 9.8 hours (SD = 7.7) in the early group and 44.6 hours (SD = 14.2) in the late group. There was a statistically significant difference in baseline characteristics of patients receiving early versus late steroids in initial C-reactive peptide, procalcitonin, brain natriuretic peptide, and cardiac dysfunction. After controlling for confounders, initiating steroids within 24 hours of admission for MIS-C was associated with a decreased hospital LOS: in patients treated with early steroids, LOS was 58.3 hours less (95% confidence interval, -100.0 to -16.6; P = 0.007) than in those who received late steroids. Among patients with MIS-C, initiating systemic corticosteroids within 24 hours of admission was associated with decreased hospital LOS.

Cross-sectional associations between patterns and composition of upright and stepping events with physical function: insights from The Maastricht Study

IntroductionAge-related declines in physical functioning have significant implications for health in later life. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between accelerometer-determined daily PA patterns, including composition and temporal distribution (burstiness) of upright and stepping events, with physical function.MethodsData was from participants who wore an activPAL3 accelerometer as part of The Maastricht Study. Exposures included a suite of metrics describing the composition and the temporal distribution (burstiness) of upright and sedentary behaviour. Physical function outcomes included the six-minute walk test (6MWT), timed chair-stand test (TCST), grip strength (GS), and SF-36 physical functioning sub-scale (SF-36pf). Multivariable linear regression models were used to assess associations, adjusting for covariates including overall PA volume (daily step count).ResultsParticipants(n = 6085) had 6 or 7 days of valid data. Upright and stepping event metrics were associated with physical function outcomes, even after adjusting PA volume. Higher sedentary burstiness was associated with better function (6MWT, TCST, and SF-36pf), as was duration and step volume of stepping events (6MWT, TCST, GS, and SF-36pf), step-weighted cadence (6MWT, TCST, and SF-36pf). Number of stepping events was associated with poorer function (6MWT, GS, and SF-36pf), as was upright event burstiness (SF-36pf). Associations varied according to sex.ConclusionOur study reveals that diverse patterns of physical activity accumulation exhibit distinct associations with various measures of physical function, irrespective of the overall volume. Subsequent investigations should employ longitudinal and experimental studies to examine how changing patterns of physical activity may affect physical function, and other health outcomes.

Moderate associations between the use of levonorgestrel-releasing intrauterine device and metabolomics profile.

Use of levonorgestrel-releasing intrauterine device (LNG-IUD) has become common irrespective of age and parity. To date, only a few studies have examined its possible metabolic changes and large-scale biomarker profiles in detail and in a longitudinal design. To apply the metabolomics technique to examine the metabolic profile associated with the use of LNG-IUD both in a cross-sectional and in a longitudinal design. The study consists of cross-sectional and longitudinal analyses of a population-based survey (Health 2000) and its 11-year follow-up (Health 2011). All participants aged 18-49 years with available information on hormonal contraceptive use and metabolomics data (n=1767) were included. Altogether 212 metabolic measures in LNG-IUD users (n=341) were compared to those in non-users of hormonal contraception (n=1426) via multivariable linear regression models. Participants with complete longitudinal information (n=240) were divided into continuers, stoppers, starters, and never-user groups, and 11-year changes in levels of each metabolite were compared. After adjustment for covariates, levels of 102 metabolites differed in LNG-IUD current users compared to non-users of hormonal contraception (median difference in biomarker concentration: -0.12 SD): lower levels of fatty acids concentrations and ratios, cholesterol, triglycerides and other lipids, as well as particle concentration, cholesterol, total lipids and phospholipids in lipoproteins. The 11-year metabolic changes did not differ in relation to changes in LNG-IUD use. The use of LNG-IUD was associated with several moderate metabolic changes, mostly suggestive of a reduced arterial cardiometabolic risk. Changes in LNG-IUD use were not related to long-term metabolic changes.

Meaningful cognitive change for the Minimal Assessment of Cognitive Function in Multiple Sclerosis.

There is limited information on interpretation of cognitive changes over time in multiple sclerosis (MS). This study aimed to provide normative data for the assessment of statistically meaningful change in all tests of the Minimal Assessment of Cognitive Function in MS (MACFIMS). We applied the reliable change methodology to a healthy Italian cohort, assessed with two alternate versions of the MACFIMS 1 year apart. We calculated confidence intervals of retest score variance using the reliable change index (RCI). Moreover, multivariable linear regression models adjusted for age, sex, education, and baseline score were built to calculate the regression-based change index (RB-CI). Overall, 200 healthy individuals were enrolled. Thresholds for interpreting change in each test were calculated. In the multivariable models, baseline score was associated with retest score in all tests (B from 0.439 to 0.760; p < 0.001). RB-CI can be calculated with data of the multivariable models. We provide normative data for reliable cognitive change evaluation for all the tests of the MACFIMS, which includes the Symbol Digit Modalities Test and Brief International Cognitive Assessment in MS, two widely used tools for screening and monitoring cognition in MS. Our findings can significantly improve the interpretation of cognitive changes in MS.

Factors affecting the sodium-glucose cotransporter 2 inhibitors-related initial decline in glomerular filtration rate and its possible effect on kidney outcome in chronic kidney disease with type 2 diabetes: The Japan Chronic Kidney Disease Database.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors often cause a transient decrease in glomerular filtration rate (GFR) shortly after the initiation, referred to as the 'initial drop'. However, the clinical significance of this initial drop in real-world practice remains unclear. Using the nationwide Japan Chronic Kidney Disease Database, we examined factors that affected the initial drop, in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). We also evaluated the effects of the initial drop on a composite kidney outcome (a decline in GFR of ≥50% or progression to end-stage kidney disease). Data from 2053 patients with CKD and T2DM newly prescribed an SGLT2 inhibitor were analysed. The follow-up period after SGLT2 inhibitor administration was 1015 days (interquartile range: 532, 1678). Multivariate linear regression models revealed that the concomitant use of the renin-angiotensin system inhibitors and diuretics, urinary protein levels ≥2+, and changes in GFR before the initiation of the SGLT2 inhibitor were associated with a larger initial GFR decline (β = -0.609, p = .039; β = -2.298, p < .001; β = -0.936, p = .048; β = -0.079, p < .001, respectively). Patients in the quartile with the largest initial GFR decline experienced a higher incidence of the subsequent composite kidney outcome than those in the other quartiles (p < .001). The concomitant use of renin-angiotensin system inhibitors and diuretics, higher urine protein levels and pre-treatment GFR changes were associated with a larger initial GFR decline. Of these factors, the use of a diuretic had the largest effect. Furthermore, patients with CKD and T2DM experiencing an excessive initial GFR drop might be at a higher risk of adverse kidney outcomes.

Structural correlations between brain magnetic resonance image-derived phenotypes and retinal neuroanatomy.

The eye is a well-established model of brain structure and function, yet region-specific structural correlations between the retina and the brain remain underexplored. Therefore, we aim to explore and describe the relationships between the retinal layer thicknesses and brain magnetic resonance image (MRI)-derived phenotypes in UK Biobank. Participants with both quality-controlled optical coherence tomography (OCT) and brain MRI were included in this study. Retinal sublayer thicknesses and total macular thickness were derived from OCT scans. Brain image-derived phenotypes (IDPs) of 153 cortical and subcortical regions were processed from MRI scans. We utilized multivariable linear regression models to examine the association between retinal thickness and brain regional volumes. All analyses were corrected for multiple testing and adjusted for confounders. Data from 6446 participants were included in this study. We identified significant associations between volumetric brain MRI measures of subregions in the occipital lobe (intracalcarine cortex), parietal lobe (postcentral gyrus), cerebellum (lobules VI, VIIb, VIIIa, VIIIb, and IX), and deep brain structures (thalamus, hippocampus, caudate, putamen, pallidum, and accumbens) and the thickness of the innermost retinal sublayers and total macular thickness (all p < 3.3 × 10-5). We did not observe statistically significant associations between brain IDPs and the thickness of the outer retinal sublayers. Thinner inner and total retinal thicknesses are associated with smaller volumes of specific brain regions. Notably, these relationships extend beyond anatomically established retina-brain connections.

Inverse association of the systemic immune-inflammation index with serum anti-ageing protein Klotho levels in individuals with osteoarthritis: A cross-sectional study.

The association between the systemic immune-inflammation index (SII) and the serum soluble-Klotho concentration (pg/ml) in osteoarthritis (OA) patients is unknown. This study aimed to investigate the relationship between the SII and serum soluble-Klotho levels in OA patients. All study data were obtained from the National Health and Nutrition Examination Survey (NHANES) database (n = 1852 OA patients; age range = 40-79 years). The SII and serum Klotho measurement data are from the NHANES mobile examination centre. The SII values were divided into quartiles (Q1-4: 0.02-3.36, 3.36-4.78, 4.79-6.70, and 6.70-41.75). A multivariate linear regression model was constructed to evaluate the association between the SII and serum Klotho levels in OA patients; interaction tests were conducted to test the stability of the statistical results. Multivariate linear regression revealed a negative linear relationship between the SII and serum Klotho concentration in OA patients (β = -6.05; 95% CI: -9.72, -2.39). Compared to Q1, Q4 was associated with lower serum Klotho concentrations (β = -59.93; 95% CI: -96.57, -23.28). Compared with that of Q1, the β value of Q2-Q4 showed a downwards trend as the SII increased (Ptrend <0.001). The stratified analysis results indicated that the SII had a greater sensitivity in predicting serum Klotho concentrations in OA patients aged 60-79 years (Pinteraction = 0.028). There was a significant negative linear correlation between the SII and serum Klotho concentration in OA patients. The SII can serve as a predictive indicator of serum Klotho concentrations in OA patients. Klotho may be a potential anti-inflammatory drug for OA treatment.

Coping strategies, resilience and quality of life: reaction to the COVID-19 pandemic among Romanian physicians

BackgroundThe COVID-19 pandemic has presented multiple psychological challenges for healthcare workers, such as anxiety, depression, burnout, and substance use disorders. In this research, we investigate the different ways Romanian physicians dealt with the difficult period of the COVID-19 pandemic. We also analyze how positive and negative stress-reducing strategies, as well as demographic variables, affect their psychological resilience and quality of life. Our goal is to provide a comprehensive overview of how physicians coped with the unprecedented global health challenges.MethodsWe carried out a national cross-sectional study of 265 physicians in Romania between January 2021 and January 2022 using a web-based questionnaire. The study employed a web-based questionnaire to assess coping mechanisms using the COPE inventory, resilience through the Connor-Davidson Resilience Scale 25 (CD-RISC 25), and quality of life via the WHOQOL-BREF scale. The COPE inventory, consisting of 60 items across 15 subscales, categorizes coping strategies into problem-focused, emotion-focused, and dysfunctional types, with each item rated on a 4-point scale. The CD-RISC 25 measures resilience on a 5-point Likert scale, with total scores ranging from 0 to 100. WHOQOL-BREF assesses quality of life through 26 items in 4 domains: physical, mental, social relations, and environmental, scored from 1 to 5 and converted to a 0–100 scale for domain scores. Univariate and multivariate linear regression models were employed to discern the intricate relationships between coping strategies, resilience levels, quality of life dimensions, and pertinent demographic factors.ResultsThe average CD-RISC score among participants was 66.2. The mean scores for the values for the QOL subscales were 64.0 for physical well-being, 61.7 for psychological well-being, 61.2 for social relationships, and 64.7 for environment. Individuals tend to use problem-focused and emotion-focused coping more than dysfunctional mechanisms, according to the COPE inventory. Problem-focused and emotion-focused coping are positively correlated with resilience, while dysfunctional coping is negatively correlated. Resilience is significantly influenced by gender and professional status, with males and senior specialists reporting higher levels while younger physicians and residents reporting lower levels.ConclusionsOur data points to specific protective characteristics and some detrimental factors on physicians' resilience and quality of life during the pandemic.

Two-step periosteal releasing incision for tension-free flap closure after implant placement with simultaneous guided bone regeneration.

We evaluated the effect of periosteal-releasing incisions on flap displacement in anterior maxillary sites following implant placement and simultaneously guided bone regeneration. Thirty patients requiring a single dental implant and guided bone regeneration in the maxillary esthetic zone were recruited. After full-thickness flap elevation, the displacement of the flap was measured under a standardized tension of 1 Ncm. Then, a two-step periosteal releasing incision was placed in the internal aspect of the flap, and the displacement was remeasured using the same standardized tension. Keratinized tissue width and mucosal thickness at the surgical site were recorded. Patient-reported outcomes were assessed at the 7- and 14-day recall visits. Flap displacement (primary outcome) was calculated before and after periosteal-releasing incisions. Multivariable linear regression models were used to evaluate the influence of mucosal thickness on flap displacement and adjusted for Keratinized tissue width. Primary wound closure was achieved in all patients. The mean difference in flap coronal displacement before and after the periosteal-releasing incisions was 8.2 mm (p<0.0001). Adjusted regression models showed no association between mucosal thickness and keratinized tissue width with the amount of flap displacement (p=0.770). PROMs for pain, swelling, and bleeding amounted to 1.28 ± 1.93, 1.36 ± 1.87, and 0.0 ± 0.0 at seven days and 0.11 ± 0.57, 0.56 ± 1.03, and 0.0 ± 0.0 at 14 days, respectively. Periosteal-releasing incisions using the two-step procedure described here are a predictable technique to obtain coronal flap displacements > 8 mm without increased surgical complications.