Multinominal Logistic Regression Research Articles

Relationship between dietary carotenoid intake and sleep duration in American adults: a population-based study

ObjectiveTo investigate the relationship between dietary carotenoid intake and sleep duration.MethodsAdults enrolled in the National Health and Nutrition Examination Survey (NHANES) 2007–2018 without missing information on dietary carotenoid intake (α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein + zeaxanthin), sleep duration, and covariates were included. Participants’ carotenoid consumption was divided into three groups by quartiles and sleep duration was grouped as short (< 7 h/night), optimal (7–8 h/night), and long (> 8 h/night). Multinominal logistic regression was constructed to examine the association between dietary carotenoid intake and sleep duration. Restricted cubic spline (RCS) regression was further utilized to explore their dose-response relationship. The weighted quantile sum (WQS) model was adopted to calculate the mixed and individual effect of 5 carotenoid sub-types on sleep duration.ResultsMultinominal logistic regression presented that people with higher intakes of α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein + zeaxanthin were less likely to sleep too short or too long. Consistent with the findings from multinominal logistic regression, the RCS models suggested a reverse U-shaped relationship between sleep duration and carotenoid intakes. The mixed effects were also significant, where β-cryptoxanthin and lutein + zeaxanthin were the top 2 contributors associated with the decreased risks of short sleep duration, while β-carotene, α-carotene, and β-cryptoxanthin were the main factors related to the lower risk of long sleep duration.ConclusionOur study revealed that the American adults with optimal sleep duration were associated with more dietary carotenoid intake, in comparison to short or long sleepers.

Mental health profiles and the related socio-demographic predictors in Hong Kong university students under the COVID-19 pandemic: A latent class analysis

While the COVID-19 pandemic has brought about significant challenges to mental health of university students, there is limited research in this area. Particularly, few studies examined the person-centered mental health symptom profiles such as depression and anxiety and the related socio-demographic predictors. Using Latent Class Analysis (LCA), this study investigated the symptom profiles of depression and anxiety in university students in Hong Kong under the COVID-19 pandemic and the socio-demographic predictors. A total of 978 undergraduate students completed an online questionnaire including socio-demographic factors and measures of depression and anxiety during the summer of 2022. The LCA identified three latent classes: “normal” group, “moderate comorbid depression and anxiety” group and “severe comorbid depression and anxiety” group. Multinominal logistic regression showed that comparing with the “normal” group and the “moderate symptom” group, the “severe symptom” group had higher personal financial difficulties and individual/family member unemployment during the pandemic. In contrast, other socio-demographic factors (age, gender, year of study, living status, and COVID-19 infection status) had no significant association with group status. The study contributes to understanding of person-centered depression and anxiety symptom profiles and the risk role of personal financial difficulty in mental health of university students under the pandemic.

Effect of baseline oestradiol serum concentration on the efficacy of anastrozole for preventing breast cancer in postmenopausal women at high risk: a case-control study of the IBIS-II prevention trial

An increased risk of breast cancer is associated with high serum concentrations of oestradiol and testosterone in postmenopausal women, but little is known about how these hormones affect response to endocrine therapy for breast cancer prevention or treatment. We aimed to assess the effects of serum oestradiol and testosterone concentrations on the efficacy of the aromatase inhibitor anastrozole for the prevention of breast cancer in postmenopausal women at high risk. In this case-control study we used data from the IBIS-II prevention trial, a randomised, controlled, double-blind trial in postmenopausal women aged 40-70 years at high risk of breast cancer, conducted in 153 breast cancer treatment centres across 18 countries. In the trial, women were randomly assigned (1:1) to receive anastrozole (1 mg/day, orally) or placebo daily for 5 years. In this pre-planned case-control study, the primary analysis was the effect of the baseline oestradiol to sex hormone binding globulin (SHBG) ratio (oestradiol-SHBG ratio) on the development of all breast cancers, including ductal carcinoma in situ (the primary endpoint in the trial). Cases were participants in whom breast cancer was reported after trial entry and until the cutoff on Oct 22, 2019, and who had valid blood samples and no use of hormone replacement therapy within 3 months of trial entry or during the trial. For each case, two controls without breast cancer were selected at random, matched on treatment group, age (within 2 years), and follow-up time (at least that of the matching case). For each treatment group, we applied a multinominal logistic regression likelihood-ratio trend test to assess what change in the proportion of cases was associated with a one-quartile change in hormone ratio. Controls were used only to determine quartile cutoffs. Profile likelihood 95% CIs were used to indicate the precision of estimates. A secondary analysis also investigated the effect of the baseline testosterone-SHBG ratio on breast cancer development. We also assessed relative benefit of anastrozole versus placebo (calculated as 1 - the ratio of breast cancer cases in the anastrozole group to cases in the placebo group). The trial was registered with ISRCTN (number ISRCTN31488319) and completed recruitment on Jan 31, 2012, but long-term follow-up is ongoing. 3864 women were recruited into the trial between Feb 2, 2003, and Jan 31, 2012, and randomly assigned to receive anastrozole (n=1920) or placebo (n=1944). Median follow-up time was 131 months (IQR 106-156), during which 85 (4·4%) cases of breast cancer in the anastrozole group and 165 (8·5%) in the placebo group were identified. No data on gender, race, or ethnicity were collected. After exclusions, the case-control study included 212 participants from the anastrozole group (72 cases, 140 controls) and 416 from the placebo group (142 cases, 274 controls). A trend of increasing breast cancer risk with increasing oestradiol-SHBG ratio was found in the placebo group (trend per quartile 1·25 [95% CI 1·08 to 1·45], p=0·0033), but not in the anastrozole group (1·06 [0·86 to 1·30], p=0·60). A weaker effect was seen for the testosterone-SHBG ratio in the placebo group (trend 1·21 [1·05 to 1·41], p=0·011), but again not in the anastrozole group (trend 1·18 [0·96 to 1·46], p=0·11). A relative benefit of anastrozole was seen in quartile 2 (0·55 [95% CI 0·13 to 0·78]), quartile 3 (0·54 [0·22 to 0·74], and quartile 4 (0·56 [0·23 to 0·76]) of oestradiol-SHBG ratio, but not in quartile 1 (0·18 [-0·60 to 0·59]). These results suggest that serum hormones should be measured more routinely and integrated into risk management decisions. Measuring serum hormone concentrations is inexpensive and might help clinicians differentiate which women will benefit most from an aromatase inhibitor. Cancer Research UK, National Health and Medical Research Council (Australia), Breast Cancer Research Foundation, and DaCosta Fund.

Comorbid trajectories of posttraumatic stress disorder symptoms and depressive symptoms in a 10-year cohort of Chinese Wenchuan earthquake survivors: Course, predictors, and consequences.

Survivors may suffer mental health problems following disasters, particularly posttraumatic stress disorder (PTSD) and depressive symptoms. However, few studies have explored longitudinal processes of co-occurring PTSD and depressive symptoms among adolescent survivors and their associated predictors and consequences. The present study examines the codevelopment of both symptoms postearthquake using a 10-year cohort. A total of 1,357 senior high school students reported PTSD and depressive symptoms at 6, 12, 18, and 24 months after the 2008 Wenchuan earthquake. Self-report measures were also used to evaluate earthquake exposure, negative life events, social support, and trait resilience. At the 10-year follow-up (T10y), 799 participants reported their quality of life (QoL) online and 744 of them provided available data. A parallel-process latent class growth analysis was used to identify trajectories. Multinominal logistic and linear regressions were used, respectively, to analyze the predictors and consequences of these trajectories. Three comorbid trajectories were found: a resilient group (56.7%), a vulnerable group (33.3%), and a chronic high-risk group (9.9%). Gender, injury/missing/killed of family members, witnessing of traumatic sciences, negative life events, social support, and trait resilience were significant predictors of vulnerable and chronic high-risk groups. Finally, adolescents in these two groups were more likely to experience poorer QoL in adulthood. The results highlight the heterogeneity of depression-PTSD comorbidities among adolescent survivors. They also emphasize PTSD-depression symptoms predictors and their adverse impacts on life outcomes in adulthood. Individualized interventions should be provided for adolescents affected by natural disasters, especially those in the vulnerable and higher risk groups. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Patterns of sleep quality and its influence factors: A latent class model among students of medical university in Hubei Province, China

BackgroundSleep problem among undergraduate students has become one of the most pressing public health problems. This study aimed to explore the latent class of sleep patterns and the factors affecting sleep in Chinese students of medical university. Methods3423 students participated in the cross-sectional study. The survey consisted of the reduced Morningness-Evening Questionnaire, the Pittsburgh Sleep Quality Index, and Health-Promoting Lifestyle Profile-II. Latent profile analysis and multinominal logistic regression analysis were performed. ResultsThree potential sleep categories were identified: “sleep disorder group” (1.87 %), “daytime dysfunction group” (24.42 %), and “good sleep group” (73.71 %). Compared with the “good sleep group,” the “sleep disorder group” showed monthly living expenses (RMB) ≥ 3000 yuan (OR) = 13.04), interpersonal relationships as poor (OR = 3.71), health status as poor (OR = 45.09), circadian rhythm as eveningness (OR = 6.17), and poor health-promoting lifestyles (OR = 2.090) as its risk factors (all p < 0.05). Meanwhile, sophomore (OR = 1.75), junior (OR = 1.52), interpersonal relationships as poor (OR = 1.88), health status as poor (OR = 4.62), intermediate-chronotype (OR = 2.19), eveningness chronotype (OR = 5.66), and health-promoting lifestyles as poor (OR = 1.55) were identified as risk factors for the “daytime dysfunction group” (all p < 0.05). LimitationsCausal conclusions can not be drawn and recall bias in data collection. ConclusionsSignificant population heterogeneity was found in the sleep quality. Implementing targeted interventions focusing on circadian rhythm and lifestyle is crucial to improve the sleep quality of students with different conditions.

Helping behaviours of community members towards older adults and the related factors: a cross-sectional study.

Community members can play important roles in helping older adults in their community. This study aimed to clarify the actual situation of community members' helping behaviours towards older adults and examine the related factors. This cross-sectional study was conducted using an online survey system with a sample of 1000 community members in the Tokyo metropolitan area selected using quota sampling. Participants were asked about their experiences with helping an older adult, involvement with older adults with dementia, knowledge of dementia and care resources in the community, and perceptions regarding the community. Content analysis was used to classify participants' freely answered responses about helping behaviours, with logistic regression analysis subsequently used to examine the related factors. Community members provided older adults with various types of spontaneous help, including help with walking (20.0%), accident care (16.8%), giving directions to a destination (11.6%), accompanying them to a destination (12.9%), and support in daily life (10.4%). In the multinominal logistic regression analysis, advanced helping behaviours were associated with having a family member with dementia, experiences involving people living with dementia, knowledge of dementia and community support centres, and a stronger sense of community integration (P < 0.05). The reasons for not being able to help included being physically unable to (42.5%), not feeling responsible (19.3%), not knowing how to help (17.4%), and hesitating to help (14.4%). The results suggest that providing learning opportunities for community members could further promote their helping behaviours for older adults. These could include interacting with older adults, especially those living with dementia; promoting a sense of community integration; or receiving training in helping actions. Such efforts could support the development of an effective community-based care system for older adults.

Blood pressure in the longevous population with different status of hypertension and frailty.

Blood pressure(BP) of the longevous population with hypertension and/or frailty was under-investigated. To investigate the association between age, BP, variation of BP, and survival among the old adults with different status of hypertension and frailty, the present study included adults ≥65 years in the Chinese Longitudinal Healthy Longevity Survey(2008-2018), defined frailty using the Fried criteria, and identified hypertension by self-report or SBP/DBP ≥ 140/90 mm Hg. The association between age and BP were investigated using linear regression models. Variation of BP was defined if annual change of BP lower than quartile1(sharp decrease) or higher than quartile3(sharp increase). The association between age and BP variation were investigated using multinominal logistic regression models. The association between BP and survival was analyzed using Cox regression models. Among 13,447 adults(centenarian: 1965[14.6%]), age was positively associated with SBP in robust hypertensive elderly but negatively associated with it in frail hypertensive elderly. Annual change of BP was more likely to be increment among the normotensive elderly, but be decrement among the hypertensive elderly, especially among those with frailty. SBP < 120 mmHg was the risk factor of mortality among the frail oldest-old(≥85 years) while SBP ≥ 150 mmHg was that among the robust young-old(65-84 years). DBP ≥ 90 mmHg was the risk factor of mortality both in the robust young-old and the frail oldest old. In conclusion, age and frailty might be the criteria to predict the change of BP to guide the BP management of the longevous population.

LOADING OF PHYSICAL ACTIVITY REDUCES RISK OF SARCOPENIA IN MIDDLE-AGED ADULTS

AbstractObjectivesThe aim of this study was to investigate whether mechanical loading induced by physical activity can reduce risk of sarcopenia in middle-aged adults.MethodsThis was a longitudinal study based on a subset of UK Biobank data consisting of 1,918 participants (902 men and 1,016 women, mean age 56 years) who had no sarcopenia at baseline (assessed between 2006 and 2010). The participants were assessed again after 6 years at follow-up, and were categorized into no sarcopenia, probable sarcopenia, or sarcopenia according to the definition and algorithm developed in 2018 by European Working Group on Sarcopenia in Older People (EWGSOP). Physical activity was assessed at a time between baseline and follow-up using 7-day acceleration data obtained from wrist worn accelerometers. Raw acceleration data were then analysed to study the mechanical loading of physical activity at different intensities (i.e. very light, light, moderate-to-vigorous). Multinominal logistic regression was employed to examine the association between the incidence of sarcopenia and physical activity loading, between baseline and follow up, controlled for other factors at baseline including age, gender, BMI, smoking status, intake of alcohol, vitamin D and calcium, history of rheumatoid arthritis, osteoarthritis, secondary osteoporosis, and type 2 diabetes.ResultsAmong the 1918 participants with no sarcopenia at baseline, 230 (69 men and 161 women) developed probable sarcopenia and 37 (14 men and 23 women) developed sarcopenia at follow-up. Physical activity loading at moderate-to-vigorous intensity was higher in men (p&lt;0.05), while women had higher physical activity loading at very light intensity (p&lt;0.05). No significant difference was found in physical activity loading at light intensity between men and women (p&gt;0.05). Logistic regression models showed that increase in physical activity loading at moderate-to-vigorous intensity significantly reduced the risk of sarcopenia (odds ratio = 0.368, p&lt;0.05), but not probable sarcopenia (odds ratio = 0.974, p&gt;0.05), while loading at light or very light activity intensity were not associated with the risk of sarcopenia or probable sarcopenia (p&gt;0.05).ConclusionLoading of physical activity at moderate-to-vigorous intensity could reduce risk of sarcopenia in middle-aged adults.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Internalization of negative societal views on old age into self-perceptions of aging: exploring factors associated with self-directed ageism.

A growing number of research has provided evidence for the negative impact of ageism on older people's health and well-being. Among the three different manifestations of ageism, namely institutional, interpersonal and self-directed ageism, significant ageism-health associations have been proved to be strongest for self-directed ageism. This supports stereotype embodiment theory, which maintains that lifetime exposure to negative age stereotypes leads to the internalization of ageism as a form of negative attitudes towards own aging and it adversely affects health and well-being in old age. However, little is known about how people internalize negative age stereotypes held in the society into self-perceptions of aging. This study aimed to explore how socially shared beliefs about old age are internalized into self-perceptions of aging focusing on uncovering factors related to self-directed ageism. Data were derived from the survey that had examined citizen's attitudes towards old age and aging in Finland. Multinominal logistic regression models were performed to examine the association of sociodemographic and contextual factors with different combinations of societal age stereotypes and two indicators of self-perceptions of aging: subjective views on old age and personal feelings of own old age. The analyses showed that being female, attaining tertiary education, evaluating poor quality of life and awareness of institutional old age discrimination were related to holding negative views on aging towards both society and oneself. The findings from univariate and multivariate models suggest that it is not age per se, but structural and cultural circumstances shaped with growing older that turns socially shared negative age stereotypes into negative self-perceptions of aging. Even though the study addressed situations in one country, the findings have an important implication for other rapidly aging societies regarding how social and cultural contexts are closely linked to the formation of self-directed ageism.

Restless legs syndrome is prevalent in adults with cystic fibrosis and impacts sleep quality

BackgroundRestless legs syndrome (RLS) is a sensorimotor disorder that is prevalent in chronic inflammatory conditions. RLS prevalence, risk factors, and impact on sleep in CF have not been extensively characterized to date. MethodsAn initial cohort was examined, including 75 persons with CF (PwCF) and 75 control subjects, to look at the prevalence and severity of RLS. A second validation cohort of 191 PwCF was then enrolled from two CF centers to examine risk factors for RLS. A diagnosis of RLS was made according to the International RLS Study Group (IRLSSG) criteria. Sleep quality was identified using the Pittsburgh sleep quality index (PSQI). Epworth sleepiness scale (ESS) was used to measure daytime sleepiness. We then analyzed laboratory and clinical risk factors and sleep symptoms for potential risk factors for RLS. ResultsIn the initial cohort, 36 % of PwCF had RLS, and 9 % of these had significant RLS. In contrast, only 15 % of controls had RLS, and none had significant RLS. In the second larger validation cohort with 191 subjects, a comparable prevalence of RLS was identified. Higher hemoglobin A1c, use of SSRI/SNRI medications, worse PSQI and ESS sleep quality scores, lower lung function, and higher antibiotic usage were significantly associated with a diagnosis of RLS. By multivariate multinominal logistic regression analysis, higher HbA1c and worse PSQI global sleep quality scores were independent predictors of significant RLS. ConclusionsRLS is highly prevalent in CF. Higher HbA1c and poor sleep quality, signified by higher PSQI, were each independent predictors of RLS.

Frequency and Characteristics of Non-Neurological and Neurological Stroke Mimics in the Emergency Department.

Stroke mimics are common in the emergency department (ED) and early detection is important to initiate appropriate treatment and withhold unnecessary procedures. We aimed to compare the frequency, clinical characteristics and predictors of non-neurological and neurological stroke mimics transferred to our ED for suspected stroke. This was a cross-sectional study of consecutive patients with suspected stroke transported to the ED of the University Hospital Essen between January 2017 and December 2021 by the city's Emergency Medical Service. We investigated patient characteristics, preclinical data, symptoms and final diagnoses in patients with non-neurological and neurological stroke mimics. Multinominal logistic regression analysis was performed to assess predictors of both etiologic groups. Of 2167 patients with suspected stroke, 762 (35.2%) were diagnosed with a stroke mimic. Etiology was non-neurological in 369 (48.4%) and neurological in 393 (51.6%) cases. The most common diagnoses were seizures (23.2%) and infections (14.7%). Patients with non-neurological mimics were older (78.0 vs. 72.0 y, p < 0.001) and more likely to have chronic kidney disease (17.3% vs. 9.2%, p < 0.001) or heart failure (12.5% vs. 7.1%, p = 0.014). Prevalence of malignancy (8.7% vs. 13.7%, p = 0.031) and focal symptoms (38.8 vs. 57.3%, p < 0.001) was lower in this group. More than two-fifths required hospitalization (39.3 vs. 47.1%, p = 0.034). Adjusted multinominal logistic regression revealed chronic kidney and liver disease as independent positive predictors of stroke mimics regardless of etiology, while atrial fibrillation and hypertension were negative predictors in both groups. Prehospital vital signs were independently associated with non-neurological stroke mimics only, while age was exclusively associated with neurological mimics. Up to half of stroke mimics in the neurological ED are of non-neurological origin. Preclinical identification is challenging and a high proportion requires hospitalization. Awareness of underlying etiologies and differences in clinical characteristics is important to provide optimal care.

Effects of COVID-19 outbreak on Korean adolescents: Impact of altered economic perception on physical activity, sedentary behavior, and stress levels in an age-, gender-, and BMI-matched study.

The current study is to examine the disparities in physical activity (PA), sedentary behavior (SB), and stress levels in Korean adolescents concerning changes in their perception of family economic status (ES) during COVID-19. Among a total of 6144 Korean adolescents aged 12 to 18, the participants were categorized into two groups based on their responses regarding changes in their family ES due to COVID-19: Declined ES (n = 3072) and Non-changed ES (n = 3072), with matching in terms of age, gender, and BMI. All variables were assessed using the 16th year (2020) of the Korean Youth Risk Behavior Survey. Statistical analyses were conducted using the SPSS 26.0 version, employing independent t-tests to examine anthropometrics' differences and multinominal logistic regression to predict the impact of perception of family ES on PA, SB, and stress while comparing the two groups. The significance level was set at α = 0.05. Adolescents in the Declined ES group were 1.2 times more likely to engage in MVPA for less than 420 mins/wk (OR = 1.16, p = 0.039), 1.7 times more likely to meet recommended muscular strength activities (i.e., ≥ 3 days/wk) (OR = 1.70, p < 0.001), 37% less likely to not meet recommended recreational sitting time (i.e., ≥ 840 mins/wk) (OR = 0.63, p < 0.01), and were 2.1 times more likely to experience very severe stress level than the Non-changed ES group (p < 0.001). These results shed light on the importance of promoting mental health care in adolescents, regardless of PA levels, for their well-being during potential future pandemics. Understanding the impact of perceived ES changes on health behaviors can inform targeted interventions and support strategies to improve the mental health outcomes of adolescents during challenging times.

Association of Sarcopenia and Its Defining Components with the Degree of Cognitive Impairment in a Memory Clinic Population.

Sarcopenia and cognitive impairment are two leading causes of disabilities. The objective was to examine the prevalence of sarcopenia and investigate the association between sarcopenia diagnostic components (muscle strength, muscle mass, and physical performance) and cognitive impairment in memory clinic patients. 368 patients were included (age 59.0±7.25 years, women: 58.7%), displaying three clinical phenotypes of cognitive impairments, i.e., subjective cognitive impairment (SCI, 57%), mild cognitive impairment (MCI, 26%), and Alzheimer's disease (AD, 17%). Sarcopenia was defined according to diagnostic algorithm recommended by the European Working Group on Sarcopenia in Older People. Components of sarcopenia were grip strength, bioelectrical impedance analysis, and gait speed. They were further aggregated into a score (0-3 points) by counting the numbers of limited components. Multi-nominal logistic regression was applied. Probable sarcopenia (i.e., reduced grip strength) was observed in 9.6% of the patients, and 3.5% were diagnosed with sarcopenia. Patients with faster gait speed showed less likelihood of MCI (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.06-0.90) and AD (OR: 0.12, 95% CI: 0.03-0.60). One or more limited sarcopenia components was associated with worse cognitive function. After adjusting for potential confounders, the association remained significant only for AD (OR 4.29, 95% CI 1.45-11.92). The results indicate a connection between the sarcopenia components and cognitive impairments. Limitations in the sarcopenia measures, especially slow walking speed, were related to poorer cognitive outcomes. More investigationsare required to further verify the causal relationship between sarcopenia and cognitive outcomes.

Abstract 13339: Proteomic Associations of Cardiac Function Trajectories Through Mid- to Late Life

Introduction: Using a novel Bayesian nonparametric modeling approach based jointly on LVEF and E/A ratio, we previously identified 3 trajectories of cardiac function through mid- to late life that associated with heighted risk of incident heart failure (HF): trajectory 1 demonstrated failure to increase LVEF with age; trajectory 2 had progressive LVEF decline; and trajectory 3 had steeper than expected rise in E/A ratio. Trajectories 1 and 2 associated with higher risk of HFrEF while trajectory 3 associated with HFpEF. Whether circulating proteins differ between trajectories is unknown. Methods: We assigned 4,419 HF-free participants with available proteomic data (SomaScan v4) at study Visit 5 of the Atherosclerosis Risk in Communities study to their most likely trajectory (2,201 trajectory 1, 162 trajectory 2, 348 to trajectory 3). Associations of plasma proteins with trajectory membership were assessed using multinominal logistic regression analyses adjusted for age and sex at a false discovery rate &lt;0.05. Two-sample Mendelian randomization (MR) was performed to assess potential causal effects between trajectory-associated proteins and LV volume and LVEF. Results: Mean age was 75±5 years and 58% were women. Several unique and shared proteins associated with each high-risk trajectory (Figure). MR identified potential causal effects of 13 trajectory-associated proteins on LV volume and LVEF. These included trajectory 3-associated proteins (B3GNT2, MFAP4) with genetically higher levels associated with smaller LV size and higher LVEF, consistent with the observed association with HFpEF. One trajectory 1-associated protein (HADH) had MR association with lower LVEF, consistent with the observed association with HFrEF. Conclusions: A Bayesian nonparametric model using multidimensional imaging data identifies trajectories of cardiac function with distinct proteomic associations, a subset of which have potential causal effects on cardiac function.

Active and productive ageing in India: evidence from the time use pattern of ageing adults

BackgroundWith the increasing proportion of older adults in India, it becomes essential to get an insight into the various influencing factors of successful ageing. However, the literature on successful ageing is minuscule in the Indian context. The present study attempted to understand successful ageing in terms of active and productive ageing by exploring their determining factors.MethodsThe data were extracted from the Longitudinal Ageing Study in India (LASI) Wave–1 (2017–2018). We utilized self-reported time use information from the experimental module of the LASI. A total of 7837 ageing adults were included in the study. We employed descriptive statistics, bivariate analysis and a multinominal logistic regression model to examine the prevalence and the determinants of active and productive ageing.ResultsThe prevalence of inactive ageing was higher among the Indian ageing population (57.47%), followed by active ageing (29.59%) and productive ageing (12.94%). Poor sleep quality and the prevalence of morbidity and disability limited the ageing population from attaining active and productive ageing. Engagement in physical activity was significantly associated with active and productive ageing (β = 0.83, 99% CI: -0.72–0.94 and β = 0.82, 99% CI: 0.66–0.98), respectively. Rural ageing adults were more likely to attain active ageing and less likely to attain productive ageing.ConclusionEngagement in physical activities among the ageing population shall be promoted to attain active and productive ageing. Since the rural ageing population were less likely to attain productive ageing than their urban counterparts, opportunities to participate in more formal economic activities in rural areas could be promoted for the wellbeing of the second demographic dividend.

Social Determinants and the Prevalence of Paan Masala Use among Adults in India: Results from Global Adult Tobacco Survey, 2016-17.

Gutkha or Paan masala with tobacco is commonly used smokeless tobacco product in India. Given the restrictions on advertisement and promotion of Gutkha and the necessity of warning labels on tobacco products, the tobacco industry has popularised paan masala without tobacco as a surrogate product. Paan masala itself is harmful for health but remains beyond scope of current tobacco control policies. It was important to understand prevalence and determinants of its use (with or without tobacco). Data from the Global Adult Tobacco Survey (GATS)-2, India was used to estimate prevalence of paan masala use (with or without tobacco) in India. Multi-nominal regression and logistic regression were used to calculate risk ratios and odds ratios. The prevalence of any form of paan masala was 12.1% among adults in India. Prevalence was higher among males (17.8%) than females (6.0%), aged 25-44 years (14.5%) than those aged 65 years or above (9.0%). Relative risk ratio (RRR) for Paan masala with tobacco was significantly high among those with no formal schooling (RRR:2.00) and among those in poorest wealth quintiles (RRR:1.26). While, RRR were lower for Paan masala use without tobacco among those with no formal schooling (RRR:0.95) and among poorest wealth quintiles (RRR:0.78). Region-wise AOR were highest for North-East (AOR:4.80) and Central regions (AOR:4.76) compared to South India. The prevalence of paan masala use is high in India. Persons belonging to lower socioeconomic status or having no formal schooling have higher risk of consuming paan masala with tobacco. However, persons from higher wealth quintiles or having formal schooling had higher risk of use of paan masala without tobacco. These findings need careful attention of policy makers and law enforcers as it indicates different marketing strategies might have adopted by industry to target these two mutually exclusive population groups.

Caesarean sections before and during the COVID-19 pandemic in western Sydney, Australia

Background To determine the changes in emergency and elective caesarean section (CS) rates since the COVID-19 pandemic, identify the groups most affected, and examine changes in the factors associated with CS rates, and reasons for CS. Methods We conducted a retrospective cohort study using routinely collected data of 22,346 births from before the pandemic (January 2018–February 2020) and 18,597 births during the pandemic (March 2020–December 2021). Data were analysed using multinominal logistic regression. Results The CS rate increased by 4.1% (from 30.1% to 34.2%), reflecting increases of 2.3% in emergency CS (from 11.5% to 13.8%) and 1.7% in elective CS (from 18.7% to 20.4%). Large groups with notable increases were women who were nulliparous (7.2% increase), from South Asia (6.0%), obese (5.2%) and giving birth at a small hospital (6.1%). Compared to pre-pandemic, the relative risk of an emergency CS versus a vaginal delivery increased 1.36 times (adjusted relative risk ratio (aRRR) = 1.36; 95% CI = 1.27, 1.45) and the risk of having an elective CS increased 1.11 times (aRRR = 1.11; 95% CI = 1.04, 1.20). Factors associated with both emergency and elective CS were age, region of birth, reproductive history, body mass index, hypertension, diabetes, mode of antenatal care and hospital. Socio-Economic Indexes for Areas and antenatal care were only associated with elective CS. Baby gender was only associated with emergency CS. Preterm gestation at delivery was associated with reduced emergency but increased elective CS. Foetal compromise was the most common indication for emergency CS (43.2%) and increased the most (8.0%). Previous CS was the most common indication for elective CS (61.5%) and reduced the most (1.9%). Conclusions Both emergency and elective CS rates increased significantly during the pandemic, with the former increasing at a higher rate. The persistent upward trend of CS rates, exacerbated by increasing proportions of nulliparous women undergoing CSs, is concerning.

Transitions in and out of work across the life course of patient with a NCD diagnosis

Abstract Background Coupled with its impact on quality of life, non-communicable Diseases (NCD) may degrade both the quality and quantity of the workforce, and stunt economic growth and productive employment. However, there is limited information about the social costs of NCDs to identify priorities in resource allocation, particularly in regard to retirement policies. In this paper, we investigate if NCDs affect them employment status, i.e., the patients’ ability to work beyond middle age, using longitudinal data. Methods We used longitudinal data from employed men and women who responded to the sixth and seventh waves of the SHARE project from several European countries and Israel. We restricted the sample to all people working up to 3 years before the expected retirement age for each country. To achieve a representative sample of employed people from each country we calculated calibrated longitudinal individual weights for participants in these two waves. It was to adjust for non-response, sample selection bias, and attrition (N = 9645). We modelled the probability to change employment status on Wave 7 as function of having a NCD, adjusting for age, gender, marital status, job satisfaction, education level, and country, using multinominal logistic regressions. Results Overall, 30.3% of the study population self-reported one NCD and 28.3% mentioned at least two chronic health conditions (multimorbidity). Among multimorbid individuals the risk of unemployment is 1.27 times more (OR = 1.271, 95% CI (1.266-1.276).), while the risk of retirement is multiplied by 1.26 (OR = 1.259, 95%CI (1.255-1.262)). Conclusions Having one NCD or multimorbidity is a common phenomenon in the working middle-aged European population. It is associated with unemployment and retirement, controlling for educational level, age, marital status, gender, job satisfaction, and country. This result highlights that early retirement will persist unless health policies are implemented to decrease the burden of NCDs. Key messages • This study shows that there is a strong association between having one or more NCD with unemployment and retirement, controlling for educational, age, and occupational type. • Results reinforce that we need health policies focused on alerting society about real impact of NCD on employment.

Correlation of Brain Metastasis Genomic Alterations with Preoperative Imaging Features

The aim of this study was to examine associations between genomic alterations in brain metastases and common preoperative imaging findings including overt intratumoral hemorrhage, cystic features, and edema. A single-center, retrospective study was performed including patients who underwent surgical resection of brain metastasis with available preoperative magnetic resonance imaging (MRI). Next-generation sequencing of more than 500 coding genes was performed on the resected brain metastases. Preoperative MRI was reviewed to identify the presence of intratumoral hemorrhage, cystic features, and edema in the resected brain metastasis. Genomic data were then correlated with the imaging features using univariate and multivariate nominal logistic regression analyses. We included 144 brain metastases from 141 patients in the study cohort. Half (72) of the metastases had an intratumoral hemorrhage, 26 (18%) had cystic features, and 130 (90%) had edema. Mutations in TP53 were associated with a reduced risk of intratumoral hemorrhage (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.07-0.5, P< 0.001). Mutations in RB1 and CCND1 were associated with elevated risk of the metastasis having cystic features (OR 10.3, 95% CI 2.0-52.6, P= 0.005, OR 18.4, 95% CI 2.2-155.3, P= 0.008, respectively). PIK3CA mutations were associated with a reduced risk of peritumoral edema (OR 0.2, 95% CI 0.04-0.8, P= 0.03). Several genomic alterations in brain metastases are associated with MRI features including hemorrhage, cystic features, and edema. These results provide insight into tumor biology and patients at risk of developing these imaging features.

Association of Obesity, Metabolic Syndrome, and Diabetes With Urinary Incontinence and Chronic Kidney Disease: Analysis of the National Health and Nutrition Examination Survey, 2003-2020.

Diabetes and obesity, components of the metabolic syndrome (MetS), are risk factors for urinary incontinence (UI) and chronic kidney disease (CKD). We interrogated US population-based data to explore independent, sex-specific associations between nondiabetic MetS, with and without obesity, and UI and/or CKD. We analyzed data from 8586 males and 8420 females ≥20 years from the National Health and Nutrition Examination Survey. Multivariable logistic regression models were used to examine associations of UI or CKD with diabetes and 4 nondiabetic obesity/metabolic phenotypes: non-MetS/nonobese, MetS/nonobese, non-MetS/obese, and MetS/obese. Multinominal logistic regression models were used to assess associations of co-occurring UI/CKD with obesity/metabolic phenotypes. Male MetS/obese participants had increased odds of any UI (1.25; 95% CI 1.00-1.57) and urgency UI (1.36; 1.03-1.80), compared with non-MetS/nonobese participants. Female MetS/obese participants had increased odds of any UI (2.16; 95% CI 1.76-2.66), stress UI (1.51; 1.21-1.87), and mixed UI (1.66; 1.31-2.11) compared with non-MetS/nonobese participants. The odds of co-occurring UI/CKD were increased relative to either condition alone in persons with diabetes, and in males with MetS/obese phenotypes and females with MetS phenotypes as compared to same sex participants with neither obesity nor MetS. We found novel associations between MetS/obese and urgency UI in males without diabetes, and between SUI and both MetS and obesity in females without diabetes. Odds estimates for UI/CKD were increased by existing obesity or MetS as compared to those for UI or CKD alone. Improved understanding of modifiable factors associated with UI will inform prevention and treatment opportunities.