Nonparametric Research Articles

Investigating Sociodemographic Features, Childhood Trauma, Personality and Psychological Symptoms as Predictors of Emotional Eating

This study examined the relationship of sociodemographic variables, childhood traumas, personality traits, and psychological symptoms with emotional eating in adults. The study was conducted on a total of 382 individuals aged 18-65 years. The Turkish Emotional Eating Scale, the Childhood Trauma Questionnaire (CTQ), the Brief Symptom Inventory, the Eysenck Personality Questionnaire Revised Abbreviated (EPQR-A), and the Demographic Information Form were administered to the participants. Non-parametric and regression analyses were performed due to the distribution pattern. All childhood trauma subscales were found to be associated with emotional eating except for the physical neglect subscale. When the relationship between psychological symptoms and emotional eating was examined, a significant positive relationship was found. The neuroticism sub-dimension of personality traits was positively associated with emotional eating. When socio-demographic variables were analyzed, a significant relationship was found between emotional eating and gender, marital status, educational status, income status, employment status, self-image, and efforts to lose weight. It was found that BSI anxiety, self-perception, age, occupation, mental disorder, gender, height, CTQ total score, emotional abuse, and somatization variables significantly predicted emotional eating behavior, and the variables explained 40.40% of the variance. The research findings were discussed in the context of the literature.

P-544. Whole Food Plant-Based Diet for HIV-Associated Reduction in Cardiovascular Risk: A Pilot Randomized Clinical Trial (PLANT-HART)

Abstract Background Globally, 39 million people are affected by HIV, most of whom are on antiretroviral therapy (ART), which increases cardiovascular risks. Guidelines lack specific dietary recommendations for this population, though plant-based diets may reduce these risks. This pilot study (NCT05796882), to our knowledge, is the first to explore the effects of a plant-based diet on cardiovascular risk in HIV-positive individuals.Table 1.Differences in variables for both groups combined and their statistical significance. Paired sample analysis. Methods This randomized controlled pilot clinical trial, conducted in Mexico, involved HIV-positive adults on stable ART, aged 30-60, with a body mass index > 25 and ≥ 1 cardiovascular risk factor. Exclusion criteria included: acquired immunodeficiency syndrome, major cardiovascular events, substance abuse, and ART non-adherence. Of 150 invited, 21 consented and 10 completed the 8-week intervention. Outcomes were analyzed using non-parametric tests (Wilcoxon Sign-rank and Mann-Whitney U). The ethics committee approved; all participants provided informed consent. Results Ten male participants (mean age 40.3 ± 8.2) were divided into a plant-based diet (PBD, n=4) and a nutritional standard care (NSC, n=6) group. After 8 weeks, reductions in cardiovascular risk were observed; the NSC group experienced a -0.9% in Framingham Hard Coronary Risk (p=0.2) and the PBD group a -0.1% (p=0.1). Blood pressure decreased significantly in both groups: systolic blood pressure decreased by 15.2 mmHg (p=0.01) and diastolic blood pressure by -7.3 mmHg (p=0.02) (Table 1). The PBD group also showed reductions in weight (-700g, p=0.7), body fat percentage (-0.9%, p=1.0), tricipital fold (-3mm, p=0.06), total cholesterol (-32.0 mg/dL, p=0.1) and LDL cholesterol (-39.7 mg/dL, p=0.2), though not statistically significant. Conclusion This pilot study suggests that a plant-based diet may reduce cardiovascular risks in HIV-positive individuals. Both groups were significant for reducing systolic and diastolic blood pressure. The plant-based diet can potentially be beneficial for weight and cholesterol management. Despite a small sample size and adherence challenges, regular follow-ups and dietary self-reports enhanced compliance, underscoring the need for larger, comprehensive studies to confirm these findings. Disclosures All Authors: No reported disclosures

Atrial strain assessment in elite athletes: unveiling physiologic adaptation

Abstract Background Left atrial (LA) strain, measured by speckle-tracking echocardiography, provides insights into cardiac function beyond traditional volumetric assessments. In athletes, the effects of chronic exercise on LA strain are unclear, with conflicting findings on whether it reflects physiological adaptation or potential dysfunction. Aims This study aimed to comprehensively assess LA remodeling and function in professional soccer players compared to controls. We hypothesized that while athletes would exhibit LA enlargement, their atrial function would remain preserved due to the physiological nature of cardiac remodeling in this population. Methods A retrospective analysis of echocardiographic parameters, namely left atrial strain, was carried out in a group of professional male athletes compared to a control group of healthy male individuals. A GE Vivid E95 echocardiographic ultrasound system and EchoPAC V.206 software (GE Vingmed Ultrasound AS, Horten, Norway) were used. Shapiro-Wilk test was used to test data distribution, ANOVA and t-test were used as a parametric tests, and Man-Whitney as a non-parametric Test (SPSS v.27). Results The study analyzed 111 athletes with a median age of 24 (21-31) years and 70 healthy male individuals from the control group with a median age of 27 (23-32) years. Athletes had a significantly higher indexed left atrial end-systolic volume compared to the control group (41 ± 9 ml/m² vs. 31 ± 7 ml/m², p<0.001). Despite the difference in volume, the early and late diastolic tissue velocities were similar in both groups and E/E’ was lower (4.4 ± 0.9 vs. 5.0 (4.5-5.8), p<0.001). There were no significant differences between athletes and the control group in Left Atrial Reservoir Strain (LASr) and Left Atrial Conduit Strain (LAScd). The active contraction of the left atrium during atrial systole is reduced in athletes, which had a significantly lower left atrial contraction strain compared to the control group (-9 (-11 – -8)% vs. -12 ± 4%, p<0.001). Conclusion The data suggests that athletes' hearts have undergone specific adaptations, particularly in terms of increased left atrial size and altered contraction patterns. Maintaining atrial reservoir strain (the most validated parameter for normality) and atrial conduit strain within normal ranges may indicate that morphological changes are merely normal adaptations to the high cardiac output demands during exercise. Descriptive analysis LA strain example

A quality improvement initiative aimed at reducing service strain and improving physician wellness in internal medicine

IntroductionHospital strain has been shown to negatively impact physician wellness, educational experience, and patient care. To address rising service demands, a non-academic hospitalist service was implemented to reduce daily clinical teaching unit (CTU) census by approximately 30%. Secondary aims were to evaluate physician and trainee wellness on CTU as well as assess unintended adverse patient outcomes.MethodsA two-phase intervention was implemented at one of two academic hospital campuses in January and April 2023. Mean daily census, mortality, 30-day readmissions, and length of stay (LOS) were obtained from an administrative database for the pre-study (October to December 2022) and study (January to December 2023) periods. The Mini-Z physician wellness survey was administered in March, June and December 2023. Data were analyzed by quarters using descriptive statistics as well as parametric and non-parametric testing, and a reflexive thematic analysis was undertaken.ResultsA CTU census trough of 71.3 was briefly attained in the second quarter of 2023 but increased to 78.6 in the fourth quarter of 2023, while remaining below pre-intervention levels. The proportion of attendings and residents reporting burnout was significantly different at the intervention (65.2%, n = 15/23) versus non-intervention site (94.1%, n = 16/17) in Q4 2023 (p = 0.033). Burnout was positively correlated with daily CTU census across both sites (r = 0.906). There were no differences in proportion of in-hospital mortality (p = 0.854), 30-day readmissions (p = 0.262), or LOS (p = 0.977) between the pre- and post-implementation periods. Qualitative analysis identified the hospitalist program as beneficial, but inadequate to address workload, education challenges, and patient safety concerns.ConclusionThe addition of a non-academic hospitalist service reduced CTU census numbers and improved burnout, but the improvement in service strain was limited by rising admissions. Multifaceted approaches to wellness are needed, but this study supports ongoing endeavors aimed at reducing clinical workload to optimize the clinical teaching environment.

P-1991. Unique Demographic Characteristics of Patients Experiencing Long COVID

Abstract Background As the COVID-19 pandemic retreats, health care providers now treat many patients experiencing lingering symptoms long after their initial infection, also known as Long COVID (LC). Given that the population of those affected by LC has been generally cumulative, understanding the current demographics of this population is critical to public health planning. Methods The US Census Bureau Household Pulse Survey data was used in this analysis. The survey data was collected January 9 - February 5, 2024. Respondents were asked about a variety of demographic factors, as well as their self-reported COVID-19 experiences. The survey was conducted online; N=68,544 respondents were included in the analysis. Demographic factors were compared between those reporting LC, COVID-19 infection that had resolved (Short COVID, or SC), and those who had not experienced COVID (No COVID, or NC). Data were analyzed using X2, between group contrast analysis, and non-parametric tests. Results Among those surveyed, 16.5% reported experiencing LC, 42.2% reported SC and 41.3% reported NC. Among those who reported LC, 64.3% identified as female (vs. 53.1% SC and 53.0% NC, comparisons to LC p< .05). The median incomes by group were LC $54.6k, SC $75.4K, and NC $59.2K (all pairwise comparisons p< .001). Median age for those with LC was 50 years old, SC was 52 years old, and NC was 60 years old (all pairwise comparisons p< .001). LC individuals were 10.1% Hispanic of any race, compared to SC 8.0% and NC 7.6% (comparisons to LC p< .05). Additionally, 6.3% of those with LC described themselves as Black or African American, vs. 5.7% of SC and 9.6% NC (comparisons to NC p< .05). Conclusion Patients experiencing LC have a substantially different demographic profile than both those who experienced SC and NC. LC individuals are younger, poorer, more female, and more likely to be Hispanic. The reasons for these differences are unclear and merit further study, but the general finding that people with LC are more likely to belong to marginalized groups suggests they could have greater difficulty getting adequate care. Reportedly, LC patients may feel their illness is trivialized by others, and these findings underscore the importance for medical personnel to identify and validate LC patient experiences. Disclosures All Authors: No reported disclosures

The value of global longitudinal strain and myocardial work indices in the early detection of left ventricular systolic dysfunction in patients with acute myocarditis

Abstract Background/introduction Conventional transthoracic echocardiography (TTE) is found to have limited sensitivity in detecting myocardial damage in patients with acute myocarditis and preserved left ventricular ejection fraction (LVEF). Purpose This study aimed to investigate the role of global longitudinal strain (GLS) and myocardial work (MW) echocardiographic indices in the identification of subclinical left ventricular systolic dysfunction in patients with acute myocarditis. Methods The study retrospectively included all patients admitted to the cardiology clinic of a tertiary hospital between December 2019 and May 2024, with suspected myocarditis, preserved ejection fraction, negative findings for coronary artery disease on coronary angiography or coronary computed tomography angiography, and whose diagnosis of myocarditis was confirmed by cardiac magnetic resonance imaging (CMR) using the Lake-Louise criteria. Gender and age-matched healthy individuals were also enrolled. The echocardiographic parameters assessed included global longitudinal strain (GLS) and myocardial work indices, specifically Global Work Efficiency (GWE), Global Work Index (GWI), Global Wasted Work (GWW), and Global Constructive Work (GCW). Statistical analysis was performed using non-parametric tests (Mann-Whitney test) and the predetermined level of statistical significance was set at p<0.05. Results A total of 41 patients (34 males – 82.9%) and 32 healthy controls (25 males – 78%) were included in the study. The median age in the patient group was 28 years (range 16-46 years), and in the healthy controls group, it was 29 years (range 17-48 years). In the patient group, the median values were as follows: GLS -18%, GWE 96%, GWI 1636 mmHg%, GWW 66 mmHg%, and GCW 1842 mmHg%. In the healthy controls group, the median values were GLS -19.6%, GWE 96%, GWI 1856 mmHg%, GWW 76 mmHg%, and GCW 2095 mmHg%. Patients showed significantly lower absolute values of GLS (p=0.014), GWI (p=0.023), and GCW (p=0.005) compared to healthy individuals. There were no statistically significant differences found for GWE and GWW values between the two groups. Conclusion Our study suggests that GLS, GWI, and GCW indices may be valuable in the early detection of left ventricular dysfunction in patients with myocarditis and preserved ejection fraction. Larger epidemiological studies are needed to further validate these findings.

Musculoskeletal adverse events associated with CDK4/6 inhibitors: a real-world study using FDA Adverse Event Reporting System (FAERS) database

ObjectiveCyclin-dependent kinase (CDK)-4/6 inhibitors have significantly improved outcomes in several cancers but can also induce various organ system toxicities, including musculoskeletal disorders. This study aimed to comprehensively characterize the musculoskeletal adverse events (MSAEs) associated with CDK4/6 inhibitors based on real-world data.MethodsReports of MSAEs linked to CDK4/6 inhibitors from the first quarter (Q1) of 2015 and 2023 Q4 were extracted from the FAERS. Descriptive analyses evaluated report frequencies over time and patient characteristics. Disproportionality analyses using reporting odds ratios (RORs) identified signals for specific musculoskeletal preferred terms (PTs). Time-to-onset analyses examined the temporal patterns of MSAEs.ResultsA total of 10,095 MSAE reports associated with CDK4/6 inhibitors were identified, most involving Palbociclib (n = 7819). The median age of patients was 64 years (IQR: 55–72), predominantly female (97.73%). Most reports were submitted by consumers (47.62%) and the majority of reports were from the United States (71.53%). Disproportionality analyses revealed distinct signals, with Ribociclib showing prominent signals for bone pain and bone lesions, and Abemaciclib for osteonecrosis of the jaw and pathological fractures. Palbociclib demonstrated a consistent but less pronounced signal across musculoskeletal PTs. Time-to-onset analyses demonstrated a significantly longer onset of MSAEs for Palbociclib (median 82 days, IQR[14–311]) compared to Abemaciclib (32.5 days, IQR[12–119]) and Ribociclib (34 days, IQR[8-177]) using the nonparametric Kruskal-Wallis test (P-value = 3.048e-11).ConclusionMusculoskeletal toxicities is a significant adverse event that affects drug safety. Early identification and proper management of these events are crucial for patients receiving CDK4/6 inhibitors. Further research is warranted to elucidate the underlying mechanisms and improve risk mitigation strategies.

P-1895. Outpatient Parenteral Antimicrobial Therapy Multidisciplinary Partnership Reduces Readmissions and Emergency Center Visits in a Comprehensive Cancer Center

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) programs have reduced readmissions without impacting emergency center (EC) visits. Our initial pilot OPAT program improved laboratory monitoring without decreasing readmissions or EC visits. We expanded the program and made additive quality improvement interventions. Outcomes Associated with Outpatient Parenteral Antimicrobial Therapy Interventions in Patients Receiving Care at a Comprehensive Cancer Center *Previously published initial pilot program. **Compared with baseline among patients with >/= 1 EC visit. OPAT, Outpatient parenteral antimicrobial therapy; APP, advanced practice provider; EMS, electronic medical system; EC, emergency center; ID, infectious diseases Methods We obtained demographic data and baseline frequencies of 30-day unplanned readmissions and EC visits from our electronic medical system (EMS) for 48 patients over 6 weeks prior to pilot implementation. Using the Model for Improvement, we made iterative additions, including pharmacist regimen review, monitoring within the EMS, online commercial laboratory result access, weekly nursing phone calls after discharge, and expansion to infectious disease outpatient starts. After interventions, we compared categorical variables to baseline by using Chi-square or Fisher’s exact test, as appropriate, and compared continuous variables by using nonparametric Wilcoxon rank sum test. We performed multivariable logistic regression to identify risk factors independently associated with readmission. Results During June 2018–November 2023, our OPAT program provided care for 1,274 patients. Readmissions decreased from 30% to 15% (p = 0.02) (Figure). Mean number of EC visits per patient decreased (1.3 vs. 1.0, p = 0.002). In multivariable analysis, EMS monitoring and online access to laboratory results were independently associated with decreased readmission risk (aOR 0.22 [95% CI: 0.09-0.56]). Nursing calls after discharge independently protected against readmission (aOR 0.18 [95% CI: 0.07-0.47]). Patients with Eastern Cooperative Oncology Group-Performance Status ≥2 were readmitted more often than those with < 2 (aOR 1.63 [95% CI: 1.05-2.52]). Conclusion Improving efficiency and access to laboratory data and weekly nursing phone follow up were associated with fewer readmissions among OPAT patients with cancer. This study is the first, to our knowledge, to show an impact of OPAT on EC visits in any population. OPAT patients with poor functional status have an increased risk for readmission and may benefit from closer monitoring. OPAT programs can improve safety for adult patients with cancer despite competing risks inherent to this population. Disclosures Natalie J Dailey Garnes, MD, MPH, MS, AlloVir: Grant/Research Support

Rural-urban disparity in uptaking skilled antenatal care visits by pregnant women in Bangladesh: Zero and One Inflated Poisson regression model.

Utilization of maternal health care services, specifically, antenatal care services from skilled health providers have been given utmost priority in low- and middle-income countries over years with a view of mitigating complications during pregnancy as well as safeguarding the health and survival of both mother and newborn. However, there is a general tendency of pregnant mothers in Bangladesh of receiving skilled antenatal care (SANC) service once, or even never which refrains us to ensure World Health Organization (WHO) recommended eight plus SANC visits, additionally, to meet Sustainable Development Goal (SDG) number three. The study aims at assessing how the average number of SANC visits taken by the reproductive women in Bangladesh changes over the time in rural and urban areas together with finding out the potential demographic and socio-economic factors associated with SANC visits by addressing possible accumulation of zero and one counts in SANC visits. In this study, data have been retrieved from last four waves of Bangladesh Demographic and Health Surveys ranging from 2011 to 2022 and later combined together to form a pooled dataset. Non-parametric Kruskal-Wallis test has been performed for exploring unadjusted association of covariates with the response and Mann-Whitney U test has been conducted for multiple comparison in case of significant association for a covariate having more than two categories. For checking the existence of concurrent inflation at zero and one in the pooled dataset, partial score test has been performed. Based on the results of score test, Zero and One Inflated Poisson regression model has been fitted to the pooled dataset, where an interaction term between area of residence and survey year has been considered for trend analysis. The study highlights that the rate of mean SANC visits is rapidly rising with time among pregnant women not only from the urban areas but also from the rural areas of Bangladesh. However, the rate of change in uptaking the SANC visits is higher in rural area compared to urban area. It was observed that for a given survey year, the rate of mean SANC visits was higher among women from urban areas compared to that among women from rural areas of Bangladesh. This study provides the evidence of 17.2% extra zero counts and 1.1% extra one counts in the pooled dataset. The study results depict that inequity in SANC services based on area of residence prevails in Bangladesh. However, the gap in the rate of mean SANC visits in rural areas compared to urban areas has gradually reduced over time. Based on the results, the study comes up with some recommendations to facilitate the policy makers in improvising strategies and ensuring sustainable rise in SANC counts as well as WHO recommended positive pregnancy experience in the country to meet SDGs.

Effects of perioperative oxycodone as the sole opioid on immunity within a multi-modal analgesia framework in patients undergoing cervical cancer surgery: A randomised controlled trial

Background and Aims: Current views on oxycodone’s effects on immunity are inconsistent. Our objective was to compare the effects of perioperative oxycodone as the sole opioid in a multi-modal analgesia regimen with conventional opioid regimens on immunity in cervical cancer. Methods: In this randomised controlled trial (RCT), patients scheduled for laparoscopic radical hysterectomy for cervical cancer were randomised to receive either oxycodone (Group O) or conventional opioid regimens (Group C). The primary outcome was the CD4+/CD8+ ratios postoperatively at 24 and 48 h. Student’s t-test was used for normally distributed variables, the non-parametric Wilcoxon test for non-normally distributed variables, and Chi-square/Fisher’s exact test for qualitative variables, with differences significant set at P < 0.05. Results: We included 56 patients in the final analysis. The postoperative CD4+/CD8+ ratios were comparable between groups. However, the mean arterial pressures (MAPs) at extubation and 5 minutes thereafter were lower in Group O than in Group C (both P < 0.001), as were the heart rates (HRs) (P = 0.001 and 0.018, respectively). Within 24 h postoperatively, the visual analogue scale (VAS) scores for resting and movement-evoked pain were lower in Group O than in Group C (all P < 0.001), and the same was observed at 48 h postoperatively (both P = 0.002), as was the incidence of catheter-related bladder discomfort (P = 0.001). The VASs for postoperative analgesia satisfaction were higher in Group O than in Group C (P = 0.006). Conclusion: In laparoscopic surgery for cervical cancer, perioperative oxycodone as the sole opioid within a multi-modal analgesia framework does not yield anticipated benefits in immunopreservation compared to conventional opioid regimens but improves postoperative pain management and haemodynamic stability.

Assessment of hemo- and cerebrospinal fluid dynamics disorders in idiopathic normal pressure hydrocephalus according to MRI data: a prospective study

INTRODUCTION: Idiopathic normal pressure hydrocephalus (NPH) is a condition characterized by enlargement of the cerebral ventricles and an isolated disturbance of cerebrospinal fluid dynamics, the etiology and pathogenesis of which are still not fully determined.OBJECTIVE: To evaluate changes in hemo- and cerebrospinal fluid dynamics in idiopathic normal pressure hydrocephalus according to phase-contrast MRI data.MATERIALS AND METHODS: Three groups of subjects were formed: patients with NPH (12 people), elderly volunteers with atrophic ventriculomegaly (15 people), a group of healthy volunteers (15 people). For each subject, the data from a routine MRI study, the volumes of gray, white matter and cerebrospinal fluid were assessed, and the volume-velocity characteristics of CSF and blood flows at several levels were calculated.Statistics: For quantitative indicators of cerebrospinal fluid dynamics, the median (Me), 25% and 75% percentiles, and interquartile range were calculated. An intergroup assessment of the significance of differences was carried out using the Mann-Whitney U test and nonparametric multivariate analysis of variance MANOVA.RESULTS: Individual neuroimaging markers of IGT were determined, as well as an increase in the volume-velocity characteristics of CSF flow at the level of the cerebral aqueduct (p<0.01, with a predominance of the retrograde component) in comparison with the control group and patients with atrophic ventriculomegaly. Multidirectional changes in the volume of intracranial venous outflow were revealed in the study groups: in patients with IGT – a decrease in outflow along the straight sinus by 1.4 times (p<0.01), in patients with atrophic ventriculomegaly – a decrease in outflow along the superior sagittal sinus by 1.3 times (p<0.05).DISCUSSION: The data obtained show a significant impairment of cerebrospinal fluid dynamics in patients with NPH, in contrast to elderly volunteers with age-related atrophy and replacement expansion of the cerebrospinal fluid spaces at the level of the brain aqueduct, and also indicates the importance of the venous link in maintaining intracranial volumetric interactions.CONCLUSION: The combined use of a routine protocol and phase-contrast MRI techniques made it possible to identify a number of neuroimaging, hemo- and CSF dynamic changes in patients with NPH in comparison with healthy volunteers, and also, most importantly, with patients of comparable age with the presence of replacement ventriculomegaly against the background of atrophy.

Beyond the spotlight: Unveiling the gender bias curtain in movie reviews.

Historically, the film industry has been male-dominated both in front of and behind the camera, resulting in a longstanding gender imbalance in storytelling and representation. This legacy of male-centric narratives may unconsciously influence critics' expectations and judgments. Existing literature suggests that negative critiques in movie reviews can significantly impact actors' earnings by diminishing a film's commercial prospects. This influence extends to potential reductions in back-end compensation and marketability for future projects, and it can directly affect actors' well-being, leading to increased stress levels and elevated cardiovascular reactivity. Previously, gender biases in movie reviews were computed using disparities in male-led versus female-led movie ratings or box-office earnings; however, no work has been done to quantify the linguistic biases within movie review transcripts. This work aims to leverage our language-model-powered gender bias detection system to measure benevolent sexism, hostile sexism, explicit marking of sex, dehumanization, and generic pronouns in reviews published by professional critics. Therefore, we analyzed 17,165 professionally written reviews, comprising a total of 735,000 sentences. Our analysis uncovers pronounced representation bias in key movie roles, with 72% of first actors, 91% of first directors, and 86% of first writers being male. More importantly, the findings indicate that movies with female-dominated casts evoke, on average, 149% higher magnitude of hostile sexism and 44% higher magnitude of benevolent sexism in their reviews compared to movies with male-dominated casts. We also find that benevolent sexism is most common in Family and Music genres, reflecting the romanticization of gender roles, whereas hostile sexism peaks in Romance. A non-parametric statistical analysis revealed significant gender differences in benevolent and hostile sexism scores for movie reviews, with female first actors, directors, and writers receiving higher levels of both benevolent and hostile sexist criticism compared to their male counterparts.

Early Recognition of Loneliness and Frailty in Relation to Chronic Disease Self-Management: A Quantitative Cross-Sectional Study

Background: Chronic disease significantly influences mental health, identity, and self-esteem. It is deeply interconnected with loneliness, frailty, stress, mental health, and the ageing process, forming a complex and interrelated dynamic. The aim was to find an association between loneliness, frailty, mental health, and the patient’s self-management. Methods: A cross-sectional study was conducted between October 2023 and May 2024. A total of 605 patients with chronic disease took part in the research, of whom 67% were female and 33% were male. In total, 71% of participating patients lived in a home environment, and 19% lived in retirement homes. Results: 605 respondents with chronic disease participated in the study and were recruited using a purposive sampling method. Participants were drawn from healthcare settings, including primary care centres, outpatient clinics, and nursing homes, to increase representativeness. The study achieved a response rate of 55% after distributing 1100 questionnaires. Data were analysed with SPSS Statistics 25.0 using descriptive and inferential statistical methods, including non-parametric tests (Kruskal–Wallis test, Mann–Whitney U test) and Spearman’s correlation. The main results showed that patients who self-rated their chronic disease as well- or very well-managed (81%) were less frail (p < 0.001), less lonely (p < 0.001), and had better mental health (p = 0.015). Significant associations were found between frailty, loneliness (rs = 0.428, p < 0.001), and lower mental health (rs = 0.185, p < 0.001). In addition, frequent social contact was associated with lower frailty and loneliness (p < 0.001). Conclusions: Without adequate assessment and support from the healthcare system, patients may face challenges in meeting their needs, which can contribute to loneliness, frailty, and mental health decline. It is crucial to acknowledge that every individual with a chronic disease, regardless of age, education level, or condition, must actively participate in managing their chronic disease. Recognising the importance of self-management and its impact on mental health is essential to mitigating the negative effects of chronic disease on a patient’s quality of life.

Real-World Efficacy and Safety of Escalation to Weekly Adalimumab for Chronic Non-Infectious Uveitis: A Multicenter Study Involving Pediatric and Adult Patients

ABSTRACT Purpose To evaluate the efficacy and safety of weekly adalimumab (ADA) treatment in non-infectious uveitis (NIU) patients, including both pediatric and adult populations, and identify factors influencing treatment efficacy. Methods A retrospective cohort study at two hospitals in Türkiye included 51 NIU patients (29 children, 22 adults) who escalated from bi-weekly to weekly ADA due to inadequate disease control. Data on six clinical parameters (anterior chamber reaction, vitreous haze, visual acuity, central macular thickness [CMT], prednisone use, uveitis flare-up frequency), adverse effects, and treatment-related factors were collected. Statistical analyses involved non-parametric tests and regression models. Results Weekly ADA led to clinical improvement in 88.2% of patients, with uveitis control achieved in 76.4% by the 6th month. Escalation to weekly dosing significantly improved all clinical parameters compared to the 6-month period before ADA initiation (p < 0.001). Patients on combined weekly ADA and DMARD therapy experienced fewer uveitis attacks (B = - 2.272, 95% CI = [−4.289, −0.254], p = 0.028). Starting ADA as first-line treatment reduced uveitis attacks (p = 0.002) and increased the likelihood of inactive uveitis (OR = 10.349, 95% CI = [1.379, 77.687], p = 0.023). Patients resistant to multiple biologics had worse preADA visual acuity (p = 0.011). Conclusion Weekly ADA is effective and safe for controlling NIU when bi-weekly dosing is insufficient. Combining ADA with DMARDs enhances outcomes and reduce uveitis attacks. Poor preADA visual acuity may suggest resistance to biologics. Prospective studies should validate these findings, explore anti-ADA antibody development, and assess how DMARD addition affects immunological parameters and treatment efficacy.

Overweight yet Undernourished: A Common Juxtaposition in the Specialist Diabetes Foot Service.

To describe the nutritional status of people with diabetes-related foot complications and explore the association between nutrition and ulceration healing. This retrospective cohort study included attendees of a diabetes foot service who completed a dietary questionnaire. Diet was compared to guideline recommendations and biochemical measures were recorded. Associations between dietary intake and biochemical measures were analysed using non-parametric tests, and their relationship with being ulcer-free at 12 weeks analysed by binary logistic regression. Of 102 participants, 83% were men, mean age 68 (SD 12), body mass index 28.6 (SD 6.1) kg/m2, and 86% had type 2 diabetes. Complications included 154 ulcerations and 7 active Charcot feet. Recommended fruit, vegetable and protein intake was seldom attained. Common insufficiencies were 25-hydroxy-vitamin D (40%), zinc (27%), iron (23%) and vitamin C (21%). Vitamin C was higher in the upper (vs lower) tertile of fruit/vegetable intake (62 [95%CI 33-88] vs 30 [13-46] umol/L, p = 0.04), and zinc higher in those meeting protein requirements (12.3 [95%CI 11.1-12.8] vs 10.6 [9.8-11.5] umol/L, p = 0.04). Haemoglobin was the only predictor of becoming ulcer-free (OR 1.03 [95%CI 1.00-1.06], p = 0.03). Nutritional inadequacies are common in people with diabetes-related foot complications; however, the benefit of assessing nutrition remains uncertain.

Descriptive retrospective cross-sectional study of rehabilitation care for poststroke users in Québec during the COVID-19 pandemic

ObjectivesDuring the COVID-19 pandemic, designated rehabilitation centres were established in the province of Québec, where strict sociosanitary measures such as isolation and mandatory personal protection equipment requirements were followed. This...

The interaction network and potential clinical effectiveness of dimensional psychopathology phenotyping based on EMR: a Bayesian network approach

The current DSM-oriented diagnostic paradigm has introduced the issue of heterogeneity, as it fails to account for the identification of the neurological processes underlying mental illnesses, which affects the precision of treatment. The Research Domain Criteria (RDoC) framework serves as a recognized approach to addressing this heterogeneity, and several assessment and translation techniques have been proposed. Among these methods, transforming RDoC scores from electronic medical records (EMR) using Natural Language Processing (NLP) has emerged as a suitable technique, demonstrating clinical effectiveness. Numerous studies have sought to use RDoC to understand the Diagnostic and Statistical Manual of Mental Disorders (DSM) categories from a qualified perspective, but few studies have examined the distribution variations and interaction characteristics of RDoC within various DSM categories through retrospective analyses. Therefore, we employed unsupervised learning to translate five domains of eRDoC scores derived from electronic medical records (EMR) of patients diagnosed with Major Depressive Disorder (MDD), Schizophrenia (SCZ), and Bipolar Disorder (BD) at West China Hospital between 2008 and 2021. The distribution characteristics, interaction networks, and potential clinical effectiveness of RDoC domains were analyzed. Using non-parametric statistical tests, we found that MDD had the highest score in Negative Valence System (NVS) (4.1, p < 0.001), while BD exhibited the highest score in Positive Valence System (PVS) score (4.9, p < 0.001) and Arousal System (AS) (4.4, p < 0.001). SCZ demonstrated the highest scores in Cognitive Systems (CS) (5.8, p < 0.001) and Social Processes Systems (SPS) (4.6, p < 0.001). Through Bayesian network (BN) analysis, we identified relatively consistent interaction relationships among various RDoC domains (NVS → AS, NVS → CS, NVS → PVS, as well as CS → SPS; parameter range = 0.156 to 0.635, p < 0.001). Lastly, using logistic regression and Cox proportional hazards models, we demonstrated that AS was significantly associated with the length of hospital stay (-0.21, p < 0.05) and 30-day readmission risk (adjusted odds ratio [aOR] = 0.91, 95% confidence interval [CI] 0.91–0.99) to some extent. In conclusion, we suggest that the eRDoC characteristics varied in different DSM. By Bayesian Network, we found NVS and CS might be potential source in interacting with other system. Furthermore, CS, SPS and AS were associated with the length of stay and 30-days readmission, making them effective for predicting prognosis of psychiatric disorders.

Evaluation of the efficiency of smear layer removal during endodontic treatment using scanning electron microscopy: an in vitro study

BackgroundThe smear layer formed during root canal instrumentation negatively affects root canal irrigation activity, which in turn can affect the treatment prognosis of endodontic treatment.AimThe aim of this study is to compare the efficiency of smear layer and debris removal in root canals using different irrigation protocols using scanning electron microscopy (SEM).Materials and methodsThe quality of smear layer removal throughout the root canal was assessed in 30 intact extracted teeth divided into 3 groups according to the irrigation protocol: Group 1: 3% sodium hypochlorite (NaOCL) alternately with 17% ethylenediaminetetraacetic acetate (EDTA) was used. Group 2: 3% NaOCL alternately with 9% etidronate solution diluted with distilled water and Group 3: 9% etidronate solution diluted in 3% NaOCL. The quality of smear layer removal was assessed using scanning electron microscopy (SEM). The nonparametric Mann-Whitney test was used to compare the protocols of irrigations.ResultsThe study showed significant differences in the quality of smear layer removal in the apical part of the root canal. The best results were obtained in the groups using 9% etidronate and 9% etidronate solution diluted in 3% sodium hypochlorite. Conducting a comparative evaluation of the effectiveness of removing the smear layer using 3% NaOCL + 17% EDTA, 3% NaOCL + 9% etidronic acid diluted with distilled water, 3% NaOCL + 9% etidronic acid diluted with 3% hypochlorite showed greater effectiveness of protocols using etidronate. When comparing statistical data, protocols using etidronate were 4 times more effective than EDTA.ConclusionThe smear layer formed during mechanical treatment of the root canal was better removed during irrigation with etidronate solution.

Early childhood growth and nutritional status in India: trends in five National Family Health Surveys spanning 1992 and 2021.

To evaluate the weight and height status of under-five children between 1992 and 2021 in relation to nutritional context. The study is based on the lengths/heights and weights of children <5 years in five national surveys (n = 505,026). After evaluating normality of the distributions, heights, and weights were expressed as z-scores relative to the WHO reference. Nonparametric tests were used as the heights and weights did not have normal distributions. Heights and weights of boys and girls increased systematically, on average, across the five national surveys, indicating improvement in nutritional status over time. Nevertheless, median z-scores for height and weight relative to the WHO reference indicated the persistence of relatively poor nutritional status across the surveys. The growth status of Indian children <5 years improved over three decades, indicating that national initiatives promoting child health had a positive impact. Unfortunately, the nutritional status of significant numbers of children has not sufficiently improved and merits further attention.

Diversity and seasonal variation of zooplankton community in a large deep-water reservoir of Eastern China using eDNA and morphological methods

Monitoring zooplankton diversity and community dynamics is essential for understanding ecological processes within freshwater ecosystems. Environmental DNA (eDNA) has been increasingly employed in this field due to its efficiency and accuracy. However, its potential applications in freshwater ecosystems require further validation. In this study, we evaluated the performance of 18S rRNA and COI primers for freshwater zooplankton diversity monitoring and systematically compared the selected primers with the microscopy method in Qiandao Lake, China. Our results indicated that the COI primer marker (mlCOIintF/jgHCO2198) was more suitable for freshwater zooplankton diversity monitoring than 18S rRNA. The eDNA method identified a total of 102 species, whereas the microscopy method detected 111 species. Non-metric multidimensional scaling (NMDS) analysis and nonparametric multivariate statistical tests revealed that both abundance and biomass species compositions determined by microscopy differed significantly from those based on eDNA reads. Both methods detected significant seasonal changes in zooplankton community species composition, while eDNA provided a comprehensive view of the complex interactions within the community. Both methods indicate that rotifers are the primary group driving seasonal changes in the zooplankton community. The eDNA identified more environmental factors associated with seasonal changes in zooplankton communities than microscopy, including dissolved oxygen (DO), nephelometric turbidity unit (NTU), ammonia nitrogen (NH3-N), and total phosphorus (TP). The eDNA reads of rotifer and crustacean plankton increased linearly with their morphological abundance but not with biomass. Furthermore, combining morphological abundance and biomass as predictor variables for eDNA reads moderately enhanced the explanatory power compared to using them individually. Although eDNA cannot yet replace morphological methods, its efficiency and sensitivity make it a valuable complementary tool for zooplankton monitoring, with considerable potential for future applications.