Cohort Participants Research Articles

Cystatin C provides substantially higher glomerular filtration rate estimates than creatinine in a subset of Black people with HIV on current antiretroviral regimens

Background In African populations, estimated glomerular filtration rate by cystatin C (eGFRcys) is better aligned with gold-standard GFR measurements than eGFR by creatinine (eGFRcr). Moreover, eGFRcys is unaffected by the effects of antiretroviral therapy (ART) on tubular secretion and may thus provide better estimates of GFR in people with HIV on ART. Setting Observational cohort study of people of African ancestry living with suppressed HIV RNA on ART in London, United Kingdom. Methods Cross sectional analysis of 360 paired serum creatinine and cystatin C measurements. Participants whose eGFRcys substantially (>10%) exceeded eGFRcr were identified, and factors associated with this outcome identified in logistic regression analysis. Results The median age was 52 years, 56% were female, and 82% born in Africa or the Caribbean. The eGFRcys substantially exceeded eGFRcr in 42% of participants in the overall cohort, and in 68% of those with eGFRcr 45-75 mL/min/1.73m2. In multivariable analysis, a higher eGFRcr was associated with lower odds (0.59 [0.50, 0.68] per 10 mL/min/1.73m2 increase) of eGFRcys substantially exceeding eGFRcr; a higher BMI was also associated with this outcome while ART regimens inhibiting tubular secretion of creatinine were not predictive. Of the 22 participants with eGFRcr 45-60 mL/min/1.73m2, 16 (73%) had eGFRcys >60 mL/min/1.73m2. Conclusion: We report substantially higher eGFRcys than eGFRcr in a subset of people of African ancestry with suppressed HIV, particularly among those with eGFRcr 45-75 mL/min/1.73m2. In this population, eGFRcys provides clinically useful information irrespective of ART regimen.

Assessing the contributions of gender, clinical symptoms, and psychometric traits to non-suicidal self-injury behaviors in Chinese adolescents: a nomogram approach.

Non-suicidal self-injury (NSSI) behaviors among adolescents with mood disorders represent a significant global public health concern. This study aimed to assess the prevalence and identify key predictors of NSSI behaviors in Chinese adolescents diagnosed with depressive or bipolar disorders, addressing a critical gap in the literature. Data from 2343 participants in the Chinese Adolescent Depression Cohort (CADC) were analyzed. The study employed a comprehensive approach, utilizing medical records, clinical assessments, and validated psychometric instruments. Statistical analyses included chi-square tests, logistic regression, and ROC curve analyses, culminating in the development of a predictive nomogram. The prevalence of NSSI behaviors was strikingly high at 73.32%. Significant predictors included female gender (AOR = 2.14, 95% CI [1.70, 2.68]), presence of hallucinations (AOR = 1.52, 95% CI [1.18, 1.97]), borderline personality features (AOR = 1.03, 95% CI [1.01, 1.08]), and childhood trauma (AOR = 1.02, 95% CI [1.01, 1.03]). The study's key contribution is a predictive nomogram with an AUC of 0.74, demonstrating good efficacy in predicting NSSI behaviors. This research reveals an alarmingly high prevalence of NSSI behaviors in Chinese adolescents with mood disorders and identifies critical predictors spanning demographic, clinical, and psychometric domains. The developed nomogram offers a novel approach for risk assessment, highlighting the importance of comprehensive evaluations in adolescent mental healthcare. These findings have significant implications for developing targeted interventions and improving risk assessment strategies in clinical practice.

Health status and quality of life before critical illness: Northern Finland Birth Cohort 1966 study.

Previous findings support the claim intensive care unit (ICU) patients have a higher rate of comorbidities and reduction of health- and functional status compared with the normal population. In this prospective observational study, our aim was to determine those health-related factors at the age of 31 years which were associated with a later critical illness among previously un-hospitalized individuals by exploring data obtained from the Northern Finland Birth Cohort 1966 (NFBC1966). NFBC1966 is a Finnish birth cohort, which includes 12,058 live births with expected dates of delivery during 1966. The study was conducted among cohort participants who had not been hospitalized for any reason before the cohort follow-up visit at the age of 31. The study group included NFBC1966 participants who were admitted to the ICU of the Oulu University Hospital. The control group included participants who were treated for any reason in regular hospital wards. The data considering the participants' health status and behavior at the age of 31 were collected from the NFBC1966 database. The gathering of ICU and hospitalization data was concluded on December 31, 2016. 849 NFBC1966 participants met the inclusion criteria: 69 were treated in the ICU (study group) and 780 on regular hospital wards (controls). In the study group, the rate of neurological diseases (26% vs. 16%, 95% CI: -21.8%, -0.2%), malignancy (3% vs. 0.7%, 95% CI: -9.7%, 0.0%), alcohol abuse (4.5% vs. 1%, 95% CI: -11.5%, -0.3%) and smoking (77% vs. 65%, 95% CI: -21.6%, -0.3%) were higher compared with the control group. The patients in the ICU group were also more prone to violent injuries, (17% vs. 7%, 95% CI: -20.2%, -1.9%), practiced less hard physical activity (65% vs. 78%, 95% CI: 2.1%, 25.3%) and had lower maximal muscle strength according to the hand grip test (30 vs. 34 kg, 95% CI: -8.2, 8.6 kg). In this study examining previously un-hospitalized patients, the main factors associated with future critical illness were neurological comorbidities, malignancy, alcohol misuse, smoking, low maximum muscle strength, and less frequent physical exercise compared with those with hospitalization not requiring ICU admission.

Initial Evaluation of Acceptability, Engagement, and Effectiveness of the MO App to Provide Tailored and Comprehensive Support for Smoking Cessation: Development and Usability Study.

Despite the growing availability of smoking cessation apps, low engagement and cessation rates have remained a significant challenge. To address this issue, we used a user-centered design to iteratively develop a mobile app (MO) to provide comprehensive, tailored, and evidence-based content to support smokers in their quitting journey. This study examined the acceptability, use, and preliminary efficacy of the MO app for smoking cessation. Specifically, we sought to understand smokers' preferred features, engagement, and satisfaction with MO; identify concerns in using the app and ways to improve the app; and evaluate its smoking cessation outcomes. Through 3 cohorts, we recruited 10, 12, and 85 adult smokers who attempted to quit smoking to pilot-test the MO app between December 2019 and July 2022. Participants were instructed to complete a baseline survey, interact with the app for 6 weeks, and fill in a postsurvey at week 6. Participants in cohort 3 completed an additional postsurvey at week 12. Participants' app use was tracked and analyzed. The primary outcome measures were participants' 7-day point prevalence abstinence at 6 and 12 weeks. Participants reported high levels of satisfaction with the MO app across all 3 cohorts, rating it between 4.40 and 4.76 on a scale of 5 for acceptability. Users engaged with app activities for an average of 89 to 159 times over 35 days. The most liked features of the app included "quit plan," "tracking," "reminders and notifications," "MOtalks," and "motivational quotes." The 7-day point prevalence abstinence rate of the modified intention to treat population in cohort 3 was 58% at 6 weeks and 52% at 12 weeks. Those who interacted more frequently with app features and engaged with more diverse activities were more likely to maintain abstinence at weeks 6 and 12. For each additional time logged into the app, the odds of staying abstinent at week 12 increased by 5% (odds ratio [OR] 1.05, 95% CI 1.01-1.08). Participants who earned >5000 points during app use also had higher odds of quitting at both 6 weeks (OR 3.12, 95% CI 1.25-7.75) and 12 weeks (OR 4.65, 95% CI 1.83-11.76), compared with those who earned <5000 points. Our study demonstrated that MO is a feasible mobile phone app with high acceptability and usability and can effectively deliver smoking cessation support to individuals who want to quit. Implications for developing and evaluating mobile phone apps for smoking cessation are discussed.

Risk factors for Ascaris lumbricoides infection and its association with nutritional status and IQ in 14-Year old adolescents in Chitwan, Nepal

Inconsistent results have been obtained from studies investigating the association between soil-transmitted helminths (STHs) and nutritional status and cognitive outcomes. This study aimed to investigate the influence of STHs and nutritional status on the intelligence quotient (IQ) of adolescents in the Chitwan Valley, Nepal. In this birth cohort study from the Chitwan district of Nepal, 74 cohort participants were followed up after 14 years. The presence and egg density of the STHs were investigated following the Kato–Katz method. Full-scale IQ was evaluated using the Wechsler Abbreviated Scale of Intelligence-II (WASI-II). Multivariate regression analysis was also conducted to examine the associations of STHs and nutritional status with IQ scores, adjusting for adverse childhood experiences (ACE) and demographic and socioeconomic factors. The only STHs detected was for Ascaris lumbricoides, which was detected in 16% (12/74) of the study participants. Similarly, 16% (12/73) of participants reported undernutrition (body mass index (BMI) Z score<-2SD), and 33% (25/74) of participants had a developmental deficit (WASI II FSIQ < 69). There were no significant associations between the presence of A. lumbricoides or egg density and IQ scores. However, undernutrition (BMIZ<-2SD) increased the odds of a developmental deficit according to both univariate and adjusted multivariate models [i.e., adjusted odds ratio (aOR) 9.41; 95% CI (2.23 to 39.80)]. While the study primarily examines the association of STHs and nutritional status with IQ, it is important to note that adolescents with educated mothers or higher incomes also showed better cognitive development. The prevalence of undernutrition and associated developmental deficits characterized by an IQ < 69 was alarmingly high in this cohort of adolescents from Chitwan, Nepal. Despite the high prevalence of A. lumbricoides, its infection was not identified as significantly associated with cognition. However, it is noteworthy that a consistent favorable impact of an enriching postnatal environment, approximated by maternal education and family income, may improve neurodevelopmental indicators.

Dietary trajectory profiles of French adults over time: Multicriteria analysis of sustainability

Abstract Despite the urgent need for sustainable dietary transitions, few studies have examined current dietary trajectories using longitudinal data. This study aimed to identify dietary consumption trajectory profiles over an 8-year period (2014-2022) while assessing their sustainability in a multicriteria approach. Consumption data from NutriNet-Santé cohort participants were collected using FFQs in 2014, 2018 and 2022. Dietary trajectory profiles were modeled using group-based multi-trajectory based on factors from Principal Component Analysis on energy-adjusted consumption data (n = 17,187). Profiles were analyzed for sustainability (environmental and nutritional dimensions) using multi-adjusted mixed-effects models. Six trajectory profiles (P) were identified. P0 (considered as reference) had average consumption for all food groups, with increased plant-based intake over time. In comparison, P1 had the highest baseline alcohol (+301%) and offal intake, increasing processed meat (+74%) and decreasing offal over time. P2 had higher milk (+187%) and sweet drinks intake, increasing animal substitutes (+1737%) and whole-grain products. P3 had higher nuts (+680%) and legumes intake, increasing egg (+166%) and reducing fruit juice. P4 had high fish (+39%) and fruit intake, increasing butter (+53%) and reducing alcohol. P5 had higher pork (+143%) and red meat intake, increasing fish (+31%) and reducing dairy. Initially, P3 and P4 had the lowest GHG emissions (-18%, -49% vs. P0), best nutritional profiles, and higher organic food consumption. P5 had the greatest environmental impact (+51%) and the lowest nutritional scores. Over time, P0 reduced GHG emissions and improved nutritional scores. P3 and P4 showed minimal changes, while P5 had the greatest GHG emissions decrease (-14%) and nutritional quality improvements. Identifying ongoing dietary transition trajectories, our findings contribute to optimizing targeted actions aimed at promoting sustainable dietary consumption habits. Key messages • Regardless of initial dietary preferences, French adults exhibit an overall trend over time towards increased intake of plant-based foods and decreased intake of red meats, at varying scales. • French adults exhibit varying degrees of transition towards more sustainable diets, with an overall decrease in GHG emissions from food consumption and an improvement in their nutritional profiles.

Lipids as the link between central obesity and diabetes: perspectives from mediation analysis

BackgroundCentral obesity is a well-recognized risk factor for diabetes, yet the potential role of lipids in the diabetes risk associated with central obesity remains unclear. This study aimed to explore the possible mediating role of 11 lipid parameters [high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), non-high-density lipoprotein cholesterol (Non-HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), remnant cholesterol (RC), and ratios of Non-HDL-C/HDL-C, RC/HDL-C, LDL/HDL-C, TG/HDL-C, TC/HDL-C] in the association of central obesity with diabetes risk.MethodsWe utilized data from 15,453 participants in the NAGALA longitudinal cohort to assess the association of baseline central obesity indicators [waist-height ratio (WHtR), waist circumference (WC)] and the 11 lipid parameters with diabetes risk. Mediation analysis models were constructed to explore the mediating role of lipid parameters in the association of WC/WHtR with diabetes.ResultsConfirmatory associative analysis using multivariable Cox regression showed that, except for Non-HDL-C, TC and LD-C, the remaining eight lipid parameters were significantly associated with WC/WHtR and diabetes risk. Mediation analysis indicated that TG, RC, HDL-C, and lipid ratios such as Non-HDL-C/HDL-C ratio, RC/HDL-C ratio, TG/HDL-C ratio, TC/HDL-C ratio and LDL/HDL-C ratio are potential lipids affecting the diabetes risk related to central obesity. Among these, the RC/HDL-C ratio seemed to contribute the most in the WC/WHtR-related diabetes risk association, with a mediation percentage of about 37%. Additionally, lipid ratio parameters appeared to play a more mediating role in the association of central obesity-related diabetes risk than individual lipids.ConclusionsIn central obesity-related diabetes risk, most lipids, especially lipid ratio parameters, play a significant mediating role. Given these findings, we advocate for increased efforts in multifactorial risk monitoring and joint management of diabetes. The evaluation of lipids, particularly lipid ratio parameters, may be holds substantial value in the prevention and management of diabetes risk under close monitoring of central obesity.

Low income, being without employment, and living alone: How they are associated with cognitive functioning - Results from the German National Cohort (NAKO)

Abstract Background While people with low socioeconomic status tend to have worse cognitive functioning, little is known about the impact of specific socioeconomic conditions. Aim of the present analysis was to investigate to what extent cognitive functioning differs by three socioeconomic conditions: low income, being without employment, and living alone. Methods A total of N = 158,144 participants (age 19-75 years) of the population-based German National Cohort (NAKO) provided data on socioeconomic conditions and completed cognitive testing. Multivariable regression model including the three socioeconomic conditions, age, sex, education, occupational status, having diabetes, hypertension, myocardial infarction, stroke, and depressive symptoms was used for analysis. Results Results from fully adjusted analysis indicated that cognitive functioning (z-score) was lower among those with low income (b=-0.53, CI95%=-0.57; -0.49) compared to not having low income, living alone (b=-0.10, CI95%=-0.14; -0.07) compared to not living alone, and being without employment (b=-0.22, CI95%=-0.27; -0.17) compared to being employed. The difference in cognitive functioning between those exposed compared to not exposed to the condition was changing slightly with older age among those with low income (interaction with age b=-2.39, CI95%=-3.24; -1.55) and, to a smaller extent, among those living alone (interaction with age b=-0.76, CI95%=-1.34; -0.19). Conclusions Low income, being without employment, and living alone were independently associated with poorer cognitive functioning after adjusting for confounders. As those with low income had the poorest cognitive functioning in old age, it is important to explore pathways of how cognitive health in this population group can be improved.

Sex differences in cardiovascular disease in relation to socioeconomic position in the NAKO study

Abstract Background Low socioeconomic position (SEP) is associated with cardiovascular disease (CVD) risk; yet, the underlying pathways are not fully clear and may affect sexes differently. We investigated sex differences in the relationship of SEP with prevalent CVD, cardiovascular risk factors (CRF) and estimated cardiovascular risk in a contemporaneous German population. Methods Data derived from the baseline examination of 204,780 participants in population-based German National Cohort (NAKO). Logistic, multinomial, and linear regression models were used to estimate sex-specific odds ratios (OR) and beta-coefficients with 95% confidence intervals (CI) of CVD, CRF and very high-risk score (SCORE2 ≥7.5% (age 40-49 years) or ≥ 10% (age 50-69 years)) associated with educational attainment and relative income. Women-to-men ratios of ORs (RORs) with 95%-CI were estimated. Results In women compared to men, low vs. high SEP was more strongly associated with obesity, overweight, self-reported myocardial infarction and hypertension, elevated blood pressure values, antihypertensive medication, and alcohol consumption, but less strongly related to smoking. In women with the lowest vs. highest educational level, the OR for a very high 10-year CVD risk was 3.61 (95%-CI 2.88; 4.53), compared to 1.72 (95%-CI 1.51; 1.96) in men. The women-to-men-ROR was 2.33 (95%-CI 1.78; 3.05), attenuated after age-adjustments. For the comparison of low vs. high relative income, the odds of having a very high 10-year CVD risk was 2.55 (95%-CI 2.04; 3.18) in women, and 2.25 (95%-CI 2.08; 2.42) in men (women-to-men ROR, 1.31 (95%-CI 1.05; 1.63). Conclusions In both sexes, there was an inverse graded relationship between SEP and the likelihood of prevalent CVD and CRF, with stronger associations in women than in men. Although women had a lower estimated 10-year CVD risk compared to men, the likelihood of having a very high CVD risk conferred by low SEP vs. a high one was higher in women than in men.

Prevalence and outcomes of American Heart Association stages of heart failure in an adult brazilian population of the ELSA-Brasil study

Abstract Aims Heart failure (HF) has a major impact on public health, affecting up to 2% of adult population. HF staging is helpful in capturing pre-clinical disease and its progression to advanced stages. We aimed to determine the prevalence and mortality of HF stages in the participants of a Brazilian adult cohort. Methods The ELSA-Brasil cohort comprises 15,105 adult public servants from 6 Brazilian capitals. In the initial evaluation of the study (2008-2010), ELSA carried out interviews and clinical, laboratory, and cardiovascular ancillary tests. In this analysis, we included participants who had electrocardiogram and echocardiogram performed at baseline visit, and additional information regarding risk factors and functional capacity. The HF stages were defined based on AHA guidelines criteria as follow: Stage 0 was defined as a healthy individual with no risk factors for heart failure. Stage A (at risk for HF) included those without cardiac structural or functional abnormality but with any of the following conditions: systemic hypertension; diabetes mellitus, obesity, history of myocardial revascularization, history of rheumatic fever, and seropositivity for Chagas’ disease. Stage B (pre-HF) was defined as asymptomatic participants with history of myocardial infarction or any major abnormalities on ECG or echocardiogram. Stage C (symptomatic HF) included participants with a clinical history of HF, or HF symptoms in the presence of structural heart disease (defined as in Pre-HF stage). Considering the community-dwelling profile of the sample, we did not expect to have advanced heart failure patients in our sample. Results We included the 3,267 participants (61±9 years; 53% women) with baseline data. Prevalences of HF stages were stage 0: 938 (29%) A: 1,385 (42%), B: 651 (28%) and C: 293 (9%), with different distribution between sexes (p&amp;lt;0.001). Older participants had higher prevalences of stages B and C (p&amp;lt;0.001), with the prevalence of stage C increasing from 1.8% at 35-44 years to 12.2% at 65-74 years. After 12 years of follow-up, total mortality rates of HF stages were Stage 0: 4%; A:10%. B: 16%, and C: 26%, and respective Cox proportional hazard ratios [95% CI] adjusted for age and sex were A: 1.94 [1.3-2.8], B:2.78 [1.9-4.1], and C: 5.39 [3.6-8.1] compared to stage 0. Conclusions The prevalence of HF in Brazilians reflects what is described in international literature, with a large proportion of individuals in pre-symptomatic stages. A notable shift in the sample toward pre-symptomatic and symptomatic HF occurred gradually and persistently across the age span studied. Mortality rates increase incrementally across the HF stages. This information is important for understanding and planning health policies for this syndrome.

Are cancer survivors at greater risk of coronary artery disease?

Abstract Background Some cancer survivors are at increased risk of coronary artery disease (CAD), due to shared risk factors, effects of cancer or cancer therapy. Typically an asymptomatic condition, CAD has historically been subject to underdiagnosis, thus risk is compounded for at-risk populations. This study investigates the difference in risk factor status between a survivor group undergoing screening for CAD risk, and a control group without cancer, recruited from the same community. Methods 1642 participants were recruited from the community in Victoria and Tasmania, Australia, and their cancer status were evaluated. Risk of CAD was identified via the Pooled Cohort Equation (PCE) and participants were stratified into low (&amp;lt;5%), intermediate (5% - 20%) and high risk (&amp;gt;20%) based on their PCE score. A 3:1 propensity matching based on age and sex was performed to match the cohort between cancer survivors and non-cancer participants. Participants’ baseline characteristics were evaluated. Results After matching, 651 (median age 66 [IQR 9] years, 70.5% female) non-cancer participants and 217 (median age 66 [IQR 10] years, 70.5% female) cancer survivors were included in the analyses. The prevalence of low and intermediate CAD risk in non-cancer population (38.4% and 57.5%, respectively) and cancer survivors (37.3%, and 54.8%, respectively) were similar (p=0.840 and 0.553, respectively). However, 17 (7.8%) of the cancer survivors were identified as high risk, which was significantly greater than non-cancer population (4.1%, p=0.049). The risk profiles of cancer survivors and the non-cancer population (Table 1) suggest a higher prevalence of lipid abnormalities in survivors. Conclusions Cancer survivors have a similar CAD risk profile to control subjects from the same population, but more commonly show lipid abnormalities. Whether this reflects undertreatment in survivors warrants further evaluation.

Dietary Pattern Trajectories in French Adults Over Time (2014-2022): Role of Socioeconomic Factors

Abstract While dietary transitions towards more plant-based diets are urgently needed, few studies have investigated current diet trajectories, based on observed longitudinal data. This study investigated current dietary transitions of French adults over an 8 years period (2014-2022), while assessing the nutritional quality of the consumed foods and the role of diverse socio-economic factors. Consumption data from 17,187 NutriNet-Santé cohort participants weighted for the French Census were collected using a food frequency questionnaire in 2014, 2018, 2022. Adopting a gender-specific approach, consumption changes in 23 food groups were assessed over time. The nutritional quality was evaluated using the cDQI score, categorizing foods into ‘healthy’ and ‘unhealthy’. The socioeconomic analysis targeted four food groups (red meat, processed meat, legumes and wholegrain products), strongly linked to mortality risk and recognized as significant markers of the sustainable diet transition. All analyses were conducted using multi-adjusted mixed-effects models. Consumption of some healthy plant-based foods (nuts +59 %, legumes +22%, wholegrain products +7%) significantly increased over time; while consumption of some unhealthy foods (red meat -19%, refined cereals -18%, sweet drinks -15%) decreased. Conversely, consumption of prepared and mixed dishes (+16%), processed meat (+35%) and butter (+100%) increased. These changes differed in magnitude between sexes and translated into an improved food quality score (cDQI). Occupational status was linked to longitudinal changes in food consumption, showing increased intake of plant-based foods among students and higher socio-professional categories. Our findings provide accurate data on trends and factors for targeted initiatives, guiding strategic interventions for a sustainable dietary transition. Key messages • Plant-based food consumption increased while unhealthy food intake, both plant and animal-based, decreased; Gender differences were observed in baseline consumption and the extent of changes over time. • Occupational status was linked to longitudinal changes in food consumption. Increased intake of plant-based foods was observed among students and higher socio-professional categories.

Sociodemographic predictors of the association between self-reported sleep duration and depression

Abstract Background This cross-sectional study is apart from one of the first and largest population-based prospective cohort studies in the UAE called the United Arab Emirates Healthy Future Study (UAEHFS). The aim of this study is to investigate the association between self-perceived sleep duration and self-perceived depression after adjustment for sociodemographic factors. Baseline line data from UAEHFS cohort participants were included in this cross-sectional study. Univariable and multivariable logistic regression models were fitted, with the binarized self-reported sleep hours as an outcome. The predictors were the self-reported PHQ-8, sociodemographic factors, and body mass index (BMI). Odds ratios with 95% confidence intervals (CI) were reported. Results Of 11,455 participants, 4,295 (37.5%) were included in the complete case analysis after omitting missing values. We applied a complete case analysis following omitting missing values. Participants’ median age was 32.0 years (Interquartile-Range: 24.0, 39.0). In total, 63.6% of the participants reported sleep duration of more than 7 hours. Statistically significant negative association was observed between the total PHQ-8 score and binarized self-reported sleep, OR = 0.961 (95% CI: 0.948, 0.974). For one unit increase in age and BMI, the odds ratio of reporting shorter sleep with OR of 0.979 (95% CI: 0.969, 0.990) and 0.987 (95% CI: 0.977, 0.998) respectively. Conclusions The study findings indicate a correlation between higher total PHQ-8 scores and an increased probability of individuals reporting shorter self-perceived sleep durations when considering some sociodemographic factors such as age, marital status and employment status. However, there was no difference between females and males in reporting self-perceived sleep duration among depressed individuals. Key messages • There is a correlation between higher total PHQ-8 scores and an increased probability of individuals reporting shorter self-perceived sleep durations. • Our results can help contribute to the knowledge based on current and potential population mental health in the UAE and Gulf Region.

Intermittently scanned continuous glucosemonitoring compared with blood glucose monitoring is associated with lower HbA1c and a reduced risk of hospitalisation for diabetes-related complications in adults with type 2 diabetes on insulin therapies.

We assessed the impact of initiating intermittently scanned continuous glucose monitoring (isCGM) compared with capillary blood glucose monitoring (BGM) on HbA1c levels and hospitalisations for diabetes-related complications in adults with insulin-treated type 2 diabetes in Sweden. This retrospective comparative cohort study included adults with type 2 diabetes who had a National Diabetes Register initiation date for isCGM after 1 June 2017. Prescribed Drug Register records identified subgroups treated with multiple daily insulin injections (T2D-MDI) or basal insulin (T2D-B), with or without other glucose-lowering drugs. The National Patient Register provided data on hospitalisation rates. We identified 2876 adults in the T2D-MDI group and 2292 in the T2D-B group with an isCGM index date after 1 June 2017, matched with 33,584 and 43,424 BGM control participants, respectively. The baseline-adjusted difference in the change in mean HbA1c for isCGM users vs BGM control participants in the T2D-MDI cohort was -3.7 mmol/mol (-0.34%) at 6 months, and this was maintained at 24 months. The baseline-adjusted difference in the change in HbA1c for isCGM users vs BGM control participants in the T2D-B cohort was -3.5 mmol/mol (-0.32%) at 6 months, and this was also maintained at 24 months. Compared with BGM control participants, isCGM users in the T2D-MDI cohort had a significantly lower RR of admission for severe hypoglycaemia (0.51; 95% CI 0.27, 0.95), stroke (0.54; 95% CI 0.39, 0.73), acute non-fatal myocardial infarction (0.75; 95% CI 0.57, 0.99) or hospitalisation for any reason (0.84; 95% CI 0.77, 0.90). isCGM users in the T2D-B cohort had a lower RR of admission for heart failure (0.63; 95% CI 0.46, 0.87) or hospitalisation for any reason (0.76; 95% CI 0.69, 0.84). This study shows that Swedish adults with type 2 diabetes on insulin who are using isCGM have a significantly reduced HbA1c and fewer hospital admissions for diabetes-related complications compared with BGM control participants.

Fatigue levels and associated factors in systemic sclerosis: a cross-sectional study of 2,385 SPIN Cohort participants.

To compare fatigue in a large multinational systemic sclerosis (SSc) cohort to general population data and identify associated sociodemographic, lifestyle and SSc disease factors. Scleroderma Patient-centered Intervention Network Cohort participants completed the Patient-Reported Outcomes Measurement Information System-29 v2.0 fatigue domain. T-scores were compared with the USA general population (mean = 50; SD = 10). Multivariable linear regression was used to assess associations with sociodemographic, lifestyle, and disease-related variables. Among 2,385 participants (mean age 54.9 (SD = 12.6) years, 87% female, 38% diffuse SSc), mean fatigue T-score was 54.6 (SD = 11.0); 438 (18%) reported mild fatigue, 641 (27%) moderate, and 180 (8%) severe fatigue. Fatigue was independently associated with sociodemographic factors age (-0.10 points per year, [95% CI -0.14;-0.07]), male sex (-1.67 points, [-2.96;-0.37]), non-married status (0.97 points [0.04; 1.89]), and country (reference USA; France -2.35 points [-3.48;-1.21] and UK 2.38 points [0.80; 3.97]), and lifestyle factors smoking (4.16 points [2.52; 5.80]), alcohol consumption (-0.18 points per drink per week [-0.28;-0.07]), and body-mass index (0.34 points per unit [0.27; 0.42]). Fatigue was associated with disease-related factors gastrointestinal involvement (4.21 points [2.99; 5.43]), digital ulcers (1.51 points, [0.25; 2.77]), moderate small joints contractures (1.41 points [0.13; 2.69]), rheumatoid arthritis (4.34 points [2.37-6.31]) and Sjögren's syndrome (1.89 points [0.23; 3.55]). When pain was included in the model, its association was large (2.19 points [2.03; 2.34]) and interstitial lung disease was also associated (1.21 points [0.42; 2.00]). In people with SSc, fatigue scores were substantially higher than the general population and associated with multiple disease factors including gastrointestinal involvement, several painful disease manifestations, and lung involvement.

Venom immunization: IgG/IgE titers, safety, risk, and methods of the VIPRBITEM cohort

Background: This is the first study to examine a cohort that engages in the practice of immunization with snake venoms. In this practice, either fresh wet venom or venom reconstituted from freeze-dried form is used in vaccination protocols to produce hyper-immunity to venom. Methods: This is a retrospective community-initiated collaborative research (CICR) project that collated the records of venom immunization. Records of schedules, formulations, photographs, medical records, and diaries were collated from existing practitioners and evaluated by inspection and interviews. One accidental bite was observed over 3 days, with vital signs, and photographic records of swelling taken to verify reality of the bite. Over 74 snake-genera man-years, and 24 man-years of injection data from 8 participants, for 22 species of venomous snakes from Elapidae and Viperidae are represented. Six of those participants had detailed records of date, dose and effects. Results: IgG titers to 6 venoms for 4 cohort members tested of 8 included 2 with clear hyper-immune status. IgE titers were elevated for some. In 861 injections, records showed a rate of atopy/anaphylaxis of 4.3% , an infection rate of 0.58% and an abscess rate of 1.51% . Serious adverse reactions were rare and these appeared to be linked to overly aggressive immunization schedules and formulation accidents. We note that greater cross-immunity of IgE over IgG is suggested. Two basic protocols were followed, one was an approximate one month interval, the other was one or more injection(s) per week. In 176 envenomations, 175 were without antivenom treatment, two hospitalizations occurred, and one received full antivenom treatment. Dry bites were not included in our dataset. Envenomations showed a 1.14% rate of atopy/anaphylaxis, a 0.57% rate of infection and a 1.7% rate of abscess. Conclusions: Immunization of humans to snakebite is effective, and reasonably safe with care. Injection records suggest immune cross-reactivity between ophidians within the same family, and better cross-reactivity within the same genera. A cohort participant was pronounced dead based on EEG, and then recovered without treatment. A neurotoxin case with &amp;ldquo;brain death&amp;rdquo; EEG should stay on life support for 6 weeks to allow time for the immune system to clear venom.

Changes in exposure to environmental contaminants in the aftermath of Hurricane Maria among pregnant women in northern Puerto Rico

Experiencing a hurricane during pregnancy is associated with increased risk of adverse birth outcomes and poor mental health. Pregnant people from marginalized communities are more susceptible to adverse effects, as they have fewer resources to overcome hardships at a time when shelter and nutrition are essential. When Hurricane Maria (HM) devastated Puerto Rico in September 2017, the archipelago was already burdened with high poverty, health disparities, environmental contamination, and fragile utility infrastructure. We aimed to compare biomarkers of environmental exposures among pregnant participants in the PROTECT cohort before and after HM and to identify hurricane-related sources of exposure. Metals, PAHs, phthalate metabolites, and phenols were measured in urine samples collected from participants at three prenatal visits (2011–2019). Samples were categorized as before, <3 months, 3–6 months, and >6 months after HM. Using linear mixed effects models, we found that in the 6 months after HM, participants had higher Co, Ni, and DEHPTP concentrations, indicating increased exposure, and lower concentrations of PAHs, several metals, and phthalates, suggesting decreased exposure, compared to pre-HM levels. Biomarkers were not associated with potential exposure sources assessed through questionnaire or previously measured tap water contaminants. This study provides insight into how extreme weather events may alter environmental exposures among pregnant people in Puerto Rico. As climate change has increased the frequency and magnitude of such events, additional research is needed to clarify the implications for maternal and child health and to identify sources of related environmental exposures within this vulnerable population.

Proteomic Signatures of Right Ventricular Outcomes in Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is a disease of progressive right ventricular (RV) failure with high morbidity and mortality. Our goal is to investigate proteomic features and pathways associated with RV-focused outcomes including mortality, RV dilation, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) in PAH. Participants in a single-institution cohort with 3 years of follow-up underwent proteomic profiling of their plasma using 7288 aptamers (targeting 6467 unique human proteins). Partial least squares discriminant analysis was performed to assess global protein variation associated with mortality, RV dilation, and NT-proBNP levels. Differentially abundant proteins and enriched pathways associated with outcomes were identified following baseline adjustments. RV vulnerability models estimated associations for individuals with similar afterload following adjustment for pulmonary vascular resistance. A total of 117 participants with PAH were included. Partial least squares discriminant analysis of the proteome showed clear separation between survivors and nonsurvivors, participants with dilated versus nondilated RVs, and across NT-proBNP levels. Proteins and pathways involving the ECM (extracellular matrix) were upregulated in participants who died during follow-up, those with severe RV dilation, and those with higher levels of NT-proBNP. Pulmonary vascular resistance adjustment reinforced the importance of ECM proteins in the association with RV vulnerability, independent of afterload. These findings were confirmed in independent PAH cohorts with available plasma proteomics and RV tissue gene and protein expression. Distinct plasma proteomic profiles are associated with mortality, RV dilation, and NT-proBNP in PAH. Proteins and pathways governing tissue remodeling are strongly associated with poor outcomes, may mediate RV vulnerability to right heart failure, and represent promising candidates as biomarkers and potential therapeutic targets.

Association between reduced hemoglobin-to-red cell distribution width ratio and elevated cardiovascular mortality in patients with diabetes: Insights from the National Health and Nutrition Examination Study, 1999-2018.

The purpose of this research was to examine the relationship between the hemoglobin-to-red blood cell distribution width ratio (HRR) and cardiovascular disease (CVD)-related mortality in people who have diabetes. Data derived from the National Health and Nutrition Examination Survey (NHANES), between the years 1999 to 2018, were meticulously analyzed. Mortality data, encompassing events until December 31, 2019, were systematically collected. A comprehensive group comprising of 8,732 participants were subjected to scrutiny, and subsequently, classified into four distinct groups predicated upon quartiles of baseline HRR levels: Q1 (n = 2,183), Q2 (n = 2,181), Q3 (n = 2,185), and Q4 (n = 2,183). The correlation between HRR and CVD-related mortality was examined through the use of survival curves and Cox proportional hazard regression models, the latter incorporating weights as advised by NHANES. Among the 8,732 participants in the study cohort, CVD-related mortality was identified in 710 cases. The Kaplan-Meier analysis demonstrated a significant association, indicating that a decreased HRR was correlated with a reduction in survival in cases with CVD. Both univariate and multivariable Cox proportional hazard regression analyses consistently indicated that patients exhibiting a lower HRR exhibited a markedly elevated risk of CVD-related mortality in comparison to those with higher HRR. Notably, the correlation between HRR and decreasing CVD-related mortality was discerned to be non-linear. In patients with diabetes, a decreased HRR was associated with an increased risk of CVD-related mortality.

Altered RBC deformability in diabetes: clinical characteristics and RBC pathophysiology

BackgroundReduced red blood cell deformability (RBCD) is associated with diabetic vascular complications, but early pathophysiological RBC changes and predictive demographic and clinical factors in populations with diabetes are unclear. An understanding of early diabetes-specific RBC changes associated with impaired RBCD is essential in investigating mechanisms that predispose to diabetic vascular complications.MethodsWe conducted an outpatient cross-sectional study of participants in a well-controlled diabetes cohort (N81) and nondiabetic controls (N78) at the National Institutes of Health. First, between-group differences in RBCD measures were assessed with shear stress-gradient ektacytometry. Differences in structural RBC parameters were assessed using osmotic gradient ektacytometry and NaCl osmotic fragility. Functional RBC changes were assessed using hemoglobin-oxygen dissociation: p50.ResultsAll shear-stress gradient RBCD measures were significantly altered in the diabetes cohort vs. nondiabetic controls, even after adjustment for confounding covariates (p < 0.001). Adjusted for diabetes-status and demographic factors, significant predictors of reduced RBCD included older age, Black race, male gender, hyperglycemia, and vascular complications (all p < 0.05). Reduced RBCD was also associated with aberrant osmotic-gradient parameters, with a left-shift on osmotic gradient profile indicative of dehydrated RBCs in diabetes. A structure-function relationship was observed with reduced RBCD associated with reduced osmotic fragility (P < 0.001) and increased hemoglobin-oxygen dissociation (P < 0.01).ConclusionsFindings suggest impaired RBCD incurs similar demographic and clinical risk factors as diabetic vascular disease, with early pathophysiological RBC changes indicative of disordered RBC hydration in diabetes. Findings provide strong evidence for disordered oxygen release as a functional consequence of reduced RBCD.Clinical trial number: NCT00071526.