Physical Check-up Research Articles

Relationship between fibrosis-4 index and new onset hypertension in the general population

Abstract Background/Introduction Non-alcoholic fatty liver disease (NAFLD) is a risk for cardiovascular events and malignant tumors as well as liver cirrhosis, and the risk increases with increasing fibrosis of the liver. Thus, the fibrosis-4 (FIB-4) index, developed as a noninvasive test to stage liver fibrosis, may predict the development of hypertension. Purpose The present study investigated the relationship of FIB-4 index with the prevalence and future development of hypertension in the general population. Methods A total of 16125 participants who visited our hospital for a physical check-up at least twice from 2008 to 2018 (male=9700, 52.0±12.3 year-old) were subjected for cross-sectional analysis. Among them, 3995 participants were hypertensive. The remaining 12111 normotensive participants (male=6984, 49.5±11.9 year-old) were followed up for the median of 1643 days with the endpoint being the development of hypertension, defined as systolic blood pressure ≥140mmHg, diastolic blood pressure ≥90mmHg or the use of antihypertensive medication. FIB-4 index was calculated as follows; (age×AST)/(platelet number×√ALT). Results Cross-sectional analysis revealed that FIB-4 index was higher in hypertensive than normotensive participants (1.40±0.74 vs. 1.09±0.54, p<0.001). During the follow-up, 2819 participants (45.7 per 1000 person-year) developed hypertension. The incidence was more frequent in male (55.6 per 1000 person-year) than female participants (32.7 per 1000 person-year, p<0.001). High level of FIB-4 index (≥2.67, n=194) showed a significant impact on the incident hypertension (80.5 per 1000 person-year) as compare with middle (≥1.30, <2.67, n=3082) or low level (<1.30, n=8835) of FIB-4 index (65.4 and 38.8 per 1000 person-year, respectively). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of FIB-4 index for the new onset of hypertension was 1.483 (1.416-1.553). In multivariate Cox hazard analysis adjusted for sex, body mass index, systolic blood pressure, pulse rate, serum creatinine, uric acid, HbA1c, LDL-cholesterol, triglyceride, hemoglobin, current smoking, frequent alcohol consumption and family history of hypertension, FIB-4 index was an independent predictor of the development of hypertension (HR 1.321, 95%CI [1.213-1.438]). Similar results were obtained in analyses of male (HR 1.382, 95%CI [1.300-1.470]) and female subgroups (HR 1.369, 95%CI [1.230-1.524]). History of viral hepatitis or frequent alcohol consumption did not affect the results (data not shown). Conclusions FIB-4 index is a useful predictor of the development of hypertension in the general population. Increased risk of cardiovascular events in patients with NAFLD may partially be attributable to the development of or coexistence with hypertension.

Effect of COVID-19 pandemic on the management of hypertension and the prevalence of lifestyle disease

Abstract Background/Introduction Behavior restrictions after the advent of COVID-19 dramatically changed our lifestyle, which may have affected self-management of metabolic factors in individuals. Purpose We examined possible changes in the prevalence and management of lifestyle-related diseases in the general population. Methods We enrolled 2582 consecutive participants aged ≥20 years (male=6984, 49.5±11.9 year-old) who visited our hospital for their annual physical check-up at least five times between 2017 and 2022. Participants were divided into 2 groups (with [n=739] or without antihypertensive medication [n=1843]) and changes in parameters that are closely related with lifestyle were examined before (2017-2019) and after (2020-2022) the pandemic of COVID-19. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or the use of antihypertensive medications. Diabetes mellitus was defined as fasting plasma glucose ≥126 mg/dL, HbA1c ≥ 6.5% or the use of antidiabetic medications. Dyslipidemia was defined as LDL-cholesterol ≥140 mg/dL, HDL-cholesterol <40 mg/dL, triglyceride ≥150 mg/dL, or the use of antidyslipidemic medications. Hyperuricemia was defined as uric acid >7.0 mg/dL for men, >6.0 mg/dL for women or the use of anti-hyperuricemic medications. Metabolic syndrome was defined based on Japanese diagnostic criteria (2005). Results The main results are shown in Table. The levels of all parameters were worse in participants with than without anti-hypertensive medication. The prevalence of hypertension, diabetes, dyslipidemia, hyperuricemia and metabolic syndrome which was higher in subjects with than without anti-hypertensive medication increased after the COVID-19 pandemic. Although the most of parameters were deteriorated after the pandemic, only the management of blood pressure in subjects under antihypertensive medication was improved. Conclusion Behavior restrictions during the pandemic might have unfavorable impact on the prevalence of lifestyle-related diseases. Although the control of blood pressure was not worsened, total management was not excellent during the pandemic in hypertensive individuals under medication.Characteristics of study participants

Early Childhood Cholestasis, Causes & Associated Factors in Children

Background: Newborn cholestasis is explained as a persisted rise of the serum conjugated bilirubin outside the first two weeks of life. There are many etiologies of newborn cholestasis that must be differentiated since immediate interference may give a better outcome. Objective: Newborn cholestasis is explained as a persisted rise of the serum conjugated bilirubin outside the first two weeks of life. There are many etiologies of newborn cholestasis that must be differentiated since immediate interference may give a better outcome. Patients and Methods: A cross-sectional research of forty-eight children consulting the Childhood Wellbeing Teaching Hospital in Baghdad/Medical City from 1st of November 2018 to the 30th of November 2021, complete evaluation by full history, physical checkup and laboratory studies. Cholestasis was demarcated as an extended raise of the levels of conjugated bilirubin outside the 1st 2 weeks of age above 1.0mg/dl(17.1µmol/l) if the whole serum bilirubin(TSB) is <5.0 mg/dL or above 20% of the TSB if the TSB is >5.0 mg/dl. Results: Out of 48 children involved in the study ,62.5% resided in Baghdad, and the remainder was belonged to other districts. The mean age of children was 11.1 months. The males constituted 58.3% of them. Eleven cases (22.9%) were caused by congenital infection, nine 18.8% had no cause detected, while 16.7% caused by biliary atresia and 16.7% had unidentified etiology, however 10.4% was related to sepsis. Biliary atresia was more frequent in boys in 62.5% compared to 37.5% in females. Family history was positive only in11.1% of idiopathic neonatal hepatitis. It was found that 81% of cholestatic jaundice were caused by congenital infection. In comparison, 62.5% caused by biliary atresia and 60% caused by sepsis appeared on the second week of the child's age, and this difference was significant statistically P-value 0.01. Conclusion: Innate infections are the most frequent source, where CMV contagion is the most commonly detected. Clinical findings included clay colored stool & elevated alkaline phosphatase concentrations observed primarily on biliary atresia. There are no specific test to identify the etiology of newborn cholestasis.

Ready to bleed when touched – Moral Injury in the Special Operations Forces military population

Abstract The armed forces combine different military populations with specific patterns of psycho-medical challenges and needs. The Special Operations Forces (SOF) exhibit one such pattern because they undergo more rigorous selection procedures, train differently and generally engage in different types of missions than other military populations. The aim of this commentary is to briefly introduce the psycho-medical patterns of SOF while paying particular attention to the growing discussion of Moral Injury (MI) in this military population. The mental health construct of MI refers to the persistent psycho-social harm resulting from exposure to events that clash with an individual’s moral beliefs. So far, research has focused on causes and symptoms of MI, less on prevention strategies and early intervention opportunities. This article advocates making a regular screening for symptoms of MI an element of routine physical check-ups of SOF to identify MI-related problems earlier and destigmatise mental health struggles, thereby countering severe manifestations of MI and alleviating suicidality rates in the SOF military population.

Analysis of language and influencing factors of children with speech disorder in Beijing

Objective: To investigate the features and influencing factors of language in children with various types of speech disorders. Methods: A case-control study was carried out, 262 children with speech disorder had been diagnosed at the language-speech clinic of the Center of Children's Healthcare, Children's Hospital, Capital Institute of Pediatrics from January 2021 to November 2023, the children with speech sound disorder as the speech sound disorder group, the children with developmental stuttering as the stuttering group. There were 100 typically-developed children who underwent physical checkups at the Center of Healthcare during the same period as the healthy group. All children experienced a standardized evaluation of language with diagnostic receptive and expressive assessment of mandarin-comprehensive(DREAM-C) and questionnaire, One-way ANOVA and LSD test were conducted to compare the differences in overall language, receptive language, expressive language, semantics, and syntax scores among 3 groups of children. According to the results of DREAM-C, the children with speech disorder were divided into language normal group and language delay group. Chi-square test and multivariate Logistic regression were implemented to analyze the association between the linguistic development of children with speech disorder and potential influential factors. Results: There were 145 children in the speech sound disorder group, including 110 males and 35 females respectively, with an age of (5.9±1.0) years; 117 children in the stuttering group, including 91 males and 26 females, with an age of (5.8±1.0) years; 100 children in the healthy group, including 75 males and 25 females, with an age of (5.7±1.2) years. The variations in overall language, expressive language, and syntax scores among 3 groups of children were statistically significant (92±18 vs.96±11 vs. 98±11, 81±18 vs. 84±14 vs. 88±13, 87±16 vs. 89±11 vs. 91±10, F=5.46, 4.69, 3.68, all P<0.05). Pairwise comparison revealed that the speech sound disorder group had lower scores in overall language, expressive language, and syntactic compared to the healthy group, and the differences were statistically significant (all P<0.01) and the overall language score was lower than that of children with stuttering (P<0.05). In terms of overall language and expressive language, there was a statistically significant difference in the incidence of language delay among the three groups of children (15.9% (23/145) vs. 20.5% (24/117) vs. 7.0% (7/100), 46.2% (67/145) vs. 39.3% (46/117) vs. 26.0% (26/100); χ2=7.93, 10.28; both P<0.05). In terms of overall language, the stuttering group took up the highest proportion. In terms of expressive language, the speech sound disorder group accounted for the highest amount. The incidence of language delay in children with speech disorder was 44.3% (116/262). Non-parent-child reading, daily screen time ≥1 hour and screen exposure before 1.5 years of age are risk factors for the development of language in children with speech disorder (OR=1.87, 2.18, 2.01; 95%CI 1.07-3.27, 1.23-3.86, 1.17-3.45; all P<0.01). Negative family history are protective factors for the progress of language ability (OR=0.37, 95%CI 0.17-0.81, P<0.05). Conclusions: Children with speech disorder tend to have easy access to language delay, especially in expressive language and syntax. The occurrence of language delay in children with speech disorder is tightly connected with factors such as the family medical history, parent-child reading, screen time, etc. Attention should be paid to the development of language in children who suffer from speech disorder.

Association of somatic comorbidity and treatment adherence in patients with psychotic disorder

BackgroundIncreased risk for somatic comorbidity in individuals with schizophrenia has been well established. In addition, psychiatric patients with somatic illnesses are more likely to have more psychiatric readmissions. Increased burden of treatment related to chronic somatic comorbidities may be associated with lower adherence to psychiatric medication. MethodsCross-sectional study of 275 patients with schizophrenia spectrum disorder. A general practitioner performed a complete physical health checkup for all participants, including a complete medical examination and laboratory tests. Patients’ adherence, attitudes, insight, and side-effects were evaluated using the Attitudes toward Neuroleptic Treatment Scale. Overall symptomatology was measured using the Brief Psychiatric Rating Scale. Regression analysis was used to investigate interactions and associations among health beliefs, disease burden, and treatment adherence. Separate regression models were utilized to account for the complexity of health behavior and treatment adherence pathways. ResultsPatients’ somatic comorbidity and health behavior were not associated with adherence or attitudes toward antipsychotic treatment. High dose of antipsychotics and obesity were related to the need for medical interventions, while a healthy diet reduced the risk. Higher BPRS score and older age were associated with having somatic symptoms. Somatic comorbidities had no negative effects on treatment adherence or attitudes. ConclusionThis study focuses on exploring possible associations between health beliefs and treatment adherence pathways in patients with psychotic disorders. Contrary to our hypotheses, we found no evidence to support our health belief and diseases burden models and their associations.

Significance of blood pressure variability in normotensive individuals as a risk factor of developing hypertension

Purpose Visit-to-visit blood pressure variability is a strong predictor of the incidence of cardiovascular events and target organ damage due to hypertension. The present study investigated whether year-to-year blood pressure variability predicts the risk of hypertension in the Japanese general population. Materials and methods This study analysed 2806 normotensive individuals who participated in our physical check-up program for five years in a row from 2008 to 2013. The average, standard deviation, coefficient of variation, average real variability, and highest value of systolic blood pressure in the five consecutive visits were determined and used as baseline data. The participants were followed up for the next 6 years with the development of ‘high blood pressure’, an average blood pressure level of ≥140/90 mmHg or the use of antihypertensive medications, as the endpoint. Result During follow-up, ‘high blood pressure’ developed in 389 participants (13.9%, 29.5 per 1 000 person-years). The incidence increased across the quartiles of standard deviation and average real variability, while the average and highest systolic blood pressure had the most prominent impact on the development of ‘high blood pressure’. Multivariate logistic regression analysis adjusted for possible risk factors indicated that the average, standard deviation, average real variability, and highest blood pressure, but not the coefficient of variation of systolic blood pressure, were significant predictors of ‘high blood pressure’. Conclusion Increased year-to-year blood pressure variability predicts the risk of hypertension in the general normotensive population. The highest blood pressure in the preceding years may also be a strong predictor of the risk of hypertension.

Progressive collapsing foot deformity: clinical presentation, diagnosis, and management options

Progressive collapsing foot deformity (PCFD) is a prevalent musculoskeletal disease that can cause significant deformity and disability. This review article aimed to overview the clinical presentation, diagnosis, and management options for PCFD. Google Scholar and PubMed were searched specifically for publications published up until May 2023 through several keywords. Inclusion criteria were articles on PCFD and articles published in English. The exclusion criteria were related to flexible flatfoot, vertical talus condition, and non-English articles. PCFD can present with various symptoms and signs, including elongation of the tibialis posterior tendon, hindfoot valgus deformity, forefoot abduction, weakness on the single-heel-rise test, and too-many-toes signs. The footprint assessment can be used easily and effectively to detect PCFD. Diagnosis of PCFD must be according to a thorough history taking, physical check-up, and appropriate imaging studies. Treatment options for PCFD range from conservative measures such as orthotic devices and physical therapy to more aggressive measures such as tendon transfers, arthroereisis, and implant-based reconstructions. The therapeutic plan should be individualized to the patient&amp;apos;s requirements and comorbidities. Different surgical modalities are available to manage flat foot deformity, including arthroereisis, lateral column lengthening, medializing calcaneal osteotomy, dorsal opening wedge osteotomy, and cotton osteotomy. Each intervention has its benefits and disadvantages, and the most appropriate modality should be selected according to the kind and severity of the deformity, the patient&amp;apos;s features and risk factors, and the surgeon&amp;apos;s experience. Pre- and postoperative patient-reported outcomes measurement information system scores can help to evaluate treatment outcomes.

Epigenetic phenotype of plasma cell-free DNA in the prediction of early-onset preeclampsia

Background In the current study, we sought to characterise the methylation haplotypes and nucleosome positioning patterns of placental DNA and plasma cell-free DNA of pregnant women with early-onset preeclampsia using whole genome bisulphite sequencing (WGBS) and methylation capture bisulphite sequencing (MCBS) and further develop and examine the diagnostic performance of a generalised linear model (GLM) by incorporating the epigenetic features for early-onset preeclampsia. Methods This case-control study recruited pregnant women aged at least 18 years who delivered their babies at our Hospital. In addition, non-pregnant women with no previous history of diseases were included. Placental samples of the villous parenchyma were taken at the time of delivery and venous blood was drawn from pregnant women during non-invasive prenatal testing at 12–15 weeks of pregnancy and nonpregnant women during the physical check-up. WGBS and MCBS were carried out of extracted genomic DNA. Then, we established the GLM by incorporating preeclampsia-specific methylation haplotypes and nucleosome positioning patterns and examined the diagnostic performance of the model by receiver operating characteristic (ROC) curve analysis. Results The study included 135 pregnant women and 50 non-pregnant women. Our high-depth MCBS revealed notably different DNA methylation and nucleosome positioning patterns between women with and without preeclampsia. Preeclampsia-specific hypermethylated sites were found predominantly in the promoter regions and particularly enriched in CTCF on the X chromosome. Totally, 2379 preeclampsia-specific methylation haplotypes were found across the entire genome. ROC analysis showed that the area under the ROC curve (AUC) was 0.938 (95%CI 0.877, 1.000). At a GLM cut-off of 0.341, the AUC was the maximum, with a sensitivity of 95.6% and a specificity of 89.7%. Conclusion Pregnant women with early-onset preeclampsia exhibit DNA methylation and nucleosome positioning patterns in placental and plasma DNA.

Association of dietary salt intake with diabetes mellitus in the Japanese general population

Abstract Background/Introduction Excess salt intake, one of the most important modifiable factors in our lifestyle, has been reported to be a risk of cardiovascular morbidity and mortality. Several mechanisms underlying the development of cardiovascular disease after excess salt intake are proposed, among which hypertension has been established. Diabetes mellitus (DM) is also a risk factor of cardiovascular disease and, thus, there may be some association between excess salt intake and DM. Purpose The present study was designed to investigate possible relationship between dietary salt intake and DM in the general population. Methods Dietary salt intake was estimated using a spot urine sample in 16018 subjects (male=9642, 52.0±12.3 year-old) who visited our hospital for a yearly physical checkup from July 2008 to March 2019 (baseline). A cross-sectional analysis for the relationship between salt intake and DM was performed at baseline. Then, subjects without DM (n=14715, male=8651, 51.3±12.3 year-old) were followed up until March 2020 (median 2107 days) with the endpoint being the development of DM. DM was defined as fasting plasma glucose (FPG) ≥126mg/dL, HbA1c≥6.5% or the use of antidiabetic medications. Results A cross-sectional analysis revealed that salt intake in subjects was 8.67±1.98 g/day. Salt intake was significantly higher in subjects with (n=1280) than without DM (9.55±2.17 vs. 8.61±1.94 g/day). Multivariate regression analysis adjusted for age, gender, body weight, systolic blood pressure, pulse rate, serum creatinine, uric acid, FPG, LDL-cholesterol, triglyceride, current smoking and frequent alcohol drink showed that salt intake was associated with the presence of DM (r=0.027, p&amp;lt;0.001). In the follow-up study, 861 subjects developed DM (10.1 per 1000 person-year), with the incidence being more frequent in males than in females (11.7 vs. 7.6 per 1,000 person-year). The incidence of DM was increased across the quartiles of salt intake at baseline (7.5, 7.6, 10.5 and 14.8 per 1000 person-year). In analysis where salt intake at baseline was taken as continuous variables, non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of salt intake for the new onset of DM was 1.146 (1.109-1.184). Multivariate Cox-hazard analysis adjusted for possible risk factors showed that salt intake was a significant predictor for the future development of DM (HR: 1.037, 95%CI: 1.001-1.073), while additional adjustment for baseline body weight disappeared the statistical significance (HR: 0.994, 95%CI: 0.958-1.031). Conclusions Salt intake is associated with the development of DM and excess salt intake may predict future development of DM in the general population. Excess food intake which is usually accompanied by excess salt intake in individuals with increased body weight may be responsible for the development of DM. Maintenance of appropriate body weight as well as restriction of dietary salt may lead to the prevention from developing DM.

Metabolic disorders predict future impairment of kidney function in the Japanese general population

Abstract Background/Introduction Metabolic syndrome (MetS) which is defined as accumulation of visceral fat followed by a cluster of metabolic disorders is one of the most important risk factors of cardiovascular morbidity and mortality. Although the close relationship between kidney dysfunction and cardiovascular events have also been reported, the association of kidney dysfunction with MetS remains unidentified. Purpose The present study investigated whether MetS or its components predict future deterioration of kidney function in the general population. Methods Consecutive 14917 subjects with normal estimated glomerular filtration rate (eGFR; ≥60mL/min/1.73m²) who visited our hospital for a physical check-up from 2008 to 2018 (male=8876, 51.3±12.4 year-old) were enrolled and followed up until 2019 for 1847 days (median) with the endpoint being the development of impaired kidney function (eGFR&amp;lt;60mL/min/1.73m²). Metabolic syndrome was defined based on the Japanese diagnostic criteria (2005; waist circumference ≥85 cm for males and ≥90 cm for females and ≥2 of the following three criteria: (1) triglyceride≥150 mg/dL and/or high-density lipoprotein cholesterol &amp;lt; 40 mg/dL; (2) systolic blood pressure≥130 mmHg and/or diastolic blood pressure ≥85 mmHg; and (3) fasting plasma glucose ≥110 mg/dL). Participants who had medication for each metabolic disorder were considered to meet each criterion. Results During the follow-up, 2150 subjects (25.9 per 1000 person-year) developed impaired kidney function. The incidence was more frequent in subjects with (39.3 per 1000 person-year) than without MetS (24.2 per 1000 person-year, p&amp;lt;0.001). Moreover, each component of MetS showed a significant impact on the incident impaired kidney function (obesity 23.0 vs. 31.2, lipid 23.3 vs. 34.2, blood pressure 19.9 vs. 35.9, glucose 24.8 vs. 35.2 per 1000 person-year) and the incidence was increased with increasing the number of metabolic disorders in individuals at baseline (0, 1, 2 and ≥3 factor(s); 17.3, 26.9, 32.9 and 39.7 per 1000 person-year, respectively). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of MetS for the new onset of impaired kidney function was 1.619 (1.447-1.810). In multivariate Cox hazard analysis adjusted for sex, age, pulse rate, serum creatinine, uric acid, hemoglobin, current smoking and frequent alcohol consumption, MetS was an independent predictor of the development of impaired kidney function (HR=1.312, 95%CI [1.167-1.475]). Similar results were obtained in sub-analysis using subjects without any medications (n=11963) (data not shown). Conclusions Metabolic syndrome and its components are important predictors for the development of impaired kidney function in the general population. Prediction of the deterioration of kidney function may lead to effective prevention of chronic kidney disease and relating cardiovascular disease.

Thyroid profile prognostic value on disease severity and mortality in COVID-19

Background: Precise accurate triage of Coronavirus disease 2019 (COVID-19) patients during hospitalization for early identification of individuals at risk of developing severe disease is essential as Intensive Care Units (ICUs) are overwhelmed by the pandemic burden. The aim of this study was to evaluate thyroid function in patients with COVID-19. Methods: 60 healthy controls and 180 patients were admitted to a cardiothoracic hospital, Minia University, Egypt, between March 2020 and September 2021 without a history of thyroid disease. Patients divided as 60 non-COVID pneumonia patients with a similar degree of severity were included as another control group to find any unique effects of COVID-19 on thyroid function, 120 positive COVID-19 divided according to clinical classifications into moderate (n = 58), severe (n = 21), and critical (n = 41), Critical group were admitted to ICU and classified to survivors (n = 33) and non-survivors (n = 8). COVID patients also were divided into tertiles according to their FT3 levels. Lowes tertile (n = 45), middle tertile (n = 37) and highest tertile (n = 38). All participants underwent routine physical checkups, acute physiology, and chronic health evaluation (APACHE-II) scores. The outcome measure was death during hospitalization; intensive care admission, mechanical ventilation, and length of hospitalization. We analyzed the ability of each parameter to predict mortality in participants. Further, we also evaluated whether the combination of free triiodothyronine (FT3) level with APACHE-II score could improve the mortality prediction. Results: Thyroid Stimulating Hormone (TSH) was lower than normal range in 56.7% (68/120) of patients with COVID-19. TSH and serum-free triiodothyronine (FT3) were significantly lower in COVID-19 patients than healthy control and non-COVID-19 pneumonia patients. TSH and FT3 were lower in severe COVID-19 with statistical significance (p &lt; 0.001) and both positively correlated with the severity. The free thyroxine (FT4) in COVID-19 patients was not significantly different from the control group. Patients in the lowest FT3 tertile had significantly higher rates of mortality (18/40), mechanical ventilation (24/53.3), and intensive care unit admission (20/44.4). In univariate analyses, FT3 remained the most significant independent predictor of death. Conclusion: The changes in serum TSH and FT3 levels may be important manifestations of COVID-19 courses.FT3 levels can serve as a prognostic tool for disease severity in early presentation of COVID-19.

Relationship chains of subhealth physical examination indicators: a cross-sectional study using the PLS-SEM approach

Subhealth is a transitional state between health and disease, and it can be detected through routine physical check-ups. However, the complexity and diversity of physical examination items and the difficulty of quantifying subhealth manifestations are the main problems that hinder its treatment. The aim of this study was to systematically investigate the physical examination performance of the subhealthy population and further explore the deeper relationships between indicators. Indicators were obtained for 878 subjects, including basic information, Western medicine indicators, inquiries of traditional Chinese medicine and sublingual vein (SV) characteristics. Statistical differences were analysed using R software. To explore the distribution of symptoms and symptom clusters in subhealth, partial least squares-structural equation modelling (PLS-SEM) was applied to the subhealth physical examination index, and a structural model was developed to verify whether the relationship chain between the latent variables was reasonable. Finally, the reliability and validity of the PLS-SE model were assessed. The most common subclinical clinical symptoms were limb soreness (37.6%), fatigue (31.6%), shoulder and neck pain (30.5%) and dry eyes (29.2%). The redness of the SV in the subhealthy group was paler than that in the healthy group (p < 0.001). This study validates the establishment of the directed acyclic relationship chain in the subhealthy group: the path from routine blood tests to lipid metabolism (t = 7.878, p < 0.001), the path from lipid metabolism to obesity (t = 8.410, p < 0.001), the path from obesity to SV characteristics (t = 2.237, p = 0.025), and the path from liver function to SV characteristics (t = 2.215, p = 0.027). The innovative application of PLS-SEM to the study of subhealth has revealed the existence of a chain of relationships between physical examination indicators, which will provide a basis for further exploration of subhealth mechanisms and causal inference. This study has identified the typical symptoms of subhealth, and their early management will help to advance the treatment of diseases.

Evaluation of Postoperative Care Protocol for Roux-en-Y Gastric Bypass Patients with Same-Day Discharge.

Same-day discharge (SDD) after bariatric surgery is increasingly being performed and is safe with careful patient selection. However, detecting early complications during the first postoperative days can be challenging. We developed a postoperative care protocol for these patients and aimed to evaluate its effectiveness in detecting complications and monitoring patient recovery. A single-center retrospective observational study was conducted with patients with who underwent Roux-en-Y Gastric Bypass (RYGB) with successful SDD. The study evaluated the effectiveness of the safety net that included simple remote monitoring with a pulsoximeter and thermometer, a phone consultation on postoperative day (POD) 1, and a physical consultation on POD 2-4. Furthermore, an analysis was performed on various factors including pain scores, painkiller usage, and incidences of nausea and vomiting on POD 1. In this study, 373 consecutive patients were included, of whom 19 (5.1%) were readmitted until POD 4. Among these, 12 patients (3.2%) reached out to the hospital themselves, while 7 (1.9%) were readmitted after phone or physical consultations. Ten of the readmitted patients had tachycardia. On POD 1, the mean numeric rating scale was 4 ± 2, and 96.6% of the patients used acetaminophen, 35.5% used naproxen, and 9.7% used oxynorm. Of the patients, 13.9% experienced nausea and 6.7% reported vomiting. A postoperative care protocol for SDD after RYGB, comprising simple remote monitoring along with a phone consultation on POD 1 and a physical checkup on POD 2-4, was effective in monitoring patient recovery and detecting all early complications.

Relationship between Helicobacter pylori and glycated hemoglobin: a cohort study.

Helicobacter pylori (H. pylori) has increasingly been shown to be related to extragastric diseases. Glycated hemoglobin A1c (HbA1c), an indicator of glycemic control, is closely linked to the event of diabetes. The purpose of this research was to analyze the association between H. pylori and HbA1c through a cohort study. The population who underwent multiple physical checkups in the physical examination center of Taizhou Hospital was included. All of them underwent urea breath test, serological examination and physical parameter measurement. Multiple regression was used for analyzing the influencing factors of HbA1c. In addition, the result of HbA1c on H. pylori infection was studied by restricted cubic spline (RCS) analysis. The triglyceride glucose (TyG) index represents the level of insulin resistance (IR) in the population. The population was classified on the basis of primary and last H. pylori infection, therefore, the variations of HbA1c and TyG index among totally different teams were investigated. Multiple regression demonstrated that H. pylori was an influential factor in HbA1c. RCS analysis showed a nonlinear relationship between HbA1c and H. pylori infection. When HbA1c>5.7%, the chance of H. pylori infection was considerably enlarged. Additionally, long-term H. pylori infection increased HbA1c levels, while HbA1c levels decreased after H. pylori eradication. Similarly, long-term H. pylori infection also increased the TyG index. Prediabetes increases the danger of H. pylori infection, long-term H. pylori infection increases HbA1c and IR levels, and wipeout of H. pylori could have a positive impact for glycemic control in the population.

Excessive salt intake reduces bone density in the general female population.

Osteoporosis is a multifactorial disorder in which nutrition is associated with its onset and progression. Excessive salt intake is closely associated with the onset and progression of various diseases, such as osteoporosis and hypertension. We investigated the effects of dietary salt intake on bone density in the general female population. In 884 female participants (60.1 ± 10.1 years old) who visited our hospital for an annual physical checkup, salt intake (g/day) was assessed using a spot urine sample, and bone density was evaluated as a speed of sound (m/s) of ultrasonic pulses in a calcaneus by quantitative ultrasound. We investigated the relationship between bone density and salt intake and the differences in bone density or salt intake between the presence and absence of lifestyle-related diseases such as hypertension, diabetes mellitus and dyslipidaemia. The average bone density and salt intake were 1497 ± 26 m/s and 8.5 ± 1.8 g/day, respectively. Univariate and multivariate regression analyses revealed that bone density was significantly negatively associated with salt intake. Bone density was lower, and salt intake was higher in participants with hypertension, diabetes mellitus and dyslipidaemia than in those without. After adjusting for age, hypertension, diabetes mellitus and dyslipidaemia, bone density was negatively correlated with salt intake. We confirmed that excessive salt intake reduces bone density independently of age and lifestyle-related diseases in the general female population. Since dietary salt intake is a modifiable factor, osteoporosis can be prevented by dietary intervention, including salt reduction.

Impact of White Matter Hyperintensity and Age on Gait Parameters in Patients With Cerebral Small Vessel Disease.

This study aimed to investigate the effect of white matter hyperintensity (WMH), a common cerebral small vessel disease (CSVD) imaging marker, and age on gait parameters in middle-aged and geriatric populations. Cross-sectional study. A total of 1076 participants (62.9% female; age 61.0 ± 9.3years), who visited the neurology clinic or obtained a physical check-up from the Affiliated Hospital of Guizhou Medical University. In total, 883 patients with WMH and 193 healthy controls were included in this study. The Fazekas scores of patients with CSVD were used to assess the burden of WMH. Based on the Fazekas scores, all participants were divided into 4 groups: 553 patients with Fazekas I, 257 patients with Fazekas II, 73 patients with Fazekas III, and 193 controls. Gait parameters, including step speed, frequency, length, width, stance time, and swing time, were quantitatively assessed using a vision-based artificial intelligence gait analyzer (SAIL system). The relationships among the Fazekas scores, age, and gait parameters were analyzed. Step speed, step length, step width, stance time, and swing time were significantly different among the 4 groups. Furthermore, Fazekas scores and age were both associated with gait parameters, including step speed, step length, stance time, and swing time. The Fazekas scores were associated with step width, whereas age was not. Age was associated with step frequency, whereas Fazekas scores werenot. Fazekas score and age are useful for evaluating gait parameters in patients with CSVD. Emerging WMH (such as Fazekas Ⅰ) could be a clinical warning sign of gait disturbance in a geriatric population.

Physical and Mental Health Status of the Homeless in a Cold Region of Japan: Alcohol Intake, Diet and Psychosocial Distress

This study sought to clarify the lifestyle and physical and mental health status of homeless people in a cold region of Japan. 28 participants who visited a soup kitchen completed the physical health check-up and questionnaire surveys in 2017. Five were invited to participate in semi-structured interviews in 2018. Mental health was evaluated using the General Health Questionnaire-28 (GHQ-28). The results revealed that a high proportion of homeless people did not consume enough food. Their meat, fish, and vegetables intake were limited, indicating that inappropriate eating habits may affect physical health. Furthermore, four people consumed meals once or less every two days, and all of them were living on the street. In addition, 18% (n = 5) answered that they often consumed alcohol in the daytime, and 68% (n = 19) had a total GHQ-28 score above the cut-off point (&gt;5). In this regard, among those with a GHQ-28 score of &gt;5, seven drank in the daytime even though they consumed meals once or less a day. Indeed, qualitative results revealed physical and psychosocial distress experienced, including limited access to food, anxiety for the future, lack of social support, and erosion of self-esteem. These findings suggest that restrictions on food selection due to financial insecurity, alcohol issues, and mental disorders may impact the food intake and subsequently lead to deteriorating physical health and living on the street may also significantly impact mental health among the homeless. which are helpful for health and social workers to develop necessary interventions targeted at this population.

Cytopathological evaluation of thyroid by fine needle aspiration cytology and its association with thyroid function

Introduction: Fine needle aspiration cytology is a reliable method for thyroid nodule evaluation (FNAC). Thyroid nodules often cause abnormal thyroid function tests, which are used for diagnosis and therapy. Thyroid cancer and incorrect thyroid function testing are still debated. Objective: We aimed to evaluate the cytopathological features of thyroid nodules by FNAC and their association with thyroid function tests. Methods: This 12-month cross-sectional study was conducted in Peshawar, Pakistan. 350 thyroid nodule patients were referred to endocrinology. All research participants had a physical checkup and thyroid function testing. Thyroid function testing measured TSH and FT4 using conventional laboratory procedures. All individuals had 23-gauge ultrasound-guided thyroid nodule FNAC. Pathologists used the Bethesda System for Reporting Thyroid Cytopathology to evaluate FNAC samples. SPSS 25 analyzed the data. Descriptive statistics detailed the study population's clinical and demographic characteristics. Logistic regression was utilized to examine the relationship between thyroid function tests and thyroid cancer risk and FNAC's thyroid cancer detection effectiveness. Results: For this research, a total of 350 thyroid nodule patients were included having the median age 39.8 (20-60) years and the ratio of female to male participants was 3:1.

Developing Patient-Centered Preventative Care to Reduce Mobility Disability With Aging: Preferences From a Discrete Choice Experiment.

Mobility disability is the most prevalent form of disability for older adults in the United States. A physical therapy mobility checkup (MC) under development is a patient-centered preventative physical therapy visit. It includes physical performance testing and education on physical performance as a valuable and modifiable health indicator. The purpose of this study was to identify the proportion of older adults willing to participate in an MC, the age at which they would initiate care, their desired frequency of participation, and the characteristics, or attributes, of the MC they preferred. In a cross-sectional study conducted at the Minnesota State Fair, adults older than 55 years answered survey questions about preventative health practices and completed a discrete choice experiment (DCE) to determine their preferences for the MC. Attributes studied in the DCE were visit duration, checkup content, education, and possible outcomes of participating in preventative care for mobility. Descriptive statistics characterized demographic information and survey responses. Conjoint choice modeling estimated the main effect for each DCE attribute. One hundred sixty-six older adults participated in the study. Seventy-eight percent indicated that they would choose an MC if available. Most participants (66%) believed that MCs should occur before 60 years of age and at least annually (68%). A 30-minute visit duration, which accounted for 84% of attribute importance, was preferred. Balance, the preferred content of the MC, accounted for 12% of the attribute importance. Preferences for educational content and possible outcomes of participation with preventative care aimed at preventing mobility loss were not statistically significant. Older adults value preventative care for reducing mobility disability. They identified time efficiency and the inclusion of measures to assess balance as priorities for this preventative physical therapy visit.