Point Increase Research Articles

A cross-sectional descriptive analysis of technology addiction in adolescents: associations with food addiction, emotional eating, and body weight status.

This cross-sectional descriptive study aimed to determine the prevalence and risk factors of technology addiction (TA) in adolescents, as well as investigate the association of TA with food addiction and emotional eating by body weight status. Adolescents (n = 1388) completed a questionnaire that featured socio-demographic characteristics, the Game Addiction Scale (GAS), the Social Media Disorder Scale (SMD), the dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0), and the Emotional Eating Scale Adapted for Use in Children and Adolescents (EES-C). The body mass index (BMI) Z-score was classified according to the World Health Organization. TA was present in one-fifth of adolescents, and boys were four times more likely to develop a digital game addiction (p < 0.001). A 1-point increase in the GAS score is associated with a 1.08-point increase in the dYFAS-C-2.0 score and a 0.5-point increase in the total EES-C score (p < 0.001). A 1-point increase in the SMD score was also related to an increased of 1.21 and 1.26, respectively (p < 0.001). All of these positive associations were significant in adolescents with overweight (p < 0.001). Given the rapidly increasing prevalence of TA among adolescents, its association with food addiction, emotional eating, and body weight status is worrisome, and our findings shed light on the relevance of developing strategies to reduce the prevalence of TA in this population.

Interoceptive Awareness Is Associated With Impaired Awareness of Hypoglycemia in Adults With Type 1 Diabetes.

To assess the association between impaired awareness of hypoglycemia (IAH) and interoceptive awareness in type 1 diabetes. A total of 154 adults with type 1 diabetes completed IAH surveys and the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). Logistic regression was performed for assessment of associations between IAH and MAIA-2, accounting for covariates. Significant relationships were observed between IAH and two MAIA-2 scales. Each 1-point increase on the Not-Worrying subscale was associated with 87% increased odds of IAH (odds ratio 1.87, CI 1.01-3.46) and on the Attention Regulation subscale was associated with 72% decreased odds of IAH (0.28, 0.12-0.66). Compared with scoring >90th percentile for Attention Regulation, scoring <10th percentile and scoring in the 10th-90th percentiles were associated with 71-fold (71.26, 3.42-1482.10) and 12-fold (12.73, 1.19-135.57) increased odds of IAH, respectively. Less worry about and reduced ability to sustain and control attention to body sensations were associated with significantly increased odds of IAH.

Association between sick child facility readiness and quality of care at the individual and facility level in five low- and middle-income countries.

Raising the quality of health services is key to continued progress in improving child health, however, data on service quality are limited and difficult to interpret. The relationship between facility readiness and the quality of care is complex. Using publicly available data sets from five low- and middle-income countries (LMICs), we assessed the relationship between structural factors and the clinical quality of care for managing sick children. We developed indices for readiness and quality accounting for available indicators, expert opinion, and alignment with integrated management of childhood illness (IMCI) guidelines. In each country, we assessed the association between readiness and quality, with and without adjusting for other factors. We considered associations overall, by domain, and by provider type, explored non-linear associations, and compared associations at the individual and facility-level. The analysis included data from 3,149 health facilities and 11,159 sick child observations. In four of the five countries included in the analysis, we observed for every 10%-point increase in readiness, quality increased by about 1% point after adjusting for facility type and managing authority. There was little evidence of a non-linear relationship or a threshold effect altering the relationship between readiness and quality of care. Beyond readiness, younger child age, higher cost of care, and having a respiratory, digestive, or febrile diagnosis were most often associated with a higher quality of care. Higher "human resources" readiness domain scores were most consistently associated with better quality of care, while the quality of care domain of "treatment" was the least influenced by readiness. Facility-level associations did not vary greatly from individual-level associations. The weak correlation observed suggests readiness plays an important role in quality but as currently measured cannot be used to characterize clinical quality of care. Data for assessing quality of health services are limited, presenting challenges for understanding impediments, assessing interventions, and gauging changes in the quality of care over time. We need better data to assess the quality of care being delivered in LMICs to understand what factors drive quality, with the goal of improving the management of sick children.

Abstract 4124506: Short Physical Performance Battery as a Marker of Severity and Predictor of Clinical Outcomes in Transthyretin Amyloid Cardiomyopathy (ATTR-CM)

Background: ATTR-CM has an age dependent prevalence and is a disorder that almost exclusively affects older adults. Objective evaluations of function are critical to assessing and managing ATTR-CM in older adults. The short physical performance battery (SPPB) is a valid measure of functional capacity that predicts morbidity and mortality in older adults but its utility in ATTR-CM remains unknown. Aims/hypothesis: To establish SPPB as a useful marker of disease severity and predictor of outcomes in ATTR-CM. We hypothesized that SPPB scores would correlate with validated markers of ATTR-CM severity and improve clinical prediction. Methods: This is a retrospective analysis of patients referred to the Columbia University Cardiac Amyloid Program. Patients were stratified into low (SPPB 0-6), moderate (7-9), and high (10-12) cohorts based on initial SPPB score and baseline characteristics were compared between groups. Cox proportional hazard models and Kaplan Meier (KM) curves were generated to assess associations with mortality as well as a composite of death and cardiovascular (CV) hospitalization in follow-up. Results: A total of 263 patients, age 78 years (IQR 73, 84), 86% male, 22% with ATTRv (variant) and 78% with ATTRwt (wild type) were studied. SPPB showed no limitation in 59%, mild limitation in 33%, and severe limitation in 8%. Lower SPPB was associated (p &lt;0.05) with older age, prior stroke/TIA, shorter 6-minute walk test, elevated NT-proBNP and HS-troponin, worse quality of life metrics on Kansas City Cardiomyopathy Questionnaire, more advanced NYHA and Mayo stages, and higher Columbia scores. On multivariate regression (adjusted for age, sex, genotype, NYHA), SPPB was independently associated with the composite of mortality and CV hospitalization, with each point increase corresponding to 13% lower incidence of the outcome (HR 0.87, p=0.01). Chair stands score, one of three SPPB subdomains, was independently associated with the composite and mortality. KM curves showed significant association with SPPB and both the composite and mortality (Fig. 1). Conclusions: SPPB score is a marker of ATTR-CM severity, associated with validated biomarkers and staging systems, and independently predicts clinical outcomes.

Prospective association between the Cardiovascular Health Diet Index and subclinical atherosclerosis: the ELSA-Brasil cohort study.

The Cardiovascular Health Diet Index (CHDI) is a diet quality score based on the dietary guidelines of the American Heart Association for cardiovascular health, but with some adaptations, such as red meat, dairy, beans, and ultra-processed foods in its components. The CHDI has shown good relative validity parameters, however, its association with health outcomes is still unclear. Thus, our aim was to investigate the association between the CHDI score with subclinical atherosclerosis. Data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort were used. Subclinical atherosclerosis was assessed by measuring coronary artery calcification (CAC) at baseline (2008-2010) and second wave (2012-2014) and carotid intima-media thickness (cIMT) at baseline and at the third wave (2017-2019). The CHDI score (ranges from 0 to 110 points) was applied to dietary data obtained from a food frequency questionnaire at baseline. Poisson regression with robust variance, linear regression and linear mixed-effects models were used to evaluate the association of the CHDI score with CAC incidence (n 2,224), CAC progression (n 725), and changes in cIMT (n 7,341) over time, respectively. After a median 8-year follow-up period, a 10-point increase in the CHDI score was associated with a decrease in cIMT of 0.002 mm (95% CI -0.005; -0.001). No association was observed between the CHDI score and CAC incidence and progression after a 4-year follow-up period. Higher scores in the CHDI were prospectively associated with decreased subclinical atherosclerosis after an 8-year follow-up period.

Factors Associated With Motivation to Reduce Alcohol Use Among Patients With Chronic Liver Disease.

Alcohol use is prevalent among hepatology clinic patients with chronic liver disease (CLD). We explored factors associated with the importance and confidence dimensions of motivation to reduce drinking. Participants (N = 121) with unhealthy alcohol use (i.e., over NIH guidelines) receiving care in hepatology clinics from a safety-net hospital (SN, N = 54) and two Veterans Affairs Healthcare Systems (VA, N = 67) were enrolled in an alcohol intervention trial from March 2022 through October 2023. Baseline assessments included Generalised Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-8), Alcohol Use Disorders Identification Test (AUDIT), COVID-19 stress; and measures of importance and confidence to decrease alcohol use (readiness rulers, scales of 1-10). Liver disease aetiology and severity were extracted from electronic health records. We performed multivariable linear regression models with forward selection to assess pre-specified variables' associations with importance and confidence. The sample was 84% male, 40% Latino, 31% White, 18% Black and 11% other races; median age was 61 years. Median (Q1-Q3) AUDIT score was 16 (12-24), importance was 9 (6-10) and confidence was 8 (5-9). On multivariable analysis, VA site (vs. SN) participants had a 0.97-point lower importance score (p = 0.02); higher symptoms of depression (PHQ-8 score ≥ 10 vs. < 10) and AUDIT scores (for each point increase) were associated with higher importance score (estimates 1.2 and 0.08, p < 0.05, respectively). Liver disease aetiology and severity were not significantly associated with outcomes. Depression, alcohol problem severity and treatment site may influence motivation to reduce alcohol use and could inform future hepatology-based interventions.

Association between changes in adherence to the 24-hour movement guidelines with depression and anxiety symptoms among Chinese adolescents: a prospective population-based study

BackgroundThe 24-hour movement guidelines (24-HMG) include screen time (ST), sleep duration, and physical activity. Previous studies have explored the associations of adherence to the 24-HMG with depression and anxiety symptoms among adolescents, ignoring changes in behaviors. This study aimed to examine whether changes in adherence to the 24-HMG were associated with depression and anxiety symptoms among adolescents.MethodsWe recruited adolescents from Shenzhen, China in 2021 and followed them up 1 year later. Changes in adherence to the individual 24-HMG were categorized into four groups: persistent non-adherence, adherence to non-adherence, non-adherence to adherence, and persistent adherence. Changes in the numbers of adherence to the overall 24-HMG were obtained by subtracting the number of guidelines adhered to in wave 2 from that in wave 1.ResultsWe included 12,570 participants aged 9–18 years with 52.2% boys. Compared with persistent non-adherence for the ST/sleep duration guideline, non-adherence to adherence and persistent adherence were associated with lower depression and anxiety symptoms, but adherence to non-adherence was not. Changes in adherence to the physical activity guideline were not related to outcomes. The β coefficients (95% CIs) for each point increase in changes in the numbers of adherence to guidelines were − 0.58 (− 0.69, − 0.47) and − 0.43 (− 0.53, − 0.33) for depression and anxiety symptoms, respectively. The association of persistently adhering to sleep guideline with anxiety symptoms and the associations of changes in the numbers of adherence to the 24-HMG had sex differences.ConclusionsMaintaining and strengthening healthy movement behaviors to meet more guidelines of the 24-HMG, especially sleep and ST, may be beneficial for preventing depression and anxiety symptoms in adolescents.

Combined healthy lifestyle factors and psychosocial outcomes among cancer survivors: a systematic review and meta-analysis.

This systematic review aims to summarize the associations between combined healthy lifestyles and psychosocial outcomes (health-related quality of life (HRQOL), depression, anxiety, psychological distress (PD), and posttraumatic stress disorder (PTSD)) among cancer survivors. PubMed, Web of Science, Cochrane Library, and EMBASE were searched for observational and interventional studies examining healthy lifestyle scores (HLS, calculated by a combination of at least three lifestyles) and psychosocial outcomes among cancer survivors from inception to April 2024. A minimum of two studies with the same study design were pooled using random effects models. Twenty-one studies (44,812 survivors) were included. Of all studies, 16 of which were included in meta-analysis. The pooling of cross-sectional evidence shows significant association between HLS and overall, physical, and psychosocial HRQOL. Significance was only observed for overall and physical HRQOL but not for psychosocial HRQOL in cohort studies. The estimations and 95% confidence interval (CI) with 1-point increase in HLS were 1.47 (0.83-2.12) and 1.42 (0.19-2.65) for overall and physical HRQOL, respectively. The evidence from interventional studies also indicated that interventions on multiple lifestyles have positive effects on the physical but not psychosocial HRQOL. Despite the limited number of studies, significant associations were found between HLS and depression, anxiety, PD, and PTSD. Although evidence is limited, we found that the combination of multiple healthier lifestyles is associated with better psychosocial outcomes in cancer survivors. This review underscores the potential for adhering to multiple healthy lifestyles to improve psychosocial outcomes and enhance HRQOL for cancer survivors.

Predictive Utility of Four Instrumental Activities of Daily Living Assessments and Cognitive Status Changes Among Cognitively In-Tact Older Adults.

To examine the factor structure and predictive utility of four instrumental activities of daily living (IADL) measures to identify cognitive status changes among older adults enrolled in the ACTIVE Trial. Extracted factors represented IADL instruments. Baseline performance on the Everyday Problems Test (EPT) predicted 5-year MMSE scores (est. = .08, p < .001), adjusting for demographic and health covariates, baseline MMSE, self-reported IADL function, and the performance-based Observed Tasks of Daily Living and Timed Instrumental Activities of Daily Living assessments. For each 1-point increase in baseline EPT financial performance, the odds of cognitive impairment decreased by 26%. IADL functional domains were not interchangeable across instruments. The EPT demonstrated better predictive utility compared to other instruments for detecting subsequent cognitive decline/impairment. This is a useful step in developing effective tools to detect early functional deficits indicating subsequent clinical impairment. Advanced Cognitive Training for Independent and Vital Elderly Trial (ACTIVE), NCT00298558, https://clinicaltrials.gov/study/NCT00298558.

Adherence to the Mediterranean diet and risk of anxiety and depression in people with obesity: a cross-sectional analysis.

Anxiety and depression are common mental disorders worldwide, in particular in people with obesity. Adherence to the Mediterranean diet has been found beneficial for the prevention of anxiety and depression in the general population. We aimed to evaluate this association in a large cohort of people with obesity. A cross-sectional study of 4957 patients with obesity (63.1% women, median age 49 years, IQR 40-58 years and BMI 33.6 kg/m2, IQR 31.6-36.9 kg/m2) was carried out. Clinical history, anthropometric measurements and lifestyle-related information were investigated. A 14-item MEDAS questionnaire was used to assess adherence to the Mediterranean diet. The 20-item STAI2 questionnaire and the 24-item QD questionnaire were used to assess the presence of anxious and depressive symptoms, respectively. Clinical cases of anxiety and depression were identified among patients with a physician-made diagnosis of anxiety and depression or with STAI2 and QD score ≥95th percentiles of reference population. Overall, 11.9% of participants were positive for anxiety and 11% for depression. Multivariate linear regression models showed a decrease in STAI2 and QD scores of 0.18 points (95%CI: -0.33, -0.03) and 0.10 points (95%CI: -0.16, -0.03), respectively, for each 1-point increase in MEDAS score. The multivariate logistic regression model showed a 7% reduction in the odds of anxiety and depression for each 1-point MEDAS increase (OR = 0.93, 95%CI: 0.89, 0.99; OR = 0.93, 95%CI: 0.88, 0.98). Mediterranean diet is associated with a lower risk of anxiety and depression in people with obesity. Longitudinal studies are needed to determine causality.

Access to affordable daycare and women's mental health in Rajasthan, India: Evidence from a cluster-randomised social intervention.

Women in India are often responsible for unpaid household work, family caregiving, and paid work, which can contribute to poorer mental health. The provision of childcare has the potential to improve women's mental health, but evidence on the effects of providing access to daycare is limited. We designed a cluster-randomised trial and used data from a sample of 2858 mothers with age-eligible children from 160 village hamlets in rural Rajasthan, India, to evaluate the impact of providing access to a community-based daycare programme on social and emotional aspects of women's mental health. We conducted a baseline survey in early 2016, randomised hamlets to intervention or control groups approximately six months later, and delivered the final post-intervention survey approximately two years thereafter. Treatment assignment increased the probability that a respondent used a daycare over the two-year follow-up by 40.9 percentage points. Providing randomised access to a daycare resulted in 0.2 (95% confidence interval (CI) = -0.1, 0.4) fewer symptoms of mental distress, representing a 9.5% decline compared to the baseline mean of 2.1 symptoms, as well as a 3.7 (95% CI = -0.8, 8.3) percentage point increase in the proportion of women who reported feeling very happy, equivalent to an 11.0% increase relative to the baseline mean of 33.6%. Among social indicators, treatment assignment was associated with a 5.6 (95% CI = -1.2, 12.4) percentage point increase in membership in an association, a relative increase of 43.4% compared to the baseline mean of 12.9%. The intervention did not have an appreciable impact on measures of life satisfaction or trust in institutions. Two-stage least squares instrumental variable analyses showed that daycare use decreased mental distress by 0.4 (95% CI = -0.1, 0.8) symptoms, increased the proportion of women who were very happy by 9.4 (95% CI = 0.0, 17.6) percentage points, and increased membership in an organisation by 15.9 (95% CI = 8.4, 23.7) percentage points. The provision of affordable, community-based daycare was associated with substantial uptake and showed potential for improving mothers' mental health in a rural context where most women were not employed in the formal labour force. ISRCTN clinical trial registry (ISRCTN45369145), registered on 16 May 2016; American Economic Association's registry for randomised controlled trials (AEARCTR-0000774), registered on 15 July 2015.

The Efficacy of the Psychiatry Clerkship in Developing Students' Comprehensive Clinical Skills.

This study investigates the impact of the psychiatry rotation in developing students' clinical skills that are applicable across various medical specialties. Medical students at Saint Louis University completed the same survey before and after completing a 3½-week psychiatry rotation. Students rated 18 statements on a Likert scale. Statements were grouped into six categories to assess students' confidence in (1) managing medical issues of psychiatric patients, (2) addressing injurious behaviors, (3) gathering a clinical history, (4) de-escalating crises, (5) self-regulating emotions, and (6) empathizing with patients. Students' pre- and post-survey numerical responses were added within the six categories and compared using paired t-tests. Forty-three students completed both the pre-clerkship and post-clerkship surveys. For all six clinical skills categories, post-survey composite scores significantly increased. Managing medical complaints had a 7-point median score increase. Addressing injurious behavior had a 3-point median increase. Gathering a clinical history had a 4-point median increase. De-escalating crises had a 4-point median increase. Emotional self-regulation had a 2-point median increase. Empathizing with patients had a 2-point median increase. All six paired t-tests between pre- and post-surveys showed p-values < 0.001, indicating subjective improvement in students' performance for each clinical competency. The psychiatry rotation effectively increased medical students' perceived acquisition of essential clinical skills. These competencies, including gathering a history, emotionally self-regulating, and de-escalating crises, apply to nearly all medical specialties. Further research is needed to investigate which specific opportunities helped students develop these skills and the broader strengths of the psychiatry clerkship.

Association between life’s essential 8 and hyperuricemia among adults in the United States: insights from NHANES 2005–2018

BackgroundHyperuricemia is a significant risk factor for various metabolic and cardiovascular conditions. Life’s Essential 8 (LE8), a comprehensive measure of cardiovascular health promoted by the American Heart Association, may have a protective role against hyperuricemia. This study aims to evaluate the association between LE8 scores and hyperuricemia in a representative sample of US adults.MethodsWe conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2018, encompassing 26,885 adults. LE8 scores were calculated based on diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. Hyperuricemia was defined as serum uric acid levels ≥7.0 mg/dL in men and ≥ 6.0 mg/dL in women. Logistic regression and generalized additive models (GAMs) were used to analyze the relationship between LE8 scores and hyperuricemia, adjusting for potential confounders.ResultsHigher LE8 scores were significantly associated with lower odds of hyperuricemia (OR per 10-point increase: 0.73, 95% CI: 0.72–0.75, p &amp;lt; 0.001). Stratified analyses revealed consistent protective effects across subgroups defined by sex, age, race/ethnicity, PIR (poverty income ratio), education level, drinking status, eGFR, and CVD status. Logistic regression and GAM analyses both confirmed a linear relationship between increasing LE8 scores and reduced hyperuricemia risk. For example, in males, the OR was 0.81 (95% CI: 0.78–0.84), and in females, it was 0.66 (95% CI: 0.64–0.68).ConclusionThe findings suggest that higher LE8 scores are robustly associated with lower odds of hyperuricemia in US adults. These results support the promotion of comprehensive cardiovascular health behaviors encapsulated by LE8 to mitigate hyperuricemia risk. Further studies are needed to explore the causal pathways and potential interventions.

Association of improvement and worsening of depressive symptoms with arthritis

PurposeThe longitudinal association between changes in depressive symptoms (improvement/worsening) and arthritis is unclear.MethodsStudy data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2011–2018. The 10-item Center for Epidemiological Studies Depression Scale (CES-D-10) was used to examine participant depressive symptoms and data on self-reported history of arthritis were collected. Depressive symptoms improving is defined as depression at baseline and no depression at follow-up. Similarly, depressive symptoms worsening is defined as no depression at baseline and depression at follow-up. Cox proportional hazards models were used to evaluate the effects of improvement or deterioration in depressive symptoms on arthritis. Participants with missing data on depression and arthritis, having arthritis in 2011 CHARLS and lost to follow-up was excluded.ResultsA total of 8556 participants free of arthritis were included from 2011 to 2018. After adjustment for confounders, depressive symptoms were associated with a 54% increased risk of developing arthritis. Each 1-point increase in CES-D-10 score was associated with a 4% higher risk of arthritis. Participants with depressive symptoms at baseline but improved symptoms (without depressive symptoms) at follow-up had a 25% lower rate of arthritis, and a 1-point reduction in CES-D-10 score during 8 years of follow-up was associated with a 5% lower risk of developing arthritis. Participants with no depressive symptoms at baseline but depression at follow-up had a 66% higher rate of arthritis, and a 1-point increase in CES-D-10 score during 8 years of follow-up was associated with a 5% higher risk of arthritis.ConclusionsImprovement in depressive symptoms was associated with lower risk of arthritis and worsening of depression was associated with higher risk of arthritis. These findings suggest that the relationship between depression and arthritis is complex.

Do hybrid closed loop insulin pump systems improve glycemic control and reduce hospitalizations in poorly controlled type 1 diabetes?

Hybrid closed-loop (HCL) systems improve glycemic control in type 1 diabetes mellitus (T1D), but their effectiveness in young, poorly controlled populations is notestablished and requires study. A pre-post study was performed using electronic health records of patients 3-24 years with baseline HbA1c≥9 % prescribed HCL within the New York City Health+Hospitals System assessing HbA1c levels and hospitalizations before and after HCL initiation and factors associated with achieving HbA1c<9 % after HCLinitiation. Of 47 children and adolescents who met inclusion criteria, 4.68 % female, 95.72 % non-White, and 82.22 % covered by public insurance, with a baseline average HbA1c10.6 % (2.28 IQR). The most prevalent pump type wasOmnipod 5 (70.21 %). The HbA1c was significantly lowerinthe postperiod than baseline (HbA1c before=median 10.6 (IQR2.28), HbA1c after=median 9.33 (IQR 2.97), difference 1.00 (IQR 1.64), p<0.05) with a decrease in median diabetes-related hospitalizations (preperiod 1.00 (IQR 1.00), postperiod 0.00 (IQR 1.00), difference-1.00, IQR 2, p<0.05). Lower baseline HbA1c levels made reaching HbA1c<9 % more likely. Multivariable analysis showed thatthe odds of having HbA1c of <9 % was 2.1 times less likely for every one point increase in baseline HbA1c and 12.5 times less likely for those with a pump at (p<0.05). HCL therapy improved glycemic control and decreased diabetes-related hospitalizations in youth with poorly controlled T1DM. Higher baseline HbA1c levels predicted less success with HCL therapy so those who standto benefit most benefit least.

Medicaid expansion and medications to treat opioid use disorder in outpatient specialty care from 2010 to 2020

IntroductionMedications for opioid use disorder (MOUD) are considered the first line treatment for opioid use disorder. As states expanded Medicaid beginning in 2014 under the Affordable Care Act, policymakers and public health officials were interested in the potential for expansion to increase access to MOUD. This study examined whether there were changes in MOUD use within outpatient admissions to specialty treatment facilities in Medicaid expansion states beyond the initial expansion period. MethodsAnalyses were conducted using 2010–2020 data from the Treatment Episode Data Set – Admissions. For states that expanded Medicaid prior to 2015, a difference-in-differences analysis was conducted to evaluate whether expansion was associated with an increased proportion of MOUD treatment comparing the initial 2014–2017 period and the 2018–2020 period to 2010–2013. We then conducted a difference-in-differences analysis to examine the overall effect of Medicaid expansion on outpatient MOUD using all states that passed expansion at any point during the study period. ResultsAmong outpatient treatment episodes for OUD in states that expanded Medicaid in 2014, there was a 9.5 percentage point (95 % CI: 0.7–18.2) increase in the probability of receiving MOUD during the initial expansion period from 2014 to 2017 compared to 2010–2013 period, and a 7.5 percentage point (95 % CI: −8.1 –23.1) increase in 2018–2020 (compared to the 2010–2013 period) after adjusting for individual-level covariates. After incorporating states that expanded Medicaid between 2015 and 2020, there was a 6.4 percentage point (95 % CI: −0.01–13.0) increase in the probability of receiving MOUD among individuals receiving care after expansion (compared to the pre-expansion period). During the study period, there was variability among states in the change in probability of receiving MOUD from prior to after Medicaid expansion from an almost 30 percentage point increase in New York to an almost 20 percentage point decrease in Washington, DC. ConclusionsMedicaid expansion increased the probability of receiving MOUD in outpatient settings across states from initial expansion through 2020. However, these results were not statistically significant. Additionally, significant variability between states warrants further study and suggests that improving access to MOUD will require additional state and local strategies.

Long Duration Load Carriage Performance Is Associated With Army Combat Fitness Test Scores and Fat-Free Mass.

Sax van der Weyden, M, Merrigan, JJ, and Martin, J. Long duration load carriage performance is associated with Army Combat Fitness Test scores and fat free mass. J Strength Cond Res 38(11): 1959-1966, 2024-A common occupational task for the military is carrying heavy loads for long periods of time. The US Army has set a time standard of 3 hours to complete a 19.31-km march with a 15.9-kg ruck sack for combat arms training and specialty schools. The purpose of this study was to identify characteristics associated with 19.31-km foot march completion rates in Reserve Officers' Training Corps (ROTC) Cadets. Demographics, anthropometrics/body composition, Army Combat Fitness Test (ACFT) scores, and vertical countermovement jump (CMJ) data were collected on 65 ROTC cadets who conducted a 19.31-km foot march. Independent t tests and Mann-Whitney U tests compared variables between those who did and did not finish the foot march in less than 3 hours. Logistic regressions were used to calculate the odds of completing the foot march using military experience, fat-free mass, ACFT, and CMJ outcomes. Cadets who met the 3 hours standard had lower body fat percent, greater fat-free mass, higher ACFT scores, and higher CMJs than those who did not. In addition, for every one point increase in ACFT score and 1-kg increase in fat-free mass, a cadet's chances of finishing the foot march increased by 6.1 and 24%, respectively. When analyzing ACFT events separately, 2-mile run was the only significant variable, and for every 1 point increase in 2-mile run score, a cadet's chances of finishing the foot march increased by 9%. Thus, aspiring and current soldiers should train to improve aerobic fitness and build muscle mass in preparation for load carriage requirements.

Repeal of Subminimum Wages and Social Determinants of Health Among People With Disabilities.

People with disabilities experience pervasive health disparities driven by adverse social determinants of health, such as unemployment. Section 14(c) of the 1938 Fair Labor Standards Act has been a controversial policy that allows people with disabilities to be paid below the prevailing minimum wage, but its impact on employment remains unknown despite ongoing national debates about its repeal. To estimate whether state-level repeal of Section 14(c) was associated with employment-related outcomes for people with cognitive disability. This quasi-experimental, synthetic difference-in-differences study used individual-level data from the 2010-2019 American Community Surveys. Outcomes before and after subminimum wage law repeal in 2 states (New Hampshire and Maryland) that repealed Section 14(c) were compared with a synthetic group of control states that did not implement repeal. Individuals aged 18 to 45 years who reported having a cognitive disability were included. Data were analyzed from May 2023 to May 2024. Repeal of Section 14(c) in New Hampshire (2015) and Maryland (2016). Primary outcomes were labor force participation and employment rates. Secondary outcomes were annual wages, annual hours worked, hourly wages, and proportion earning above state minimum wage among employed individuals. The sample included 450 838 individuals. Of these, 253 157 (55.7%) were male, and the mean (SD) age was 31.3 (8.4) years. In state-specific analyses, New Hampshire's labor force participation and employment had a statistically significant increase by 5.2 percentage points (β = 0.05; 95% CI, 0-0.10; P = .04) and 7 percentage points (β = 0.07; 95% CI, 0.01-0.13; P = .03), respectively, following Section 14(c) repeal. Labor force participation and employment both increased in Maryland, although estimates were not statistically significant. Pooling both states, Section 14(c) repeal was associated with a statistically significant 4.7-percentage point (β = 0.05; 95% CI, 0.01-0.08; P = .01) increase in labor force participation and a nonsignificant 4.3-percentage point (β = 0.04; 95% CI, 0-0.09; P = .07) increase in employment. In this study, repeal of Section 14(c), a policy allowing subminimum wages for people with disabilities, led to increases in labor force participation, though with heterogeneity at the state level. These findings suggest the importance of state-level factors in shaping program effects, especially as national-level Section 14(c) repeal is being debated.

Accelerated biological age mediates the associations between sleep patterns and chronic respiratory diseases: Findings from the UK Biobank Cohort

BackgroundUnhealthy sleep patterns and accelerated biological age are frequently associated with multiple chronic respiratory diseases (CRDs), including COPD, asthma, and interstitial lung disease (ILD). However, few studies have explored the role of biological age in the relationship between sleep patterns and CRDs. ObjectivesTo explore the association between sleep patterns and CRD, and the extent to which biological age mediates the relationship between sleep patterns and CRD. MethodsThis was a prospective cohort study based on UK Biobank. The sleep score was derived from five self-reported sleep traits: sleep duration, daytime sleepiness, chronotype, snoring, and insomnia. The score ranged from 0 (least healthy) to 5 (healthiest). Biological age was represented by PhenoAgeAccel. ResultsAmong 303,588 participants, 11,105 (3.7 %), 9,380 (3.1 %), and 1,667 (0.5 %) were diagnosed with asthma, COPD, and ILD, respectively. Each 1-point increase in the sleep score was associated with a 0.156-year reduction in PhenoAgeAccel, and 14.3 %, 12.4 %, and 6.7 % reduction in asthma, COPD, and ILD, respectively. For each 1-year increase in PhenoAgeAccel, the risk of asthma, COPD, and ILD increased by 2.8 %, 4.3 %, and 5.7 %, respectively. PhenoAgeAccel mediated the associations between the sleep score and asthma, COPD, and ILD, with a mediated proportion (95 % CI) of 2.81 % (2.35 % to 3.27 %), 4.94 % (4.23 % to 5.66 %), and 12.48 % (10.43 % to 14.53 %), respectively. ConclusionA better sleep score was significantly associated with younger biological age and decreased risk of CRDs, with biological age playing a mediating role in the association between sleep score and CRDs.

The global burden of enteric fever, 2017–2021: a systematic analysis from the global burden of disease study 2021

Enteric fever is a major public health challenge in developing countries. We conducted a systematic analysis from the Global Burden of Diseases 2021 Study to provide updated estimates of enteric fever's burden. We presented estimates for incident cases and deaths, age-standardized incidence and mortality rates, years of life lost (YLLs), and case-fatality rates spanning the study period of 2017-2021, stratified by region, country, socio-demographic index (SDI), and age group. Random-effects Poisson regression for longitudinal data was used to estimate the association between SDI and case-fatality rates, adjusting for antimicrobial resistance patterns. In 2021, there were 9.3 million global cases of enteric fever (95% uncertainty interval: 7.3-11.9) and 107.5 thousand deaths (56.1-180.8). The age-standardized incidence rate decreased from 152/100,000 person-years (118-195) in 2017 to 128/100,000 person-years (100-163) in 2021, and the mortality rate decreased from 1.87/100,000 person-years (0.95-3.18) to 1.50/100,000 person-years (0.78-2.54). There were wide geographical differences, with South Asia contributing the most cases and deaths. Age-standardized incidence exceeded the threshold for "high burden" of enteric fever (100/100,000 person-years) in 23 countries in2021.Children under five accounted for 40% of deaths and 47% of YLLs, with incidence and mortality peaking during the second year. Case-fatality was highest in low SDI countries and showed a global trend toward reduction, except among children aged 1-4 years. After adjusting for the prevalence of multidrug resistance, fluoroquinolone non-susceptibility, and third-generation cephalosporin resistance, a higher SDI was associated with a lower case-fatality rate, with a 1.1% (0.7-1.7) reduction for each percentage point increase in SDI. Despite notable improvements, several countries still showed a high burden of enteric fever, which remains a significant global health concern, especially among children under five. Although enhancing water and sanitation systems is crucial, the most significant reductions in the global disease burden are likely to be achieved through broader vaccine coverage. This includes the use of typhoid conjugate vaccines, which are effective in infants and young children and offer extended protection, along with improved data collection and surveillance to guide vaccine distribution efforts across high-incidence areas. This work was partially supported by "Ricerca Corrente" funding from Italian Ministry of Health to IRCCSHumanitas Research Hospital.