Population Subgroups Research Articles

Conditional cash transfers and mortality in people hospitalised with psychiatric disorders: A cohort study of the Brazilian Bolsa Família Programme.

Psychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CCTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Família Programme (BFP) recipient and the risk of mortality among people previously hospitalised with any psychiatric disorders. This cohort study utilised Brazilian administrative datasets, linking social and health system data from the 100 Million Brazilian Cohort, a population-representative study. We followed individuals who applied for BFP following a single hospitalisation with a psychiatric disorder between 2008 and 2015. The outcome was mortality and specific causes, defined according to International Classification of Diseases 10th Revision (ICD-10). Cox proportional hazards models estimated the hazard ratio (HR) for overall mortality and competing risks models estimated the HR for specific causes of death, both associated with being a BFP recipient, adjusted for confounders, and weighted with a propensity score. We included 69,901 psychiatric patients aged between 10 and 120, with the majority being male (60.5%), and 26,556 (37.99%) received BFP following hospitalisation. BFP was associated with reduced overall mortality (HR 0.93, 95% CI 0.87,0.98, p 0.018) and mortality due to natural causes (HR 0.89, 95% CI 0.83, 0.96, p < 0.001). Reduction in suicide (HR 0.90, 95% CI 0.68, 1.21, p = 0.514) was observed, although it was not statistically significant. The BFP's effects on overall mortality were more pronounced in females and younger individuals. In addition, 4% of deaths could have been prevented if BFP had been present (population attributable risk (PAF) = 4%, 95% CI 0.06, 7.10). BFP appears to reduce mortality rates among psychiatric patients. While not designed to address elevated mortality risk in this population, this study highlights the potential for poverty alleviation programmes to mitigate mortality rates in one of the highest-risk population subgroups.

Autoantibody-Based Clinicoradiopathologic Phenotyping of Idiopathic Inflammatory Myopathies: An Indian Cohort.

We aim to characterize the clinical, pathological, laboratory and imaging features of various antibody defined IIM subgroups in Indian population. 103 patients who satisfied 2017 ACR/ EULAR Classification criteria for IIM, and tested seropositive for myositis antibodies using Immunoblot technique were retrospectively identified. Patients were classified into following subgroups - Mi2B group, SRP group, Anti RNA Synthetase antibody group (Jo 1, PL 7, PL 12, OJ), multiple MSA, only MAA group (U1RNP, Ro 52, SS-A, SS-B, PM Scl 75, PM Scl 100). Clinical, laboratory, histopathology and imaging parameters were compared among different groups. Ro52 (n = 31; 22.46%) was the most common autoantibody seen in our cohort followed by Mi2B (n = 26; 18.84%) and SRP (n = 20; 14.49%). Skin manifestations (p = 0.053) and joint involvement (p = 0.023) were seen more frequently among Mi2B and MAA sub groups. Three out of 4 patients with persisting antibody positivity on serial measurements developed clinical relapse between 2 and 3 years after the initial episode. Remaining 2 patients showed declining titres of antibodies and developed no clinical relapses during follow up period of 5 and 6 years. Among histopathology features, perifascicular atrophy was found to be more prevalent among Mi2B (55.6%) and MAA subgroups (31.3%) (p value = 0.037). In thigh muscle MRI, Mi2B group showed a pattern of diffuse involvement of affected muscles without regional preference, with sparing of hamstring group. SRP group showed characteristic pattern of edema involving peripheral regions of Quadriceps femoris and central regions of Adductor group along with severe atrophy involving hamstring and adductor compartment muscles. ILD was seen in 27.5% of patients who underwent CT Chest. 3 patients were found to have underlying malignancy at the time of diagnosis of myositis (Mi2B = 2 and PM Scl = 1). Classification of IIM patients based on myositis antibodies yields subgroups with certain differences in clinical, laboratory, histopathological and imaging features.

Cervical Cancer Screening Uptake Among Women with Disabilities: Findings from a Cross-Sectional Study in Chile

The Papanicolaou (Pap) test is one of the most effective methods for cervical cancer screening. However, women with disabilities are less likely to be screened. The objective of this study is to determine whether there is a difference in Pap test utilisation between women with and without disabilities and to analyse the demographic, socioeconomic, and health-related characteristics associated with Pap test uptake among women with disabilities in Chile. Data from the 2022 National Socioeconomic Characterization Survey were analysed, and 71,989 women between 18 and 75 years of age were included. The dependent variable was Pap test utilisation, and the exposure variable was disability. We used logistic regressions to control for demographic, socioeconomic, and health-related covariates. The results showed that women with disabilities were less likely to undergo a Pap test compared to those without disabilities. Characteristics such as being married, being aged between 25 and 64 years, and having secondary or tertiary education increased the likelihood of Pap test utilisation. Conversely, being single, having received special education, and being inactive decreased these odds. Effective public health policies are needed that will increase Pap test utilisation for all population subgroups, including women with disabilities and, therefore, promote health equity.

Association between atherogenic index of plasma and peripheral arterial disease.

Background: Growing body of evidence suggests that the atherogenic dyslipidemia phenotype is a precursor to Peripheral Arterial Disease (PAD). Nonetheless, there is limited research regarding the association between Atherogenic Index of Plasma (AIP) and PAD which utilized a community population-based database in the United States. We sought to fill this knowledge gap. Methods: A total of 3,517 participants from the National Health and Nutrition Examination Survey 1999-2004 cycles were enrolled in our study. AIP was calculated as log10 (triglycerides/high-density lipoprotein cholesterol). Logistic regression models were adopted to reveal the relationship of AIP and PAD. Additionally, stratified and interaction analyses were also undertaken to see if the relationship was stable in different subgroups. Results: Participants in the higher tertile of AIP tended to have higher prevalence of PAD. A positive correlation was identified between AIP increase and PAD after fully multivariate adjustment (OR=1.30, 95% CI: 1.06-1.59). The multivariable-adjusted OR and 95% CI of the highest AIP tertile compared with the lowest tertile was 1.50 (1.07-2.1). Subgroup analysis demonstrated that the positive association between AIP and PAD was persistent across population subgroups. Conclusions: Our findings demonstrate a positive association between AIP and the incidence of PAD among adults in American adults. Specifically, 1 unit increase in AIP led to a 30% greater risk of PAD.

Paying the price: Financial hardship and its association with psychological distress among different population groups in the midst of Great Britain’s cost-of-living crisis

BackgroundGreat Britain has been experiencing a cost-of-living crisis since late 2021, with the cost of everyday essentials rising more quickly than the average household income. This study provides up-to-date information on levels of subjective and objective financial hardship during this crisis, differences across population subgroups, and associations with psychological distress. MethodsWe used data from a representative cross-sectional survey of adults (≥16y) in Great Britain (n=7,027) conducted January-March 2023. Subjective financial hardship was defined as reporting finding it quite/very difficult to manage financially these days and objective financial hardship as reporting having been in rent/mortgage arrears in the past 12 months. Past-30-day psychological distress was assessed with the K6 and categorised as no/low (scores ≤4), moderate (5-12), and severe distress (≥13). Covariates included sociodemographic characteristics, mental health history, smoking status, and alcohol consumption. ResultsOverall, 12.9% [95%CI=12.0-13.8%] reported subjective financial hardship and 6.5% [5.8-7.2%] objective financial hardship. Groups experiencing more hardship included non-binary people, ethnic minority groups, less advantaged social grades, those living in private rented or social housing, unemployed and seeking work or not in paid work for other reasons, those with more children in the household, those with a history of ≥1 mental health conditions, those who currently smoked and those who drank not at all or at very high levels. Subjective/objective financial hardship was associated with greater odds of experiencing moderate (ORadj=1.96 [1.59-2.42]/ORadj=1.86 [1.40-2.47]) or severe psychological distress (ORadj=4.11 [3.07-5.50]/ORadj=2.23 [1.52-3.29]). These associations between financial hardship and psychological distress were similar across all sociodemographic, mental health, smoking, and alcohol characteristics. ConclusionsIn the first quarter of 2023, around one in eight adults in Great Britain reported finding it difficult to manage financially and one in fifteen reported having been in rent or mortgage arrears in the past 12 months, with higher rates of financial hardship among disadvantaged groups. However, disadvantage did not appear to compound the psychological impact of financial hardship: people experiencing financial hardship were substantially more likely to report moderate or severe psychological distress regardless of their sociodemographic characteristics.

Cost-Effectiveness of Extending Human Papillomavirus Vaccination to Population Subgroups Older Than 26 Years Who Are at Higher Risk for Human Papillomavirus Infection in the United States.

In June 2019, the U.S. Advisory Committee on Immunization Practices recommended shared clinical decision making regarding potential human papillomavirus (HPV) vaccination of men and women aged 27 to 45 years ("mid-adults"). To examine the incremental cost-effectiveness ratios (ICERs) and number needed to vaccinate (NNV) to prevent 1 HPV-related cancer case of expanding HPV vaccination to subgroups of mid-adults at increased risk for HPV-related diseases in the United States. Individual-based transmission dynamic modeling of HPV transmission and associated diseases using HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation). Published data. All U.S. mid-adults and higher-risk subgroups within this population. 100 years. Health care sector. Expanding 9-valent HPV vaccination to mid-adults and higher-risk subgroups. ICERs and NNVs. Expanding 9-valent HPV vaccination to all mid-adults, those with more lifetime partners, and those who have just separated was projected to cost an additional $2 005 000, $763 000, and $1 164 000 per quality-adjusted life-year (QALY) gained, respectively. The NNVs to prevent 1 additional HPV-related cancer case were 7670, 3190, and 5150, respectively, compared with 223 for vaccination of persons aged 9 to 26 years (vs. no vaccination). The mid-adult strategy with the lowest ICER and NNV was vaccinating infrequently screened mid-adult women who have just separated and have a higher number of lifetime sex partners (ICER, $86 000 per QALY gained; NNV, 470). Uncertainty about rate of new sex partners and natural history of HPV among mid-adults. Vaccination of mid-adults against HPV is substantially less cost-effective and produces higher NNVs than vaccination of persons younger than 26 years under all scenarios investigated. However, cost-effectiveness and NNV are projected to improve when higher-risk mid-adult subgroups are vaccinated, such as mid-adults with more sex partners and who have recently separated, and women who are underscreened. Centers for Disease Control and Prevention.

Changes in food and drink purchasing behaviour in England during the first three months of the COVID-19 pandemic: An interrupted time series analysis.

This study examined changes food and drink purchasing during the first three months of the COVID-19 pandemic in England, and if changes varied by population subgroups. We investigated changes in take-home food and drink purchasing and frequency of out-of-home purchasing using an interrupted time series analysis design. The start of pandemic restrictions (the intervention) was defined as 16th March 2020, when first announced in the UK. London and the North of England. 1,245 households reporting take-home and 226 individuals reporting out-of-home purchases between January 2019 and mid-June 2020 from the GB Kantar Fast Moving Consumer Goods Panel. The marginal mean estimate of total take-home energy purchased was 17.4% (95% CI 14.9, 19.9) higher during the pandemic restriction period compared to the counterfactual. Increases of 35.2% (95% CI 23.4, 47.0) in take-home volume of alcoholic beverages and 1.2% (95% CI 0.1, 2.4) in foods and drinks high in fat, salt and sugar were observed. Reductions in purchased energy from fruit and vegetables (-7.3%, 95% CI -10.9, -3.6), ultra-processed foods (-4.0%, 95% CI -5.2, -2.8), and in out-of-home purchasing frequency (-44.0%, 95% CI -58.3, -29.6) were observed. Changes in chocolate and confectionery, soft drink and savoury snack purchases levelled off over time. Changes in all studied outcomes varied by sociodemographic characteristics and usual purchasing. Pandemic restrictions were associated with positive and negative changes in food and drink purchasing, which differed by individual characteristics. Future research should ascertain if changes persist and translate into changes in health.

Secular trends in dietary energy, carbohydrate, protein, and fat intake among Korean children and adolescents.

We aimed to analyze the evolving trends in macronutrient intake and dietary composition among Korean children and adolescents over a 10-year period. We utilized cross-sectional data from the Korean National Health and Nutrition Examination Survey (KNHANES) spanning the years 2010-2020. Overall, the study included 11,861 participants aged 6-18 years who completed the 24-h dietary recall survey. Subsequently, we assessed trends in energy consumption and macronutrient intake across population subgroups, including age, sex, and obesity status. Survey-weighted linear regression was employed to determine the beta coefficient and p-value for trends in dietary nutrient consumption, treating the survey year as a continuous variable. KNHANES from 2010 to 2020. 11,861 children and adolescents aged 6-18 years. Total energy intake significantly decreased across the 10-year survey period, with a corresponding decline in the percentage of energy intake from carbohydrates. Conversely, the proportion of energy intake from fat increased during the same period. Subgroup analysis revealed changes in the composition of energy intake across age, sex, and obesity status, with a consistent increase in total fat intake observed across all subgroups. Upon analyzing data on dietary fibers, total sugars, and fat subtypes intake, we found insufficient dietary fiber intake and increased intake of all fat subtypes. This study underscores the gradually changing dietary intake patterns among Korean children and adolescents. Our findings revealed that these transitions in dietary nutrient consumption may pose potential risks of diet-related diseases in the future.

Subgroup differences in public attitudes, preferences and self-reported behaviour related to deceased organ donation before and after the introduction of the ‘soft’ opt-out consent system in England: mixed-methods study

BackgroundIn the UK, over 7,000 people are on the waiting list for an organ transplant and there are inequalities in need, access and waiting time for organs, with notable differences between minority ethnic groups. In May 2020, England changed the law and introduced a ‘soft’ opt-out system of consent to organ donation with a view to increase consent rates. We aimed to learn more about the impact of the law change on attitudes and views likely to be relevant to consent to deceased organ donation between different population subgroups.MethodsMixed-methods design involving latent class analysis of data from twelve repeated cross-sectional surveys undertaken from 2015 to 2021 (n = 19,011); analysis of the law change survey dataset collected quarterly from 2018 to 2022 (n = 45,439); and interviews with purposively selected members of the public (n = 30) with a focus on minority perspectives.ResultsSupport for the principle of deceased organ donation remained high and stable in the general population (80%) but was 20% lower among ethnic minorities. From 2018 to 2022, an average of 58% of the general population was aware of the law change; this was lower among minority ethnic groups (31%). We identified four population subgroups (supportive donors (24% of the population); unengaged donors (22%); uncommitted donors (46%); and unsupportive donors (9%)). Interview themes included the challenges of discussing organ donation decisions, balancing autonomy with respecting family relationships, targeted misinformation, frustrations at the lack of consensus between community leaders, limited understanding of what happens during the end-of-life care leading to organ donation, and how this aligns with cultural values and preferences.ConclusionImplementation of the law change has not been associated to date with any change in public attitudes and preferences likely to influence consent overall or in minority ethnic groups in England. Uncommitted donors may benefit from encouragement to express their organ donation decision, and unengaged donors from attempts to address mis/information, confusion, and uncertainty. Interventions to raise the consent rate need to take account of the significant role of the family as well as wider community influences on attitudes, preferences and decision-making, particularly among certain minority (ethnic) groups.

Cardiovascular Diseases and Metabolic Medications in the Lebanese Population: A Post Hoc Analysis from a Nationwide Cross-Sectional Study.

This study assesses the association of metabolic drugs (specifically hypoglycemic and hypolipemic agents) with cardiovascular diseases (CVD) among the Lebanese population and patients' subgroups. A nationwide cross-sectional retrospective study was carried out in Lebanon. The survey collected information on sociodemographic characteristics, lifestyles, comorbidities, and medication use. Logistic regression models were employed to analyze the data and determine associations between CVD and metabolic drugs. Stratification analyses were performed based on diabetes and dyslipidemia status. The study found significant associations with CVD among the 2048 participants. Higher scores on the Lebanese Mediterranean Diet Score (LMDS; ORa = 1.06), hypertension (ORa = 1.71), diabetes (ORa = 1.75), dyslipidemia (ORa = 1.89), family history of CVD (ORa = 1.58), and smoking (previous: ORa = 1.63, current: ORa = 2.15) were linked to increased CVD odds. Higher income (intermediate: ORa = 0.64, high: ORa = 0.40) was inversely related to it. A subsequent model that included hypoglycemic and lipid-lowering medications yielded similar results. However, neither hypoglycemic nor lipid-lowering medications demonstrated a significant association with CVD risk. A third regression model was conducted by taking the classes of drugs as an independent variable. Also, the result revealed that all the classes of medication were not associated with the risk of CVD. Stratification by diabetes revealed LMDS and hypertension as risk factors in both groups. Among non-diabetic participants, dyslipidemia (ORa = 2.40), current smoking (ORa = 2.28), and higher income (intermediate: ORa = 0.57, high: ORa = 0.62) were linked to CVD. Among people with diabetes, a family history of CVD (ORa = 2.69) increased the CVD odds, while being an employer (ORa = 0.49) lowered it. Stratification by dyslipidemia showed consistent risk factors, and higher LMDS (ORa = 1.07), diabetes (ORa = 2.14), hypertension (ORa = 1.79), and previous smoking (ORa = 1.95) were linked to CVD without dyslipidemia. Being a female (ORa = 0.52) and having a lower income (ORa = 0.40) were associated with lower CVD odds in those with dyslipidemia. Subgroup analyses showed that medications were not significantly associated with CVD odds among patients with diabetes or hyperlipidemia. This study's findings highlight the importance of addressing modifiable risk factors and socioeconomic factors to reduce the burden of CVD. Targeted interventions and longitudinal research are necessary to optimize preventive strategies and improve the management of CVD in individuals using hypoglycemic and hypolipemic agents in low- and medium-income countries.

Nutrition status of nulliparous married women (15-24 years) in South Asia: trends, predictors, and program implications.

Preconception nutrition, the nutritional status of women before pregnancy, is crucial for maternal and child health. Interventions focusing on preconception nutrition can help break the intergenerational cycle of malnutrition by improving the health and nutritional status of women before pregnancy. This study investigated the recent trends and patterns in the nutritional status of nulliparous adolescents and young women across six countries in South Asia: Bangladesh, India, Maldives, Nepal, Pakistan, and Sri Lanka. This study utilized the cross-sectional data from the Demographic and Health Survey (DHS) conducted between 2010 and 2022 for six South Asian countries. A total sample of 20,024 nulliparous married women aged 15-24 years was analyzed to estimate the pooled prevalence for various anthropometric outcomes. Annual changes in the prevalence of the outcome indicators were presented for each country. Predictors of thinness and overweight were analyzed using logistic regression models. Based on the latest rounds of DHS for respective countries, the pooled weighted prevalence of thinness was 24.4%, overweight was 24.8%, and short height was 11.3%. The prevalence of underweight ranged from 14.6% in Pakistan (DHS 2018) to 25.9% in India (DHS 2021). The least reduction in the prevalence of underweight was observed in India at 2.8% and Nepal at 0.7%. Based on the latest surveys, the mean BMI among women aged 15-24 years was the highest in Maldives (24.1, 95% CI: 23.4, 24.8) and Pakistan (22.9, 95% CI: 22.2, 23.5) and the lowest in India (20.9, 95% CI: 20.9, 21.0) and Nepal (20.8, 95% CI: 20.4, 21.2). The pooled prevalence of thinness and short height was high in rural areas (26.2 and 11.8%), among less educated (28.1 and 14.5%), and bottom 40% wealth quintile groups (29.8 and 15.8%). Compared to young women (20-24 years), adolescent girls were 39% more likely to be underweight (OR: 1.39; 95% CI: 1.25, 1.54). The findings highlight the need to broaden the scope of policies and programs designed for pregnant and lactating women so that nulliparous married women can be screened frequently for their anthropometric progress. Given the uneven distribution of the burden, it is recommended to implement comprehensive nutrition packages to reach all population subgroups across the regions.

Forecast skill assessment of an operational continental heat-cold-health forecasting system: New avenues for health early warning systems.

More than 110,000 Europeans died as a result of the record-breaking temperatures of 2022 and 2023. A new generation of impact-based early warning systems, using epidemiological models to transform weather forecasts into health forecasts for targeted population subgroups, is an essential adaptation strategy to increase resilience against climate change. Here, we assessed the skill of an operational continental heat-cold-health forecasting system. We used state-of-the-art temperature-lag-mortality epidemiological models to transform bias-corrected ensemble weather forecasts into daily temperature-related mortality forecasts. We found that temperature forecasts can be used to issue skillful forecasts of temperature-related mortality. However, the forecast skill varied by season and location, and it was different for temperature and temperature-related mortality due to the use of epidemiological models. Overall, our study demonstrates and quantifies the forecast skill horizon of heat-cold-health forecasting systems, which is a necessary step toward generating trust among public health authorities and end users.

Cardiac Geometry and Function in Patients with Reflex Syncope.

Reflex syncope (RS) is the most prevalent form of syncope, yet its pathophysiology and clinical presentation are not well understood. Despite controversy, the 'ventricular theory' remains the most plausible hypothesis to explain RS in susceptible patients. Certain assumptions regarding the geometry and function of the heart are essential in supporting this theory. Given these considerations, the goal of this review was to try to integrate data on heart morphology and function in a phenotype of a patient susceptible to RS. Previous research suggests that a small left ventricle and atria, in addition to a normo- or hypercontractile myocardium, predispose to more syncopal events. These findings have been confirmed in different subsets of patients, including those with small heart and chronic fatigue syndrome, highlighting common pathophysiologic pathways in these subgroups of population. Heart geometry and function seem to play a role in different treatment strategies for RS patients, including the administration of medications, pacing, and possibly cardioneural ablation. In addition, parameters related to the geometry of the heart chambers and of the electrical activation of the heart seem to have predictive value for syncope recurrence. These parameters could be included in the future and improve the accuracy of predictive models for RS.

Genetic and phytochemical evaluation of M2 generation mutants of fenugreek (Trigonella foenum-graecum L.) induced by gamma rays and Ethyl Methane Sulphonate (EMS).

Fenugreek (Trigonella foenum-graecum L.) is highly esteemed for its therapeutic properties and is widely used in traditional medicine and modern pharmacology. Enhancing its genetic traits and phytochemical profile, particularly its trigonelline content, can significantly increase its medicinal and agricultural value. This study aims to investigate the effects of gamma rays and Ethyl Methane Sulphonate (EMS) as mutagenic agents on the genetic and phytochemical characteristics of the M2 generation of fenugreek, focusing on genetic diversity and desirable trait enhancement. To achieve this, various concentrations of EMS and gamma rays were administered to fenugreek seeds, and 27 traits were assessed in the resulting M2 generation. These traits were analyzed for variance, mean values, and correlations. The genetic diversity of 23 M2 offspring was investigated using nine Start Codon Targeted (SCoT) markers. The genetic diversity assessment involved Principal Coordinate Analysis (PCoA) and cluster analysis, utilizing the Dice similarity coefficients and the Unweighted Pair Group Method with Arithmetic Mean (UPGMA). A Bayesian model provided deeper insights into the genetic structure. Results revealed that lower doses of gamma rays (100Gy) and EMS (0.2%) positively impacted specific traits. In comparison, higher doses (200Gy and 0.4% EMS) increased seed trigonelline content to 0.71mg/g dry weight. Among the SCoT markers, SCoT-9 was the most efficient, segregating the populations into three clusters. The first three principal components in the PCoA explained 20% of the total variance, leading to seven subgroup populations distinction. These findings underscore the potential of induced mutagenesis in enhancing desirable traits in fenugreek.

Pace of Aging in older adults matters for healthspan and lifespan.

As societies age, policy makers need tools to understand how demographic aging will affect population health and to develop programs to increase healthspan. The current metrics used for policy analysis do not distinguish differences caused by early-life factors, such as prenatal care and nutrition, from those caused by ongoing changes in people's bodies due to aging. Here we introduce an adapted Pace of Aging method designed to quantify differences between individuals and populations in the speed of aging-related health declines. The adapted Pace of Aging method, implemented in data from the US Health and Retirement Study and English Longitudinal Study of Aging (N=21,463), integrates longitudinal data on blood biomarkers, physical measurements, and functional tests. It reveals stark differences in rates of aging between population subgroups and demonstrates strong and consistent prospective associations with incident morbidity, disability, and mortality. Pace of Aging can advance the population science of healthy longevity.

Comparing predictive validity of Youth Level of Service/Case Management Inventory scores in Indigenous and non-Indigenous Canadian youth.

There is an increasing recognition of the necessity to establish the predictive validity of risk assessment scores within specific population subgroups, particularly those (including Indigenous peoples) who are overrepresented in the criminal justice system. I compared measures of discrimination and calibration of the Youth Level of Service/Case Management Inventory (YLS/CMI) in Indigenous and non-Indigenous youth probationers in Ontario, Canada. Compared with non-Indigenous youth, Indigenous youth would have higher risk scores and reoffense rates. The YLS/CMI would predict reoffending and time to reoffense significantly and comparably for Indigenous and non-Indigenous youth, but there would be group difference discrimination (sensitivity, specificity) and calibration (positive predictive value, negative predictive value). Justice ministry-supplied data on 400 Indigenous and non-Indigenous youth (330 male, 70 female) individually matched on key background variables were analyzed to provide measures of discrimination and calibration of the YLS/CMI, with 3-year recidivism as the primary outcome. Indigenous youth were assessed at significantly higher risk than non-Indigenous youth (d = .60); 70% of Indigenous youth and 46% of non-Indigenous youth reoffended (ϕ = .24). Overall measures of discrimination (area under the curve) and calibration (logistic regression) were significant and did not differ across groups. Cross-area under the curve results indicated that the YLS/CMI discriminated Indigenous recidivists from non-Indigenous nonrecidivists but differentiated Indigenous nonrecidivists from non-Indigenous recidivists at chance level. In addition, recidivism was underestimated for low-risk Indigenous youth compared with non-Indigenous youth, but specificity was also low; only 28% of Indigenous youth who did not reoffend were assessed as low risk. Results were largely consistent across male and female youth. Examining subgroup predictive validity using multiple indices provides important information that should inform policy and practice discussions regarding fair use of risk assessment tools. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Analysis of tirzepatide in the US FDA adverse event reporting system (FAERS): a focus on overall patient population and sex-specific subgroups.

Tirzepatide, a novel GIP and GLP1 agonist, has been extensively examined in clinical trials. However, specific data on its adverse drug events (ADEs) remain limited. This study aims to comprehensively assess real-world ADEs associated with tirzepatide by mining data from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. ADE reports from the FAERS database were retrieved for the second quarter of 2022 through the first quarter of 2024. Significant associations between ADEs and tirzepatide were evaluated using proportional disproportionality analyses, including the Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinkage (MGPS). A total of 37,827 ADE reports associated with tirzepatide were identified, with 100 significantly disproportionate preferred terms (PTs) recognized by all four algorithms. The top five PTs with the highest reporting rates were incorrect dose administered, injection site pain, off-label use, nausea, and injection site hemorrhage. Additionally, unexpected signals such as starvation ketoacidosis were identified. The median time to onset for all ADEs was 23 days. Furthermore, sex-specific high-intensity signals were found, with males primarily experiencing gastrointestinal disorders and females experiencing general disorders and administration site conditions. This study provides valuable insights into the occurrence of ADEs following tirzepatide administration, potentially supporting clinical monitoring and risk identification efforts.

Impact of Heat on Respiratory Hospitalizations among Older Adults in 120 Large US Urban Areas.

Extreme heat exposure is a well-known cause of mortality among older adults. However, the impacts of exposure on respiratory morbidity across US cities and population subgroups is not well understood. A nationwide study to determine the impact of high heat on respiratory disease hospitalizations among older adults (65+) living in the 120 largest US cities between 2000-2017. Daily rates of inpatient respiratory hospitalizations were examined with respect to variations in ZIP-code-level daily mean temperature and heat index. For each city, we estimated cumulative associations (lag-days 0-6) between warm-season heat (June-September) and cause-specific respiratory hospitalizations using time-stratified conditional quasi-Poisson regression with distributed lag non-linear models. We estimated nationwide associations using multivariate meta-regression and updated city-specific associations via best linear unbiased prediction. With stratified models, we explored effect modification by age, sex, and race (Black/white). Results were reported as percent change in hospitalizations at high temperatures (95th percentile) compared to median temperatures for each outcome, demographic group, and metropolitan area. We identified 3,275,033 respiratory hospitalizations among Medicare beneficiaries across 120 large US cites between 2000 and 2017. Nationwide, 7-day cumulative associations at high temperatures, resulted in a 1.2% (0.4%, 2.0%) increase in hospitalizations for primary diagnoses of all-cause respiratory disease, primarily driven by increases in respiratory tract infections [1.8% (0.6%, 3.0%)], and chronic respiratory diseases/respiratory failure [1.2% (0.0%, 2.4%)]. Stronger associations were observed when exposure was defined using the heat index instead of temperature. Across the 120 cities, we observed considerable geographic variation in the relative risk of heat-related respiratory hospitalizations, and we observed disproportionate burdens of heat-related respiratory hospitalizations among the oldest beneficiaries (85+ years), and among Black beneficiaries living in South Atlantic cities. During the 18-year study period, there were an estimated 11,710 excess respiratory hospitalizations due to heat exposure. Results suggest that high temperature and humidity contribute to exacerbation of respiratory tract infections and chronic lung diseases among older adults. Geographic variation in heat-related hospitalization rates suggests that contextual factors largely account for disproportionate burdens, and area-level influences should be further investigated in multi-city studies.

Identifying genetic determinants of forage sorghum [Sorghum bicolor (Moench)] adaptation through GWAS

BackgroundForage sorghum is a highly valued crop in livestock feed production due to its versatility, adaptability, high productivity, and resilience under adverse environmental conditions, making it a crucial option for sustainable forage production. This study aimed to investigate ninety-five forage sorghum genotypes and identify the marker – trait associations (MTAs) in adaptive traits, including yield and flowering through genome-wide association studies (GWAS).ResultsUsing 41,854 polymorphic SNPs, a GWAS involving the GLM, MLM, and FarmCPU models was performed to analyse fourteen adaptive traits. The population structure revealed the presence of two subpopulation groups. Linkage disequilibrium (LD) plots showed varying degrees of LD decay across the chromosomes, with an average LD decay of 19.49 kbp. Twelve common significant QTNs, encoding 17 putative candidate genes, were simultaneously co-detected and studied by at least two or more GWAS methods. Three QTNs were associated to days to 50% flowering; two each to leaf-to-stem ratio and number of nodes per plant; and one each to plant height, leaf width, number of leaves per plant, stem girth, and internodal length. Six candidate genes were associated with days to 50% flowering, two each with leaf width, stem girth, leaf-to-stem ratio, and number of nodes per plant, and one each with plant height, number of leaves per plant, and internodal length.ConclusionFarmCPU was identified as the most suitable and effective among all the models for controlling both false positives and false negatives. Further in-depth analysis of the newly discovered QTNs may lead to the identification of new candidate genes for the trait of interest. These studies elucidate gene functions and could transform forage sorghum breeding through marker-assisted selection and transgenic approaches, accelerating the development of superior forage sorghum varieties and enhancing global food security.

Health-related social needs screening, reporting, and assistance in a large health system

BackgroundNational mandates require screening for and addressing health-related social needs (HRSNs) in healthcare settings. However, differences in HRSN screening process (i.e., completed screenings, screening results, documented offer of assistance, documented assistance request) have been reported by population subgroup. Knowledge of the most effective HRSN screening and intervention methods is limited. We sought to describe differences in completed HRSN screenings, screening results, and assistance request rates across patient and healthcare visit characteristics. MethodsWe examined data from all patients aged ≥18 years and residing in the US receiving services at a large, Midwestern healthcare system with a goal to screen all patients for HRSN at least once annually between July 2021–June 2023 (n = 1,190,488). We examined the proportion of patients with any HRSN screening, with any reported HRSN, asked whether they wanted assistance, or who requested assistance for a reported HRSN stratified by patient demographics and healthcare visit characteristics (i.e., payer, screening location, who completed the screening). ResultsLess than half of eligible patients (47.0 %) were screened for HRSNs. About one-sixth (16.9 %) reported any HRSN. Although most patients reporting HRSNs were asked whether they wanted assistance, only about one-quarter (26.8 %) responded affirmatively. Proportions included in each step of the HRSN screening process significantly differed by patient and healthcare visit characteristics. DiscussionThis study is one of the first to investigate various steps of a population-wide HRSN screening program. Our findings suggest that examining differences in HRSN screening process by population subgroup is key to addressing HRSNs through a health equity lens.