Positive Association Research Articles

Evergreen: An existential video game to increase the indices associated with existential thinking in the audience

Humans are thinking beings. Pondering about the purpose of life has always been one of their concerns historically. In this study, an adventure game called Evergreen was created, enabling players to engage in dialogue-based interactions centered around existential issues, with a specific focus on the crisis of meaning. The game draws inspiration from Yalom's existential psychotherapy and seeks to convey profound human concerns through an interactive digital medium. We interviewed experts in psychology and computer games to assess and refine the game. Subsequently, we assessed the levels of meaning in life and the existential thinking among players before and after playing the refined version of the game. The results revealed a positive association between the game and the meaning in life scores of the players [Control group (50.63 ± 5.18) and Test group (54.60 ± 8.12), (P = 0.028)]. However, there was no significant relationship between the implementation of the existential game created in the present study and the shifts in the scores on the Scale for Existential Thinking of the intervention group [Control group (33.98 ± 5.07) and Test group (34.20 ± 4.74), (P = 0.865)].

Conditioned preferences: Gated by experience, context, and endocrine systems

Central to the navigation of an ever-changing environment is the ability to form positive associations with places and conspecifics. The functions of location and social conditioned preferences are often studied independently, limiting our understanding of their interplay. Furthermore, a de-emphasis on natural functions of conditioned preferences has led to neurobiological interpretations separated from ecological context. By adopting a naturalistic and ethological perspective, we uncover complexities underlying the expression of conditioned preferences. Development of conditioned preferences is a combination of motivation, reward, associative learning, and context, including for social and spatial environments. Both social- and location-dependent reward-responsive behaviors and their conditioning rely on internal state-gating mechanisms that include neuroendocrine and hormone systems such as opioids, dopamine, testosterone, estradiol, and oxytocin. Such reinforced behavior emerges from mechanisms integrating past experience and current social and environmental conditions. Moreover, social context, environmental stimuli, and internal state gate and modulate motivation and learning via associative reward, shaping the conditioning process. We highlight research incorporating these concepts, focusing on the integration of social neuroendocrine mechanisms and behavioral conditioning. We explore three paradigms: 1) conditioned place preference, 2) conditioned social preference, and 3) social conditioned place preference. We highlight nonclassical species to emphasize the naturalistic applications of these conditioned preferences. To fully appreciate the complex integration of spatial and social information, future research must identify neural networks where endocrine systems exert influence on such behaviors. Such research promises to provide valuable insights into conditioned preferences within a broader naturalistic context.

Is digit ratio (2D:4D) a biomarker for lactate? Evidence from a cardiopulmonary test on professional male footballers

BackgroundLactate accumulation is associated with vigorous exercise, cardiovascular disease and a number of cancers. Digit ratio (2D:4D) has also been linked to oxygen metabolism, myocardial infarction and various cancers. Such similarities suggest the possibility that 2D:4D is a biomarker of lactate. Here, we consider the relationship between 2D:4D and lactate during an incremental cardiopulmonary exercise test. MethodThe participants were male professional football players. The treadmill test began at a speed of 8 km/h when the first lactate measurement was taken. The speed was increased by 2 km/h every 3.15 min, with measurements at 10, 12, 14 and 16 km/h. ResultsThere were 72 Caucasian and 7 Black participants, results are reported for the most numerous group. Lactate levels increased with running speed and were not correlated with age, body size or body composition. Median splits of digit ratios (right, left and right-left 2D:4D [Dr-l]) were calculated. In comparison to the Low ratio group, the High ratio group showed higher lactate levels across speeds. Effect sizes varied from very large to huge (right 2D:4D), large (left 2D:4D) and medium (Dr-l). At the individual level, positive correlations between digit ratios and lactate at the five different speeds varied from large (right 2D:4D), medium (left 2D:4D) and small (Dr-l). ConclusionThere were large positive associations between right 2D:4D and lactate at all running speeds. We discuss our findings in relation to oxygen metabolism and suggest that 2D:4D may be a biomarker for lactate in the wider context of the latter's importance in health and disease.

Impact of Women\'s Participation in Local Governance on Socio-Economic Development: A Case Study of Panchayati Raj Institutions in Maharashtra

Abstract: The participation of women in local governance, particularly in Panchayati Raj Institutions (PRIs), is increasingly recognized as crucial for fostering socio-economic development. This study focuses on the state of Maharashtra, India, examining the impact of women’s involvement in PRIs on various socio-economic indicators. Utilizing empirical data from a comprehensive survey conducted across multiple districts, the study analyzes the correlation between women’s representation in PRIs and key development parameters. Findings reveal a positive association between higher levels of women’s participation in PRIs and improvements in socio-economic indicators. Specifically, districts with greater female representation in PRIs demonstrate enhanced access to basic services such as healthcare, education, and sanitation. For instance, districts with more than 50% female representation in PRIs saw a 25% increase in primary healthcare coverage compared to districts with lower female representation.

Get advanced or retreat: well-informed board and bank risk-taking

Purpose This paper aims to examine the relationship between board structure and risk-taking, exploring how this association is influenced by advanced technologies in the banking sector. Design/methodology/approach This study uses a panel sample of 22 Pakistani banks from 2011 to 2018. To test the authors’ hypothesis, the authors use regression analysis with two-way cluster robust standard errors. Further, the authors also check the robustness of the authors’ findings using alternate proxies of board structure and bank risk-taking behavior. To address endogeneity concerns, the authors use the two-stage least square technique. Findings In the era of the Fourth Industrial Revolution, Pakistani banks’ digitalization is modeled by the presence of Temenos-T24/Oracle as their core banking system (software providing end-to-end operational integration). Its interactional effect with corporate governance is evaluated to implicate informed risk-taking by the board as a result of improved information access and analysis. The authors find that board size has a positive association with risk-taking, and the use of modern technology reshapes this association in the banking sector. Originality/value The contribution of this paper is twofold. First, the impact of board structure on bank risk-taking has not been extensively researched in Pakistan – a highly volatile and unpredictable economy. Second, the evaluation of the role of technology on bank risk is being researched for the very first time – a uniqueness of this paper.

Human capital and financial performance of Islamic banks: a meta-analysis

Purpose This paper aims to meta-analyze the results of the prior studies related to the relationship of human capital and financial performance in Islamic banking. Design/methodology/approach To examine the relationship between human capital and financial of Islamic banks, 23 empirical studies having sample of 15,607 are considered for the meta-analysis. Moreover, different measures related to financial performance including return on assets (ROA), return of equity (ROE) and Tobin’s Q have been taken as moderating for further subgroup analysis. Findings The results of meta-analysis reveal a positive correlation between human capital and financial performance with an effect size of 0.268. The subgroup analyses showed significant positive associations of human capital with ROA and ROE, insignificant with Tobin’s Q. Originality/value This study suggests Islamic banking should prioritize human capital development, maintain consistency and adopt a long-term perspective. Future research should consider context-specific factors and harmonize human capital and financial performance measurements for consensus.

Unleashing the power of social media: examining farmers’ adoption for agriculture knowledge exchange

Purpose This study uses a comprehensive theoretical framework that combines social cognitive theory and neighborhood effect to investigate the influence of neighborhood effects on farmers’ outcome expectations, observational learning and self-efficacy. This study aims is to analyze the mechanisms that underlie the adoption of social media by farmers for knowledge exchange in the agricultural context. Specifically, this research explores the role of neighborhood effects, outcome expectations, observational learning and self-efficacy in shaping farmers’ decision-making process regarding the use of social media platforms for exchanging agricultural knowledge. Design/methodology/approach The study data was collected through a sample survey conducted among 570 agricultural households residing in the provinces of Thai Nguyen, Cao Bang, Bac Kan and Phu Tho, located in the northern region of Vietnam. To analyze the data, structural equation modeling was used as the statistical technique of choice. Findings The findings of the study indicate a significant influence of neighborhood effects on outcome expectations, observational learning and self-efficacy. These factors, derived from social cognitive theory, also exhibit a positive association with farmers’ adoption of social media for knowledge exchange. Additionally, the study highlights that neighborhood contribute to a favorable adoption of social media among farmers via outcome expectations, observational learning, and self-efficacy. Research limitations/implications The study is limited in examining farmers’ social media adoption for agriculture knowledge exchange in Northern mountainous area of Vietnam. This study could be replicated across various regions or nations, providing comparative insights into the adoption of social media among farmers for knowledge exchange. Practical implications The study findings suggest practical and innovative means to promote farmers’ social media adoption for agriculture knowledge exchange. Originality/value This study presents a pioneering approach by integrating social cognitive theory and neighborhood effect to elucidate the factors influencing farmers’ adoption of social media for the purpose of agriculture knowledge exchange.

Multimorbidity and the Etiology of Schizophrenia.

A globalstudy of multimorbidity in schizophrenia, especially of the association with physical conditions, might offer much needed etiological insights. Our review suggests that life-style factors and medication related to schizophrenia are only part of the explanation of the increase in risk for cardiovascular, metabolic, pulmonary disorders, and some cancers. Positive associations with autoimmune disorders (with the exception of rheumatoid arthritis) and epilepsy are promising avenues of research but to date have not been fully exploited. The same holds for the negative comorbidity seen for rheumatoid arthritis and some cancers (e.g., prostate). As a whole, our review suggests that most of the explored conditions have a different prevalence in schizophrenia than in the general population. Several hypotheses emerged from this review such as the role of immune and genetic factors, of sex hormones, and of more general variability factors.

Divergent Associations of Slow-Wave Sleep versus Rapid Eye Movement Sleep with Plasma Amyloid-Beta.

Recent evidence shows that during slow-wave sleep (SWS), the brain is cleared from potentially toxic metabolites, such as the amyloid-beta protein. Poor sleep or elevated cortisol levels can worsen amyloid-beta clearance, potentially leading to the formation of amyloid plaques, a neuropathological hallmark of Alzheimer disease. Here, we explored how nocturnal neural and endocrine activity affects amyloid-beta fluctuations in the peripheral blood. We acquired simultaneous polysomnography and all-night blood sampling in 60 healthy volunteers aged 20-68 years. Nocturnal plasma concentrations of amyloid-beta-40, amyloid-beta-42, cortisol, and growth hormone were assessed every 20 minutes. Amyloid-beta fluctuations were modeled with sleep stages, (non)oscillatory power, and hormones as predictors while controlling for age and participant-specific random effects. Amyloid-beta-40 and amyloid-beta-42 levels correlated positively with growth hormone concentrations, SWS proportion, and slow-wave (0.3-4Hz) oscillatory and high-band (30-48Hz) nonoscillatory power, but negatively with cortisol concentrations and rapid eye movement sleep (REM) proportion measured 40-100 minutes previously (all t values > |3|, p values < 0.003). Older participants showed higher amyloid-beta-40 levels. Slow-wave oscillations are associated with higher plasma amyloid-beta levels, whereas REM sleep is related to decreased amyloid-beta plasma levels, possibly representing changes in central amyloid-beta production or clearance. Strong associations between cortisol, growth hormone, and amyloid-beta presumably reflect the sleep-regulating role of the corresponding releasing hormones. A positive association between age and amyloid-beta-40 may indicate that peripheral clearance becomes less efficient with age. ANN NEUROL 2024.

Ophthalmologic profile of patients with systemic sclerosis.

To study the ophthalmologic manifestations of systemic sclerosis (SSc) and its correlation with autoantibody profile. A cross-sectional study on 200 eyes of 100 consecutive adult patients diagnosed with SSc was performed at a tertiary care center in Northern India. The examination of ocular adnexa, anterior segment, and posterior segment with slit-lamp biomicroscopy, tear film break-up time (TBUT), Schirmer's II test, and choroidal thickness measurement by swept-source ocular coherence tomography was done. Autoantibody profile was available for 85 patients, and its statistical association with the ocular examination findings was analyzed. In total, 100 patients (93 females and 7 males) were included. The mean age was 45.11 ± 11.68 years, and the mean disease duration was 6.93 ± 3.68 years. Meibomian gland disease was more commonly found in patients with the diffuse subtype of SSc (P = 0.037). Choroidal thickness was increased in 34% and decreased in 7% (reference range = 307 ± 79 mm) patients. Reduced TBUT, meibomian gland dysfunction, and eyelid stiffness had a statistically significant association with the presence of anti-Scl-70 antibody (P = 0.003, <0.0001, and 0.004, respectively). These patients had ocular fatigue, foreign body sensation, and burning sensation. No significant association was noted with the presence of SS-A/Ro and SS-B/La antibodies. This study highlights the need for an active comprehensive ophthalmic evaluation. Approximately 75% of the patients in our cohort had ocular involvement to varying extent. An isolated presence of anti-Scl70 antibody was also found to have a positive association with dry eye disease.

Long-Term Intake of Proton-Pump Inhibitors Could Be Associated with an Increased Incidence of Liver Cancer in Women

Background: Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in gastroenterology. Although PPIs are mostly well tolerated, long-term PPI intake has been linked with diabetes mellitus, osteoporosis and infectious disease. In the present study, we evaluated a potential association between PPI intake and a subsequent diagnosis of liver cancer in a large real-world cohort of outpatients in Germany. Methods: A total of 1766 patients with liver cancer, as well as 8830 propensity-score-matched controls, were identified from the Disease Analyzer database (IQVIA). The outcome of the study was the association between PPI use and a subsequent diagnosis of liver cancer, which was evaluated using multivariable logistic regression analyses. Results: Overall, 42.9% of the liver cancer patients and 39.0% of the controls received at least one PPI prescription before the index date. PPI prescriptions at any time before the index date were associated with an increased risk of subsequent liver cancer (OR: 1.18; 95% CI: 1.06–1.31). The positive association was observed in all age groups, as well as in women and men, but only in women (OR: 1.30; 95% 1.09–1.55) did it reach the predefined level of significance (p &lt; 0.01). When considering the duration of PPI therapy, only PPI therapy for at least two years was significantly associated with an increased risk of liver cancer (OR: 1.28; 95% 1.09–1.50). In an analysis stratified by age and sex, this association was strongest in the age group &lt; 60 years (OR: 1.99; 95% 1.21–3.26). Conclusions: Our data suggest that long-term PPI intake in women as well as in patients &lt; 60 years might be associated with an increased risk of liver cancer. These findings support current efforts to reduce the inappropriate use of PPIs in routine clinical practice and to link PPI prescribing to a clear medical indication.

Effect of social media analytics on firm performance: the moderating role of entrepreneurial orientation

Purpose The purpose of this study was to analyze the effects of social media analytics on firm performance using a sample of small and medium enterprises (SMEs) in Thailand. This study also investigated whether entrepreneurial orientation (EO) moderated the effects of social media analytics on firm performance. Design/methodology/approach This study used SMEs listed in the Department of Business Development of Thailand as the sampling frame. Probability sampling was used to draw the sample. A questionnaire survey was used to collect data from 334 firms. The data were analyzed using partial least squares structural equation modeling. Findings The results supported the positive association between social media analytics practices on firm performance. Moreover, this study found that EO moderated this association significantly. In particular, the positive association between social media analytics practices on firm performance was higher for firms that exhibit a high EO than those that exhibit a low EO. This result indicated that firms that implement social media analytics practices achieved higher performance when they exhibited a high EO. Practical implications Social media data analytics should be implemented to strengthen the technological competence of firms. Moreover, firms should integrate EO practices into their implementation of social media analytics to increase their ability to generate substantial improvements in their strategic implementation, thereby enabling them to gain sustainable competitiveness in their market. Social implications Because SMEs are the driving force for economic growth and development in Thailand, their ability to achieve higher performance when they effectively integrate EO practices into their implementation of social media data analytics could be beneficial for the sustainable development of Thailand, especially in the current data-driven era. Originality/value The result that EO moderates the effect in enhancing social media analytics practices’ influence on firm performance provides new knowledge that extends the boundary of research on this topic. The authors provided a theoretical explanation to clarify the way the implementation of social media analytics practices should be integrated with EO to increase the level of performance that firms achieve from such practices.

Adherence, Burden, and Morbidity in Adults with Chronic Diseases in the Dominican Republic: A Cross-sectional Study in a Tertiary-level Hospital (A-CaMo II)

Introduction: Pharmacological adherence is a key factor in managing chronic non-communicable diseases (NCDs), so its efficacy concerning new therapies emerges as an essential consideration. Despite efforts, adherence rates vary widely, highlighting the complexity of the problem. Non-adherence affects treatment effectiveness and increases patient burden and medical costs. Understanding the interplay between burden, morbidity, and adherence is crucial for adapting health strategies. Objective: This study aims to measure pharmacological adherence, burden, and morbidity among patients with chronic diseases in the Dominican Republic, emphasizing the interplay between these dimensions. Methods: Data were collected using a cross-sectional design at the Centro Médico de Diabetes, Obesidad y Especialidades (CEMDOE) in Santo Domingo during August 2023. Patient interviews were conducted using standardized tools, including the Medication Adherence Reasons Scale (MAR-Scale) and the Disease Burden Morbidity Assessment (DBMA). Nonprobability convenience sampling yielded a sample of 384 patients who met the inclusion criteria. Significant statistical analysis included an ordinal regression analysis correlating medication adherence with disease burden. Results: Among the patients studied, the ordinal regression analysis unveiled a significant correlation (p = 0.001) between nonadherence and disease burden, indicating a 0.29 ± 0.09 unit increase in burden for every one-point decrease in adherence score. Patients with private health insurance and higher education levels exhibited more excellent adherence rates (65.97% and 63.89%, respectively), with a substantial portion also reporting a burden score ≥ 5 (70.07% and 70.42%, respectively). Moreover, the study population experienced a significant burden of multimorbidity (88.8%), with hypertension displaying the lowest burden (1.63 ± 1.13) despite its prevalence (76.76%). Conclusion: Despite the limitations, common reasons for non-adherence were identified, and significant disease burdens were observed, particularly in osteoarthritis, cancer, and rheumatoid arthritis. Notably, a positive association was found between adherence and disease burden, underlining the importance of adherence in chronic disease management. Health disparities affecting access to medication and patient education were observed, highlighting the need for further research and intervention. The combined use of a scale that integrates both the DBMA and the MAR-Scale, in which adherence, burden, and morbidity are investigated simultaneously for each disease, would allow for a more comprehensive approach to all three characteristics regardless of which disease is included in the scales separately.

Policy Approaches for Increasing Adolescent HPV Vaccination Coverage: A Systematic Review.

US jurisdictions have enacted a wide range of policies to address low human papillomavirus (HPV) vaccination coverage among adolescents, but it is unclear which policies are effective. To systematically review the impact of governmental policies on adolescent HPV vaccination coverage. PubMed, Embase, and Scopus databases. Eligible studies, published from 2009 to 2022, evaluated the impact of governmental policies on HPV vaccination coverage among adolescents ages 9 to 18. Two investigators independently extracted data on study sample, study design and quality, policy characteristics, and HPV vaccination outcomes. We summarized findings by policy type: school-entry requirements (SERs), federally-funded policies related to the Vaccines for Children program and Medicaid, educational requirements, and others. Our search yielded 36 eligible studies. A majority of studies evaluating HPV vaccine SERs found positive associations between SERs and HPV vaccination coverage (8 of 14), particularly for SERs in Rhode Island and Washington, DC. All studies evaluating SERs for other adolescent vaccines observed positive spillover effects for HPV vaccination (7 of 7). Federally-funded policies related to Vaccines for Children and Medicaid were consistently associated with higher HPV vaccination coverage (7 of 9). Relatively few studies found associations between educational requirements and HPV vaccination coverage (2 of 8). Studies used limited vaccination data sources and non- or quasi-experimental designs. Some studies had no or poorly matched comparison groups. Our findings suggest promise for SERs and federally-funded policies, but not educational requirements, for increasing HPV vaccination coverage among adolescents.

Placental IGFBP1 levels during early pregnancy and the risk of insulin resistance and gestational diabetes

AbstractReduced insulin sensitivity (insulin resistance) is a hallmark of normal physiology in late pregnancy and also underlies gestational diabetes mellitus (GDM). We conducted transcriptomic profiling of 434 human placentas and identified a positive association between insulin-like growth factor binding protein 1 gene (IGFBP1) expression in the placenta and insulin sensitivity at ~26 weeks gestation. Circulating IGFBP1 protein levels rose over the course of pregnancy and declined postpartum, which, together with high gene expression levels in our placenta samples, suggests a placental or decidual source. Higher circulating IGFBP1 levels were associated with greater insulin sensitivity (lesser insulin resistance) at ~26 weeks gestation in the same cohort and in two additional pregnancy cohorts. In addition, low circulating IGFBP1 levels in early pregnancy predicted subsequent GDM diagnosis in two cohorts of pregnant women. These results implicate IGFBP1 in the glycemic physiology of pregnancy and suggest a role for placental IGFBP1 deficiency in GDM pathogenesis.

Circadian misalignment proxies, BMI, and chronic conditions: the role for weekday to weekend sleep differences.

To evaluate whether social jet lag (SJL) and weekend catch-up sleep (CUS), proxies of circadian misalignment, were associated with BMI and chronic conditions. Participants (n = 2,050,18-65y) were part of a virtual cross-sectional and population-based research. We examined CUS and SJL as continuous and categorical (< 1h,1-2h, > 2h). Linear regression analyses were performed to assess the differences in BMI (outcome) associated with CUS and SJL. Restricted cubic splines were performed to explore the shape of the relationship between weekday-to-weekend variability in sleep duration, midpoint, wake time, and bedtime. Logistic regression models were used to estimate ORs(95%CIs) for chronic conditions and overweight related to CUS and SJL. Analyses were adjusted for sleep duration, biological and behavior-related variables. We found a positive association of SJL and CUS with BMI. The effects remained even after adjustment for weekly sleep duration and demonstrated a proportional increase with the magnitude of sleep variability. Among participants with SJL > 2h, BMI increased by 2.29kg/m2 (95%CI:0.84;3.74,p:0.002). They also had 129% higher odds of chronic conditions (95%CI:1.16;4.52, p:0.01) and 119% higher odds of overweight (95%CI: 1.20;3.98,p:0.01). Individuals with CUS > 2h presented 78% higher odds of overweight (95%CI:1.27;2.50,p:0.001) and an increase of 1.61kg/m2 in BMI (95%CI: 0.81; 2.40,p < 0.001). Our findings, which demonstrate that even a slight weekend sleep extension and variability of just 1h is associated with higher values of BMI, suggest incorporating measures for sleep consistency and regularity into clinical protocols and public health guidelines to prevent and treat obesity and related diseases.

Does internationalization and board diversity affect family firms' sustainable performance? Empirical evidence from an emerging economy

AbstractThe purpose of this study is to examine the relation between internationalization and firm sustainable performance on a set of listed Indian family firms belonging to mid‐cap and large cap categories and listed on NIFTY 500. This paper aims to explore the heterogeneity among internationalization and a set of defined variables, namely, female representation on the board, firm size, firm age, industry type, leverage, corporate social responsibility (CSR) and the number of female executives in influencing the firm performance. We aim to incorporate corporate governance, the factors influencing decisions related to it and gender diversity in understanding the relationship between internationalization and firm performance in the context of Indian family firms. The Generalized Method of Moments (GMM) and panel data regression models are both used in the study's empirical methodology. In order to examine the relationship between internationalization, as indicated by the percentage of foreign ownership, and family firm performance, as indicated by Return on Equity (ROE), the study uses the data from 2014 to 2023 for analysis, totaling 16,586 firm‐year observations. The findings indicate that internationalization, measured in this study by the investments the companies make abroad, positively affects the performance of the family firms. Age, women on board and number of female executives are seen to have positive associations with the performance of family firms. However, it is seen that firm size for family firms negatively impacts the performance while CSR and leverage seem to have no significant impact.

Entrepreneurial Success Factors of Small and Medium Size Women Enterprises in Kathmandu

This study examines the personal and external factors affecting the success of women entrepreneurs in Kathmandu Valley. To achieve the research objective, the data were collected from the primary source mainly through a structured questionnaire under convenience sampling basis from 384 women entrepreneurs in Kathmandu Valley. Descriptive and inferential statistics have been used to develop the breadth and depth of the study. The results of the study revealed a positive significant association of personal and external factors with the success of women entrepreneurs. The study found stronger factors self-confidence, need for achievement, and risk-propensity. In addition, the study revealed social-cultural factors as the external factors detrimental to women entrepreneurs’ success. This study contributes to the existing theory of entrepreneurial success by incorporating personal and external factors in a holistic approach.

Reduction in cervical length after vaginal progesterone in women with short cervix is significantly associated with preterm delivery at ≤ 34 weeks and < 37 weeks of gestation.

To evaluate the association between changes in cervical length (CL) after vaginal progesterone treatment and preterm delivery (PTD). This was a retrospective cohort study that included 197 singleton pregnancies without (n = 178) and with (n = 19) a history of PTD which were found to have a short cervix (≤ 25 mm) between 18 + 0 and 23 + 6 weeks' gestation with a follow-up transvaginal CL measurement taken at least 1 week after vaginal progesterone treatment started. Receiver-operating-characteristics (ROC)-curve analysis was performed and three CL shortening patterns were evaluated: (1) ≥ 10% reduction; (2) ≥ 20% reduction; and (3) ≥ 5 mm reduction relative to the first CL measurement. The predictive performance of each CL reduction cut-off and its association with PTD ≤ 34 weeks and PTD < 37 weeks were evaluated. Overall, the rate of PTD ≤ 34 weeks was 16.8% (33/197) and that of PTD < 37 weeks was 36.5% (72/197). The area under the ROC curve of cervical shortening expressed in % for predicting PTD ≤ 34 weeks and PTD < 37 weeks was 0.703 and 0.608, respectively. Cervical shortening was observed in 60/197 (30.5%) patients, with 49/60 (81.7%) women showing ≥ 10% reduction, 32/60 (53.3%) ≥ 20% reduction and 27/60 (45.0%) ≥ 5 mm reduction in CL. Sensitivity and specificity for PTD ≤ 34 weeks were, respectively, 48.5% and 79.9% for ≥ 10% reduction; 36.4% and 87.8% for ≥ 20% reduction; and 27.3% and 89.0% for ≥ 5 mm reduction in CL. For PTD < 37 weeks, sensitivity and specificity were, respectively, 36.1% and 81.6% for ≥ 10% reduction; 27.8% and 90.4% for ≥ 20% reduction; and 20.8% and 90.4% for ≥ 5 mm reduction in CL. The highest positive likelihood ratios for PTD ≤ 34 and < 37 weeks were for ≥ 20% CL reduction (2.98 (95% CI, 1.62-5.49) and 2.89 (95% CI, 1.52-5.57), respectively). Despite significant differences in sensitivity among the different cut-offs for cervical shortening, favoring the ≥ 10% reduction cut-off, a reduction of ≥ 20% in CL showed the strongest association with PTD ≤ 34 weeks (odds ratio (OR), 4.11 (95% CI, 1.75-9.62)) and < 37 weeks (OR,3.62 (95% CI, 1.65-7.96)), as compared with a less pronounced reduction in CL. In women with a short cervix treated with vaginal progesterone, a reduction in CL on a subsequent ultrasound scan can predict PTD ≤ 34 and < 37 weeks. A ≥ 20% reduction in CL had the highest positive likelihood ratio and association with PTD ≤ 34 and < 37 weeks compared with ≥ 10% or ≥ 5 mm reduction. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Association between the initial physical activity and functional recovery after 1 month of inpatient rehabilitation for subacute stroke: stratified analysis by nutritional status.

Objectively measured physical activity volume serves as a predictive factor for functional recovery in patients with stroke. Malnutrition, a frequent complication of stroke, may influence the relationship between physical activity and functional recovery. This study aimed to examine the association between physical activity volume and functional recovery in patients with stroke, stratified by their nutritional status. This multicenter prospective observational study included 209 patients with stroke admitted to two Japanese convalescent rehabilitation hospitals. Participants were categorized based on the geriatric nutritional risk index (GNRI) at admission [≥92, high GNRI group ( n  = 133); <92, low GNRI group ( n  = 76)]. Physical activity levels were measured as the duration of total physical activity (TPA), which is the sum of light-intensity physical activity and moderate-to-vigorous physical activity, using a triaxial accelerometer during the first 7 days after admission. Outcome measures are represented as the relative gain of the motor score on functional independence measure (M-FIM effectiveness) during the first month after admission. The multiple regression analysis, adjusting for age, sex, comorbidity, onset to admission intervals, motor paralysis, initial M-FIM, and cognitive FIM, showed that the duration of TPA in the first 7 days was significantly associated with the M-FIM effectiveness over the first month in both low GNRI [ B  = 0.12, 95% confidential intervals (CI) = 0.01; 0.24, P  = 0.049] and high GNRI group ( B  = 0.11, 95% CI = 0.01; 0.21, P  = 0.027). This study demonstrates a positive predictive association between early TPA level and functional recovery in stroke patients, irrespective of their nutritional status.